Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720060001&lang=es vol. 134 num. 1 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>El creciente desafio del proceso editorial en la <i>Revista Médica de Chile</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Comparación de las frecuencias de los alelos factor V Leiden (G1691A) y protrombina-G20210A entre pacientes con trombosis venosa profunda y población general mediterránea española</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100002&lng=es&nrm=iso&tlng=es Background: Factor V leiden and the -G20210A variant of prothrombin gene are associated to a higher risk of deep venous thrombosis. Aim: To assess the frequency of factor V Leiden (G1691A) and prothrombin -G20210A alleles in patients with deep venous thrombosis (DVT) and in the general population from Spain. Material and methods: Factor V Leiden (g1691a) and prothrombin-g20210a alleles were genotyped in 493 individuals from the Spanish general populations and in 131 patients with DVT. The presence of DVT was confirmed by phlebography. Allelic frequencies and the DVT risk associated with these variants were estimated. Results: Allelic frequencies for the factor V Leiden (G1691A) allele were 0.019 in patients with DVT and 0.010 in the general population (p=0.235). The frequencies for the prothrombin-G20210A allele were 0.027 and 0.026 (p=0.975). After adjustment for age and gender, the odds ratio for DVT, associated with the presence of G1691A allele was 2.41, but not statistically significant (95% confidence intervals 0.63-9.19). Conclusions: Prothrombin-G20210A allele was more prevelant than factor V Leiden (G1691A) allele in the Spanish population. However, the magnitude of the association between the G20210A and DVT risk is very low. On the contrary, the G1691A allele is associated by itself with a two fold increase in DVT risk in this population although without reaching statistical significance due to its low frequency <![CDATA[<b>Sensibilidad a IGF-I en niños pequeños para la edad gestacional</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100003&lng=es&nrm=iso&tlng=es Background: The lack of catch up growth (CUG) in small for gestational age (SGA) children may be related to a reduced sensitivity to insulin growth factor 1 (IGF-I). Aim: To assess the sensitivity to IGF-I in small for gestational age children, measuring basal and post IGF-I nocturnal profile of growth hormone (GH). Patients and methods: We studied 34 prepubertal SGA children aged 4 to 11 years. Twenty three had CUG and 11 did not have CUG. As an IGF-I sensitivity test, nocturnal GH levels were measured every 20 minutes from 23:00 h to 07:00 h, both under baseline conditions and after the administration of a subcutaneous bolus of 1 mg/kg/body weight of the IGF-I + IGFBP-3 complex (Somatokine®). Results: At the time of the study, the Z scores for height among children with and without CUG were -1.55 ± 0.22 and -3.24 ± 0.28, respectively (p <0.0001). There were no statistical differences between CUG + vs CUG- patients in mean basal GH (6.6 ± 0.5 and 5.6 ± 0.6 ng/ml, respectively). After Somatokine® administration, mean GH, and the mean GH area under the curve (AUC) decreased significantly in both groups. However, mean overnight GH AUC decreased in all SGA children with CUG, after Somatokine® administration, whereas 3 out of 11 SGA children without CUG had an increase in their mean GH AUC in response to Somatokine®. Conclusions: These findings suggest that pituitary sensitivity to IGF-I may be decreased in some SGA children without CUG <![CDATA[<b>Piomiositis</b>: <b>presentación de 17 casos en niños y adultos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100004&lng=es&nrm=iso&tlng=es Background: Pyomyositis is a bacterial infection of skeletal muscle. Although more commonly seen in the tropics, it is increasingly recognized in temperate regions. The age distribution for patients with so called "tropical" or "temperate" pyomyositis differs. Most cases of tropical pyomyositis are seen in otherwise healthy patients and mainly in children, while the majority of cases of temperate pyomyositis occur in inmunocompromised adults. Aim: To report a series of patients with pyomyositis. Material and Methods: Retrospective review of clinical records of patients admitted to our hospital with pyomyositis during the period 1996-2001. Results: Seventeen patients were identified, aged from 5 to 86 years old, nine (53%) males. Staphylococcus aureus (13 cases, 76%) was the most common infecting organism. Eleven patients (65%) had a history of previous trauma. All patients were immunocompetent. Six patients underwent surgical drainage. Six patients (35%) presented complications and of those, one died. Conclusions: All patients of this series were immunocompetent. Pyomyositis is a serious and life threatening disease but curable. An early treatment is the key to a better prognosis <![CDATA[<b>Puntuación diagnóstica para apendicitis</b>: <b>estudio prospectivo de su aplicación por profesionales de salud no-médicos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100005&lng=es&nrm=iso&tlng=es Background: Diagnostic scores have been developed as simple, user-friendly, cost-effective instruments to improve the early diagnosis of acute appendicitis. Aim: To assess the yield of a diagnostic score for acute appendicitis, measured by trained health-related non-physician professional. Patients and methods: A prospective, double blind, non-randomized trial. Emergency room nurses applied a previously validated diagnostic score for appendicitis to patients aged more than 15 years with abdominal pain and tachycardia or fever. The main outcome was the percentage of patients operated for acute appendicitis that had a positive score for appendicitis and a pathologically demonstrated appendicitis. Results: The mean scores for patients operated or not operated for appendicitis were 8.64 and 3.31, respectively. The figures for sensitivity, specificity and diagnostic accuracy of the score were 0.83, 0.98 and 0.94, respectively. Conclusions: An appendicitis score measured by health-related non-physician professionals has a similar diagnostic yield than clinical judgment <![CDATA[<b>La frecuencia de nacimientos de gemelos aumentó en un hospital chileno coincidiendo con el consumo periconcepcional de harina fortificada con ácido fólico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100006&lng=es&nrm=iso&tlng=es Background: A significant increase in the frequency of twins has been described in the literature as a secondary effect of perinatal supplementation with folic acid. Aim: To verify if the frequency of twins increased in a Chilean hospital, after the start of flour folic acid supplementation. Material and methods: The frequency of twins was compared in the University of Chile Clinical Hospital, before and after the start of flour fortification with folic acid. Results: There was a 34% increase in the frequency of twins during the post fortification period (2001-2004) as compared with the previous period (1998-2000). A decrease in the frequency of male twins, when compared with single newborns, was also observed in the post fortification period. There was a higher frequency of stillborns among twins, when compared with single newborns. Conclusions: The frequency of twin pregnancies increased after flour folic acid supplementation in sample of Chilean population <![CDATA[<b>Funcionamiento social en niños hemofílicos</b>: <b>Análisis de encuesta para determinar factores psicopatológicos de riesgo</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100007&lng=es&nrm=iso&tlng=es Background: Children with hemophilia can experience problems with their mental health status and social functioning. Aim: To assess the mental health status of hemophilic children. Material and methods: Thirty four hemophilic children aged 5 to 13 years were studied. A translation of the special survey to assess mental health in children, denominated "Domingo" Mental Health Survey was applied. It consisted in animated cartoon questions related to the family, social and school life. According to the score obtained, children were classified as normal, doubtful or pathologic. The social functioning areas studied were family, school, relationship and emotional. Aggressiveness, depression/anxiety and rejection were the psychopathologic factors analyzed. Results: Forty four percent of hemophilic children were considered normal, 20% doubtful and 35% pathologic. According to the severity of the disease, 67% of children with severe, 57% with moderate and 45% with mild hemophilia, were considered abnormal. Aggressiveness was the main risk factor in the emotional and family area, depression/anxiety in the family and emotional area and rejection in the family area. Fifty six percent of children had abnormalities in their social functioning and the severity of the disease was a predisposing factor. Conclusions: Psychopathologic factors in children with hemophilia appear mainly in the family environment <![CDATA[<b>Efecto de dosis altas de budesonida y función suprarrenal de niños asmáticos severos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100008&lng=es&nrm=iso&tlng=es Background: The use of inhaled steroids is common in the treatment of bronchial asthma in children. Aim: To assess adrenocortical function in children with severe asthma receiving inhaled budesonide for six or more months. Material and methods: Children with severe asthma that required 800 µg/day or more of inhaled budesonide and that did not required systemic steroids for more than six days in the last four months to control their disease, were studied. Serum cortisol was measured one hour after administration of 0.25 mg of ACTH (Cosyntropin®) intravenously. The test was considered normal if post stimulation serum cortisol was over 18 µg/ml. Results: Twenty children (aged 5 to 14 years, 15 males), were studied. The stimulation test was normal in 17 children. Conclusions: Alterations in adrenal function are present in a small proportion of asthmatic children who require 800 µg/day of inhaled budesonide <![CDATA[<b>Factores determinantes de cumplimiento terapéutico en adultos mayores hipertensos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100009&lng=es&nrm=iso&tlng=es Background: In Chile, less than 30% of treated hypertensive patients achieve normal blood pressure values. Lack of compliance with treatment may influence the lack of success of treatments. Aim: To identify determinant treatment compliance factors, according to the Health Belief Model, in elderly hypertensive patients. Material and methods: A stratified and randomized sample with 245 elderly hypertensive patients, participating in the Cardiovascular Program of the San Pedro de la Paz Health Center in Chile, was studied. Modified Miller's Health Behavior Scale to measure therapeutic compliance and Health Belief Questionnaire to measure independent factors influencing compliance, were applied. Data analysis was done with Student's, test ANOVA and linear regression. Results: Eight of 23 factors were predictors of compliance: gender, occupational activity, smoking, modification of health behaviors, difficulties to take medications, perception of treatment effectiveness, knowledge and perception about hypertension. Conclusions: Knowledge about factors that influence therapeutic compliance allows to modify health care programs and improve their effectiveness <![CDATA[<b>Prevalencia de enteroparásitos en niños de la etnia Yukpa de Toromo, Estado Zulia, Venezuela</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100010&lng=es&nrm=iso&tlng=es Background: Yupkpa community in Perijá Sierra does not have drinking water or sewage elimination systems. Thus it becomes a propitious place for infection with intestinal parasites. Aim: To determine the prevalence of intestinal parasites in children, ages 0 to 14 years, in the Yukpa ethnic population of Toromo in the Perijá Mountains, Zulia State, Venezuela. Material and Methods: Ninety one fecal samples were analyzed by the following coproparasitologic methods: saline solution and lugol fresh mount, formalin-ether concentration (Ritchie), and Kinyoun stain for intestinal coccidians. Results: Overall parasite infection prevalence was 83.5%. The most frequently observed parasites were: Ascaris lumbricoides (57.1%), Trichuris trichiura (20.8%), Hymenolepis nana (14.2%), Blastocystis hominis (51.6%), Giardia lamblia (30.7%), and Entamoeba histolytica/E. dispar complex (21.9%). Coccidians were nont observed in any of the stool samples. Conclusions: The large number of infected people is directly related to the hygienic and sanitary conditions of the population studied <![CDATA[<b>Hemorragia pulmonar secundaria a una reactivación tardía de un síndrome de Churg-Strauss en un paciente en hemodiálisis crónica</b>: <b><i>Report of one case</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100011&lng=es&nrm=iso&tlng=es We report a 22 years old male with chronic allergic rhinitis, who presented with asthma, prolonged fever, eosinophilia, cutaneous vasculitis, subcutaneous nodules, polyarthritis, ulcers in the nasal mucosa and external auditory canal, hematuria, proteinuria, renal failure, severe hypertension, pulmonary infiltrates and mesenteric ischemia with a perforation of the sigmoid colon. Arteriography showed multiple aneurysmae of intrarenal arteries and a skin biopsy showed a leukocytoclastic vasculitis. A diagnosis of Churg-Strauss syndrome was made. He was initially treated with steroids and cyclophosphamide but abandoned therapy. Eighteen years after the onset of the disease, he required hemodialysis. Eight months after being on dialysis, he suffered a reactivation of the disease with lung hemorrhage and finally died, due to an upper gastrointestinal bleeding caused by a duodenal ulcer <![CDATA[<b>Fibromatosis mesentérica</b>: <b>caso clínico-imagenológico y revisión bibliográfica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100012&lng=es&nrm=iso&tlng=es We report a 42 years old female that presented with abdominal pain and no palpable mass. Imaging abdominal ultrasound, CAT scan and magnetic resonance showed a solid tumor located in the retroperitoneum. The patient was operated on excising the tumor. Pathological examination of the surgical piece disclosed a retroperitoneal fibromatosis or desmoid tumor. Postoperative evolution of the patient was uneventful and she was discharged 12 days after the surgical procedure <![CDATA[<b>Hidrotórax agudo masivo secundario a diálisis peritoneal aguda en síndrome hemolítico urémico</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100013&lng=es&nrm=iso&tlng=es Massive acute hydrothorax (MAH) is a severe and unusual noninfectious complication of peritoneal dialysis (PD). It can lead to acute respiratory failure and may diminish the effectiveness of the dialytic therapy. Many therapeutic strategies for this complication are employed, ranging from conservative methods like reduction of the volume of the dialysate and the transitory interruption of the PD, to more aggressive therapies as the closure of diaphragmatic defects by videothoracoscopy with or without pleurodesis. Herein, we report a two years old girl that developed acute renal failure due to an hemolytic uremic syndrome. She underwent PD and developed MAH. PD was temporarily ceased and continuous veno-venous hemofiltration was started. After 8 days, PD was resumed uneventfully. The temporary interruption of the PD was an effective measure to avoid the recurrence of the MAH <![CDATA[<b>Estrés oxidativo, prooxidantes y enfermedad de Crohn</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100014&lng=es&nrm=iso&tlng=es The frequency of Crohn disease shows a significant increase in the last century. Affected patients show a misbalance between production of free radicals and anti oxidant defenses. Thus, one of the increasingly accepted htypotheses to explain the origin of this disease, is the oxidative stress that occurs in the intestinal mucosa. Dietary factors including self administered vitamin and mineral supplemets may play a role, especially when they contain excessive amounts of iron and copper, known for their prooxidant capacities. Unfortunately, little is known about how these metals may influence the antioxidant defenses in the intestinal mucosa. This article reviews the literature on the why and how these elements may act on individuals susceptible to develop Crohm disease, including the evidence supporting the hypothesis that oxidative stress in the intestinal mucosa is an important pathogenetic factor <![CDATA[<b>La exposición prenatal a andrógenos como factor de reprogramación fetal</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100015&lng=es&nrm=iso&tlng=es Both epidemiological and clinical evidence suggest a relationship between the prenatal environment and the risk of developing diseases during adulthood. The first observations about this relationship showed that prenatal growth retardation or stress conditions during fetal life were associated to cardiovascular, metabolic and other diseases in later life. However, not only those conditions may have lasting effects after birth. Growing evidence suggests that prenatal exposure to steroids (either of fetal or maternal origin) could be another source of prenatal programming with detrimental consequences during adulthood. We have recently demonstrated that pregnant women with polycystic ovary syndrome exhibit elevated androgen levels compared to normal pregnant women, which could provide an androgen excess for both female or male fetuses. We have further tested this hypothesis in an animal model of prenatal androgenization, finding that females born from androgenized mothers have a low birth weight and high insulin resistance, that starts at an early age. On the other hand, males have low testosterone and LH secretion in response to a GnRH analogue test compared to control males and alterations in seminal parameters. We therefore propose that our efforts should be directed to modify the hyperandrogenic intrauterine environment to reduce the potential development of reproductive and metabolic diseases during adulthood <![CDATA[<b><i>Medicina Obstétrica</i></b>: <b><i>Atención médica interdisciplinaria para embarazadas y mujeres que deseen concebir</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100016&lng=es&nrm=iso&tlng=es The concept of 'obstetrical medicine' was established in the late 19th century, but overshadowed during most of the 20th century by dramatic improvements in surgical, anesthetic, antimicrobial therapeutics, and obstetrical methods and practice. During the last quarter of the 20th century the causes of maternal morbidity and mortality increasingly became pre-existing hereditable and acquired medical disorders and treatable or preventable medical complications of pregnancy. The role of obstetric medicine re-emerged because of surgical, therapeutic, and medical success. New professional associations have been formed to support, through education and research, the growth in numbers of clinicians from many specialties concerned with the medical care of the pregnant patient<hr/>El concepto de «Medicina Obstétrica» se originó a fines del siglo 19, pero quedó sobrepasado durante la mayor parte del siglo 20 por los avances dramáticos en la terapéutica quirúrgica, en la anestesia, en la disponibilidad de antimicrobianos, y en los métodos y la práctica de la obstetricia. Durante las últimas décadas del siglo 20 las causas de morbilidad y mortalidad maternas cambiaron progresivamente hacia patologías médicas preexistentes, hereditarias o adquiridas, y a complicaciones médicas del embarazo que son prevenibles y tratables. El rol de la medicina obstétrica emergió nuevamente debido a los éxitos quirúrgicos, terapéuticos y médicos. Se han constituido nuevas sociedades profesionales que apoyan a través de la educación y la investigación al número creciente de clínicos de distintas especialidades que se involucran en la atención médica de las embarazadas <![CDATA[<b>¿Debo aplicar los resultados de este estudio a mi paciente?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100017&lng=es&nrm=iso&tlng=es The concept of 'obstetrical medicine' was established in the late 19th century, but overshadowed during most of the 20th century by dramatic improvements in surgical, anesthetic, antimicrobial therapeutics, and obstetrical methods and practice. During the last quarter of the 20th century the causes of maternal morbidity and mortality increasingly became pre-existing hereditable and acquired medical disorders and treatable or preventable medical complications of pregnancy. The role of obstetric medicine re-emerged because of surgical, therapeutic, and medical success. New professional associations have been formed to support, through education and research, the growth in numbers of clinicians from many specialties concerned with the medical care of the pregnant patient<hr/>El concepto de «Medicina Obstétrica» se originó a fines del siglo 19, pero quedó sobrepasado durante la mayor parte del siglo 20 por los avances dramáticos en la terapéutica quirúrgica, en la anestesia, en la disponibilidad de antimicrobianos, y en los métodos y la práctica de la obstetricia. Durante las últimas décadas del siglo 20 las causas de morbilidad y mortalidad maternas cambiaron progresivamente hacia patologías médicas preexistentes, hereditarias o adquiridas, y a complicaciones médicas del embarazo que son prevenibles y tratables. El rol de la medicina obstétrica emergió nuevamente debido a los éxitos quirúrgicos, terapéuticos y médicos. Se han constituido nuevas sociedades profesionales que apoyan a través de la educación y la investigación al número creciente de clínicos de distintas especialidades que se involucran en la atención médica de las embarazadas <![CDATA[<b>Análisis crítico de un artículo</b>: <b>Cáncer de próstata inicial ¿operar o esperar?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100018&lng=es&nrm=iso&tlng=es Background In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. Methods: From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; thesecondary end points were death from any cause, metastasis, and local progression. Results: During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test). Conclusions: Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial <![CDATA[<b>Eustanasia y derecho a morir a morir </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000100019&lng=es&nrm=iso&tlng=es Background In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. Methods: From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; thesecondary end points were death from any cause, metastasis, and local progression. Results: During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test). Conclusions: Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial