Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 130 num. 9 lang. es <![CDATA[SciELO Logo]]> <![CDATA[Efecto de la vitamina E(DL <FONT FACE=Symbol>a</FONT>-tocoferol) sobre el daño cromosómico en linfocitos de pacientes con ataxia telangiectasia]]> Background: In ataxia telangiectasia (A-T), the lack of a functional ATM kinase is associated with disturbances in the processing of DNA damage and a chronic oxidative stress. These disturbances may be responsible for an increment of chromosomal damage in A-T cells. Aim: To study the in vitro effect of vitamin E (DL-alpha-tocopherol) on the frequency of chromosomal damage of lymphocytes from patients with A-T. Patients and methods: Seven patients with A-T and age-sex matched controls were studied. Chromosomal damage in mitosis was evaluated in lymphocytes cultures both under basal conditions and when G2 repair was prevented by 5 mM caffeine. Results: In cells from patients with A-T, vitamin E induced a 57.1 and 47.9% decrease in chromosomal damage under basal and inhibited G2 repair conditions, respectively. However, there was a non significant improvement in their repair activity. Vitamin E effects on chromosomal damage was not significant in control subjects. Conclusions: Vitamin E reduces chromosomal damage in lymphocytes from patients with ataxia telangiectasia (Rev Med Chile 2002; 130: 957-63). <![CDATA[Feminidad, masculinidad, androginidad y trastornos del hábito del comer]]> Background: There are marked gender differences in the attitudes towards eating behaviors. Aim: To compare gender identity traits among females with eating disorders and subjects of both sexes without eating disorders. Material and Methods: An structured clinical interview based on the DSM-IV diagnostic criteria for eating disorders, the Eating Attitudes Test (EAT-40), the Eating Disorders Inventory (EDI) and the Bem Sex Role Inventory (BSRI) were administered to 119 female patients that fulfilled the DSM-IV criteria for anorexia nervosa and/or bulimia nervosa and/or eating disorders not otherwise specified (FCT group), 89 males (MST group) and 63 females (FST group) without eating disorders. Results: The FCT group ranked significantly higher than the FST group on the EAT-40 and EDI and all its items (p <0.001). There were no significant differences between FST and MST groups. The FST group ranked significantly higher than the MST group on the Drive for thinness (p= 0.003) and Body dissatisfaction (p= 0.009). The MST group scored significantly higher than the FST group on Perfectionism (p= 0.020) and Interpersonal distrust (p= 0.008). The FCT group was significantly identified with Feminine and Masculine categories and the FST group with Androgynous and Undifferentiated categories on the BSRI (p= 0.001). Comparatively, the MST group was significantly identified with Masculine category and the FST group with Feminine category on the IBRS (p= <0.001). All groups rejected and approved feminine, masculine and neutral qualities. The higher correlations were observed among feminine quality on the BSRI with the total score on the EAT-40 (r=0.46). Drive for thinness (r=0.51) and Body dissatisfaction (r=0.41). Discussion: Femininity emerged as the main trait of gender identity in patients with eating disorders, in contrast to androgyny showed by male and female subjects without eating disorders. Females without eating disorders were more motivated to achieve thinness and displayed more body dissatisfaction than males (Rev Méd Chile 2002; 130: 964-75). <![CDATA[Síndrome de Turner: Crecimiento y descripción clínica en 83 niñas chilenas]]> Background: Short stature is the main feature of patients with Turner's syndrome. There is limited information regarding the spontaneous growth of these patients in Chile. Aim: To develop a specific growth chart for Chilean patients with Turner's syndrome. Material and methods: We retrospectively analyzed 668 height measurements from 85 Chilean girls, born after 1968, with 45XO karyotype (minimum 15%), and without an Y chromosome fragment. Patients with hormonal therapy, such as growth hormone or estrogen, except thyroid hormone replacement, were excluded. Results: The karyotypes were 60% 45XO, 25% 45XO, 46XX, and 15% other complex mosaics. The birth length was 46.8 ± 2.1 cm. The final height of our patients was 138,20 ± 7,0 cm. Conclusions: The final height achieved by our patients, is similar to Argentinian and Japanese patients, but is below the mean stature reported for Scandinavian and Northamerican patients who achieve a mean adult height of approximately 147 and 142 cm respectively. The birth length is also lower than that reported in those studies (Rev Méd Chile 2002; 130: 977-84). <![CDATA[Tumores neuroendocrinos gástricos: presentación clínica, endoscópica y alternativas de tratamiento]]> Background: Gastric neuroendocrine tumors correspond to less than 1% of all gastric tumors. These tumors can be of three types. Seventy five percent are type I and are associated to chronic atrophic gastritis type A (CAG- A). Half of them are associated with pernicious anemia. Type II tumors are associated with Zollinger Ellison syndrome and type I multiple endocrine neoplasia. Type III are sporadic tumors. Aim: To report the clinical, endoscopical features and response to the treatment of gastric neuroendocrine tumors. Patients and methods: A retrospective study of eleven patients (seven male, aged 38 to 72 years old) with a pathological diagnosis of gastric neuroendocrine tumor. Their clinical presentation, associated diseases, treatment and follow up were reviewed. Results: Epigastric pain was present in eight patients, weight loss in three, epigastric pain and weight loss in one and post prandial abdominal pain in two. At endoscopy, multiple polyps in the fundus were observed in six, verrucose gastritis in one, polyps in the antrum in one, two subcardial polyps in 1, a fundus ulcer in one and a Bormann III type lesion in one. Chronic atrophic gastritis was diagnosed in seven patients and pernicious anemia in five. Serum gastrin levels were determined in 4 patients and were high in all. Four subjects were treated with endoscopic polipectomy only. A partial or total gastrectomy was done in seven patients. No complications or mortality occurred during the follow up. Conclusions: Abdominal pain is a common presentation of patients with gastric neuroendocrine neoplasia. Polyps predominantly in the fundus are the most common endoscopic finding. Surgical treatment or endoscopical polypectomy, depending of the extension of the disease, yield satisfactory results (Rev Méd Chile 2002; 130: 985-92). <![CDATA[Utilidad clínica de los hemocultivos en pacientes hospitalizados por neumonía adquirida en la comunidad]]> Background: The clinical role of blood cultures (BC) in the management of hospitalized patients with community-acquired pneumonia (CAP) is controversial. Aim: To evaluate the clinical usefulness of blood cultures in CAP. Material and methods: We prospectively studied 244 immunocompetent adults with two or more BC obtained at admission. The diagnostic yield of BC and its impact on antibiotic therapy were assessed. Results: Mean age (x±sd) of patients was 67±20 years, 80% had underlying diseases and 29% received antibiotics prior to admission. Hospital length of stay was 10.4±10 days and global mortality was 7%. The diagnostic yield of BC was only 8.2% (20 patients). Mortality was significantly higher in patients with positive BC (20%) than in those with negative BC (5.8%). In only one of the 20 patients with positive BC (0.4% of total study population), attending physicians changed empiric antimicrobial therapy based on these results. Conclusions: This study confirms that the diagnostic yield of BC in CAP hospitalized patients is low, that mortality in bacteremic patients is high and suggests that clinical usefulness of BC to guide changes on empiric antimicrobial therapy is limited, in part because attending physicians seldom use such information (Rev Méd Chile 2002; 130: 993-1000). <![CDATA[Bacteriología urinaria asintomática en mujeres diabéticas tipo 2]]> Background: Urinary tract infection (UTI) is frequent among diabetics, especially women. It may be preceded by asymptomatic bacteriuria. Aim: To study the frequency of asymptomatic bacteriuria in type 2 diabetic women. Patients and methods: Fifty women with type 2 diabetes and 50 non diabetic women were studied. In aseptic conditions, morning midstream urine specimens were obtained for microbiological analysis. The test was repeated in similar conditions during consecutive days. Urine samples were cultured in blood agar, Mac Conkey agar and CPS ID 2. Colony forming units were counted. Asymptomatic bacteriuria was defined as the presence of 100,000 or more colony forming units per ml. Leukocyturia was also quantified. Results: There was microbial growth in 40% of samples from diabetic women and 6% of samples from controls (p <0.01). Asymptomatic bacteriuria was present in 32% of diabetics and 4% of controls (p <0.01). E Coli was the most frequently isolated strain, in 55% of patients and 100% of controls. Klebsiella pneumoniæ was isolated in 10% of diabetics, coagulase negative Staphylococcus in 10%, Enterococcus spp in 10% and Pseudomonas aeruginosa in 5%. Leukocyturia of more than 10 cells per field, was present in 80% of diabetic women with positive culture. Women with positive cultures had a longer lasting diabetes than those with negative cultures. There was no association between urine microbiological results and glycosilated hemoglobin, fasting blood glucose, chronic complications of diabetes and treatment received. Conclusions: This study shows a high prevalence of asymptomatic bacteriuria among diabetic women (Rev Méd Chile 2002; 130: 1001-7). <![CDATA[Efecto de la midodrina en la hipotensión sintomática en hemodiálisis]]> Background: Hypotension occurs in 20% of hemodialysis procedures. Aim: To study the effects of midodrine on hypotension during hemodialysis. Patients and methods: Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design. Results: Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3±28 mmHg with midodrine and 23.4±28 mmHg with placebo. Diastolic blood pressure fell 7.3±11.5 mmHg with midodrine and 11.1±12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine. Conclusions: Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension (Rev Méd Chile 2002; 130: 1009-13) <![CDATA[Traqueobroncomalacia en pacientes pediátricos: experiencia clínica]]> Background: Tracheobronchomalacia is characterized by a deficiency in the cartilaginous support of the trachea and bronchi and hypotony in the myoelastic elements, that lead to different levels of airway obstruction. Aim: To report our experience in the treatment of traqueobronchomalacia. Material and methods: Retrospective review of 24 patients with tracheomalacia of different levels (3 tracheobronchomalacia, 3 laryngotracheomalacia) and 8 patients with bronchomalacia. Results: The age at diagnosis ranged from 9 days to 9 years. Clinical presentation was recurrent wheezing in 19 patients, stridor in 6 and atelectasis in 4. The associated factors were neurological impairment in 8, congenital heart disease in 10 and prolonged mechanical ventilation in 4. The diagnosis was done by flexible bronchoscopy in all patients, using sedation and allowing spontaneous breathing. At the moment of diagnosis, treatment consisted in oxygen supply in 14 patients, physiotherapy in 21, beta2 adrenergic agonists in 27, racemic epinephrine in 8, mechanical ventilation in 12, ipratropium bromide in 5 and inhaled steroids in 13. After diagnosis, 24 patients received bronchodilator therapy with ipratropium bromide, 15 received racemic epinephrine and 22 received inhaled steroids. In 21, beta2 adrenergic agonists were discontinued. Thirteen patients required ventilation support and home oxygen. Twenty two patients showed a satisfactory clinical evolution and 6 patients died. Conclusions: The clinical presentation of tracheobronchomalacia is varied and diagnosis is done by flexible bronchoscopy. Treatment will depend on the severity of the disease, but beta2 adrenergic agonists should be excluded (Rev Méd Chile 2002; 130: 1014-20). <![CDATA[Comparación de susceptibilidad de especies de Shigella a antimicrobianos de uso habitual en el Hospital Regional de Temuco, Chile 1990-2001]]> Background: The permanent surveillance of antimicrobial susceptibility of Shigella sp in the Temuco Regional Hospital, allowed us to define the empirical use of antimicrobials in dysenteric syndrome. Aim: To study antimicrobial susceptibility of Shigella strains collected from 1997 to May 2001 and compare the results with those reported in 1990. Material and methods: Two hundred and seventeen Shigella strains, coming from stool cultures of pediatric patients, were studied. Results: In the period 1989-1990 Shigella flexneri was the main species isolated (83%) whereas, in the period 1997-2001, Shigella sonnei (55.8%) predominated. In the second period, an increase of antimicrobial resistance, as compared with the period 1989-1990, was observed for ampicillin (74.5 and 42% respectively), for cotrimoxazol (57.5 and 45% respectively) and tetracycline (64 and 8% respectively). Chloramphenicol resistance increased from 0 to 57.5%. In the second period no resistance to ciprofloxacin was detected. There was simultaneous resistance to four drugs in 30% of the strains, predominating multiresistance in S flexneri (52.1%). Conclusions: In the two periods studied, a significant increase was detected in the resistance of Shigella strains to antimicrobials (Rev Méd Chile 2002; 130: 1021-6). <![CDATA[Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular. Casos clínicos]]> The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions. (Rev Méd Chile 2002; 130: 1027-32) <![CDATA[Edema pulmonar relámpago (<I>flash pulmonary edema</I> ): cuando el riñón descompensa al corazón]]> Flash pulmonary edema is a paroxismal pulmonary edema associated to a hypertensive crisis, that subsides in hours with the usual therapeutic measures. It occurs in patients with renal artery stenosis. We report two male patients aged 71 and 74 years old, presenting with acute dyspnea and high blood pressure. Diffuse rales were auscultated and arterial blood pressure was high in both. Dyspnea subsided in few hours with diuretics and oxygen. In both, a critical renal arterial stenosis was found and an angioplasty with stent placement was performed. After 5 and 6 months of follow up, the patients remain asymptomatic (Rev Méd Chile 2002; 130: 1033-6). <![CDATA[Neuropatía por disulfiram: Comunicación de tres casos clínicos]]> Disulfiram is widely used for aversive treatment of alcoholism. Although it is well tolerated in most patients, one in 15,000 patients will develop peripheral neuropathy every year, which is frequently misdiagnosed as alcoholic neuropathy. Disulfiram neuropathy can be mild or severe, depending on diverse factors such as time of exposure and the dosage. Most patients will present with a motor-sensory neuropathy of the lower limbs, which tends to improve as disulfiram administration ceases, however some cases may remain with permanent sequelae. We report the clinical, laboratory and electrophysiological features of three patients who developed disulfiram neuropathy during treatment of alcoholism. Recovery was incomplete at 8 weeks after treatment cessation in all of them. No other findings justified the clinical features described in these patients. Considering the incidence of alcoholism and the wide use of disulfiram treatment in Chile, we suggest that disulfiram neuropathy is being underdiagnosed. We also stress the fact that disulfiram neuropathy could be avoided by using lower doses (Rev Méd Chile 2002; 130: 1037-42). <![CDATA[El polimorfismo genético del factor de necrosis tumoral alfa como factor de riesgo en patología]]> Cytokine unbalance is responsible for the pathogenesis of diverse inflammatory, autoimmune and infectious diseases, and Tumor Necrosis Factor Alpha (TNFalpha), among other cytokines, plays a central role. TNFalpha production can be regulated at the transcriptional, post-transcriptional, and translational levels. Variability in the promoter and coding regions of the TNFalpha gene may modulate the magnitude of its secretory response. Up to date, several single nucleotide polymorphisms (SNPs) have been identified in the human TNFalpha gene promoter. One of these, is a guanine to adenine transition at position -308, that generates the TNF1 and TNF2 alleles, respectively. The TNF2 allele is associated to a high in vitro TNF expression, and it has also been linked to an increased susceptibility and severity, for a variety of illnesses, such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, Alzheimer disease and cerebral malaria among others. It is also associated with a higher septic shock susceptibility and mortality. The investigation of polymorphisms within the TNFalpha cluster will be important in understanding the role of TNFalpha regulation in specific diseases (Rev Méd Chile 2002; 130: 1043-50). <![CDATA[Un fondo competitivo de desarrollo para el fomento de la calidad de la educación superior en Chile]]> In 1997, the Chilean Government and the International Bank for Development convened on a strategy to improve Chilean university education. It was based on quality improvement, effectiveness, relevancy and innovation on university education programs. A US$ 245 millions fund was afforded, for a five years competitive grants program, among certain traditional Universities and Technical Education Institutes. The authors reviewed the projects that won the contests during the first three years in the health area, to determine their impact, demands supported, difficulties and assets. These projects obtained 13.6% of the assigned funds (a total of US$ 16.5 millions). Funds were requested mostly to build spaces, obtain equipment, laboratories and computational support. Funds were also requested to carry out methodological changes and teaching improvements. The importance of teaching health sciences in locations outside the Metropolitan area of Santiago, the modification of undergraduate medical curriculum and the development of post graduate networks are emphasized (Rev Méd Chile 2002; 130: 1051-4). <![CDATA[Manejo actual de la acalasia del esófago: revisión crítica y experiencia clínica]]> The therapeutic options for treatment of Achalasia of the esophagus include medical treatment, endoscopic and surgical procedures. The latter can be either conservative, such as cardiomyotomy or more aggressive, such as cardioplasty or esophageal resection. In this article, we discuss the early and long term results after the different therapeutic options. We also present the results of our recent surgical experience. The definitive results seem to be better after surgical treatment compared to medical management or endoscopic procedures (Rev Méd Chile 2002; 130. 1055-66). <![CDATA[Boerhaave: una mente brillante, un carácter virtuoso]]> Hermann Boerhaave (1668-1738), a physician and humanist, is considered one of the most influential clinicians and professors of the eighteenth century. He was a medical teacher in Leiden, Holland, reaching great fame and celebrity in his city and around, extending outside of Europe into China. His contemporaries would name him "Europe's professor". He obtained his academic degrees in philosophy, chemistry and botany, but continued in medicine which more befit his nature. This brilliant man declared himself in favour of experimental knowledge instead of theory and, following Thomas Sydenham, he greatly contributed in making clinical medicine more systematic. In some extent he was the founder of academic hospitals. Boerhaave was an affectionate, cheerful and correct man, an admirable example of moderation, vigour, humbleness and devotion. In the last months of his life, suffering a painful disease, he showed his strength by letting his soul master himself, and resigned to the will of God (Rev Méd Chile 2002; 130: 1067-72). <![CDATA[<B>BIOÉTICA Y MEDICINA. ASPECTOS DE UNA RELACIÓN</B>. Dr. Fernando Lolas Stepcke. EDITORIAL BIBLIOTECA AMERICANA. 2002]]> Hermann Boerhaave (1668-1738), a physician and humanist, is considered one of the most influential clinicians and professors of the eighteenth century. He was a medical teacher in Leiden, Holland, reaching great fame and celebrity in his city and around, extending outside of Europe into China. His contemporaries would name him "Europe's professor". He obtained his academic degrees in philosophy, chemistry and botany, but continued in medicine which more befit his nature. This brilliant man declared himself in favour of experimental knowledge instead of theory and, following Thomas Sydenham, he greatly contributed in making clinical medicine more systematic. In some extent he was the founder of academic hospitals. Boerhaave was an affectionate, cheerful and correct man, an admirable example of moderation, vigour, humbleness and devotion. In the last months of his life, suffering a painful disease, he showed his strength by letting his soul master himself, and resigned to the will of God (Rev Méd Chile 2002; 130: 1067-72).