Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720010001&lang= vol. 129 num. 1 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>The International Advisory Committee</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100001&lng=&nrm=iso&tlng= The Editors of Revista Médica de Chile are taking steps aimed to improve the "visibility" of this journal and to stimulate local and foreign authors to submit better original articles, appealing to a broader and international readership. Until now, the journal’s editorial policy has been to stress its educational role, focused in Chilean readers and authors. In the recent years, an increasing number of research articles is being received, including manuscripts from North America, Europe and other Latinamerican countries. This is explainable, in part, by the fact that this journal is indexed in MEDLINE, ISI (Current Contents/Clinical Medicine) and several other major databases. The Revista is also one of the oldest medical journals in the world, published since 1872. In this issue of the Revista we welcome the new members of an "International Advisory Committee", with prominent physicians, scientists and teachers from the U.S.A. and Europe. They accepted to advise the Editors in their task, to submit review articles, state-of-the-art or position papers on topics of their own interest, and to help in the assessment of some manuscripts. We thank them warmly for their enthusiastic response to our invitation (Rev Méd Chile 2001;129: 7-8). <![CDATA[<I>Heart transplantation as a treatment for advanced heart failure</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100002&lng=&nrm=iso&tlng= Background: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. Aim: To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation. Patients and methods: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19±4.5%, mean systolic pulmonary artery pressure 48±13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58%) had a previous median sternotomy. Immunosupression did not include induction therapy and steroids were discontinued early. Results: Operative mortality was 4% at 30 days. Actuarial survival at one year was 90% and at 5 years 72%. Freedom from rejection at one year was 76% and at 5 years 50%. Freedom from infection was 70% at one year and 56.5% at five years. All patients with more than 3 months of follow-up were in functional class I. Conclusions: These results justify the proposed modifications for transplantation protocols (Rev Méd Chile 2001; 129: 9-17). <![CDATA[<I>Hepatitis C virus in a group of hematological and oncohematological patients</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100003&lng=&nrm=iso&tlng= Background: Little information is available in Chile about hepatitis C virus (HCV) in hematological and oncohematological patients. Aim: To evaluate the prevalence of hepatitis C virus markers in a group of hematological and oncohematological pediatric patients seen at Valdivia Regional Hospital. Patients and methods: Antibodies against virus C, determined by ELISA and viral RNA, determined using RT-polymerase chain reaction, were measured in 54 blood samples from children with hematological diseases (34 with Acute Lymphoblastic Leukaemia, 4 with Hodgkin Diseases, 4 with Haemolytic Anemia, 5 with Sarcomas, 2 with Non-Hodgkin Lymphoma, 2 with Thrombocytopenic Purpura, 1 with an Ependimoma, one with a Wilms Tumor and 1 with a Von Willebrand Disease). Results: All samples were negative for antibodies against hepatitis C virus. Viral RNA was found in four children, all with a diagnosis of acute lymphoblastic leukemia and who received chemotherapy and multiple transfusions. Conclusions: The prevalence of Viral RNA for hepatitis C virus in oncohematological patients in our study is high and associated with the use of chemotherapy and multiple transfusions (Rev Méd Chile 2001; 129: 18-22) <![CDATA[<I>Clinical use and inter rater agreement in the application of the functional independence measure</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100004&lng=&nrm=iso&tlng= Background: The Functional Independence Measure (FIM) is an instrument widely used to assess the results and progress of a medical rehabilitation program. Aim: To assess the inter rater agreement in the application of FIM and show the clinical experience with its use in disabled patients enrolled in a rehabilitation program. Patients and methods: FIM was applied in 40 patients and the inter rater agreement was assessed, comparing raters with and without training in its use. Agreement was evaluated using Kappa test. Afterwards, the FIM was used to assess changes in 100 patients hospitalized and being rehabilitated at the Rehabilitation ward of a general hospital. Results: Inter rater agreement is high in physical areas of the FIM and low in cognitive areas. Training significantly improves agreement in communication and cognitive areas. During a mean period of hospitalization of 38 days, FIM score changed from a mean of 47.2 to 92 points, with an improvement of 1.18 points per hospitalization day. The higher improvement was achieved in the physical area of the instrument. Conclusions: Training is required for a proper application of FIM. When used adequately, this instrument allows an assessment of the degree of disability and the changes obtained with rehabilitation programs (Rev Méd Chile 2001; 129: 23-31). <![CDATA[<I>Indoor air pollution in a zone of extreme poverty of Metropolitan Santiago</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100005&lng=&nrm=iso&tlng= Background: Indoor pollution can be an important risk factor for human health, considering that people spend more than 60% of their time in their houses. Aim: To investigate indoor pollution in a zone of extreme poverty in Metropolitan Santiago. Material and methods: During 24h, carbon monoxide (CO), sulfur dioxide (SO2), respirable particulate matter (PM10), polycyclic aromatic hydrocarbons absorbed in PM5, temperature and humidity, were measured in the interior of 24 houses in La Pintana, Santiago. Results: The higher pollutant concentrations were observed during hours when heating was used, in houses that used coal (mean PM10 250 µg/m3, CO 42 ppm, SO2 192 ppb) or firewood (mean PM10 489 µg/m3, CO 57 ppm, SO2 295 ppb). In all houses, polycyclic aromatic hydrocarbons were detected and they came from the interior of the house and not from external filtered air. Coal, firewood and cigarette smoke were important sources of carcinogenic and kerosene and gas were sources of non carcinogenic polycyclic aromatic hydrocarbons. Conclusions: In the houses studied, the population was exposed to an accumulation of highly toxic pollutants, caused by a lack of ventilation. A high relative humidity also contributed to the growth of biological pollutants (Rev Méd Chile 2001; 129: 33-42). <![CDATA[<I>Differences in plasma antioxidants according to socioeconomic level in Chilean women</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100006&lng=&nrm=iso&tlng= Background: Free radical-mediated oxidative damage is a known initial event in atherogenesis. Cardiovascular disease is frequent in the Chilean population showing differences in the prevalence of risk factors of the disease according to socioeconomic level (SEL). Aim: To determine levels of antioxidants and lipid peroxides in Chilean women from different SEL. Patients and methods: Blood samples were taken from 81 women for measurements of plasma ascorbic acid, ß-carotene, alpha-tocopherol, licopene, ubiquinol, glutathione, total plasma antioxidant capacity, and lipid peroxides (TBARS). Results: Individuals in the lower SEL showed reduced levels of plasma ß-carotene, ascorbic acid, alpha-tocopherol, and ubiquinol compared to women in the higher SEL. There were no differences between groups in the plasma levels of glutathione, total antioxidant capacity, or TBARS. Conclusions: The results could be explained in part by the higher consumption of fruits and vegetables in women from the upper SEL (Rev Méd Chile 2001; 129: 43-50) <![CDATA[<I>Respiratory muscle power output in patients with chronic heart failure and patients with chronic pulmonary obstructive disease</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100007&lng=&nrm=iso&tlng= Background: The maximal pressure generated by inspiratory muscles (PIMax) is an index of their strength which is diminished in both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Although inspiratory muscle power output (IMPO), which includes both strength and velocity of shortening, has been shown to be reduced in COPD, there is no information regarding IMPO in CHF. Aim: To measure Impo in patients with CHF and COPD. Patients and methods: We studied 9 CHF patients with functional capacity II and III and 9 patients with severe COPD. Eight normal subjects of similar ages were included as controls. Power output was measured using the incremental threshold loading test. Results: Maximal IMPO was significantly reduced in both groups of patients. Power output developed with each increasing load was also diminished, basically as a consequence of a reduction in <IMG SRC="../img/v.gif" WIDTH=9 HEIGHT=12>insp. The degree of dyspnea at the end of the test was greater in COPD than in CHF patients and normal subjects. For a given level of power, dyspnea was also greater in patients than in normals subjects. There was no decrease in SpO2 during the test. Conclusions: IMPO is equally reduced in COPD and CHF patients. Power output is better related to dyspnea than PIMax, probably because of the inclusion of shortening velocity (Rev Méd Chile 2001; 129: 51-59). <![CDATA[<I>Radiofrequency catheter ablation in symptomatic premature ventricular depolarizations in patients without heart disease</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100008&lng=&nrm=iso&tlng= Introduction: Premature ventricular depolarizations (PVDs) in patients without heart disease, are a frequent clinical problem that can cause important symptoms. Most commonly, this benign arrhythmia responds to treatment with antiarrhythmic drugs. However, occasionally PVDs are refractory to pharmacological treatment but they can be eliminated with radiofrecuency catheter ablation. Aim: To show our experience with four patients in whom we used this method. Material and method: We studied three men and a woman, twelve to forty six years old. All of them were symptomatic, their EKG and echocardiogram were normal and they had been treated with several drugs without response. In three of them the PVDs had left bundle-branch block morphology with inferior axis; the other patient had right bundle-branch block morphology with superior axis. The origin of the PVDs was determined using pace mapping. Results: Two of the patients had spontaneous PVDs; in the other two isoproterenol infusion was used to induce them. In three patients the origin of the PVDs was located in right ventricular outflow and in the other in the anterolateral region of the left ventricle. None had sustained atrial or ventricular arrhythmia. In all of them PVDs were eliminated. A patient presented a second morphology that could not be treated. None of the patients had complications and they were discharged within the next 24 hours. Three noted symptomatic improvement and after 18 months, only one had a probable recurrence of the arrhythmia. Conclusions: radiofrecuency catheter ablation can be successfully used to eliminate PVDs in severely symptomatic and drug-resistant patients (Rev Méd Chile 2001; 129: 60-66) <![CDATA[<I>Disabling congenital defects in Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100009&lng=&nrm=iso&tlng= Background: The ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) is an epidemiological surveillance program for congenital defects that operates in Chile since 1969. Aim: To communicate the frequency of disabling congenital defects in Chile in the period 1982-1997. Material and methods: A review of the ECLAMC registry, choosing 12 congenital defects: amelia, limb amputations, limb reductions, arthrogryposis, hip luxation and subluxation, spina bifida, hydrocephaly, microcephaly, cephalocele, talipes equinovarus, Down syndrome and multiple abnormalities. Results: In the study period, 283,403 births occurred and 7,917 newborns were malformed (7,654 born alive and 263 stillbirths). The congenital defects prevalence rates appeared higher in Chile than in other Latin American countries, specially among stillbirths. Among the studied maternity hospitals, the Clinical Hospital of the University of Chile, showed the higher prevalence of congenital defects. Rancagua and the Navy Hospital in Valparaiso have a high frequency of Down syndrome. Global rates in Chile and in the rest of ECLAMC for specific defects, do not have significant differences, except for hip subluxation, that has a lower incidence in Chile. Conclusions: The ECLAMC allows to have a good knowledge of the prevalence of congenital malformations in Latin America (Rev Méd Chile 2001; 129: 67-74). <![CDATA[<I>Study of three hypervariable loci in a mixed Chilean population</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100010&lng=&nrm=iso&tlng= Background: Genetic markers are useful to study evolution parameters in populations and to determine kinship. Aim: To characterize three short tandem repeat loci in a sample of Chilean subjects and compare them with Caucasian and Hispanic populations. Material and methods: Three hundred ninety three unrelated subjects that were sent for genetic studies from courts of justice, were studied. The loci FESFPS, F13A01 and vWA in blood samples, were typified amplifying DNA by polymerase chain reactions. Results: The three studied loci were highly polymorphic. F13A01 and FESFPS were in Hardy-Weinberg genetic equilibrium. A significant excess of heterozygotes was detected for vWA locus. There were no differences in allele frequencies, according to ethnic origins of last names. Allele frequencies for F13A01 and vWA loci were similar to those of Hispanic populations of Unites States and FESFPS loci was different. Conclusions: All three loci had a high efficiency for genetic identification tests according to the estimated a priory exclusion probability (Rev Méd Chile 2001; 129: 75-79) <![CDATA[<I>Bleeding caused by gastroduodenal artery pseudoaneurysm in a patient with an infected pancreatic pseudocyst</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100011&lng=&nrm=iso&tlng= We report a 52 year old man with a pancreatic pseudocyst, that was admitted with severe abdominal pain, severe vomiting, fever and malaise. The clinical picture was considered secondary to a pseudocyst infection and the patient was operated, draining the infected cyst performing a necrosectomy and pancreatocystojejunostomy. Forty eight hours after the operation, an ostomy bleeding was detected. A upper mesenteric artery angiography showed two pseudoaneurysms in the gastroduodenal artery, that were embolized. Bleeding stopped initially, but seven days later, it reappeard. The patient was subjected to an emergency pancreatoduodenectomy. Postoperative evolution was uneventful and the patient was discharged two weeks later. Spontaneous bleeding of pseudoaneurysms secondary to chronic pancreatitis is a complication with a 15 to 40% mortality that must be bore in mind (Rev Méd Chile 2001; 129: 81-85). <![CDATA[<I>Late pancreatic metastasis of a renal cell carcinoma.</I>: <I>Report of three cases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100012&lng=&nrm=iso&tlng= We report two males and one female, aged 71, 81 and 73 years old respectively, previously operated of a renal cell carcinoma. During the follow up of the 71 years old male, the CAT scan showed three lesions in the pancreas. Also, the CAT scan in the female showed one lesion in the tail of the pancreas. The 81 years old male was admitted to the emergency room due to a upper gastrointestinal bleeding. Endoscopy showed a proliferating lesion in the second portion of the duodenum whose biopsy showed a clear cell carcinoma. The CAT scan showed also a tumoral mass in the head of the pancreas. All three patients were subjected to surgical resection of the tumors without postoperative complications or mortality (Rev Méd Chile 2001; 129: 86-90). <![CDATA[<I>Bilateral pheochromocytoma</I>: <I>laparoscopic adrenalectomy in two cases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100013&lng=&nrm=iso&tlng= Laparoscopic adrenalectomy, if done by skilled surgeons, is now the first choice for treating most adrenal tumors, including bilateral pheochromocytoma. We report two women, aged 35 and 34 years old, with bilateral adrenal pheochromocytoma successfully excised by laparoscopic surgery. Both had severe hypertension, high urinary catecholamine values (epinephrine + norepinephrine: 528 and 1083 ug/24h) and bilateral adrenal tumors at CT scan. After 4 weeks of doxazosin treatment, a laparoscopic transperitoneal adrenalectomy was done (Gugner’s technique), with surgical times of 7 and 5 hours respectively. Both patients received hydrocortisone and only the second one required one unit of packed cells. Postoperative evolution was uneventful and both patients were discharged at the fifth postoperative day. At two months of follow up, both patients are asymptomatic and normotensive (Rev Méd Chile 2001; 129: 91-94) <![CDATA[<I>The Chilean Association of Biomedical Journal Editors</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100014&lng=&nrm=iso&tlng= On September 29th, 2000, The Chilean Association of Biomedical Journal Editors was founded, sponsored by the "Comisión Nacional de Investigación Científica y Tecnológica (CONICYT)" (the Governmental Agency promoting and funding scientific research and technological development in Chile) and the "Sociedad Médica de Santiago" (Chilean Society of Internal Medicine). The Association adopted the goals of the World Association of Medical Editors (WAME) and therefore it will foster "cooperation and communication among Editors of Chilean biomedical journals; to improve editorial standards, to promote professionalism in medical editing through education, self-criticism and self-regulation; and to encourage research on the principles and practice of medical editing". Twenty nine journals covering a closely similar number of different biomedical sciences, medical specialties, veterinary, dentistry and nursing, became Founding Members of the Association. A Governing Board was elected: President: Humberto Reyes, M.D. (Editor, Revista Médica de Chile); Vice-President: Mariano del Sol, M.D. (Editor, Revista Chilena de Anatomía); Secretary: Anna María Prat (CONICYT); Councilors: Manuel Krauskopff, Ph.D. (Editor, Biological Research) and Maritza Rahal, M.D. (Editor, Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello). The Association will organize a Symposium on Biomedical Journal Editing and will spread information stimulating Chilean biomedical journals to become indexed in international databases and in SciELO-Chile, the main Chilean scientific website (www.scielo.cl) (Rev Méd Chile 2001;129: 95-98) <![CDATA[<I>Investigation and development of new medications</I>: <I>from the molecule to drug</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100015&lng=&nrm=iso&tlng= There are many stages and a large investment of both time and money involved in the process of research and development before a new drug can be prescribed for clinical use. Of the thousands of new molecular entities, only one or two are approved for commercialization, after having endured a trajectory of 12 to 15 years in clinical trials in both animals and humans, demonstrating their therapeutic effectiveness and safety. There are three large administrators of medicines that control the process of new drug registration, the FDA - Food and Drug Administration of the USA being the largest and most well known. This article is based on their model and details the various stages that the molecule must undergo before finally being administered to patients. The future holds many exciting promises for new drug development with the advent of the human genome project and other highly advanced technological methods. However, the main challenge still remains, which is to guarantee the access of basic medicines to the majority of the world’s population that is still without them (Rev Méd Chile 2001; 129: 99-106) <![CDATA[<I>New concepts in hypertension</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100016&lng=&nrm=iso&tlng= The management of arterial hypertension has experienced great changes during the past years, based on the knowledge of its pathophysiology, as well as the development of new antihypertensive drugs. Recent studies show the effect of the dysfunction of the endothelium in hypertension, sleep apnea and a higher prevalence of primary hyperaldosterism. The Sixth report of the Joint Committee makes a new classification of this pathology, including a new concept of the stratification of risk for each stage of the disease, and according to it a new way of treatment. This fact marks a new and a more aggressive behaviour to treat the hypertense patient. With respect to the treatment, the emphasis has been on the non-pharmacological measures, and the development of new antihypertensive drugs of long action and high through/peek rate. Prevention continues to be an important goal and main challenge for the clinician, given the high morbidity and mortality rate caused by hypertension (Rev Méd Chile 2001; 129: 107-114) <![CDATA[<I>Molecular biology techniques in articles published in Revista Médica de Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100017&lng=&nrm=iso&tlng= The management of arterial hypertension has experienced great changes during the past years, based on the knowledge of its pathophysiology, as well as the development of new antihypertensive drugs. Recent studies show the effect of the dysfunction of the endothelium in hypertension, sleep apnea and a higher prevalence of primary hyperaldosterism. The Sixth report of the Joint Committee makes a new classification of this pathology, including a new concept of the stratification of risk for each stage of the disease, and according to it a new way of treatment. This fact marks a new and a more aggressive behaviour to treat the hypertense patient. With respect to the treatment, the emphasis has been on the non-pharmacological measures, and the development of new antihypertensive drugs of long action and high through/peek rate. Prevention continues to be an important goal and main challenge for the clinician, given the high morbidity and mortality rate caused by hypertension (Rev Méd Chile 2001; 129: 107-114) <![CDATA[<I>Successful rescue of out-of-hospital airway emergency using the Esophageal-Tracheal Combitube® by non skilled personnel</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000100018&lng=&nrm=iso&tlng= The management of arterial hypertension has experienced great changes during the past years, based on the knowledge of its pathophysiology, as well as the development of new antihypertensive drugs. Recent studies show the effect of the dysfunction of the endothelium in hypertension, sleep apnea and a higher prevalence of primary hyperaldosterism. The Sixth report of the Joint Committee makes a new classification of this pathology, including a new concept of the stratification of risk for each stage of the disease, and according to it a new way of treatment. This fact marks a new and a more aggressive behaviour to treat the hypertense patient. With respect to the treatment, the emphasis has been on the non-pharmacological measures, and the development of new antihypertensive drugs of long action and high through/peek rate. Prevention continues to be an important goal and main challenge for the clinician, given the high morbidity and mortality rate caused by hypertension (Rev Méd Chile 2001; 129: 107-114)