Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720000001&lang=es vol. 128 num. 1 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Artículos de investigación]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100001&lng=es&nrm=iso&tlng=es Since 1973, Revista Médica de Chile has classified biomedical and clinical prospective research papers in a Section named "Research Articles", while purely clinical and retrospective studies were classified into another Section, named "Clinical Experiences". This distinction seems no longer necessary, because both types of manuscripts are subjected to a uniform external peer-review system and their intrinsic quality is not a distinctive feature. Furthermore, the name of Sections where similar papers are classified by the major general clinical medicine journals is clearly non-uniform. Therefore, "Research Articles" and "Clinical Experiences" will from now on be included into a single Section: "Research Articles". (Rev Méd Chile 2000; 128: 7-8) <![CDATA[Partículas lipoproteicas LpA-I, LpA-I: A-II y LpB en enfermedad coronaria]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100002&lng=es&nrm=iso&tlng=es Background: High density lipoproteins are an heterogeneous population of particles. Two main subpopulations have been identified, one contains Apo A-I and Apo A-II and is denominated LpA-I:A-II and another one contains only Apo A-I and is denominated LpA-I. Aim: To measure the concentrations of these particles in patients with stable coronary artery disease. Patients and Methods: Serum lipids, A-I and B apolipoproteins, LpA-I, LpA-I:A-II and LpB particles were measured in 73 men aged 33 to 82 years with angiographically documented coronary artery disease (CAD) and 33 control subjects aged 39 to 76 years. LpA-I, LpA-I:A-II and LpB were measured by a noncompetitive enzyme linked immunoassay using previously characterized monoclonal antibodies against ApoA-I, ApoA-II and apoB. Results: Patients with CAD had significantly higher mean levels of LDL cholesterol than the control group (p= 0.038). The mean concentration of LpA-I particles in patients with CAD was significantly lower (p= 0.031) than in control subjects, while the concentration of LpA-I:A-II particles was significantly higher (p=0.016). The percentage of coronary stenosis correlated negatively with LpA-I and positively with LpA-I:A-II. The best relative risk (RR) indicator in these patients was LDL-cholesterol. The relative risk increases 2.5 fold when LpA-I falls below the cut-off level. Likewise, the relative risk increases 3-fold when LpA-I:A-II raises over the cut-off level. Conclusions: Our findings indicate that the quantification of LpA-I and LpA-I:A-II particles might allow a more accurate evaluation of the CAD risk than HDL cholesterol. LpA-I might represent the antiatherogenic fraction of HDL. (Rev Méd Chile 2000; 128: 9-16) <![CDATA[Síndrome de exceso aparente de mineralocorticoides por déficit de 11 ß hidroxiesteroide deshidrogenasa.: Estudios clínicos y genéticos en una familia chilena afectada seguida por 19 años]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100003&lng=es&nrm=iso&tlng=es An 11-year old girl was seen in 1981 with hypokalemia, low renin, low aldosterone, and severe hypertension. A medical adrenalectomy with dexamethasone and aminoglutethimide, and the blockade of mineralocorticoid receptors with spironolactone improved her condition, but the blockade of glucocorticoid receptors with RU-486 worsened it. An aldosterone infusion induced no changes. A sister was born in 1982 with similar findings. Both patients had an impaired ability to convert cortisol to cortisone after an oral load of 200 mg cortisol. In urine, an elevated ratio for metabolites of cortisol to metabolites of cortisone was found. These data suggested a defect in the activity of renal 11ß-hydroxysteroid dehydrogenase. Both parents were asymptomatic, phenotypically normal and non-consanguineous. Their urinary metabolites of cortisol and cortisone were normal before and after stimulation with ACTH. However, the mother reached a peak plasma cortisone concentration 3 SD below the mean reached by normal subjects after an oral 200-mg cortisol load, a fact that suggests that this test could be used to detect heterozygotes. The genetic studies revealed a homozygous mutation on exon 3 of the HSD11K gene, which by substituting TGC for CGC changes Arg 213 for Cys and induces a loss of 84% of the enzymatic activity in transfected cells. Both unrelated parents had the same heterozygous mutation. Both patients have been treated with dexamethasone but have also required spironolactone. The older sister has also required high doses of nifedipine to lower her blood pressure. After 19 years of follow-up, the older sister has become normotensive and normokalemic under therapy, and reached a final height of 140 cm at age 17. The younger sister has increased her mean blood pressure at a rate of 1 mm Hg per year, in spite of treatment. Her final height is 143.5 cm. (Rev Méd Chile 2000; 128: 17-26) <![CDATA[Detección de los genes de las exotoxinas pirogénicas SpeA, SpeB y SpeC en cepas chilenas de Streptococcus pyogenes y su asociación con la clínica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100004&lng=es&nrm=iso&tlng=es Background: The virulence of Streptococcus pyogenes is determined by a variety of structural molecules, toxins and complex enzymes. Pyrogenic exotoxins cause fever, erythematous reactions, cytotoxic and immunological effects. Aim: To assess the frequency of speA, speB and speC genes in Chilean Streptococcus pyogenes strains and their association with the invasiveness of infections. Material and methods: The genes for pyrogenic exotoxins SpeA, SpeB and SpeC were determined by polymerase chain reactions in 114 strains of group A Streptococcus pyogenes isolated from Chilean patients with invasive or non invasive infections. Results: The gene for SpeA was present in 30.7% of isolates, the gene for SpeB was present in 69.3% and the gen for SpeC in 44.7% of isolates. The gene for SpeA was present in 20 of 33 invasive infections and in 15 of 81 non invasive infections (p <0.0001). On the contrary, the gene for SpeC was present in 11 of 33 invasive infections and in 41 of 81 non invasive infections (p <0.05). The frequency of speB was similar in invasive and non invasive infections. Conclusions: There is a clear relationship between the presence of SpeA genes and the severity of infections caused by Streptococcus pyogenes. (Rev Méd Chile 2000; 128: 27-34) <![CDATA[Pruebas de función tiroidea en embarazadas normales (tercer trimestre) y en embarazadas con colestasis gravídica o con hepatitis aguda]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100005&lng=es&nrm=iso&tlng=es Background: Intrahepatic cholestasis of pregnancy (ICP) is a disease of unknown cause characterized by pruritus and biochemical cholestasis in the 3rd trimester of pregnancy. Its pathogenesis may be due to the interaction of abnormalities in the metabolism of estrogens and progesterone, while still unknown environmental factor (s) modulate the expressivity of a genetic predisposing trait. Aims: To verify if thyroid function tests (TFT) are altered in ICP as in other hepatic diseases and whether a dietary iodine deficiency could be involved. Material and methods: From 1983 to 1986, 13 normal pregnancies (3rd trimester), 26 ICP patients (with 30 pregnancies) and 4 patients with acute non-A non-B hepatitis in pregnancy, were studied. Serum T3, rT3, T4, fT4 and TSH (before and after TRH) were measured by RIA; in ICP patients, measurements were repeated in puerperium. Urinary 24 h iodine excretion was measured in normal pregnancies and in 6 ICP patients. Results: In normal pregnancies, T3 (3.00±0.22 nmol/L) and rT3 (0.40±0.03 nmol/L) were higher than the values detected in non-pregnant women; other TFT were unchanged. Urinary iodine excretion was normal in all individuals tested. Patients with acute hepatitis in pregnancy or with ICP had lower T3 than normal pregnancies (1.82±0.19 nmol/L in hepatitis; 2.24±0.12 nmol/L in ICP; p<0.01) and higher rT3 (0.80±0.25 nmol/L in hepatitis; 0.54±0.05 nmol/L in ICP; p<0.05), while other TFT were unchanged. None of them had clinical signs of hypo or hyperthyroidism. A "euthyroid sick syndrome" was detected in 2 ICP patients and in 2 acute hepatitis in pregnancy. In puerperium of ICP patients, T3 and rT3 returned to levels in non-pregnant women. Conclusions: In ICP patients, TFT show similar trends than in more severe hepatic and non-hepatic diseases. Although thyroid binding-globulin was not measured in our patients, the pattern of TFT suggests that an impaired peripheral (hepatic?) deiodination of T4 is responsible for these changes. The influence of a dietary iodine deficiency can be ruled out. (Rev Méd Chile 2000; 128: 35-43). <![CDATA[Asociación obesidad y leptina en tres poblaciones aborígenes de Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100006&lng=es&nrm=iso&tlng=es Background: Although there is a clear relationship between body mass index and leptin levels, few authors have addressed the possible influence of ethnic factors on these levels. Aim: To measure serum leptin in three different Chilean aboriginal populations. Subjects and methods: Fasting serum leptin and insulin levels were measured by radioimmunoassay in 345 rural mapuche individuals, 247 rural aymara subjects and 162 urban mapuche subjects. A body mass index of 27.5 kg/m2 was used as cutoff point to classify study subjects. Results: Among the three ethnic groups, women had serum leptin levels three times higher than men. In all three ethnic groups, there was a significant association between leptin levels, body mass index and gender (r2= 0.32 and 0.5 p <0.001, in rural mapuche, r2= 0.32 and 0.5 p <0.001, in aymara and r2= 0.24 and 0.49, p <0.001 in urban mapuche populations). No differences in leptin levels were observed for the interaction between age and insulin. The increments per quartile in leptin levels were lower among mapuche than aymara individuals. Conclusions: Rural mapuche individuals have a high frequency of obesity. However their leptin levels are lower than those of aymara or urban mapuche populations. The higher leptin levels observed in urban mapuche subjects could be due to environmental influences. (Rev Méd Chile 2000; 128: 45-52) <![CDATA[Endarterectomía carotídea bajo anestesia regional: experiencia inicial]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100007&lng=es&nrm=iso&tlng=es Background: Endarterectomy is the treatment of choice for internal carotid artery critical stenosis. Some authors have proposed that the use of regional anesthesia has advantages over general anesthesia. Aim: To report our initial experience with carotid endarterectomy under regional anesthesia. Patients and methods: Between 1998 and 1999, patients with critical carotid artery stenosis, asymptomatic or with transient and recovered symptoms, were selected. A C2, C3, C4 root deep cervical block and superficial block was performed, using a mixture of lidocaine and bupivacaine. A carotid endarterectomy with patch and without routine shunt insertion, with standard and neurological monitoring, was performed. Results: During the study period, 94 carotid endarterectomies were done, 22 under regional anesthesia in 21 patients (12 male, age range 58-90 years old). Ninety five percent had hypertension, 52% smoked and 38% had renal dysfunction. One patient was converted to general anesthesia. Seventeen patients were discharged within 48 hours of the procedure and the rest, within 72 hours. There was no mortality or complications. Conclusions: Endarterectomy under regional anesthesia is less invasive, has excellent results and is well accepted by patients. (Rev Méd Chile 2000; 128: 53-58) <![CDATA[Seguridad y eficacia de celiprolol en hipertensos con enfermedad pulmonar obstructiva crónica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100008&lng=es&nrm=iso&tlng=es Background: Third generation beta blockers have an intrinsic simpatico-mimetic activity and are cardioselective. Therefore, they should not have adverse bronchial effects and could even have a slight bronchodilator activity. Aim: To test the efficacy and safety of celiprolol in hypertensive patients with chronic obstructive lung disease. Patients and methods: Uncomplicated hypertensive patients with chronic obstructive lung disease received celiprolol during 12 weeks. They were subjected to monthly clinical assessment and ventilatory function was measured on the basal period and at the end of the trial. Results: During the study period, blood pressure fell significantly from 179±6/112±8 to 161±4,7/98±1.6 mmHg. No changes were observed in forced expiratory volume in 1 s or in forced expiratory flow between 25 and 75% of the vital capacity. No subjective changes in respiratory function were reported during the trial. Conclusions: No changes in ventilatory function were observed in these patients with chronic obstructive lung disease, treated with celiprolol during 12 weeks. (Rev Méd Chile 2000; 128: 59-63) <![CDATA[Sobrevida de pacientes con cáncer de esófago sometidos a esofagectomía total torácica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100009&lng=es&nrm=iso&tlng=es Background: Esophageal carcinoma has a dismal prognosis. Several authors have reported a very low survival in Chile. Aim: To report the survival of patients with esophageal carcinoma, subjected to esophageal resection. Material and methods: Analysis of 108 patients subjected to thoracic esophageal resection between 1985 and 1996. Patients were classified according to the location of the tumor and its staging. Results: Eleven patients died in the immediate postoperative period and 90 patients were followed. In 53 the exact cause of death was determined. Global five years survival was 29% and median survival was 18 months. Survival was 100% in stage I tumors. Adjuvant therapy resulted in a better survival of stage III tumors. Survival of stage IV tumors was worst than stage I to III tumors. There was no survival difference between squamous carcinoma or adenocarcinoma. Tumors located in the superior third of the esophagus had a worst prognosis. Causes of death were mediastinic metastases, local recidivism, pleural or pulmonary metastases and less frequently, brain, bronchial or bone metastases. Conclusions: The survival of these, patients with esophageal carcinoma did not differ from the figures reported abroad. (Rev Méd Chile 2000; 128: 64-74) <![CDATA[Delirium en pacientes de una Unidad de cuidados intermedios: estudio prospectivo]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100010&lng=es&nrm=iso&tlng=es Background: Delirium or acute confusional state is defined as an acute disturbance of consciousness and attention. Its prevalence among hospitalized patients fluctuates between 25 and 60%. Aim: To assess the prevalence and features of delirium in an intermediate care unit. Patients and methods: All patients admitted to intermediate care unit during a period of two months were assessed and followed. Delirium was assessed daily during the stay in the unit, using the Inouye Confusion Assessment Method. Delirium was classified as hyperactive if the patient required pharmacological or physical restraining methods. Results: Sixty four patients, 32 female, aged 19 to 90 years old were assessed. Forty one percent had delirium. Of these, delirium started after admission in 46% and was hyperactive in 35%. Cognitive disturbances were ascertained by the health care team in 69% of patients with delirium. Age over 70 years old and a history of dementia were defined as predisposing factors for delirium. Serum albumin was > 3.5 g/dl in 14 of 18 patients with and in 11 of 27 patients without delirium (p=0.04). The most frequent risk factors were systemic infections, metabolic disturbances and intracranial lesions. Physical restraining and neuroleptics were the most commonly used measures to deal with hyperactive patients. Conclusions: The prevalence of delirium found in this study is similar to that reported elsewhere, except for the high proportion of patients whose delirium started after admission. (Rev Méd Chile 2000; 128: 75-79) <![CDATA[<B>Síndrome de "huesos hambrientos": experiencia clínica en su diagnóstico y tratamiento</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100011&lng=es&nrm=iso&tlng=es Hungry bone syndrome is a unusual complication of the postoperative period of primary hyperparathyroidism. This syndrome is characterized by hypocalcemia, hypophosphatemia and hypomagnesemia, due to an excessive bone remineralization. We report the clinical features, laboratory and therapy in four females (aged 39 to 73 years old) with a long standing hyperparathyroidism, elevated alkaline phosphatases and decreased bone mineralization in two. The mean size of the adenoma was 2.9 ± 1.1 cm. Hypocalcemia appeared between days 1 and 6 of the postoperative period. All were treated with calcium, calcitriol and magnesium at different timing and dosages. The mean hospitalization period was 19.8 ± 2.1 days. As reported previously, low bone mineralization and a large adenoma are risk factors for the syndrome. Serial monitoring of serum calcium and magnesium and an early supplementation of these minerals could prevent hypocalcemia and decrease the hospitalization time. (Rev Méd Chile 2000; 128: 80-85) <![CDATA[Crisis de esclerodermia renal.: Rol de la vasculopatía esclerodérmica en la inducción de fibrosis cutáneo-visceral en dos casos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100012&lng=es&nrm=iso&tlng=es Although fibrosis and vasculopathy coexist in most patients with progressive systemic sclerosis, it is not clear if these events are the result of an unique etiologic factor or if one is consequence of the other. We report two cases of progressive systemic sclerosis that evolved to a renal scleroderma crisis. A 36 years old female presented with a Sjögren syndrome and painful subcutaneous nodules whose biopsy showed perivascular lymphocytic infiltration, perivascular thickening and normal skin. The ESR was 100 mm/h. She developed an hypertensive crisis and progressive renal failure, followed by a rapidly evolving progressive systemic sclerosis. The patient died in the course of this crisis. A 32 years old female with a progressive systemic sclerosis refractory to D-penicillamine treatment, receiving cyclosporin, presented a renal scleroderma crisis, that was successfully treated, with complete recovery of renal function. We highlight the different evolution of these cases, probably due to an early diagnosis and a better experience in the management of this condition. (Rev Méd Chile 2000; 128: 86-92) <![CDATA[Uso de midodrín y congelación de semen en el tratamiento de las alteraciones del transporte espermático.: Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100013&lng=es&nrm=iso&tlng=es Retrograde ejaculation severely compromises male fertility. The use of sympathicomimetics for the treatment of this condition has poor results, except in patients with partial retrograde ejaculation, whose semen has a higher spermatozoa concentration. The semen of two patients with partial retrograde ejaculation was collected and frozen after the injection of a sympathicomimetic (Midodrine). The frozen/thawed samples were mixed with fresh semen recently ejaculated to obtain a minimal number of motile spermatozoa, and used for intrauterine insemination (> de 1 x 106 motile spermatozoa/ml). In both cases, pregnancies that developed satisfactorily, were obtained. (Rev Méd Chile 2000; 128: 93-97) <![CDATA[El estudio HERS conmociona a la terapia de sustitución hormonal]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100014&lng=es&nrm=iso&tlng=es Cardiovascular protection of hormonal replacement therapy was considered a fact. The effects of estrogens on lipid levels and vascular health gave biological support to estrogen cardioprotection. The recently published HERS study showing no protective effects of estrogen and progesterone replacement therapy on the risk of myocardial infarction or coronary deaths is provoking perplexity. These surprising results may have several causes such as the use of progesterone, the associated use of cardioprotective agents or the short observation period. However, the study results scope is rectricted to secondary prevention. These cannot be extrapolated to frequent conditions of postmenopausal women such as primary prevention or sequential schemes. Likewise, this investigation underscores the importance of a critical and continued evaluation of apparently well established therapeutic approaches. (Rev Méd Chile 2000; 128: 98-104) <![CDATA[Prevención y tratamiento de la obesidad desde la niñez: la estrategia para disminuir las enfermedades crónicas no transmisibles del adulto]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100015&lng=es&nrm=iso&tlng=es The prevalence of obesity among children and teenagers is increasing by 1.5% per year, probably due to a higher consumption of highly caloric foods and to physical inactivity. Hypercholesterolemia, increased insulin levels and high blood pressure of childhood obesity, precede atherosclerosis, coronary artery disease, diabetes and hypertension in adulthood. The prevention of childhood obesity is an efficient strategy to decrease the prevalence of non transmissible chronic diseases in the adult. The recommendations of experts committees for the prevention, diagnosis and treatment of childhood obesity are reviewed. They aim at a change in dietary habits and increasing physical activity. A well balanced healthy diet and a decrease in physical inactivity time will result in a successful treatment approach for obesity. (Rev Méd Chile 2000; 128: 105-110) <![CDATA[Determinación de la actividad in vitro de dos glicopéptidos (vancomicina y teicoplanina) frente a Staphylococcus aureus meticilino resistente de origen intrahospitalario]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100016&lng=es&nrm=iso&tlng=es The prevalence of obesity among children and teenagers is increasing by 1.5% per year, probably due to a higher consumption of highly caloric foods and to physical inactivity. Hypercholesterolemia, increased insulin levels and high blood pressure of childhood obesity, precede atherosclerosis, coronary artery disease, diabetes and hypertension in adulthood. The prevention of childhood obesity is an efficient strategy to decrease the prevalence of non transmissible chronic diseases in the adult. The recommendations of experts committees for the prevention, diagnosis and treatment of childhood obesity are reviewed. They aim at a change in dietary habits and increasing physical activity. A well balanced healthy diet and a decrease in physical inactivity time will result in a successful treatment approach for obesity. (Rev Méd Chile 2000; 128: 105-110) <![CDATA[<b>REVISTA DE REVISTAS</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100017&lng=es&nrm=iso&tlng=es The prevalence of obesity among children and teenagers is increasing by 1.5% per year, probably due to a higher consumption of highly caloric foods and to physical inactivity. Hypercholesterolemia, increased insulin levels and high blood pressure of childhood obesity, precede atherosclerosis, coronary artery disease, diabetes and hypertension in adulthood. The prevention of childhood obesity is an efficient strategy to decrease the prevalence of non transmissible chronic diseases in the adult. The recommendations of experts committees for the prevention, diagnosis and treatment of childhood obesity are reviewed. They aim at a change in dietary habits and increasing physical activity. A well balanced healthy diet and a decrease in physical inactivity time will result in a successful treatment approach for obesity. (Rev Méd Chile 2000; 128: 105-110) <![CDATA[CRÓNICA]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000100018&lng=es&nrm=iso&tlng=es The prevalence of obesity among children and teenagers is increasing by 1.5% per year, probably due to a higher consumption of highly caloric foods and to physical inactivity. Hypercholesterolemia, increased insulin levels and high blood pressure of childhood obesity, precede atherosclerosis, coronary artery disease, diabetes and hypertension in adulthood. The prevention of childhood obesity is an efficient strategy to decrease the prevalence of non transmissible chronic diseases in the adult. The recommendations of experts committees for the prevention, diagnosis and treatment of childhood obesity are reviewed. They aim at a change in dietary habits and increasing physical activity. A well balanced healthy diet and a decrease in physical inactivity time will result in a successful treatment approach for obesity. (Rev Méd Chile 2000; 128: 105-110)