Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720000009&lang=pt vol. 128 num. 9 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>Evidences for mineralocorticoid excess in essential hypertension</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900001&lng=pt&nrm=iso&tlng=pt Background: Primary hyperaldosteronism is more frequent among subjects with essential hypertension than previously thought. The prevalence, according to local and international evidence could fluctuate between 9 and 10%. Aim: To investigate if subjects with essential hypertension have different aldosterone and renin plasma levels than normotensive subjects. Patients and methods: One hundred twenty five subjects with essential hypertension, not receiving medications for at least two weeks prior to the study and 168 age and sex matched normotensive controls were studied. Blood was drawn between 9 and 10 AM during a sodium free diet to determine plasma aldosterone, plasma renin activity and potassium. Results: Plasma aldosterone was higher in hypertensive subjects than controls (11.6 ± 7.6 and 9.9 ± 5.1 ng/dl respectively; p=0.04). Plasma renin activity was lower in hypertensives than controls (1.42 ± 1.28 and 1.88 ± 1.39 ng/ml/h respectively; p<0.001). Thus, plasma aldosterone/plasma renin activity ratio was higher in hypertensives (13.8 ± 13.5 and 8.3 ± 7.8; p<0.001). A pathological ratio was defined as over 25, corresponding to the mean plus two standard deviations of the control group. Primary hyperaldosteronism was found in 5/125 hypertensives (4%) and 1/168 normotensive subject (0.6%). None had hypokalemia. Conclusions: Subjects with essential hypertension have higher plasma aldosterone and lower plasma renin activity than normal controls. A plasma aldosterone/plasma renin activity over 25 was defined as abnormal. (Rev Méd Chile 2000; 128: 955-61) <![CDATA[<I>Usefulness of AgNOR assay in the assessment of serous effusions</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900002&lng=pt&nrm=iso&tlng=pt Background: AgNOR technique detects, using silver salts, argyrophylic proteins of the nucleolar organizer region (NOR). The number and size of NOR reflect cell activity, proliferation and transformation and may help to differentiate benign from malignant cells. Aim: To assess the value of AgNOR assay to differentiate reactive mesothelial cells from malignant cells in serous effusions. Material and methods: Thirty one fluids obtained from 16 pleural, 14 peritoneal and one pericardial effusion, were studied. The fluids were processed with Giemsa and Papanicolau stains and with the AgNOR technique. The number of AgNOR dots were counted (only when it was possible to distinguish each individual dot) and the mean value per nucleus was calculated for each smear. Results: Mesothelial cells had a mean of 4,88 ± 1,5 dots compared with 13,78 ± 3,88 dots in the malignant cells (p<0,001). Conclusions: AgNOR assay can be useful for the differentiation of benign and malignant cells in serous effusions. (Rev Méd Chile 2000; 128: 963-8) <![CDATA[<I>Endoscopic mucosectomy for the treatment of early gastric malignant lesions </I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900003&lng=pt&nrm=iso&tlng=pt Background: Endoscopic mucosectomy is a routine treatment mode for benign and malignant gastric lesions. The prognosis of patients with endoscopically treated early gastric cancer does not differ from patients subjected to surgical gastrectomy, when the indications for endoscopic mucosectomy are respected. Aim: To report the experience in endoscopic mucosectomy for early gastric cancer. Patients and methods: Between 1990 and 1997, 12 lesions in 10 patients, aged 48 to 107 years old, were treated with endoscopic mucosectomy. Clients were followed for 1 to 72 months after the procedure. Results: Treated lesions ranged in size from 7 to 20 mm. Ten patients had differentiated carcinomas, one had an undifferentiated carcinoma and one had a primary gastric carcinoid. Endoscopic appearance was II a in six lesions, II c + II a in two, II a + II c in one. II c in one, I in one and II c + III in one. In two patients, the tumor persisted and were subjected to oncologic surgery. In one of these, no malignant lesion was recognized in the pathological specimen. The other patient had a multicentric carcinoma that was already detected by endoscopy. Neither had lymph node metastases. Endoscopical and pathological follow up in the other 8 patients has not shown persistence or reappearance of malignant lesions during a follow up ranging from 3 to 72 months. Conclusions: Endoscopic mucosectomy can be a valuable therapeutic alternative in early gastric cancer (Rev Méd Chile 2000; 128: 969-76) <![CDATA[<I>Prevalence of smoking among academic, non-academic workers and students of the University of Concepción</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900004&lng=pt&nrm=iso&tlng=pt Background: Effective smoking cessation campaigns require as baseline, precise estimations of smoking habits in different populations. Aim: To assess the prevalence of smoking in academic, non-academics workers and student of the University of Concepción. Material and methods: In a random and stratified sample of 272 workers (including academics) and 1146 students, a previously validated, self administered questionnaire about smoking was applied. Daily smoking was defined as smoking seven or more cigarettes per week and occasional smoking as smoking less than seven cigarettes per week. Results: The prevalence of smoking was 23% among academics, 34% among non-academic workers and 44% among students. Nineteen percent of men and 16% of women were occasional smokers; 23% of men and 25% of women were daily smokers. Students started smoking at 15 ± 2 years old and workers did so at 18 ± 3 years old. The grater influence about smoking came from parents. Workers from the administrative services and from the natural sciences faculty had the higher prevalence of the habit. The total annual cost of smoking was $33,000,000 (US$62,000). Conclusions: The prevalence of smoking at the University of Concepción is higher among students than workers. Quitting programs are urgently needed (Rev Méd Chile 2000; 128: 977-84). <![CDATA[<I>Premature labor with intact membranes.</I>: <I>Relationship of amniotic fluid and lower genital tract microbiology with maternal and neonatal outcomes</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900005&lng=pt&nrm=iso&tlng=pt Background: The prevalence of idiopathic spontaneous premature labor or without an evident clinical cause, has not been reduced with tocolytic treatments, suggesting that premature labor has multiple causes and infections play a not well-defined role. Aim: To perform microbiological studies of the amniotic fluid and of the lower genital tract in women with idiopathic premature labor and intact membranes, relating these findings with maternal and neonatal outcomes. Patients and methods: Women with pregnancies between 24 and 34 weeks, with premature labor and without an evident clinical cause were enrolled. Amniotic fluid and genital tract samples were obtained for traditional microbiological cultures. This information was related with delivery events and neonatal outcome. Results: Sixty-three patients were included. The overall frequency of microbial invasion of amniotic cavity was 23.8% and of cervical or vaginal infection was 63.5% (in 39.7% there was only cervical or vaginal infection without involvement of the amniotic sac). Absence of infection was documented in 36.5% of women. Compared to patients without infection, women with microbial invasion of amniotic cavity had a higher rate of prematurity (73.3% p < 0.05), a higher rate of prematurity of less than 34 weeks (60% p < 0.01), a higher frequency of preterm rupture of membranes (40% p < 0.001), a shorter admission-to-delivery interval (median 3.0 days p < 0.01) and lower gestational age at delivery (median 33 weeks p < 0.01). Clinical chorioamnionitis and endometritis (20% p < 0.01) was observed only in patients with amniotic cavity infections. Severe asphyxia (26.7% p < 0.05) and neonatal admission to Intensive Care Units (46.7% p < 0.05) were more frequent and neonatal weight was less in the offspring of women with microbial invasion of amniotic cavity (2020 g median p < 0.01). Conclusions: In preterm labor with intact membranes, intraamniotic infection is the most frequent cause of prematurity and is associated with a higher prevalence of maternal and neonatal problems (Rev Méd Chile 2000; 128: 985-95). <![CDATA[<I>p53 Gene mutation in colorectal carcinoma</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900006&lng=pt&nrm=iso&tlng=pt Background: Genetic events associated to colorectal carcinoma are well characterized, but there is scanty information about this issue in Chilean subjects. Aim: To determine the frequency and distribution of exons 5, 6, 7, 8 and 9 mutations and the immunohistochemical expression of p53 gene in biopsy samples of colorectal carcinoma. Material and methods: p53 gene exons 5, 6, 7, 8 and 9 were directly sequenced in 42 biopsy samples of colorectal carcinoma. Immunohistochemical expression of p53 was determined in 35 samples. Results: Thirty one discrete mutations (12 transitions, 11 transversions and 8 insertions) were observed in 21 samples (60%). Nine samples had mutations in exon 5, twelve samples had mutations in exon 6, seven samples had mutations in exon 7 and three samples had mutations in exons 8 and 9. Immunohistochemical expression of p53 protein was observed in 18 of 35 cases. There was a high correlation between the genetic alteration and immunohistochemistry, when p53 was expressed in more the 20% of cells. The positive and negative predictive values of p53 expression were 87 and 80% respectively. There was a non significant lower mortality among patients with mutations in their biopsies. Conclusions: These results confirm the involvement of p53 gene mutations in colonic carcinogenesis. Immunohistochemical methods for the detection of p53 protein have a high predictive value (Rev Méd Chile 2000; 128: 996-1004) <![CDATA[<I>Pseudoprognathism frequency and masseter muscle activity in operated cleft lip patients</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900007&lng=pt&nrm=iso&tlng=pt Background: As a consequence of a growth inhibition of middle third of the face, cleft lip surgery could lead to a pseudoprognathism. However, this is not always the case. Also, when facial architecture is changed, the activity of muscles such as the masseter could be disturbed. Aim: To study masseter electromyographic activity in operated cleft lip patients. Material and methods: Forty two patients with cleft lip (25 male, aged 13 to 35 years old) were studied. All were operated during their first year of life. An electromyography of masseter muscle was performed and from a teleradiography, ANB and Gonion angles were obtained. Forty healthy subjects conformed the control group Results: The sample was divided in two groups. A group of 20 patients had a significantly lower EMG voltaje than control subjects (662 ± 228 and 1511 ± 340 µV respectively, p < 0.001). Only seven patients had an anteriorly inverted bite with a mean ANB of + 1.7 and a mean molar relation of -4.8, figures that confirm the presence of pseudoprognathism. Conclusions: Eighty three percent of cleft lip patients do not have cephalometric parameters of pseudoprognathism and half of the patients have a lower masseter activity (Rev Méd Chile 2000; 128: 1005-1010) <![CDATA[<I>Ventilation-perfusion scintigraphy in patients with suspected pulmonary thromboembolism</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900008&lng=pt&nrm=iso&tlng=pt Background: The Progressive Investigation of Pulmonary Embolism Diagnosis (PIOPED) classifies the results of ventilation perfusion scintigraphy as having a high, intermediate and low diagnostic probability of pulmonary embolism or as normal. This classification can be confusing for the clinician. Aim: To retrospectively review the diagnoses of ventilation perfusion scintigraphies performed at a general hospital. Material and methods: All reports of ventilation perfusion scintigraphies done between 1997 and 2000 at the Nuclear Medicine Service of Valdivia Hospital were retrospectively reviewed. Results: During the study period, 85 patients with suspected pulmonary thromboembolism were referred for a ventilation perfusion scintigraphy and in 70, the procedure was done. Twenty-one (30%) patients were classified as having a high probability of pulmonary thromboembolism, 12 (17%) as having an intermediate probability, 31 (44%) as having a low probability and the scintigraphy was considered normal in 6 (9%) patients. Conclusions: The predictive value of ventilation perfusion scintigraphy must be interpreted using this diagnostic classification (Rev Méd Chile 2000; 128: 1011-4). <![CDATA[<I>Pituitary apoplexy secondary to a metastatic renal cell carcinoma</I>: <I>Report of a case followed for seven years</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900009&lng=pt&nrm=iso&tlng=pt We report a man in whom a 15 cm. renal tumor was excised at the age of 49. The pathological examination showed a clear cell carcinoma. Five years later, he presented with headache, vomiting and unilateral palpebral ptosis. Imaging studies showed a sellar tumor with pituitary apoplexy. The tumor was excised and the pathological study disclosed a clear cell tumor, positive for vimentin, cytokeratins AE1 and AE3 and immunohistochemically negative for LH, TSH, ACTH and GH. Considering the similar histopathological features, it was considered as a metastasis of the renal tumor. The patient was supplemented with thyroid, adrenal and gonadal hormones. Seven years later, he presented a new tumor in the remaining kidney, that corresponded to a cystic papillary renal cell carcinoma. Afterwards, he presented a transitional urinary bladder tumor. Mortality associated to renal cell tumors is 90% at 5 years, and pituitary metastases are extraordinarily uncommon (Rev Méd Chile 2000; 128: 1015-8). <![CDATA[<I>Fluorodexyglucose SPECT in acute myocardial infarction</I>: <I>case report</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900010&lng=pt&nrm=iso&tlng=pt We report a 50-year-old woman with a recent myocardial infarction in whom a myocardial perfusion single photon emission computed tomography (SPECT) with Thallium201201Tl SPECT to study viability and a FDG-SPECT with a dual head high-energy collimator camera were done. Images, acquired 45 min after injection, were analyzed visually. In anterior and medial apical sectors, discordance between flux and metabolism, considered a classical mismatch, was observed. Echocardiographic hypokinesia disappeared three month after revascularization (Rev Méd Chile 2000; 128: 1019-23). <![CDATA[<I>Use of gemcitabine in gallbladder cancer.</I>: <I>Report of four cases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900011&lng=pt&nrm=iso&tlng=pt Surgery continues to be the only curative therapy for gallbladder cancer, but useful in very few patients. Mean survival of patients with gallbladder cancer, that are out of the reach of surgery, is 3 months. The few clinical trials of chemotherapy for this disease, report very low success rates. We report four patients with advanced gallbladder cancer, treated with gemcitabine in an intravenous dose of 1000 mg/m2, given in 30 min, once a week during three consecutive weeks, every 28 days. There was a partial response that lasted 40,3 23,2 weeks with a mean survival of 59,75 17 weeks. One patient survives without evidences of disease after 17 months of the diagnosis of an advanced cancer. In all patients, symptoms were alleviated, functional status and quality of life improved. Toxicity was mild and did not require reduction in doses or delay in therapy. Therefore, this medication deserves further investigation for the treatment of gallbladder cancer. (Rev Méd Chile 2000; 128: 1025-1030). <![CDATA[<I>An evidence based proposal of basic services that should be provided by primary health care</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900012&lng=pt&nrm=iso&tlng=pt Background: Health care research has demonstrated that the primary care level can provide effective services. Aim: To propose a basic package of services for primary health care in medium income countries, based on evidences about its effectiveness. Materials and methods: Scientific evidence for the effectiveness of primary care services was first sought through a systematicliterature research. Interventions with evidences of effectiveness and appropriate for the Chilean epidemiological profile were selected. The cost in US dollars for a 100.000 inhabitant population was established. Results: Fourteen programs with evidence of effectiveness were selected: immunizations, infant growth and development surveillance, pregnancy surveillance, family planning, cervical cancer screening, diabetes, hypertension, prevention of stroke, smoking cessation, treatment of problem drinkers, depression, lower respiratory infections in children of less than 6 years old, tuberculosis and palliative care. The total cost was calculated in US$ 36 per person/year. Conclusions: This proposal must be flexible, according to local conditions and changes in evidence. It is based in the "new universality" proposed by WHO, that combines a high coverage in key zones with economical realism (Rev Méd Chile 2000; 128: 1031-8). <![CDATA[<I>Objective Structured Clinical Examination for the evaluation of medical students</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900013&lng=pt&nrm=iso&tlng=pt Background: Objective structured clinical examination has advantages over traditional oral examinationt of medical student. However, it is not routinely used in Chile. Aim: To describe the objective structured clinical examination system and report the results of its first use with Chilean medical students. Material and methods: Thirteen interns ware evaluated at the end of their surgical rotation, using the objective structured clinical examination. Thirteen stations were structured for this examination: one for history taking, two for physical examination, four for problem solving and knowledge, one for radiological interpretation, one for instrumental recognition, one for skills and one for text comprehension. There were a total of 88 questions. Results: All students exceeded 60% of requirements. Mean approval score was 73%. The higher score was 80% and the lower 61%. Ten students had a score over 70%. The method was well accepted by teachers and students. Conclusions: This first local experience with the objective structured clinical examination was successful (Rev Méd Chile 2000; 128: 1039-44). <![CDATA[<I>Congenital malformations in the offspring of diabetic mothers</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900014&lng=pt&nrm=iso&tlng=pt The offspring of diabetic mothers have a 10 times higher frequency of congenital malformations and 5 times higher frequency of spontaneous abortions. Since the discovery of insulin, the prognosis of pregnancies has improved, both for the mother and the offspring. However, the prevalence of congenital malformations at birth has not decreased significantly. The embriological process that leads to anomalies in the offspring of diabetic mothers probably occurs between 6 and 8 weeks of gestation. According to animal experiments, hyperglycemia, ketones and free radicals may be involved in the genesis of malfomations, but different strains of rats respond differently to these potential teratogenic agents. Possibly, a higher genetic susceptibility towards congenital malformations also plays a role in diabetic women. Therefore, although the intimate mechanism producing malformations in the offspring of diabetic women is not known, several strategies to decrease the prevalence of malformations in these women, such as the use of antioxidants, are being tested <![CDATA[<I>Medical practice licensing in Chile.</I>: <I>Experience of the Re-valuation Committee of the University of Chile Medical School, period 1984-1999</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900015&lng=pt&nrm=iso&tlng=pt We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to esatblish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure exammination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee (Rev Méd Chile 2000; 128: 1053-60) <![CDATA[<I>The crisis of Internal Medicine</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900016&lng=pt&nrm=iso&tlng=pt We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to esatblish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure exammination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee (Rev Méd Chile 2000; 128: 1053-60) <![CDATA[<I>The terminal patient</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900017&lng=pt&nrm=iso&tlng=pt We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to esatblish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure exammination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee (Rev Méd Chile 2000; 128: 1053-60) <![CDATA[<I>Rene Favaloro MD (1923-2000)</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000900018&lng=pt&nrm=iso&tlng=pt René Favaloro MD, was born in La Plata, Argentina, in July 1923. He studied medicine in La Plata and made his cardiology residence in the Cleveland Clinic, where he developed coronary bypass surgery for the treatment of ischemic heart disease. At the present time, this surgical procedure is a well recognized therapy for coronary artery disease that has benefited millions of patients. Back in Argentina, he founded in 1992 the Institute of Cardiology and Cardiovascular Surgery that had an important research and teaching activity. Dr Favaloro wanted to be remembered as a teacher rather than as a surgeon, but he really was a great Master of Surgery in the Americas (Rev Méd Chile 2000; 128: 1065-6).