Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720050011&lang=es vol. 133 num. 11 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Unidades de tratamiento del ataque cerebrovascular (UTAC) en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Características de la enfermedad cerebrovascular en un Servicio de Cuidados Intermedios Neurológicos, en Chile</b>: <b>Análisis de 459 pacientes consecutivos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100002&lng=es&nrm=iso&tlng=es Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. Aim: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. Material and methods: Retrospective review of clinical records of 459 patients (mean age 65±48 years, 238 female) that were admitted to our unit during a period of 37 months. Results: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. Conclusions: The most common type of stroke is ischemic and high blood pressure is the main risk factor <![CDATA[<b>Biomarcadores coronarios y evolución clínica alejada en pacientes con síndromes coronarios agudos sin elevación del segmento ST</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100003&lng=es&nrm=iso&tlng=es The use of new biomarkers improved risk stratification for patients with acute coronary syndromes (ACS). Aim: To evaluate the relationship between multiple biomarkers and long-term clinical outcome in ACS without ST segment elevation. Patients and Methods: Consecutive patients presenting with suspected ACS were studied. On admission to the emergency room, serum was obtained to determine highly sensitive C reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), lipoprotein (a) (LPa) and soluble P selectin (sPS). Clinical endpoints were mortality and a composite endpoint of major adverse cardiovascular events (MACE) including death, re-infarction, and angina. Results: Seventy patients, aged 63±13 years, 54 males, were studied. Final diagnosis was unstable angina in 71% and non-ST-segment elevation myocardial infarction in 29%. MACE and mortality rate were 17% and 5.8%, respectively. We found higher plasma levels of hsCRP, ESR and Lp(a) in patients with MACE (p=0.032, p=0.015 and p=0.010, respectively). Plasma levels of hsCRP and ESR were also higher in patients who died during the follow up (p=0.002 y p=0.045, respectively). Conclusion: Plasma levels of inflammatory markers and atherosclerosis biomarkers are associated with a worse long-term clinical outcome in ACS without ST segment elevation. The inclusion of these biomarkers in the routine blood test on admission, could improve risk stratification of patients with ACS in the future <![CDATA[<b>Enfermedades inflamatorias intestinales</b>: <b>Experiencia de dos centros chilenos </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100004&lng=es&nrm=iso&tlng=es The incidence of Inflammatory Bowel Disease (IBD) has increased, particularly in the developed world, and probably also in Chile. Aim: To report our experience with a large group of patients from two medical centers, Hospital Clinico de la Universidad de Chile (HCUCH) and Clinica Las Condes (CLC) and to characterize the clinical features of IBD in Chile. Patients and methods: Retrospective review of 238 patients with IBD (age range 14-78 years, 143 women) treated at HCUCH and CLC between January 1990 and August 2002. Results: One hundred eighty one patients had ulcerative colitis (UC) and 57 had Crohn's disease (CD), with an UC/CD ratio of 3.2/1. Forty eight percent of patients were aged between 20 and 39 years old and 69% were diagnosed after 1995. Patients from HCUCH had more severe disease, more complications and needed surgery more often. Conclusions: Clinical features of Chilean patients with IBD are similar to those of other countries. UC is more common than EC. There is a higher proportion of women with the disease. The severity of the disease was higher among HCUCH <![CDATA[<b>Características de presentación del microcarcinoma papilar del tiroides</b>: <b>Experiencia retrospectiva de los últimos 12 años </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100005&lng=es&nrm=iso&tlng=es Thyroid microcarcinoma is a tumor of 10 mm or less, that should have a low risk of mortality. However, a subgroup of these carcinomas is as aggressive as bigger tumors. Aim: To describe the pathological presentation of these tumors, and compare them with larger tumors. Material and methods: All pathological samples of thyroid carcinoma that were obtained between 1992 and 2003, were studied. In all biopsies, the pathological type, tumor size, the focal or multifocal character, the presence of lymph node involvement and the presence of lymphocytic thyroiditis or thyroid hyperplasia, were recorded. Results: One hundred eighteen microcarcinomas and 284 larger tumors were studied. The mean age of patients with microcarcinoma and larger tumors was 42.7±14 and 49.3±16 years respectively (p <0,001) and 83% were female, without gender differences between tumor types. Mean size of microcarcinomas was 8.6 mm and 116 (98%) were papillary carcinomas. Of these, 109 (94%) were well differentiated and seven (6%) were moderately differentiated. Thirty six (31%) were multifocal and in 10 (8,6%), there was lymph node involvement. The mean size of larger tumors was 23.8 mm and 241 (85%) were papillary carcinomas. Of these, 200 (83%) were well differentiated, and 41 (17%) were moderately differentiated. Eighty five (35%) were multifocal and in 44 (18%) there was lymph node involvement. The prevalence of thyroiditis and hyperplasia was significantly higher among microcarcinomas than in larger tumors (15 and 2.5%, respectively, p <0.001, for the former; 32.4 and 1.7%, respectively, p <0.001, for the latter). Conclusions: In this series, one third of microcarcinomas were multifocal and 10% had lymph node involvement. Therefore, the aggressiveness of these tumors is higher than what is reported in the literature and they should be treated with total thyroidectomy <![CDATA[<b>Hepatitis crónica por virus C</b>: <b>factores asociados a la severidad del daño histológico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100006&lng=es&nrm=iso&tlng=es Twenty percent of patients with chronic hepatitis C evolve to cirrhosis in 10 to 20 years. The degree of steatosis and hepatic iron stores in liver biopsy increase the risk. Age, high body mass index, diabetes mellitus and alcohol consumption are factors associated to the severity of liver damage. Aim: To study the association of steatosis and increased iron stores in the liver biopsy and age, overweight, alcohol consumption and diabetes with the severity of liver damage in patients with hepatitis C virus infection. Patients and methods: Retrospective study of 84 liver biopsies of patients with chronic infection with hepatitis C virus were studied. The pathological appearance was classified as stage I when chronic hepatitis with mild activity without fibrosis was observed; as stage II when moderate chronic hepatitis with mild fibrosis was observed and as stage III when there was a moderate chronic hepatitis with fibrosis or cirrhosis. The amount of steatosis and iron deposition in the biopsy were also assessed. Results: Forty one percent of patients were in stage I, 32% in stage II and 27% in stage III. Patients in stage I were younger than those in stages II and III (40.7 and 52.2 years respectively, p <0,001). No association between the severity of liver damage and the degree of steatosis, hemosiderosis, body mass index or alcohol intake, was observed. The frecuency of diabetes mellitus increased along with pathological staging (3, 15 and 30% in stages I, II and III, respectively, p <0,05). Conclusions: This study confirms that severity of chronic hepatitis C is associated with age and the presence of diabetes mellitus <![CDATA[<b>Enfermedad Celíaca del adulto</b>: <b>Experiencia clínica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100007&lng=es&nrm=iso&tlng=es The prevalence of celiac disease (CD) is unknown in Chile. We have recently noted a rise in the number of cases diagnosed among adults. Aim: To describe the clinical characteristics of a group of adult celiac patients. Patients and methods: Clinical data of patients older than 15 years with positive antitransglutaminase or antiendomysial autoantibodies and a duodenal biopsy characteristic of CD were retrospectively reviewed. Age at diagnosis, symptoms and signs and laboratory, endoscopic and histological findings, were analyzed. Results: Thirty seven patients (28 women), were studied. Median age at diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weight loss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%, elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and a rise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22 (77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive of CD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients. The three patients with normal histology had positive serology and a good response to gluten free diet. Conclusions: CD should be considered in the differential diagnosis of patients with unespecific digestive symptons, even when they present late in adult life. Serologic markers are a good diagnostic tool. A normal duodenal pathology does not exclude the diagnosis, if other diagnostic features are present <![CDATA[<b>Manejo ambulatorio de la neumonía comunitaria del adulto en las unidades de emergencia</b>: <b>Servicio de Salud Viña del Mar-Quillota de la V Región</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100008&lng=es&nrm=iso&tlng=es There is limited information about the effectiveness of the treatment of community-acquired pneumonia (CAP) in Chilean emergency rooms. Aim: To assess the treatment of CAP in emergency rooms at the Viña del Mar Health Service in Chile. Material and methods: Prospective study of immunocompetent adult patients consulting for a CAP in emergency rooms. Those that required hospital admission were considered ineligible. The initial clinical and laboratory assessment, antimicrobial treatment and their condition after 30 days of follow up, were recorded. Results: Three hundred eleven adult patients aged 57±22 years (152 males), were evaluated. Patients with class I CAP (40% of cases) were treated with Clarithromycin (71.8%) or Amoxicillin (26.6%) for 10 days. Patients with class II CAP (60%) were treated with Amoxicillin-clavulanate (80.7%) or Levofloxacin (18.2%) for 10 days. Three hundred eight patients (99%) were cured without need of hospital admission; three patients (1%) were subsequently hospitalized because of clinical failure of ambulatory treatment. Overall, three patients (1%) died; all deaths occurred during or immediately after hospitalization and were related to the severity of lung infection but not to the choice of antibiotic treatment. Conclusions: The outpatient management of CAP by general practitioners working at emergency rooms was clinically effective with low rates of hospital admission and mortality <![CDATA[<b>genético, clínico y molecular de una familia afectada con una malformación del esmalte dental</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100009&lng=es&nrm=iso&tlng=es Amelogenesis Imperfecta (AI) is a group of conditions where there is an abnormal formation of enamel in terms of quantity, structure and composition. AI is clinically and genetically heterogeneous, there are sex linked and autosomal versions, dominant and/or recessive, with phenotypes of hypoplastic, hypocalcified or hypomature enamel. Only recently, through clinical, genetic and molecular studies of affected families, phenotypic-genotypic correlations are being established in this group of anomalies. Aim: To carry out a genetic, clinical and molecular analysis of a Chilean family affected with an enamel malformation, which probably would correspond to Amelogenesis Imperfecta Dominant Autosomal (AIDA), of hypoplastic type, resulting from g.6395G>A mutation in the enamelin gene. Patients and Methods: A genealogical pattern was created for five generations. Five members of this family group were clinically examined, and four of them had a molecular analysis that consisted of the detection of a mutation in the enamelin gene using PCR. Results: In this family, the enamel malformation presents a dominant autosomal pattern of inheritance. The clinical examination of the group allowed a diagnosis of Amelogenesis Imperfecta, of the hypoplastic local type. However, the molecular analysis revealed that the members analyzed did not exhibit the g.6395G>A mutation reported for the enamelin gene (ENAM). Conclusions: The enamel phenotype in this family could be explained by the presence of one of four other mutations recently described in this or another gene, thereby supporting the findings of allelic heterogeneity reported in the literature <![CDATA[<b>Valores plasmáticos de proteína C reactiva (PCR) en cirugía ortopédica electiva</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100010&lng=es&nrm=iso&tlng=es C reactive protein (CRP) is used as a marker of inflammatory, infectious and surgical processes. Aim: To measure post operative plasma CRP levels after elective orthopedic surgery. Materials and Methods: Four groups of 25 patients each were defined according to the type of surgical procedure performed. Group I corresponded to pure arthroscopic meniscectomy. Group II to arthroscopic anterior cruciate ligament reconstruction or knee osteotomy. Group III to elective primary total hip or knee arthroplasty and group IV to instrumented elective spine surgery. Plasma CRP levels were measured prospectively at the preoperative day and at the 1st, 2nd, 3rd, 7th and 15th postoperative day. Patients that had any complication were evaluated independently. Results: In all uncomplicated patients, a similar shape and distribution of plasma CRP curves were observed, with maximum postoperative levels observed between the second and third day. Patients with more complex surgical procedures had higher CRP values. In all groups, CRP levels decreased significantly at 7th and 15th day, with respect to the higher measured value. In patients with surgical complications, PCR values were higher or did not decrease significantly at the seventh postoperative day, as in patients without complications. Conclusion: Plasma CRP levels fluctuate after elective orthopedic surgical procedures, with maximum values observed between the 2nd and 3rd postoperative day followed by an ulterior decrease. This behavior changes if postoperative complication appear. Serial measurements of CRP levels may be useful in the early detection of surgical complications <![CDATA[<b>Eficacia de la asociación rituximab-vindesina en el tratamiento de un caso de púrpura trombótico-trombopénico (PTT) adquirido idiopático refractario </b>: <b>Report of one case </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100011&lng=es&nrm=iso&tlng=es We report a 23 years old female who presented a second episode of thrombotic thrombocytopenic purpura (TTP). She was treated with fresh frozen plasma infusions and 14 plasma exchange (PE) sessions without response. Therefore a second-line therapy was started, associating a weekly cycle administration of vindesine (Vds) 2 mg/m² and rituximab (R) 375 mg/m². Five cycles of this association plus one cycle of R exclusively, were administered. After the third course, biological signs of improvement were observed and complete normalization of blood cell counts and other specific parameters was seen after 8 weeks. From the beginning of her second relapse we detected a severe deficit (<5%) in von Willebrand-cleaving factor (ADAMTS13) associated to the presence of ADAMTS13 inhibitors. The combined treatment induced an improvement in ADAMTS13 values without detectable inhibitors. After 21 months of follow-up the patient was well, without signs of relapse but ADAMTS13 values were still under normal, which may be an unfavorable prognostic factor. PE is the treatment of choice for acquired idiopathic TTP, but for refractory cases or TTP cases with severe ADAMTS13 values/high inhibitor titers, PE associated to an immunosuppressive treatment should be considered <![CDATA[<b>Quiste aneurismático del maxilar superior</b>: <b>Reporte de un caso </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100012&lng=es&nrm=iso&tlng=es Aneurysmal bone cysts are benign fibro osseous lesions, rarely present in maxillary region. We report the CT and morphological findings of aneurysmal bone cyst of the maxilla in a 15 years old female. The patient was subjected to a maxillectomy, preserving the orbit floor. The postoperative evolution has been uneventful. The tumor mainly involved the maxillary sinus with extension to the orbit wall and osseous palate. Very few cases of aneurysmal bone cysts of the maxilla have been reported in the literature <![CDATA[<b>Sobrecrecimiento bacteriano intestinal</b>: <b>An update</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100013&lng=es&nrm=iso&tlng=es Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions <![CDATA[<b>Emergencias endocrinas en pediatría</b>: <b>diagnóstico y manejo </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100014&lng=es&nrm=iso&tlng=es The study of endocrine emergencies in childhood is important due to their high mortality and residual morbidity, that can be reduced with an adequate diagnosis and/or therapy. In this article, we review hypoglycemia, adrenal crisis, hypocalcemia, hypercalcemia and thyroid storm in children, with focus on initial diagnostic approach and management <![CDATA[<b>Virginia Woolf</b>: <b>enfermedad mental y creatividad artística </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100015&lng=es&nrm=iso&tlng=es This is an attempt to evaluate the mental disorder that the novelist Virginia Woolf suffered, and to determine the relatioship between her creativity and her insanity. What mostly characterizes her illness is the presence of typical phases of severely impairing depression and significant hypomania, culminating in suicide at the age of 59. This is a convincing life history of a bipolar II disorder, although the «broad bipolar spectrum» is less easy to define operational than bipolar disorder I. She was moderately stable as well as exceptionally productive from 1915 until she committed suicide in 1941. Virginia Woolf created little or nothing while she was unwell, and was productive between attacks. A detailed analysis of her own creativity over the years shows that her illnesses were the source of material for her novels <![CDATA[<b>Accidentes en pediatría</b>: <b>oportunidades para la prevención </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100016&lng=es&nrm=iso&tlng=es This is an attempt to evaluate the mental disorder that the novelist Virginia Woolf suffered, and to determine the relatioship between her creativity and her insanity. What mostly characterizes her illness is the presence of typical phases of severely impairing depression and significant hypomania, culminating in suicide at the age of 59. This is a convincing life history of a bipolar II disorder, although the «broad bipolar spectrum» is less easy to define operational than bipolar disorder I. She was moderately stable as well as exceptionally productive from 1915 until she committed suicide in 1941. Virginia Woolf created little or nothing while she was unwell, and was productive between attacks. A detailed analysis of her own creativity over the years shows that her illnesses were the source of material for her novels <![CDATA[<b>Distribucion de alelos del polimorfismo VNTR en la región 3' no codificante del gen del DAT1 (SLC6A3) en São Paulo/Brasil y su importancia para los estudios genéticos de los trastornos neuropsiquiátricos en poblaciones mixtas</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100017&lng=es&nrm=iso&tlng=es This is an attempt to evaluate the mental disorder that the novelist Virginia Woolf suffered, and to determine the relatioship between her creativity and her insanity. What mostly characterizes her illness is the presence of typical phases of severely impairing depression and significant hypomania, culminating in suicide at the age of 59. This is a convincing life history of a bipolar II disorder, although the «broad bipolar spectrum» is less easy to define operational than bipolar disorder I. She was moderately stable as well as exceptionally productive from 1915 until she committed suicide in 1941. Virginia Woolf created little or nothing while she was unwell, and was productive between attacks. A detailed analysis of her own creativity over the years shows that her illnesses were the source of material for her novels http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005001100018&lng=es&nrm=iso&tlng=es