Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720040007&lang=es vol. 132 num. 7 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<B>Reversibilidad espirométrica en la enfermedad pulmonar obstructiva crónica</B>: <B>Efecto diferencial del salbutamol sobre el volumen espiratorio forzado del primer segundo y el volumen pulmonar</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700001&lng=es&nrm=iso&tlng=es Background: In recent years it has been suggested that in COPD, lung volumes can be modified more than expiratory flows, with bronchodilators. Aim: To study the acute effects of salbutamol on FEV1 and lung volumes at rest. Subjects and Methods: Forty stable COPD patients were studied using a single dose of salbutamol (200 µg). Forced expiratory volumen in 1 second (FEV1), slow vital capacity (SVC), forced vital capacity (FVC), and inspiratory capacity (IC) were measured at baseline and after salbutamol administration. Results: After salbutamol, 39/40 patients exhibited a clinically significant increase in volumes (SVC, FVC or IC ž10% predicted). A significant increase in FEV1 (ž10% predicted) was observed in only 13 patients. Conclusions: Our results demonstrate that changes in lung volumes, and consequently in dynamic lung hyperinflation, take place more frequently than changes in maximal expiratory flows during the spirometric test in patients with COPD. Assessment of spirometric reversibility based only on changes in FEV1 underestimates the effect of bronchodilator drugs in these patients (Rev Méd Chile 2004; 132: 787-93) <![CDATA[<B>Contenido de ADN y sobrevida en el carcinoma subseroso de la vesícula biliar</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700002&lng=es&nrm=iso&tlng=es Background: The clinical and morphological characterization of the subserous gallbladder carcinomas is controversial. Aim: To study the prognostic importance of DNA content of subserous gallbladder carcinoma. Material and methods: We studied 104 females aged 60±12 years old and 16 men aged 70±13 years old. In all of them diagnosis was established after mapping of cholecystectomy sample and had a complete clinical follow up. DNA content was measured by flow cytometry. Results: All tumors were adenocarcinoma, and only 16% were well differentiated. Aneuploidy was observed in 29 cases (26%) with DNA index fluctuating between 1.1 and 1.8. Lymphatic vessel tumor involvement was present in 16 of 22 cases with aneuploidy and in 22 of 46 diploid tumors (p= 0.05). Eighty nine percent of aneuploid tumors were detected macroscopically and 11% were unapparent. Five years survival was non significantly better among patients with diploid tumors than in patients with aneuploid tumors (45 and 28%, respectively, p= 0.2). The histological differentiation was the only variable significantly associated with survival. Conclusions: Aneuploidy is present in 26% of subserous gallbladder carcinoma. It is not related with any of the morphological or clinical variables studied in this series of patients (Rev Méd Chile 2004; 132: 794-800) <![CDATA[<B>Cronología del desarrollo puberal en niñas escolares de Santiago</B>: <B>relación con nivel socio-económico e índice de masa corporal </B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700003&lng=es&nrm=iso&tlng=es Background: Recent studies in the United States have demonstrated that a significant proportion of girls show thelarche before the age of eight years. Nutritional status, geographic influences and racial factors are known to affect the timing of puberty. Aim: To evaluate the age of onset of puberty, development of secondary sexual characteristics and menarche in Chilean girls, and its relation to obesity and socioeconomic status. Material and methods: Healthy girls attending elementary school, from first to ninth grade in Santiago, Chile, were studied. A pediatric endocrinologist evaluated pubertal development using Tanner classification. Breast development was assessed by inspection and breast palpation. Average age of onset of pubertal events was determined by probit analysis. Results: A total of 758 girls, aged 5.8 to 16.1 years, were recruited. Obesity, defined as a BMI greater than 90th percentile, was found in 24.4%. The age of menarche was 12.7 years, the onset of Tanner stage 2 breast development and pubic hair was at 8.9 and 10.4 years, respectively. Sixteen percent of girls aged 7 to 7,9 years, had thelarche. Upper class girls showed a later onset of breast Tanner stage 4 stage than low-middle class girls. Obesity was not found in logistic regression analysis to be a significant predictive factor in the onset of puberty. Conclusions: The age of menarche has not changed in the last thirty years, but an earlier onset of thelarche has occurred. The high frequency of thelarche between 7 and 8 years suggests that the normal age of breast development should be revised (Rev Méd Chile 2004; 132: 801-8) <![CDATA[<B>Características psicológicas y estilos cognitivos de estudiantes de medicina y de otras carreras de la Pontificia Universidad Católica de Chile</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700004&lng=es&nrm=iso&tlng=es Background: The similarity between the psychological features of medical school freshmen of different cohorts suggests that Medicine attracts students with specific psychological types. However, it is also possible that medical students are similar to the students admitted to any other career with high admission requirements. Aim: To determine if medical school freshmen are different from those of Engineering, Architecture, Psychology and Journalism. Subjects and methods: The Spanish version of the Myers Briggs Psychological Type Indicator (MBTI) was applied to two cohorts of Medical School freshmen (90 students of the 2000 cohort and 91 students of the 2001 cohort) and to a sample of 669 freshmen from the careers of Engineering, Psychology, Architecture and Journalism. Results: Students entering Medical School are similar to the students admitted to Engineering and different from those that entered Architecture, Psychology and Journalism in the Pontificia Universidad Católica de Chile in 2000 and 2001. Medicine attracts a larger proportion of concrete and practical students that have an objective and systematic approach to study and to life in general. Unlike Medicine, Psychology and Architecture attract more students that have a cognitive style characterized by an intuitive perception, and that face life with an open and flexible attitude. Conclusions. This study reveals that the psychological features of undergraduate students are associated to their career choice. These psychological variables, therefore, may be relevant to the students' vocational preferences and possibly to their future specialty choice (Rev Méd Chile 2004; 132: 809-16) <![CDATA[<B>Análisis mutacional del gen Homeobox de segmento muscular 1 (MSX1) en chilenos con fisuras orales</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700005&lng=es&nrm=iso&tlng=es Background: Mutations of the MSX1 gene may contribute to nonsyndromic forms of cleft lip and/or cleft palate. Aim: To search for mutations of MSX1 coding regions, including one highly conserved non-coding region in the single intron, among Chilean patients with cleft lip/palate. Patients and Methods: We studied 45 patients with cleft lip/palate and their parents. Oral mucosa samples were obtained with a swab. DNA was extracted and amplified by PCR. Results: Two missense mutations (G16D and G34A) were identified in this study that may be useful for future admixture studies. The G16D mutation appears to disrupt a possible splicing site and may contribute to clefting in this population. Conclusions: Rare MSX1 mutations are found in some cases of cleft lip and/or cleft palate but others remain to be found most likely in other regulatory regions of the gene (Rev Méd Chile 2004; 132: 816-22) <![CDATA[<B>Monitorización hemodinámica intraoperatoria con ecocardiografía transesofágica</B>: <B>Experiencia clínica</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700006&lng=es&nrm=iso&tlng=es Background: Transesophageal echocardiography allows a semi-invasive hemodynamic monitoring, during cardiac and non cardiac surgery. The benefits of such surveillance must be assessed, since it may help to change patient management. Aim: To assess the usefulness of transesophageal echocardiography during surgical procedures in critical patients. Material and methods: Based on the indications of the North American Societies of Cardiology and Anesthesiology, 264 patients were monitored using a multiplanar transducer. The type of surgery, insertion difficulties, quality of visualization, complications and usefulness of the method were recorded. Results: One hundred eleven cardiac and 153 non cardiac surgical procedures were monitored. In 97% of cases, visualization was good. In 2 cases, it was impossible to obtain a transgastric axis. No complications of the procedure were recorded. The method was useless in nine patients, helpful to change drug and volume management in 126 (48%) patients, helpful to change perioperative management in 49 (19%) patients and was a substitute for pulmonary artery catheterization in 79 (30%) patients. Conclusions: Intraoperative transesophageal echocardiography is a safe technique that renders high quality images, with a low incidence of complications and that, when well indicated, orients therapeutic changes in 98% of patients (Rev Méd Chile 2004: 132: 823-31) <![CDATA[<B>Adultos Mayores institucionalizados en Chile</B>: <B>¿Cómo saber cuántos son?</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700007&lng=es&nrm=iso&tlng=es Background: Elderly people (>60 years) in Chile represented 11.4% (n=1.717.478) of the total population in 2002. The group with disabilities or mental problems is increasing and there is no reliable information about the number of institutionalized elderly subjects. Aim: To estimate the number of elderly people living in residences for long term care and their and main characteristics. Patients and methods: Chilean Census does not provide exact information about institutional care, therefore we developed a «proxy» indicator of the percentage of institutionalized elderly (those living in «collective residences with more than 5 elderly persons and in which they represent more than 25% of the residents». This proxy has a R2=0.9859 with the true value of institutionalized persons for those Latin-American countries with exact value in census data at CELADE. Results: Using the proxy we found that institutionalized elderly population had increased from 14,114 (1992) to 26,854 (2002) and is projected to reach 83,500 (2025). In 2002, there were 1.668 institutions (37.4% informal care). In the Metropolitan Area, there were 804 institutions (14.178 elderly persons) and 40.3% of these were registered at the Ministry of Health. The proportion of institutionalized elderly subjects was 1.56% of the total elderly population; this proportion increased from 0.87% in subjects 60-74 years old to 2.5% among subjects aged 75-84 years and 6.1% in subjects 85 years old and over. Among subjects living in institutions, 60.9 were women, 21% were married, 35% were single, approximately 50% receive a pension and around 15% were handicapped. Conclusions: Institutional care affects a small percentage of elderly population, but it will increase in the near future. The main characteristics of institutionalized elderly subjects are not well known. We propose to create a formal Registry of these institutions and to include Nursing Homes and hospitals in type of housing of future Censuses (Rev Méd Chile 2004; 132: 832-8) <![CDATA[<B>El trastorno por estrés postraumático: una consecuencia de los asaltos</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700008&lng=es&nrm=iso&tlng=es Background: Urban violence is increasing in Metropolitan Santiago and assault victims may suffer from post traumatic stress disorders. Aim: To study the clinical and evolutive profile of post traumatic stress disorders among assault victims. Material and methods: Retrospective review of medical records of assault victims with post traumatic stress disorder, that were attended at the Hospital del Trabajador between 1987 and 2000. The features of these patients were compared with other patients with post traumatic stress disorders not caused by assaults. Results: The records of 140 subjects (88 female) aged 34.9±10.9 years old, were reviewed. Seventy one percent of subjects worked as clerks and 59% were attended during the first month after the assault. Treatment with psychotherapy and psychotropic drugs lasted a median of 60 days and 62% was discharged before completing three months of treatment. These subjects used more antidepressants and had more physical lesions than subjects with a post traumatic stress disorder not caused by assaults. Conclusions: Timely diagnosis and treatment of post traumatic stress disorders caused by assaults, results in a favorable outcome in two thirds of patients (Rev Méd Chile 2004; 132: 839-44) <![CDATA[<B>Eficacia de la flutamida en el tratamiento del hirsutismo</B>: <B>Contribución del uso combinado con anticonceptivos orales en mujeres normoandrogénicas</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700009&lng=es&nrm=iso&tlng=es Background: Flutamide is an antiandrogen devoid of other hormonal effects, except for a decrease in the secretion of adrenal androgens such as dehydroepidandrosterone sulphate (DHEA-s) and androstenedione. Aim: To assess the effectiveness of flutamide in the treatment of hirsutism, used as monotherapy or combined with oral contraceptives (OC). Patients and methods: Women with peripheral hirsutism (defined as the presence of normal serum androgen levels and normal ovulatory menstrual cycles) were assigned to receive flutamide alone (500 mg/day) or flutamide plus an OC (ethynylestradiol 0.03 mg and desogestrel 150 µg). Hirsute with hyperandrogenism (polycystic ovary syndrome) were assigned to receive flutamide plus an OC. The degree of hirsutism was assessed using a clinical score (Moncada) at three, six and twelve months of therapy. Results: Twenty five women with peripheral hirsutism received flutamide alone and 18 receive flutamide plus the contraceptive. Eighteen women with polycystic ovary syndrome were studied. At three months, the reduction in hirsutism was 11.2, 15.9 and 24.7% in women with peripheral hirsutism receiving flutamide alone or flutamide plus OC and in hyperandrogenic women receiving flutamide plus OC, respectively. At twelve months, the figures were 57.2, 57.3 and 52.5% respectively. In hyperandrogenic women, at baseline and three months, serum testosterone levels were 0.96 and 0.42 ng/ml and serum DHEA-s levels were 2,980 and 1,490 ng/ml respectively. No collateral effects of treatment or elevations in serum transaminase levels were observed. Conclusions: Flutamide is effective in the treatment of hirsutism in women with normal or elevated androgen levels. Adding OC did not improve the efficacy of the drug (Rev Méd Chile 2004; 132: 845-52) <![CDATA[<B>Hemangioma esclerosante pulmonar como nódulo pulmonar solitario</B>: <B>comunicación de un caso</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700010&lng=es&nrm=iso&tlng=es Lung sclerosing hemangioma is an uncommon tumor that presents as a solitary asymptomatic nodule and that affects middle age women. It derives from type II pneumocytes. We report a 52 years old female with a solitary lung nodule detected in a chest X ray requested for the diagnosis of an acute respiratory disease. The nodule was excised by video thoracoscopy and the frozen section biopsy was informed as a non small cell undifferentiated carcinoma. Therefore an inferior right lobectomy with lymph node resection was performed. The definitive biopsy was informed as a lung sclerosing hemangioma (Rev Méd Chile 2004; 132: 853-6) <![CDATA[<B>Adenoma hipofisiario productor de somatotrofina en una paciente con antecedente de <I>struma ovarii</I> carcinoide</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700011&lng=es&nrm=iso&tlng=es Strumal carcinoid is an unusual form of monodermal ovarian teratoma with thyroid-like follicles mixed with typical carcinoid tumor patterns. We report a 49 years old woman presenting with an acromegaly. At the age of 45, an ovarian strumal carcinoid was excised and at three years of follow up, she complained of finger and feet growth. Laboratory showed an elevated serum IGF-1 and a sella turcica magnetic resonance imaging showed an 8 mm microadenoma. She was subjected to a transphenoidal excision and the pathological study disclosed a solid acidophilic pituitary adenoma. Two months after surgery, there was a significant decrease in serum IGT-I levels (Rev Méd Chile 2004; 132: 857-9) <![CDATA[<B>Uso precoz del BiPAP en el tratamiento de la insuficiencia respiratoria en un lactante con osteogénesis imperfecta</B>: <B>Case report </B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700012&lng=es&nrm=iso&tlng=es Osteogenesis imperfecta (OI) is an heterogeneous group of genetic disorders that affect connective tissue integrity. Severe forms cause chest deformities, sometimes associated to alveolar hypoventilation. We report a 4 months old infant with OI type III, who developed respiratory failure (RF) due to a bronchiolitis and required mechanical ventilation. Weaning progressed successfully to a nasal bi-level Positive Airway Pressure (n-BiPAP) device. Clinical follow up showed a normal cognitive development and growth. Respiratory condition, blood gases and ventilation status were in normal ranges. Non invasive ventilation, associated to careful monitoring may avoid tracheostomy and its complications in infants with OI (Rev Méd Chile 2004; 132: 861-4) <![CDATA[<B>Algunos antecedentes sobre la inequidad en la situación de salud del adulto mayor en Chile</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700013&lng=es&nrm=iso&tlng=es Health problems of the elderly are important in Chile. The proportion of elderly subjects will increase in the next few years due to expected demographic changes. Mortality rates for different specific causes in Chile are very high, when compared to those of more developed countries such as Spain. National data show inequities according to socioeconomic status both in the mortality figures and in the access to health services. The new health program from the Ministry of Health for the elderly is presented. This program needs more resources to reach better levels of primary, secondary and tertiary prevention actions. The future health reform, presently under discussion in the National Congress will contribute to reinforce primary health care for the elderly. Medications should be provided with small co-payments, both in the public and the private health systems (Rev Méd Chile 2004; 132: 865-72) <![CDATA[<B>Exposición a pesticidas y toxicidad reproductiva y del desarrollo en humanos</B>: <B>Análisis de la evidencia epidemiológica y experimental</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700014&lng=es&nrm=iso&tlng=es Several epidemiological studies link pesticide exposure to reproductive and developmental toxicity. However, additional studies have shown little or no evidence to support such relationship. On the other hand, experimental data show that some pesticides may indeed alter the reproductive function or produce birth defects (as evidenced by intrauterine death, in utero growth retardation, visceral and skeletal malformations or functional deficits) in laboratory animals. This review is a critical analysis of the epidemiological and experimental evidence available to date, that links pesticide exposure with induction of reproductive or developmental defects. Factors that must be considered when establishing a cause-effect relationship are also discussed, including the shape of the dose-response curve, exposure to pesticides in chemical mixtures and the influence of genetic background (Rev Méd Chile 2004; 132: 873-9 <![CDATA[<B>Medicina en televisión</B>: <B>¿un problema ético?</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700015&lng=es&nrm=iso&tlng=es Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice. (Rev Méd Chile 2004; 132: 881-5) <![CDATA[<B>Acido acetilsalicílico en la prevención primaria de la cardiopatía coronaria</B>: <B>¿a todos?</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700016&lng=es&nrm=iso&tlng=es Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice. (Rev Méd Chile 2004; 132: 881-5) <![CDATA[<b>Disipando la Niebla. El cáncer en retirada</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700017&lng=es&nrm=iso&tlng=es Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice. (Rev Méd Chile 2004; 132: 881-5) <![CDATA[<B>Revisión por pares, año 2003</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000700018&lng=es&nrm=iso&tlng=es Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice. (Rev Méd Chile 2004; 132: 881-5)