Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720090003&lang=es vol. 137 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Polimorfismo +49 A/G del gen del antígeno 4 del linfocito T citotóxico <i>(CTLA-4) </i>en la diabetes tipo 1</b>: <b>Asociación con el perfil de anticuerpos y citoquinas</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300001&lng=es&nrm=iso&tlng=es Background: Cytotoxic T lymphocyte associated antigen 4 (CTLA-4) has been one ofthe non HLA genes more commonly studied in type 1 diabetes mellitus (TID). CTLA-4 is a co-stimulation protein that has a key role in the negative regulation ofT cells and is related with a functional cytokine imbalance, generating a T helper (Th) 1 over Th2 dominance. Aim: To analyze the association of +49 A/G polymorphism of CTLA-4 and its relationship with autoantibodies and cytokine expression in recently diagnosed TID patients. Patients and Methods: CTLA-4 genetic variants and auto-antibody levéis were studied in 260 chiídren with TID and 255 healthy chiídren matched by age and gender +49 A/G polymorphism of CTLA-4 was studied by polymerase chain reaction and restriction fragmentpolymorphism (PCR-RFLP). Autoantibody levéis were measured by conventional ELISA. A panel of60 cytokines was studied simultaneously by serum array analysis in 15 TID and 15 healthy controls stratified according CTLA-4 genotype. Results: The +49 A/G genetic frequency was similar in TID cases and healthy chiídren. A positive anti-GAD65 and anti-IA-2 level was observed in 673% of TID group. This percentage was increased among GG carriers (79.4% to GAD65 and 70.6% to IA-2). Finally, TID patients carrying this genotype showed a high expression of interleukin 2, 10, tumor necrosis factor alpha and interferon gamma. Conclusions: The +49 A/G polymorphism of CTLA-4 was similar in diabetic and control chiídren. Among patients with TID and carriers of GG genotype, a higher frequency of anti-GAD65 and a preferential Thl cytokine expression profile was observed. <![CDATA[<b><i>Frecuencia y características del síndrome metabólico en pacientes con estenosis carotídea sintomática</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300002&lng=es&nrm=iso&tlng=es Background: Metabolic syndrome (MetS) is associated with increased risk of carotid atherosclerosis. Aim: To estimate the frequency of MetS in patients with symptomatic carotid atherosclerotic disease, and to compare clinical, biochemical and ultrasonographic characteristics of patients with and without MetS. Material and methods: Cross-sectional study of 657 consecutive patients (412 males) with symptomatic carotid atherosclerotic disease. Carotid atherosclerosis was estimated by high resolution B-mode ultrasonography. National Cholesterol Education Program (NCEP) M criteria were used for estimation of MetS. Results: Metabolic syndrome was present in 55.6% of studied patients. Among patients with metabolic syndrome there was a significantly higher proportion of women, and mean values ofbody weight, body mass index, waist circumference, percentage of body fat, systolic and diastolic blood pressure, serum triglycerides, total cholesterol and glucose were significantly higher. Mean values of high density lipoprotein cholesterol and alcohol consumption were significantly lower in patients with MetS. No differences between patients with or without MetS, were observed for age, smoking, mean values of low density lipoprotein cholesterol, high sensitive C-reactive protein and fibrinogen, and for degree of carotidstenosis or severity of clinical manifestations. Conclusion: Half of these patients with carotid stenosis have features of the metabolic syndrome.<hr/>Antecedentes: El síndrome metabólico se asocia a un mayor riesgo de ateroesclerosis carotídea. Objetivo: Evaluar la frecuencia de síndrome metabólico en pacientes con ateroesclerosis carotídea sintomática y comparar las características clínicas, bioquímicas y ultrasonográficas en pacientes con y sin síndrome metabólico. Material y método: Estudio transversal de 657 pacientes consecutivos (412 varones) con ateroesclerosis carotídea sintomática. El síndrome metabólico fue diagnosticado de acuerdo a los criterios del National Cholesterol Education Program (NCEP) III. la ateroesclerosis carotídea se investigó mediante ultrasonografía de alta resolución modo B. Resultados: Se diagnosticó síndrome metabólico en 55.6% de los pacientes estudiados. Entre los sujetos portadores del síndrome había una mayor proporción de mujeres y el peso, índice de masa corporal, circunferencia de cintura, porcentaje de grasa corporal, presión arterial sistólica y diastólica y niveles séricos de triglicéridos, colesterol total y glicemia fueron mayores. los valores promedio de colesterol HDI y de consumo de alcohol fueron significativamente menores en los pacientes con síndrome metabólico. los pacientes con el síndrome consumían menos alcohol y tenían niveles de colesterol HDI más bajos. No se encontraron diferencias entre sujetos con y sin síndrome metabólico en edad, tabaquismo, lipoproteínas de baja densidad, proteína C reactiva ultrasensible, fibrinógeno, grado de estenosis carotídea o severidad de sus manifestaciones clínicas. Conclusiones: la mitad de estos pacientes con estenosis carotídea tiene un síndrome metabólico. <![CDATA[<b>Influencia de la obesidad en los costos en salud y en el ausentismo laboral de causa médica en una cohorte de trabajadores</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300003&lng=es&nrm=iso&tlng=es Background: The health associated costs of obesity can represent between 2% and 9% of the total health costs of a given country. Aim: To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Patients and wethods: Prospective study of 4.673 men, employees of a mining company, aged 49 ± 7 years that were followed for 24 ± 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Results: Mean annual health care costs for obese workers were 17% higher (p <0.001) compared to workers with normal weight and 58% higher (p <0.001) for workers with severe and morbid obesity. Mean annual days of sick leave increased by 25%o in the obese (p =0.002) and by 57%o in subjects with severe and morbid obesity (p <0.001). For health care costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95%o confidence intervals (95% CI) 4.9 to 7.9), hypertension (OR 3-99; 95% CI3-4 to 4.6) and severe and morbid obesity (OR 2.55, 95%o CI 1.9 to 3-4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95%> CI 1.2 to 2.0), hypertension (OR 1,34, 95%> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95%o CI 1.1 to 2.1). Conclusions: Obesity increases significantly health care costs and absenteeism. <![CDATA[<b>Prevalencia de disfunción sexual en mujeres climatéricas</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300004&lng=es&nrm=iso&tlng=es Background: The Female Sexual Function index (FSFI), is a scale designed to evaluate sexuality and diagnose the presence of sexual dysfunction in women. Aim: To apply the FSFI to climacteric women. Patients and methods: The FSFI was applied to 370 healthy women aged between 40 and 59years old (49 ± 6years) that accompanied patients to public health services in Santiago. Results: Fifty six percent of women were married, 44% were postmenopausal, 6% used hormone replacement therapy, 67% were sexually active, and sexual dysfunction was present in 57% of them. Thirty two percent of women aged between 40 and 44 years and 65% of women aged between 55 and 59 years, had sexual dysfunction (p <0.01). In a logistic regression model, the risk of sexual dysfunction increased among women that perceive having health problems (Odds ratio (OR) 3-9; 95%o confidence intervals (95% CI): 1.1-13-8), women older than 48 years (OR 1.9; 95% CI: 1.1-3-4) and women that gave birth to two or more children (OR 1.8; 95% CI: 1.0-3-1). Conclusions: Climateric women have high prevalence of sexual dysfunction. Age is its main risk factor. <![CDATA[<b>Evolución del compromiso cardiovascular de pacientes insuficientes renales, en hemodiálisis, sin bloqueo del eje renina-angiotensina</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300005&lng=es&nrm=iso&tlng=es Background: Diabetes mellitus is an important risk factor for cardiovascular complications among patients on hemodialysis. However, the incidence of these complications among non diabetic patients on hemodialysis is not well known. Aim: To assess the incidence of cardiovascular complications in non diabetic patients on hemodialysis. Patients and methods: Seventy five non diabetic patients aged 55.6 ± 17 years (48 males), receiving hemodialysis three times a week were evaluated with laboratory tests, echocardiogram anda carotid ultrasound. In 26 patients, interleukin 6, tumor necrosis factor alpha, and intercellular adhesión molecule (ICAM-1) were also measured. Patients were followed during two years. Results: The mean lapse of dialysis therapy was 6.5 ±5 years. The main cause of renal failure was hypertension. Sixty two percent had systolic hypertension, 86% had concentric left ventricular hypertrophy, 43% had atrial dilatation and 60% had calcifications in the thoracic aorta. Compared with normal controls, patients had higher levels of interleukin 6, tumor necrosis factor alpha and ICAM-1. Carotid media thickness was also higher and increased in the two years of follow up. No correlations were found between ventricular hypertrophy and dialysis lapse, packed red cell volume, calcium phosphorus product, parathormone levels or median arterial pressure. No cardiovascular events were recorded during the follow up period. Conclusions: Non diabetic patients on chronic hemodialysis have a high frequency of ventricular hypertrophy, carotid media thickening, aortic calcifications and an increase in proinflammatory cytokines. <![CDATA[<b>Consumo de tabaco y alcohol entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300006&lng=es&nrm=iso&tlng=es Background: Tobacco and alcohol consumption are public health problems, generally starting in adolescence. Medical students are not an exception. Aim: To determine the characteristics of tobacco and alcohol use among medical students at the Pontificia Universidad Católica de Chile and their association with gender, career level and mental health. Material and methods: A questionnaire to evaluate substance use was applied along with Goldberg Health Questionnaire (GHQ-12), as a mental health risk predictor, to all medical students in November 2005- Results: The survey was completed by 569 of 775 students (74%). Current smokers were 23- 7%, with the lowest figure, 13-5% in sixth year, and the highest, 40.5% in seventh year (p <0.01). Thirty one percent of students with an score of five and over in the GHQ-12 were smokers, compared to 19% among those with a lower score. Daily smokers were 40%o of the current smokers. Seventy four percent of students consumed alcohol during the last month. No association with sex or GHQ-12 was observed. The lowest alcohol consumption rate was observed in second year, and the highest in sixth year (66%o and 89-2%o, respectively, p <0.01). Fifty three percent of men and 26%o of women drank three or more drinks in any given day (p <0.01). Sixty three percent of men and 81% of women never drank more than five drinks in one day, during the last month (p <0.01). Conclusions: Our medical students smoke less than Chilean youth but more than medical students of countries such as the USA. They drink less than Anglo-Saxon medical students but more than Chilean youth. Male consumption is greater than that of women. Smoking and alcohol drinking are mutually associated. <![CDATA[<b>Propiedades probióticas de <i>Lactobacillus </i>spp aislados de biopsias gástricas de pacientes con y sin infección por <i>Helicobacter pylori</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300007&lng=es&nrm=iso&tlng=es Background: Gastric microbiota is a complex ecosystem, composed by diverse microorganisms, where H pylori and Lactobacillus are relevant species. Aim: To study the probiotic properties of Lactobacillus spp isolated from gastric biopsies of subjects bearing or not H pylori. Materials and Methods: Gastric biopsies from 197 individuals that consulted for gastrointestinal disorders were cultivated in media specific for H pylori and Lactobacillus spp. Probiotic properties of lactobacilli isolates and histological diagnosis of H pylori colonized patients were performed. Results: Among 197 individuals evaluated, Hpylori was detected in 43%, Lactobacillus spp in 24%, while 8% presented both bacteria simultaneously. Forty one percent of the Lactobacillus spp strains produced hydrogen peroxide, S'3% presented a highly hydrophobic surface and 32% had an inhibitory effect upon Hpylori ATCC 43504, even greater than Lactobacillus LGG or LAL reference strains. The main pathological diagnosis of patients ivas chronic non-atrophic gastritis (73%) followed by intestinal metaplasia (19%). A similar proportion of both conditions were observed in patients colonized by Lactobacillus spp, while not colonized individuals developed preferentially chronic non-atrophic gastritis (p =0.002). Conclusions: Lactobacillus spp and H pylori were mutually excluded, suggesting a competitive colonization model between probiotic bacteria and pathogens . <![CDATA[<b>Detección y tipificación de virus papiloma humano en adenocarcinoma de cuello uterino mediante <i>reverse line blot, </i>Región de La Araucanía, Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300008&lng=es&nrm=iso&tlng=es Background: The genotyping of Human Papillomavirus (HPV) will improve knowledge about the local epidemiological association of this virus with adenocarcinoma. Aim: To determine the frequency of HPV genotypes in biopsies of women with uterine cervical adenocarcinoma in a geographic region of Chile. Materials and Methods: Forty-one cervical biopsies with a pathological diagnosis of adenocarcinoma, corresponding to all women diagnosed with this cancer between 2002 and 2004, were analyzed. Viral gene Ll was amplified by PCRfor viral detection. HPV genotyping was carried out by a Reverse Line Blot technique. Results: Seventy one percent of biopsies were positive for HPV. The most common genotypes found were HPV 16 (61%), followed by HPV 18 (19.5%). Eighty seven percent of biopsies had a single HPV infection. Three patients had a multiple HPV infection. All of the latter were infected by HPV 16, associated with other three viral genotypes (45, 52 and 66). No low-risk HPV genotypes were found. Conclusions: In this sample of biopsies, there was a high prevelence of HPV 16 and a low prevalence of HPV 18, which historically has been related to adenocarcinoma. The genotypes found correspond to those described in South America. <![CDATA[<b>Uso de inmunoglobulina humana endovenosa en pacientes con necrolisis epidérmica tóxica y síndrome de sobreposición Stevens Johnson necrolisis tóxica epidérmica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300009&lng=es&nrm=iso&tlng=es Background: Toxic epidemial necrolysis (TEN) is an acute adverse drug reaction, that has an unpredictableprogression and a 30% mortality. The incidence of TEN in the general population is approximately 0.4 to 1.2 cases/million/year. It is characterized pathologically by keratinocyte apoptosis which leads to epidemial detachment. Keratinocyte apoptosis is triggered by activation of the Fas-FasL, pathway and could be prevented by the use of intravenous immunoglobulin (IVIG). Aim: To report the experience with the use of IVIG in TEN. Material and methods: Retrospective study of 15 patients with a diagnosis of Stevens-Johnson/TEN overlap (SJS/TEN) or TEN, that received a total dose of 23 ± 0.6 mg/kg ofIVIG over aperiod of 3 to 4 days. The infusión was initiated during thefirst 24 hours after diagnosis and was associated with standard care for burn victims. Steroids were avoided if the patient was not in chronic steroidal therapy. Results: Allpatients responded to IVIG in a lapse of 46.4 ± 14.2 hours from the beginning of infusión. Eighty percent of patients survived, but one developed acute renal failure due to IVIG, and another became blind due to corneal opacities, a complication of TEN. Those who survived were discharged after a lapse of 19-8 ± 6.6 days from the beginning ofthe disease. Conclusions: Despite the lack of blind, multicentric and randomized triáis, we agree with some international studies that TVIG is beneficial as a treatment for SSJ/NETand TEN . <![CDATA[<b>Linfoma periaórtico tóraco-abdominal, que simula un síndrome aórtico agudo y revisión de la literatura</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300010&lng=es&nrm=iso&tlng=es Systemic lymphoma that involves the aorta is called periaortic lymphoma, and may be misdiagnosed clinically or in CT sean, mimicking a thoracic aortic aneurysm, dissection, penetrating ulcer or an intramural hematoma. We report a 70 year-old woman in whom a systemic non-Hodgkin 's lymphoma ivas diagnosed after she presented with the clinical features of an acute aortic syndrome. A CT sean showed the presence of a large thoracoabdominal periaortic soft tissue mass without aneurism or dissection. Later, a biopsy of the mass ivasperformed which showed a non-Hodgkin's lymphoma. Chemotherapy with CHOP-R was effective, with complete initial resolution of the mass, developing in the follow up chylothorax, malnutrition and death. <![CDATA[<b>Carcinoma hepatocelular variedad fibrolamelar metastásico en menores de 20 años</b>: <b>Reporte de 2 casos tratados con intención curativa y revisión de la literatura</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300011&lng=es&nrm=iso&tlng=es Fibrolamellar hepatocellular carcinoma (FLC) is a rare histologic variant of hepatocellular carcinoma that appears most commonly in teenagers andyoung adults. The diagnosis is often made incidentally and surgical resection is the only curative treatment. Here we report two cases of incidental FLC involving a 19 year-old male, initially diagnosed with screening abdominal ultrasound, and a 14 year-old female that presented with abdominalpain. Diagnostic workup consisted of abdominal PET/CT and MR1Imaging studies and tissue diagnosis was confirmed with percutaneous liver biopsy. Both patients were treated with radical liver resection/tumor excision. However, tumor recurrence was observed in both during short-term follow-up. The male patient was treated successfully with surgical treatment however the female patient succumbed top regression of disease. <![CDATA[<b>Bradicardia asociada a crisis epilépticas</b>: <b>Casos clínicos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300012&lng=es&nrm=iso&tlng=es Cardiac rate and rhythm due to autonomic activation, may occur during epileptic seizures. They are probably a consequence of the spreading seizure activity to structures involved in the autonomic control of cardiac rhythm. Sinus tachycardia is the most frequent finding (90%). letal bradycardia is rare and Ufe threatening asystoles require cardiac pacemaker insertion. We report two patients with a right frontal seizure associated to bradycardia, during simultaneous EEG/ECG monitoring. Interictal autonomic function tests showed preserved sympathetic and cardiac vagal responses. Normal interictal autonomic function tests, suggested a transient failure of sympatho-vagal balance . <![CDATA[<b>Trastorno linfoproliferativo post trasplante renal en un niño</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300013&lng=es&nrm=iso&tlng=es Post transplant lymphoproliferative disorder (PTLD) is the commonest form of post transplant malignancy in children. The incidence in renal transplant recipients varies between 2%-4%. They are characterized by uncontrolled B lymphocyte proliferation, in most cases driven by Epstein Barr virus (EBV). They are more common in younger children, EBV seronegative patients and those who receive aggressive immunosuppression. PTLD commonly presents in an unspecific form and it requires high suspicion rate for its diagnosis, especially in children with risk factors. We report a twelve year-old girl who developed fever, sore throat and lymph node enlargement, six months after receiving a renal allograft. Laboratory assessment and imaging studies were compatible with PTLD, which was confirmed by biopsy. Treatment was reduction of immunosuppression and surveillance. The patient had a favorable evolution. <![CDATA[<b>Función respiratoria en la senectud</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300014&lng=es&nrm=iso&tlng=es Aging generates four important changes in the structure and function of the respiratory system. There is a reduction in the elastic recoil of the lung causing "senile emphysema", a condition characterized by reduction in the alveolar surface area without alveolar destruction, which is associated with hyperinflation, increased lung compliance and reduction in alveolar-capillary diffusing capacity. There is a decrease in the compliance of the chest watt, due to calcification of its articulations, dorsal kyphosis and "barrel chest". There is a decrease in the strength of respiratory muscles which correlates with cardiac Index, nutritional status and hyperinflation, and there is a reduction in the ventilatory response to hypoxia and hypercapnia as well as in the perception of increased airway resistance. The increased static lung compliance combined with the decreased chest watt compliance leads to an increase in the functional residual capacity with aging. On the other hand, the loss of alveolar and airways elastic recoil combined with the reduction in the strength of the expiratory muscles, leads to an increase in residual volume and decreased maximal expiratory airflow rates and vital capacity. Despite these changes, the respiratory system maintains an adequate gas exchange at rest and during exercise during the whole life span, showing a normal PaCO2 and a slight decline in PaO2 (-0,3 mmHg per year) which is attenuated to become almost undetectable over the age of 70. <![CDATA[<b>La contribución de la neurociencia a la comprensión de la conducta: El caso de la moral</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300015&lng=es&nrm=iso&tlng=es The neuro-scientific study of moral actions and judgments is particularly relevant to medicine, especially when assessing behavior disorders secondary to brain diseases. In this paper, moral behavior is reviewed from an evolutionary and neuro-scientific perspective. We discuss the role of emotions in moral decisions, the role of brain development in moral development and the cerebral basis of moral behavior. Empirical evidence shows a relationship between brain and moral development: changes in cerebral architecture are related to changes in moral decision complexity. Moral development takes a long time, achieving its maturity during adulthood. It is suggested that moral cognition depends on cerebral regions and neural networks related to emotional and cognitive processing (i.e. prefrontal and temporal cortex) and that moral judgments are complex affective and cognitive phenomena. This paper concludes with the suggestion that a satisfactory clinical/legal evaluation of a patient requires that the neural basis of moral behavior should be taken into account. <![CDATA[<b>Experiencias autogestionarias en salud</b>: <b>El legado de Gandulfo en La Hoja Sanitaria y el Policlínico de la Organización Sindical Industrial Workers of the World (1923-1942)</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300016&lng=es&nrm=iso&tlng=es There are many ways to understand self-management. They vary from Government-dependent technical-administrative meanings (i.e. hospital self-management, in the context of health reform in Chile), to those related to efforts to abolish the State. Thus, the "self-management" concept was developed from the very beginning by the anarchist movement as one of its organizational principies. Henee, there is a need to break myths and prejudices about anarchist philosophy seen as a synonym of chaos, and to review its deeply constructive aspects and its highly moral character, hand in hand with genuine self-management in health. In this context, the work of Juan Gandulfo, a physician and anarchist, in the management of the Worker Polyclinic of the Industrial Workers of the World (IWW) and its diffusion media "The sanitary page" must be emphasized. The aim of this paper is to review the history of particular initiatives in self management, complementing them with some biographical aspects of Dr. Gandulfo's life. <![CDATA[<b>Marcel Proust: el rol de su enfermedad y la Medicina en la vida y obra del autor de "A la busca del tiempo perdido", a un siglo de su creación</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300017&lng=es&nrm=iso&tlng=es Marcel Proust is one of the greatest French writers of the XX century and of all times. In bis supreme work 'In Search of lost Time", Proust demonstrated a great knowledge of medicine and specifically neurology. He ivas surrounded by doctors in his family and himself carne in touch with many brilliant neurologists as Babinski and Sollier due to bis asthma, wrongly considered as a manifestation of his "neurasthenia". He used as a literary tool the concept of emotional memory which is the basis of bis work. Nearly a century after Proust began the elaboration of bis masterpiece, this paper reviews important medical aspects of bis life and the influence that medicine had on bis work. <![CDATA[<b><i>Un mensaje desde Norteamerica</i></b>: <b><i>Lo romántico de la medicina -viajes y héroes</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300018&lng=es&nrm=iso&tlng=es Becoming a physician is a lifelong journey, not merely the completion of medical school and postgraduate training. For those pedagogues that wish to train doctors as technicians the notion that there is something heroic and romantic in a physician's life is quaint, old fashioned, and out of date! In today's teaching hospitals virtual patients come via digital technology in computed x-ray and magnetic resonance images, automated laboratory test panels, electrophysiologic studies, and algorhythmic histories. Doctors have no need to leave their computer and increasingly doctors do not leave their computers for the bedside, the home, the neighborhood, or the country of their "patients". Contemporary doctors are in danger of losing their bedside clinical skills and with them go the role of physician as a wise, widely traveled human being knowledgeable about the rigors of inhospitable environs, the hardiness of the species, the despair of poverty, and the seductive dangers of wealth. There is similarity of this kind of physician to mythic heroes, and they still have stories to tell.<hr/>Convertirse en médico es una jornada de toda la vida, que no termina al graduarse de una escuela de medicina ni al completar una formación de postgrado. Para aquellos docentes que pretenden formar médicos como tecnólogos, la noción de que en la vida del médico haya algo romántico y heroico suena a arcaico, fuera de moda y de lugar. En los hospitales docentes de hoy los pacientes se convierten en entes virtuales mediante la tecnología digital con imágenes radiológicas computarizadas o de resonancia magnética, "perfiles" de laboratorio automatizados, estudios electrofisiológicos e historias clínicas forzadas por algoritmos. Los médicos no necesitan dejar de lado sus computadoras para atender a sus pacientes en sus camas, en sus hogares, sus barrios o países. Los médicos contemporáneos arriesgan perder las competencias clínicas y con ello se perdería el rol de aquellos médicos que sean seres humanos competentes en conocimientos, que viajen mucho conociendo los rigores de ambientes inhóspitos, las características complejas de nuestra especie, la desesperanza de la pobreza y la seducción peligrosa de la riqueza. Hay una similitud entre este tipo de médicos con los héroes mitológicos y los que aún quedan tienen muchas historias que relatar. <![CDATA[<b>EDEMA PULMONAR AGUDO E HIPERTIROIDISMO</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300019&lng=es&nrm=iso&tlng=es Becoming a physician is a lifelong journey, not merely the completion of medical school and postgraduate training. For those pedagogues that wish to train doctors as technicians the notion that there is something heroic and romantic in a physician's life is quaint, old fashioned, and out of date! In today's teaching hospitals virtual patients come via digital technology in computed x-ray and magnetic resonance images, automated laboratory test panels, electrophysiologic studies, and algorhythmic histories. Doctors have no need to leave their computer and increasingly doctors do not leave their computers for the bedside, the home, the neighborhood, or the country of their "patients". Contemporary doctors are in danger of losing their bedside clinical skills and with them go the role of physician as a wise, widely traveled human being knowledgeable about the rigors of inhospitable environs, the hardiness of the species, the despair of poverty, and the seductive dangers of wealth. There is similarity of this kind of physician to mythic heroes, and they still have stories to tell.<hr/>Convertirse en médico es una jornada de toda la vida, que no termina al graduarse de una escuela de medicina ni al completar una formación de postgrado. Para aquellos docentes que pretenden formar médicos como tecnólogos, la noción de que en la vida del médico haya algo romántico y heroico suena a arcaico, fuera de moda y de lugar. En los hospitales docentes de hoy los pacientes se convierten en entes virtuales mediante la tecnología digital con imágenes radiológicas computarizadas o de resonancia magnética, "perfiles" de laboratorio automatizados, estudios electrofisiológicos e historias clínicas forzadas por algoritmos. Los médicos no necesitan dejar de lado sus computadoras para atender a sus pacientes en sus camas, en sus hogares, sus barrios o países. Los médicos contemporáneos arriesgan perder las competencias clínicas y con ello se perdería el rol de aquellos médicos que sean seres humanos competentes en conocimientos, que viajen mucho conociendo los rigores de ambientes inhóspitos, las características complejas de nuestra especie, la desesperanza de la pobreza y la seducción peligrosa de la riqueza. Hay una similitud entre este tipo de médicos con los héroes mitológicos y los que aún quedan tienen muchas historias que relatar. <![CDATA[<b>BICENTENARIO DE DARWIN</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300020&lng=es&nrm=iso&tlng=es Becoming a physician is a lifelong journey, not merely the completion of medical school and postgraduate training. For those pedagogues that wish to train doctors as technicians the notion that there is something heroic and romantic in a physician's life is quaint, old fashioned, and out of date! In today's teaching hospitals virtual patients come via digital technology in computed x-ray and magnetic resonance images, automated laboratory test panels, electrophysiologic studies, and algorhythmic histories. Doctors have no need to leave their computer and increasingly doctors do not leave their computers for the bedside, the home, the neighborhood, or the country of their "patients". Contemporary doctors are in danger of losing their bedside clinical skills and with them go the role of physician as a wise, widely traveled human being knowledgeable about the rigors of inhospitable environs, the hardiness of the species, the despair of poverty, and the seductive dangers of wealth. There is similarity of this kind of physician to mythic heroes, and they still have stories to tell.<hr/>Convertirse en médico es una jornada de toda la vida, que no termina al graduarse de una escuela de medicina ni al completar una formación de postgrado. Para aquellos docentes que pretenden formar médicos como tecnólogos, la noción de que en la vida del médico haya algo romántico y heroico suena a arcaico, fuera de moda y de lugar. En los hospitales docentes de hoy los pacientes se convierten en entes virtuales mediante la tecnología digital con imágenes radiológicas computarizadas o de resonancia magnética, "perfiles" de laboratorio automatizados, estudios electrofisiológicos e historias clínicas forzadas por algoritmos. Los médicos no necesitan dejar de lado sus computadoras para atender a sus pacientes en sus camas, en sus hogares, sus barrios o países. Los médicos contemporáneos arriesgan perder las competencias clínicas y con ello se perdería el rol de aquellos médicos que sean seres humanos competentes en conocimientos, que viajen mucho conociendo los rigores de ambientes inhóspitos, las características complejas de nuestra especie, la desesperanza de la pobreza y la seducción peligrosa de la riqueza. Hay una similitud entre este tipo de médicos con los héroes mitológicos y los que aún quedan tienen muchas historias que relatar. <![CDATA[<b>WHEN BLUSHING HURTS</b>: <b>OVERCOMING ABNORMAL FACIAL BLUSHING</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300021&lng=es&nrm=iso&tlng=es Becoming a physician is a lifelong journey, not merely the completion of medical school and postgraduate training. For those pedagogues that wish to train doctors as technicians the notion that there is something heroic and romantic in a physician's life is quaint, old fashioned, and out of date! In today's teaching hospitals virtual patients come via digital technology in computed x-ray and magnetic resonance images, automated laboratory test panels, electrophysiologic studies, and algorhythmic histories. Doctors have no need to leave their computer and increasingly doctors do not leave their computers for the bedside, the home, the neighborhood, or the country of their "patients". Contemporary doctors are in danger of losing their bedside clinical skills and with them go the role of physician as a wise, widely traveled human being knowledgeable about the rigors of inhospitable environs, the hardiness of the species, the despair of poverty, and the seductive dangers of wealth. There is similarity of this kind of physician to mythic heroes, and they still have stories to tell.<hr/>Convertirse en médico es una jornada de toda la vida, que no termina al graduarse de una escuela de medicina ni al completar una formación de postgrado. Para aquellos docentes que pretenden formar médicos como tecnólogos, la noción de que en la vida del médico haya algo romántico y heroico suena a arcaico, fuera de moda y de lugar. En los hospitales docentes de hoy los pacientes se convierten en entes virtuales mediante la tecnología digital con imágenes radiológicas computarizadas o de resonancia magnética, "perfiles" de laboratorio automatizados, estudios electrofisiológicos e historias clínicas forzadas por algoritmos. Los médicos no necesitan dejar de lado sus computadoras para atender a sus pacientes en sus camas, en sus hogares, sus barrios o países. Los médicos contemporáneos arriesgan perder las competencias clínicas y con ello se perdería el rol de aquellos médicos que sean seres humanos competentes en conocimientos, que viajen mucho conociendo los rigores de ambientes inhóspitos, las características complejas de nuestra especie, la desesperanza de la pobreza y la seducción peligrosa de la riqueza. Hay una similitud entre este tipo de médicos con los héroes mitológicos y los que aún quedan tienen muchas historias que relatar. http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000300022&lng=es&nrm=iso&tlng=es