Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720000011&lang=pt vol. 128 num. 11 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>Tradition and progress</I>: <I>now also a bilingual journal?</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100001&lng=pt&nrm=iso&tlng=pt Since it was founded, in 1872, Revista Médica de Chile has published all its contents in Spanish. Abstracts in English began to appear in 1960 and in 1962 they became mandatory for every article published. Since 1974 the Abstract in English is presented at the beginning of the respective article. This is currently a regulation enforced by MEDLINE, SCI and other organizations that include this journal in their indexing services. An Assistant Editor is specifically in charge of improving the format and contents of these abstracts, with the best available use of the English language. While Revista Médica de Chile will continue to publish in Spanish those articles originated in Chile and other Spanish-speaking countries, this issue of the journal starts adding articles in English, by guest authors from English-speaking countries. This policy will give us the opportunity to include articles in frontier topics, written by distinguished authors. (Rev Méd Chile 2000; 128: 1187-89) <![CDATA[<I>Acute myeloid leukemia in the adult</I>: <I>Results of the National Antineoplastic Drug Protocol (Panda) at the Hospital del Salvador, Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100002&lng=pt&nrm=iso&tlng=pt Background: The incidence of acute myeloid leukemia is 3 cases per 100.000 inhabitants/year and its five years event free survival is 15 to 20%. Since the incorporation of trans retinoic acid, event free survival of M3 acute myeloid leukemia is 80%. Aim: To report the results of acute myeloid leukemia treatment at the Hospital del Salvador, between 1990 and 1998. Patients and methods: The medical records of 117 patients (66 female, mean age 48.2 years), treated between 1990 and 1998 using PANDA protocol, were retrospectively reviewed. Immunophenotyping was done in 69 patients and cytogenetic studies were done in 65. Results: Sixteen percent of patients had M3 acute myeloid leukemia. The most frequent phenotype was the association of DR, CD34 plus a panmyeloid marker. DR and CD34 were negative in seven of nine patients with M3 acute myeloid leukemia. Cariotype was abnormal in 78% of patients. Complete remission was achieved in 65% of cases with a 13% of failures. Early mortality was 21.3% and decreased to 6.1% in the last three years. Infections and coagulation disorders were the main causes of death. Mean survival was 10.5 months. Five years event free survival was 11%. In M3 acute myeloid leukemia, the figure is 50%. Conclusions: Treatment results are less effective than protocols that consider more aggressive chemotherapeutic protocols or bone marrow transplantation. The reduction in early mortality is due to a better management of febrile neutropenia (Rev Méd Chile 2000; 128: 1191-98) <![CDATA[<I>Preliminary report on the effectiveness of the 5-item version of the Geriatric Depression Scale for depression screening in a Chilean community-dwelling elderly population</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100003&lng=pt&nrm=iso&tlng=pt Introduction: The best approach to improve under-recognition of depression is routine screening, idealy using an instrument that is highly effective and easy to administer. Objective: To test the effectiveness of the 5-item version of the Geriatric Depression Scale (5-GDS) for depression screening in a community-dwelling Chilean elderly population. Participants and Methods: 110 subjects were evaluated at the geriatric outpatient clinic of a university teaching hospital. Patients answered a questionnaire that included the Geriatric Depression Scale (GDS), and demographic information. Using the 15-item GDS score as reference standard to classify subjects as depressed, test characteristics of the 5-GDS were evaluated. Results: Subjects had a mean 15-item GDS score of 5.4; 47% classified as depressed. Depressed and not depressed subjects were similar with regard to demographics, educational level and comorbid conditions. The mean score was 1.9 for the 5-item GDS. Pearson correlation for 15-item and 5-item GDS scores was 0.92, p<0.001. Using 15-item GDS score as reference standard, the 5-item GDS had a sensitivity of 0.88, specificity 0.90, positive predictive value 0.88 and negative predictive value 0.90. Conclusions: The 5-item GDS seems to be a promising screening tool for depression. If revalidated against clinical evaluation, it might be the preferred screening tool for depression in the Chilean community-dwelling elderly. (Rev Méd Chile 2000; 128: 1199-1204) <![CDATA[<I>Clinical features and response to systemic treatment in episcleritis and scleritis resistent to local treatment</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100004&lng=pt&nrm=iso&tlng=pt Background: Scleritis and episcleritis may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. Aim: To evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. Patients and methods: Forty six patients with refractory scleritis and episcleritis were studied and treated during the period 1991 to 1998. Results: Necrotizing type was the most common and severe category in the scleritis group of patients. A decrease in vision occurred in 58.3% of patients with scleritis v/s a 23.5% of patients with epiescleritis (p<0,05). Uveitis was present in 35.4% of patients with scleritis and scleromalacia was present in 33.3% (p<0,05). A specific disease association was uncovered in 51% of scleritis and in 38% of episcleritis patients. Rheumatoid arthritis, primary systemic vasculitic disease and Sjögren syndrome with vasculitis were the most common associated systemic diseases. Three patients with scleritis had tuberculosis. Conclusions: Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information. A meticulous approach for the detection of a specific associated disease must be undertaken. Scleritis associated with vasculitis has a worse ocular prognosis than other non infectious diseases. Cyclophosphamide is the most effective inmunosuppresive treatment to control severe ocular involvement (Rev Méd Chile 2000; 128: 1205-14) <![CDATA[<I>Tissue infections caused by group A ß hemolytic Streptococcus in a Regional Chilean Hospital</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100005&lng=pt&nrm=iso&tlng=pt Background: A resurgence of group A ß hemolytic Streptococcus infections such as fasciitis, cellulitis and Strptococcal Toxic Syndrome has been observed recently. Aim: To study the clinical features of patients with group A ß hemolytic Streptococcus infections in a regional hospital. Patients and methods: Retrospective review of medical records of patients notified as having a group A ß hemolytic Streptococcus tissue infection, between 1994 and 1999. Results: twenty four patients were notified in the period as having a group A ß hemolytic Streptococcus infection and 18 (13 male, mean age 39 tears old) had tissue involvement. Eleven patients had a fasciitis (61%), six had a cellulitis (33%) and 14 patients (77%), a Streptococcal Toxic Shock Syndrome. Eight patients died during hospital stay. The infection portal of entry was identify in 13 patients (the skin in 10 and intramuscular injections in three). Deceased patients had a longer lapse of disease before admission than patients discharged alive (5(range 3h-7 days) and 2.1 (range 6h-5 days) respectively). In seven patients a quick serological test, designed for pharyngeal infections was performed and it was positive in five. Blood cultures were positive in seven patients and in 11, the germ was isolated from the lesions. Conclusions: As the early diagnosis of group A ß hemolytic Streptococcus tissue infections has a prognostic value, the population should be instructed to recognize early signs and symptoms of these infections (Rev Méd Chile 2000; 128: 1215-19) <![CDATA[<I>Clinical experience in home care of children with a tracheostomy</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100006&lng=pt&nrm=iso&tlng=pt Background: Home care of tracheostomized children is considered a safe and low-cost alternative. Aim: To report the experience with tracheostomized children at the Pediatric Respiratory Unit of the Catholic University Hospital. Patients and methods: The records of 16 children (9 male) with tracheostomy (TQ) in home care between 1992 and 1998 were reviewed. Results: The average age at the moment of TQ was 9 months (range 1-30 months) and the postoperative hospital management period was 5 months (range 1-11 months). The average age at discharge was 13 months (range 3 to 30 months). Surgical indication were upper airway obstruction (congenital or acquired subglotic stenosis in three, upper airway malformations in one, vocal cord palsy in one and tracheobronchomalacia in one) and chronic assisted ventilation (severe tracheobronchomalacia in four, pulmonary hypoplasia in two, myopathy in one, central nervous injury in one and bronchopulmonary displasia in one). Overall rate complications were 2 per 100 tracheostomy months during home care and 8 per 100 tracheostomy months during hospital care. No tracheostomy-related deaths were observed. A parenteral education program to teach about tracheostomy management and cardiopulmonary resuscitation was carried out. Conclusions: Tracheostomized children can be safely managed at home (Rev Méd Chile 2000; 128: 1221-26) <![CDATA[<I>Retrospective analysis of 450 patients with cerebrovascular disease admitted to a public hospital during 1997</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100007&lng=pt&nrm=iso&tlng=pt Background: In Chile, cerebrovascular diseases are the fifth cause of death among men and the third cause among women. Aim: To assess the clinical features and management of patients with cerebrovascular disease admitted to a public hospital during 1997. Patients and methods: A retrospective analysis of clinical records of patients discharged with a diagnosis of cerebrovascular disease. Those records in which there was discordance between the discharge diagnosis and the clinical picture were not considered in the analysis. Results: Of the 563 discharges from the hospital with the diagnosis of cerebrovascular disease, 487 records were located and 450 were considered in the analysis. Fifty four percent of patients were male and ages ranged from 17 to 96 years old. Fifty one percent of patients had an ischemic stroke, 34% a cerebral hemorrhage, 12% a subaracnoidal hemorrhage and 3% a transient ischemic attack. There was a history of hypertension in 64% patients and 20% had an adequate treatment. Eighteen percent were diabetics, 34% had a heart disease and 20% had a previous episode of stroke. Mean hospital stay was 6.3 days in the emergency room and 11 days in the neurology ward. Hospital infections appeared in 21% of patients (respiratory in 68% and urinary in 22%), lethality was 30.5% and a CAT scan was done in 94%. At the moment of admission, 10% of patients had an evolution of less than 2 hours, 27% had an evolution between 2 and 6 hours and nine cases were potential eligible for thrombolysis. Conclusion: This is a picture of the local features of patients with cerebrovascular diseases that can be used as a reference for future studies. (Rev Méd Chile 2000; 128: 1227-36) <![CDATA[<I>Esophageal motility disorders in subjects with esophageal reflux disease but without abnormal reflux, measured by 24h Esophageal pH monitoring</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100008&lng=pt&nrm=iso&tlng=pt Background: In a high proportion of patients with symptomatic gastroesophageal reflux disease, 24 h esophageal pH monitoring is normal. Aim: To study esophageal motility in patients with symptomatic gastroesophageal reflux disease and normal 24 h esophageal pH monitoring. Patients and methods: Fourteen patients (12 women, aged 28 to 74 years old) with esophageal reflux disease and normal 24 pH monitoring and 14 asymptomatic controls (8 women, aged 19 to 69 years old), were studied. Symptoms were evaluated using an analog scale and all subjects underwent a barium meal, upper gastrointestinal endoscopy and a standard esophageal manometry. Results: Lower esophageal sphincter was normal in 11 patients, hypotonic in one and displaced to the thorax in two. Esophageal wave amplitude was lower in patients than in asymptomatic controls (10 to 50 and 13 to 70 mm Hg respectively). The proportion of hypotonic waves was Grade I and II in seven patients, Grade III in three and grade IV in four cases. Four patients had localized aperistalsis (that can be considered normal) and four had more severe forms of aperistalsis, along with severe hypotonia. Conclusions: Patients with gastroesophageal reflux disease without alterations in 24 h pH monitoring, have alterations in esophageal motility (Rev Méd Chile 2000; 128: 1237-44) <![CDATA[<I>Humoral rejection in heart transplantation</I>: <I>Report of two cases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100009&lng=pt&nrm=iso&tlng=pt Heart transplantation is a therapeutic alternative for selected patients with refractory heart failure. Acute allograft rejection is one of the main causes of early death after transplantation. The cellular rejection is characterized by cellular infiltrates with or without miocyte necrosis. However, some patients develop left ventricular dysfunction due to rejection without evidence of cellular infiltration. In these patients, the rejection is mediated by antibodies and complement. Humoral rejection is a relative rare but potentially fatal form of acute allograft rejection. We report two patients with left ventricular dysfunction secondary to humoral rejection, shortly after cardiac transplantation. Both patients were treated with methylprednisolone, and azathioprine was substituted by cyclophosphamide. One patient underwent plasmapheresis. The clinical outcome was satisfactory and the left ventricular function returned to normal in both cases. The diagnostic and therapeutic strategies for the management of humoral rejection are reviewed (Rev Méd Chile 2000; 128: 1245-49) <![CDATA[<I>Retractile mesenteritis</I>: <I>Report of four cases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100010&lng=pt&nrm=iso&tlng=pt Retractile mesenteritis is a rare condition in which the inflammation proces of the mesentery is the characteristic pathological. The histologic changes are variable proportions of fat necrosis, chronic inflammation and fibrosis. The clinical presentation of this process is diverse, also the natural history is variable, ranging from a benign to fatal disease. We reviewed 4 cases of retractile mesenteritis and evaluated the clinical manifestations. There was no gender predominance. The patients aged range was 63-69 years (average 65) Patients more often presented with abdiminal mass (cases n: 1 and n: 4), and chronic diarrhea (cases n: 1 and 3). The etiology is unknown, the treatment is empirical, including corticosteroids, colchicine, immunosuppressive drugs and oral progesterone. (Rev Méd Chile 2000; 128: 1250-54) <![CDATA[<I>Severe Henoch-Schönlein purpura in multiple myeloma. Report of one case</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100011&lng=pt&nrm=iso&tlng=pt A Multiple Myeloma (MM), IgG-lambda stage III-A was diagnosed in a 41-year-old-man. After VAD cycles IgG decreased from 7.5 to 2.4 g/dL. were mobilized with cyclophosphamide and 10 µg/Kg G-CSF. Three days after the collection of peripheral stem cell, the patient had fever, nausea, vomiting, liquid stools, shoulder and knee arthralgia and dehydration. Upper GI endoscopy showed esophageal candidiasis and ulcerative necrotic lesions both in stomach and duodenum; the biopsy confirmed necrosis. Simultaneously, the appearance of purpura with maculopapular lesions of diverse sizes appeared in the feet progressing to the limbs and trunk. Hematuria and proteinuria were also observed. Skin biopsy showed leukocytoclastic vasculitis. Renal biopsy showed focal and segmental glomerulonephritis. Serum ANCA, cryoglobulins, anti-HCV and RF were negative, and serum monoclonal IgG was 1290 mg/dL. Daily treatment with iv methylprednisolone pulses for 3 days improved skin lesions and digestive involvement. Macroscopic hematuria and proteinuria improved after two months of steroid treatment (Rev Méd Chile 2000; 128: 1255-60) <![CDATA[Molecular epidemiology: The impact of molecular biology in epidemiology research]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100012&lng=pt&nrm=iso&tlng=pt Progress in molecular biology and genetics is changing the practice of medicine and public health through the development of molecular diagnostics and targeted interventions for susceptible individuals. The ethical, legal and social issues that are becoming apparent as these important discoveries are introduced into practice will have an enormous impact on society. The accurate translation of this new genetic information from the laboratory to the community is an urgent need. Molecular epidemiology is at the foundation of this important link, and represents the scientific basis of public health for the 21st Century. (Rev Méd Chile 2000; 128: 1261-68)<hr/>Los avances en la biología y genética moleculares, a través del desarrollo del diagnóstico molecular y de acciones médicas dirigidas a individuos genéticamente susceptibles, están cambiando aceleradamente la práctica de la medicina y de la salud pública. Las consecuencias éticas, legales y sociales están llegando a ser evidentes mientras estos descubrimientos se introducen en la práctica clínica. La apropiada traducción de esta nueva información desde el laboratorio a la comunidad es una necesidad urgente. La aplicación de herramientas moleculares a la epidemiología es considerada parte fundamental en el cumplimiento de esa tarea. El presente artículo describe el concepto de epidemiología molecular que representa la base científica de la salud pública para el Siglo XXI <![CDATA[<I>p53 tumor supresor gene in digestive cancer</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100013&lng=pt&nrm=iso&tlng=pt Malignant diseases of the digestive tract cause more than 50% of deaths due to cancer in Chile. There is a high incidence of gastric and gallbladder cancer and an increasing frequency of colorectal cancer. P53 tumor suppressor gene has a great importance in carcinogenesis and its alterations are specially important in digestive tract tumors such as colorectal cancer. There is contradictory evidence about the frequency of p53 gene or protein alterations or their biological significance. There is little information about p53 in Chile and it is mostly limited to immunohistochemical studies. This revision analyzes the frequency of p53 alterations in digestive tract tumors in Chile, using immunohistochemical and molecular biology methods. A special emphasis is given to the prognostic importance of this gene (Rev Méd Chile 2000; 128: 1269-78) <![CDATA[<I>Genetics of addictive disorders</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100014&lng=pt&nrm=iso&tlng=pt Given the spectacular advances of genetics during the last five years, it seems appropriate to revisit the important subject of genetics of alcoholism and substance abuse. In recent studies alcohol abuse was shown to have an heredability of roughly 38%, whereas psychostimulant and opiate use exhibit heredabilities of 11 to 45%. The heredability of smoking was found to be around 50%. There is a strong comorbidity between alcoholism and smoking. More than 80% of alcoholics smoke cigarettes in the U.S.A.. Other genetic methods such as linkage analysis, allele sharing methods, association studies and analysis of inbred, transgenic and gene-knockout rodents, have partially agreed in showing that the 5HT-IB serotonin receptor and the DRDI, DRD2 and DRD4 dopamine receptors, as well as the dopamine transporter DAT, play an important role in behaviors related to alcoholism and substance abuse. Some neurochemical markers, as for example monoamine oxidase and adenylate cyclase have also been implicated in addictive disorders. The aldehyde dehydrogenase allele ALDH2*2 has a protective effect against alcoholism. Two whole genome linkage studies have shown linkage to chromosomal regions that are in the proximity of the DRD4 dopamine receptor, the GABA receptor gene cluster and the alcohol dehydrogenase gene cluster (Rev Méd Chile 2000; 128: 1279-82) <![CDATA[<I>Perinatal mental health during the hospital care of labor and puerperal period</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100015&lng=pt&nrm=iso&tlng=pt The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile (Rev Méd Chile 2000; 128: 1283-89) <![CDATA[<I>Role of the universities and the Chilean National Certification of Medical Specialties Council</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100016&lng=pt&nrm=iso&tlng=pt The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile (Rev Méd Chile 2000; 128: 1283-89) <![CDATA[<I>Osteoporosis in Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100017&lng=pt&nrm=iso&tlng=pt The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile (Rev Méd Chile 2000; 128: 1283-89) <![CDATA[<I>Periodontal infections and cardiovascular diseases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100018&lng=pt&nrm=iso&tlng=pt The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile (Rev Méd Chile 2000; 128: 1283-89) https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100019&lng=pt&nrm=iso&tlng=pt https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001100020&lng=pt&nrm=iso&tlng=pt