Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720000007&lang=es vol. 128 num. 7 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Diagnóstico psiquiátrico: rótulo, trastorno, comorbilidad.]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700001&lng=es&nrm=iso&tlng=es This editorial emphasizes the descriptive character of two of the most widely employed psychiatric diagnostic systems currently in use: DSM-IV and ICD-10. While they cannot be deemed atheoretical, they strive for neutrality and propose a nomenclature devoid of derogatory connotations. It is contended that the lowered "labeling threshold" of these systems tends to identify conditions that, while abnormal in the sense of producing personal discomfort or dysfunction, could not always be considered diseases requiring intervention from healthcare systems. This distinction is useful when evaluating studies which acritically apply screening instruments with a diagnostic purpose. These studies, while producing data, may not always be relevant for empirical studies of comorbidity or prevalence. (Rev Méd Chile 2000; 128: 705-7). <![CDATA[Endocarditis infecciosa: análisis de 261 casos y resultados del tratamiento con un enfoque multidisciplinario]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700002&lng=es&nrm=iso&tlng=es Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE) Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de Chile Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Méd Chile 2000; 128: 708-20). <![CDATA[Estudio de asociación entre magnitud de la hipotonía esfinteriana y trastorno motor del cuerpo esofágico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700003&lng=es&nrm=iso&tlng=es Background: One of the most important factors involved in the pathophysiology of gastroesophageal reflux disease (GERD) is the lower esophageal sphincter rest pressure (LESRP), but these patients can have esophageal motor disorders (EMD). Aim: To assess an association between LESRP and the appearance of EMD in patients with GERD. Subjects and methods: A cross-sectional study was conducted in 229 patients with GERD and 49 healthy controls. Forty five patients with LESRP &lt; 6 mmHg and a mean age of 49 years were assigned to group 1, 128 patients with a LESRP between 6 and 12 mmHg and mean age of 47 years were assigned to group 2, 56 patients with a a LESRP &gt;12 mmHg and a mean age of 47 years were assigned to group 3 and group 4 was conformed by 49 healthy subjects aged 40 years old. Esophageal manometry was performed using previously published techniques. Results: There was a significant association between LESRP, waves amplitude and the frequency of tertiary waves. Conclusions: Resting lower esophageal sphincter pressure is inversely proportional to the presence of esophageal motor disorders in patients with gastroesophageal reflux disease. (Rev Méd Chile 2000; 128: 721-8). <![CDATA[Comorbilidad de enfermedades médicas crónicas y trastornos psiquiátricos en una población de consultantes en el nivel primario de atención]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700004&lng=es&nrm=iso&tlng=es Background: As a part of the World Health Organization multicentric study of emotional disorders in general medical care, we studied patients who had a chronic medical ailment and a psychiatric disorder, according to ICD-10. Aim: To report the prevalence of patients with coexisting medical and psychiatric disorders. Patients and methods: All patients, aged 15 to 65 years old, consulting in primary care outpatient clinics, were interviewed using a general health questionnaire. In a second phase, patients with chronic medical disorders were subjected to the World Health Organization Composite International Diagnostic Instrument. Results: Sixty nine percent of interviewed Chilean patients had a medical condition, compared to 60,3% of the global study group. Of these, 66% had a coexisting psychiatric diagnosis, compared to 31% of the global study group. The most frequent diagnoses in the Chilean sample were somatization disorders in 25%, harmful alcohol use in 14%, depression in 35% and hypocondriasis in 6%. There was a higher prevalence and odds ratio for psychiatric diagnoses among Chilean women. Conclusions: Patients with chronic medical disorders should be considered a high risk group for the coexistence of psychiatric disturbances. (Rev Méd Chile 2000; 128: 729-34). <![CDATA[Prevalencia de anticuerpos anti-hantavirus en personal de salud en contacto directo con pacientes portadores del síndrome pulmonar por hantavirus.: Temuco 1997 a 1999]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700005&lng=es&nrm=iso&tlng=es Background: An outbreak of Hantavirus Cardiopulmonary Syndrome (HVCS) caused by the Andes virus, affected Chile since 1995. Antibodies to Hantavirus in health care workers who had cared patients with HVCS in Coyhaique, Argentinean reports and familial clustering of hantaviral illness, raised the possibility of person to person transmission. Familial clustering could occur secondary to a similar exposure to a common infected environment of more than one member of the family. Moreover, the prevalence of antibodies in health care workers in Coyhaique does not differ from the prevalence in general population in that region. Aim: To study the prevalence of antibodies to Hantavirus in health care workers exposed to body fluids of 20 patients. Material and methods: Among health care workers exposed to patients with HVCS, we registered information about the exposure to patients and to the environment outside the hospital in which they could have been infected. IgG antibodies against Hantavirus were measured by ELISA using two dilutions. Results: Sixty seven workers were studied. Of these, 73% were exposed.to respiratory secretions and blood, 21% to blood and 6% to respiratory secretions. Only 6% protected themselves properly, 49% used facial masks and gloves, 25% only facial masks, 7% only gloves and 12% used no protection measures. In none of these workers, Hantavirus antibodies were detected. Conclusions: These results are supporting evidence against person to person transmission of the Andes virus. (Rev Méd Chile 2000; 128: 735-9). <![CDATA[Perfil lipídico en recién nacidos con retardo del crecimiento intrauterino]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700006&lng=es&nrm=iso&tlng=es Background: The X syndrome, related to coronary disease in adults, could be possibly programmed priory to delivery, in children with intrauterine growth retardation. Aim: To measure serum lipids in newborns with symmetrical or asymmetrical intrauterine growth retardation. Patients and methods: One hundred thirty five newborns with intrauterine growth retardation and 116 normal term newborns, with 38 to 41 gestational weeks, were studied. Total, HDL, and LDL cholesterol, triglycerides and apoproteins. A1 and B were measured in imbilical cord blood samples. Results: No differences in total, HDL, LDL cholesterol, apoproteins A1 and B were observed between the study groups. Triglycerides were higher in newborns with intrauterine growth retardation, compared to normal term newborns (45 ± 27 and 36 ± 19 mg/dl respectively, p&lt;0,001). Differences in serum triglyceride levels respect to controls were observed in both male and female newborns with asymmetrical growth retardation. Likewise the differences respect to controls were observed in newborns with mild or severe but not with moderate growth retardation. Conclusions: Newborns with intrauterine growth retardation have higher triglyceride levels than normal term newborns. (Rev Méd Chile 2000; 128: 741-8). <![CDATA[Estudio prospectivo, randomizado, comparativo de la eficacia, seguridad y costos de cefuroxima vs cefradina en la pielonefritis aguda del embarazo]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700007&lng=es&nrm=iso&tlng=es Background: Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting. Aim: To compare the efficacy, safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy. Patients and methods: Hospitalized women with 12 to 34 weeks of pregnancy, with clinical and bacteriological diagnosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef (r), GlaxoWellcome) 750 mg t.i.d, i.v or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patient was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clinical status and treated for a total of 14 days. Laboratory tests, including urine culture were requested during controls and at the end of follow-up at 28 days. Results: One hundred and one patients were randomized: 49 to receive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime group had fewer febrile days (mean 1.7 vs 2.2, p&lt;0.05), faster clinical recovery (mean 2.7 vs 3.1 days, p&lt;0.05), a higher rate of bacteriological cure at 28 days (78.8% and 59.2%, p&lt;0.05) and lower rate of failure (21.2% vs 40.8 % p&lt;0.05). The rate of resistance of isolated uropathogens was l4% to cephradine and 1% to cefuroxime. Conclusions: Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance, microbiological activity and efficacy. (Rev Méd Chile 2000; 128: 749-57). <![CDATA[Prevalencia de <I>Chlamydia trachomatis</I> en conjuntivitis neonatal determinada mediante las técnicas de inmuno- fluorescencia y amplificación génica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700008&lng=es&nrm=iso&tlng=es Backgrund: Chlamydia trachomatis is one of the most common identifiable infectious agents in neonatal conjunctivitis. It also causes pneumonitis, that is preceded by conjunctivitis in one third of cases. Aim: To asses the prevalence of Chlamydia trachomatis in newborns with conjunctivitis. Patients and methods: In 162 newborns, coming from 14 Primary Health Centers from Santiago de Chile, C. trachomatis was detected by indirect fluorescence and two polymerase chain reaction (PCR 1 and 2), wich amplified different sequences from the common endogenous plasmid. Those patients with positive indirect fluorescence and PCR 2 were definedas infected: Results: The prevalence of C. trachomatis was 8%, and the distribution of the positive cases was similar in the different Health Centers. Other isolates were: S. aureus (9.8%), S. pneumoniae (8%), S. viridans (6.2%) y H. influenzae (5.5%). Conclusions: The prevalence of C. trachomatis in neonatal conjunctivitis in Chile is similar to that of developed countries. Therefore, C. trachomatis should be considered in the election of antimicrobials for the treatment of neonatal conjunctivitis, to avoid ocular and respiratory complications. (Rev Méd Chile 2000; 128: 758-65). <![CDATA[Evaluación de los criterios de Nugent y Amsel para el diagnóstico de vaginosis bacteriana]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700009&lng=es&nrm=iso&tlng=es Background: Bacterial vaginosis (BV) is a common disease in reproductive-age women and is associated to important gynecologic and obstetric complications. Aim: To study the occurrence of BV in apparently healthy women attending family planning clinics, using Amsel and Nugent diagnostic criteria. Material and methods: Two hundred thirty nine women consulting for symptoms associated to cervicovaginitis, were studied. A sample from the lateral walls of the vagina was obtained with a sterile swab for microscopic analysis, Gram stain and amine test. Results: According to Amsel and Nugent criteria a 31.1% and 31.8% BV prevalence was observed. The sensitivity and specificity of Nugent criteria, compared with Amsel criteria were 83.3% and 92.1%, respectively. Conclusions: The high prevalence of BV found in this study suggests that this vaginal infection should be diagnosed with standardized methods. Nugent criteria are economic easy to perform and sensitive and we propose that they should be used in local health centers. (Rev Méd Chile 2000; 128: 767-71). <![CDATA[Mialgias post ejercicio como forma de presentación de una distrofinopatía.: <I>Case report.</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700010&lng=es&nrm=iso&tlng=es Cramps and myalgias are frequent presentations of many disorders whose diagnosis is generally difficult. Among the unusual causes stand the milder phenotypes of dystrophinopathies, which are caused, just as Duchenne and Becker’s dystrophy, by mutations in the dystrophin gene. An 8 year-old boy presented severe muscle pain on exercise and serum rise in creatine kinase over 1000 U/l. He had normal muscle power and mild calf hypertrophy. The molecular analysis by polymerase chain reaction (PCR) of the dystrophin gene showed deletions of exons 45 to 51. Dystrophin analysis by Western blot revealed a dystrophin of reduced quantity and molecular weight. Emphasis is made to include dystrophinopathies in the differential diagnosis of myalgias and the usefulness of molecular genetic techniques in the identification of these disorders (Rev Méd Chile 2000; 128: 772-7). <![CDATA[Microdeleción del cromosoma Y en paciente infértil oligozoospérmico severo]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700011&lng=es&nrm=iso&tlng=es We are reporting a 37 year old male with severe oligozoospermia and a history of infertility for thirteen years and surgery for severe unilateral varicocele. The hormonal levels for FSH, LH and T, and karyotype were within the normal range. Multiplex PCR revealed the presence of a de novo microdeletion in the azoospermia factor (AZF) c region involving the deleted in azoospermia (DAZ) and basic protein Y-2 (BPY2) genes. These results suggest that severe oligozoospermia should be considered for the screening of microdeletions of Yq involving the AZFc region even in the presence of a varicocele (Rev Méd Chile 2000; 128: 778-82). <![CDATA[Linfoma tiroideo.: Comunicación de un caso]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700012&lng=es&nrm=iso&tlng=es Thyroid lymphoma represents less than 1% of malignant thyroid tumors and its diagnosis is difficult. We report a 25 years old woman, admitted with the diagnosis of diffuse euthyroid goiter and thyroid cancer. She was subjected to a subtotal thyroidectomy and the pathological study of the surgical piece showed a Hodgkin lymphoma, subtype nodular sclerosis. The patient was treated with three cycles of chemotherapy, using cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastin and radiotherapy. She refused to continue treatment after the third cycle and after 3 years and 5 months of follow up, is well and free of disease (Rev Méd Chile 2000; 128: 783-6). <![CDATA[Reflexiones en torno al libro "El fin de la Medicina" de Alejandro Goic]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700013&lng=es&nrm=iso&tlng=es Thyroid lymphoma represents less than 1% of malignant thyroid tumors and its diagnosis is difficult. We report a 25 years old woman, admitted with the diagnosis of diffuse euthyroid goiter and thyroid cancer. She was subjected to a subtotal thyroidectomy and the pathological study of the surgical piece showed a Hodgkin lymphoma, subtype nodular sclerosis. The patient was treated with three cycles of chemotherapy, using cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastin and radiotherapy. She refused to continue treatment after the third cycle and after 3 years and 5 months of follow up, is well and free of disease (Rev Méd Chile 2000; 128: 783-6). <![CDATA[Neoplasias endocrinas múltiples: un modelo clínico para aplicar técnicas de genética molecular]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700014&lng=es&nrm=iso&tlng=es Multiple endocrine neoplasias (MEN) are syndromes inherited as autosomal dominant. The application of the techniques of molecular biology has made possible the identification of the genes causing MEN 1 and 2. The gene responsable for MEN 1 belongs to the family of tumor suppressor genes and encodes for a protein named MENIN whose function remains to be elucidated. The identification of mutant MEN 1 gene carriers who are at risk of developing this syndrome requires frequent biochemical screening for the development of endocrine tumors. MEN 2 is a consequence of mutations in the Ret proto- oncogene (c-Ret). This gene encodes for a tyrosine kinase receptor thought to play a role in the development of neural crest- derived tissue. Members of kindred with either MEN 2A or MEN 2B should be screened by direct DNA testing early in life for mutations in c-Ret. Those with the mutation should be advised to have thyroidectomy at five years of age in children with MEN 2A and earlier in children with MEN 2B . Some cases of sporadic MTC are actually MEN 2A or Familial MTC after c-Ret testing is done, therefore routine application of this test is recommended in all cases of apparent sporadic MTC (Rev Méd Chile 2000; 128: 811-20). <![CDATA[Los Beca en la psiquiatría chilena]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700015&lng=es&nrm=iso&tlng=es The Chilean psychiatrists, Manuel and Francisco Beca, father and son, who lived at the turn of the XIX century and in the first half of the XX respectively, dedicated their lives to the care of mental patients and to the teaching of psychiatry, contributing in their own way and time to the development of the specialty in Chile. Manuel Beca, a clinician, published the first mental patient statistics and Francisco, an academic, became professor of Psychiatry at the Catholic University. Altough they dedicated themselves to different fields in the area of mental health, such as clinical research and teaching, both have outstanding merits to become a part of the historical memory of Chilean psychiatry (Rev Méd Chile 2000; 128: 827-32). <![CDATA[Definiciones en medicina: ¿Estamos en que el fin justifica los medios y actos médicos?]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700016&lng=es&nrm=iso&tlng=es The Chilean psychiatrists, Manuel and Francisco Beca, father and son, who lived at the turn of the XIX century and in the first half of the XX respectively, dedicated their lives to the care of mental patients and to the teaching of psychiatry, contributing in their own way and time to the development of the specialty in Chile. Manuel Beca, a clinician, published the first mental patient statistics and Francisco, an academic, became professor of Psychiatry at the Catholic University. Altough they dedicated themselves to different fields in the area of mental health, such as clinical research and teaching, both have outstanding merits to become a part of the historical memory of Chilean psychiatry (Rev Méd Chile 2000; 128: 827-32). <![CDATA[Situación de la osteoporosis en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700017&lng=es&nrm=iso&tlng=es The Chilean psychiatrists, Manuel and Francisco Beca, father and son, who lived at the turn of the XIX century and in the first half of the XX respectively, dedicated their lives to the care of mental patients and to the teaching of psychiatry, contributing in their own way and time to the development of the specialty in Chile. Manuel Beca, a clinician, published the first mental patient statistics and Francisco, an academic, became professor of Psychiatry at the Catholic University. Altough they dedicated themselves to different fields in the area of mental health, such as clinical research and teaching, both have outstanding merits to become a part of the historical memory of Chilean psychiatry (Rev Méd Chile 2000; 128: 827-32). https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700018&lng=es&nrm=iso&tlng=es https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000700019&lng=es&nrm=iso&tlng=es