Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720030011&lang= vol. 131 num. 11 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>Microsatellite instability and allelic imbalance in neoplastic and preneoplastic gastric lesions</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100001&lng=&nrm=iso&tlng= Gastric cancer is the leading cause of cancer deaths in the general population in Chile, with mortality rates as high as 33.7 per 105 in males in the IX region. A chain of genetic and morphological events precedes the intestinal type of gastric carcinoma. One of them is the called multifocal atrophic gastritis often associated with intestinal metaplasia. Aim: To study the frequency of microsatellite instability (MSI) and loss of heterocigozity (LOH) in neoplastic and preneoplastic lesions of gastric carcinoma, especially intestinal metaplasia. Material and methods: Ninety four gastric cancer biopsies were studied using laser capture microdissection, to obtain well defined cell populations from paraffin-embedded tissues: lymphocytes (control DNA), intestinal metaplasia and gastric cancer areas. Primer flanking microsatellite 15 highly polymorphic regions were used to study MSI and LOH. Radioactive PCR products were electrophoresed and exposed for autoradiography. Results: LOH was observed in 83% of gastric carcinomas and in 54% areas containing intestinal metaplasia. The most commonly altered regions were the CA repeat associated with the p53 gene and the 3p21 region. High grade MSI was observed in 11.7% of gastric cancer preparations and 17% of intestinal metaplasia associated to cancer with MSI-H phenotype. Conclusions: MSI and LOH were frequently observed in intestinal metaplasia glands in patients with gastric carcinoma. The frequency of MSI-H phenotype in gastric patients was slightly lower than the one described in sporadic colorectal cancer not associated to HNPCC. The high incidence of genetic lesions in intestinal metaplasia area, support the idea that intestinal metaplasia is a genetically highly unstable cell population (Rev Méd Chile 2003; 131: 1227-36). <![CDATA[<I>Clinical and electrophysiological characteristics of patients with AV nodal reentry tachycardia who underwent slow pathway ablation</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100002&lng=&nrm=iso&tlng= AV nodal reentry tachycardia (AVNRT) is the most common cause of paroxysmal supraventricular tachycardia. Radiofrequency ablation is today the treatment of choice. Aim: To report our experience in patients who underwent slow pathway ablation. Patients and methods: Fifty six consecutive patients (68% female, mean age 43 years old) that underwent slow pathway ablation are reported. Results: Sixty four percent of patients had failed drug therapy. During electrophysiological study, AVNRT was induced in 55 patients. Isoproterenol was required for induction in 36%. Programmed atrial stimulation revealed dual AV nodal pathway in only 64% of the patients; 29% had AVNRT with single nodal curve and 7% only prolongation of AH interval. The slow pathway was ablated in 55 patients. One patient refused ablation because of risk of AV block. All patients had immediate success post ablation. Sixty four percent of patients persisted with partial evidence of dual curve manifested by sudden AH prolongation and single echoes. Conclusions: Isoproterenol is essential for ruling out AVNRT, since 29% of the patients had baseline single nodal curve and in only 64% was tachycardia induced without isoproterenol. Persistence of residual dual physiology does not rule out the success of ablation (Rev Méd Chile 2003; 131: 1237-42) <![CDATA[<I>Validation of the chronic respiratory questionnaire in Chilean patients with chronic airflow limitation</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100003&lng=&nrm=iso&tlng= Chronic respiratory diseases are an important problem in Chile, causing disability and worsening the quality of life. Aim: To validate the Spanish version of the Chronic Respiratory Questionnaire (CRQ) to be used in Chilean population. Material and methods: The CRQ was applied to 38 patients with chronic respiratory diseases. At the same time the functional and physiologic status of patients (the 6 Minute Walking Test and spirometry) was assessed in an independent and blinded fashion. Results: CRQ scores were associated with 6 Minute Walking Test and forced expiratory volume results (p <0.01 adjusted by age, sex and smoking). The Internal Consistency analysis showed a Cronbach a between 0.60 and 0.89. Conclusions: Considering the construct validation as an on-going process, the present results give additional evidence supporting the use of the CRQ in Chilean population to evaluate the health-related quality of life of patients with chronic respiratory diseases (Rev Méd Chile 2003; 131: 1243-50). <![CDATA[<I>Sexual function in postmenopausal women using hormone replacement therapy</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100004&lng=&nrm=iso&tlng= The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions. Aim: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI. Material and methods: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service. Results: The mean age of the sample studied was 51±5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3±5.8 in women between 45 and 49 years of age to 19.3±7.0 in women between 60 and 64 years (p <0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1±5.5 and 24.6±6.8 in HRT users and non users, respectively (p <0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction. Conclusions: Female sexuality decreases with aging. HRT users have a better sexual function than non users (Rev Méd Chile 2003; 131: 1251-55 ) <![CDATA[<I>Mental and communication disorders in Mapuche and non Mapuche elderly subjects in rural communities in southern Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100005&lng=&nrm=iso&tlng= The main predictors of functional impairment in the elderly are alterations in mental or communication functions. Aim: To study mental and communication functions in rural elderly subjects of Mapuche and non Mapuche origin. Patients and methods: Elderly subjects coming from a rural Mapuche community and a non Mapuche community were studied. Subjects were interviewed at their homes. The communication and mental function assessments of the Functional Autonomy Measurement System were applied. Results: Fifty one Mapuche and 49 non Mapuche subjects with a mean age of 71 ± 7 and 74 ± 8 years respectively, were studied. Fifty four percent were female and 31% were illiterate. Twenty six percent had impairment in mental functions. The item with the highest difficulty was memory. The visual function was the most severely impaired among communication items. Mapuche elderly subjects had significantly higher degrees of impairment in mental and communication functions. Conclusions: There is a higher degree of mental and communication impairment among rural Mapuche elderly subjects than in their non Mapuche counterparts (Rev Méd Chile 2003; 31: 1257-65) <![CDATA[<I>A ten years experience in flexible bronchoscopy in pediatric patients</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100006&lng=&nrm=iso&tlng= Approximately a decade ago, pediatric Flexible Bronchoscopy (FB) was introduced in Chile, after being used for several years in adults. Aim: To describe our clinical experience in FB in a ten years period. Patients and Methods: Records of procedures done between January 1993 and September 2002 at the Pediatric Service of the Catholic University Hospital, were retrospectively reviewed. We evaluated the clinical indications for the procedures in relation to patient's age and the correlation between indications and FB findings. Results: A total of 700 procedures were performed during the period, 59% in men and 53% in patients younger than 1 year. Seventy seven percent of procedures were done in an examination room, using a nasal approach. The main indication was visualization of the airway (49%). The most common clinical diagnosis, in descending order were: atelectasis, stridor and etiologic study of pneumonia by bronchoalveolar lavage (BAL). In children younger than 6 months the most common clinical diagnosis was stridor, followed by atelectasis. The main diagnosis in the whole sample, reached by FB was atelectasis secondary to mucous plug. In children younger than 6 months, the main diagnosis was laryngomalacia. A positive microbial culture was obtained in 43% of patients in whom BAL was done. Complications were uncommon (5%) and mostly mild. In 2.3% of cases, these were severe, such as bronchospasm and need for mechanical ventilation. Severe complications were observed in patients younger than 3 months with severe stridor or in children with cancer, who required FB and BAL. Conclusions: Flexible bronchoscopy is a safe and useful procedure in pediatric patients (Rev Méd Chile 2003; 131: 1266-72) <![CDATA[<I>Collagen and elastic fibers of skin connective tissue in patients with and without primary inguinal hernia</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100007&lng=&nrm=iso&tlng= There are few studies looking for collagen matrix defects in patients with inguinal hernia. Aim: To study the skin connective tissue in patients with and without inguinal hernia. Patients and methods: Skin from the surgical wound was obtained from 23 patients with and 23 patients without inguinal hernia. The samples were processed for conventional light microscopy. Collagen fibers were stained with Van Giesson and elastic fibers with Weigert stain. Results: Patients without hernia had compact collagen tracts homogenously distributed towards the deep dermis. In contrast, patients with hernia had zones in the dermis with thinner and disaggregated collagen tracts. Connective tissue had a lax aspect in these patients. Collagen fiber density was 52% lower in patients with hernia, compared to subjects without hernia. No differences in elastic fiber density or distribution was observed between groups. Conclusions: Patients with inguinal hernia have alterations in skin collagen fiber quality and density (Rev Méd Chile 2003; 131: 1273-79) <![CDATA[<I>Phenylketonuria diagnosed during the neonatal period and breast feeding</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100008&lng=&nrm=iso&tlng= Phenylketonuria (PKU) is due to of a defect in the phenylalanine hydroxylase gene (12q22-24.1) leading to hyperphenylalaninemia. Treatment consists in a low phenylalanine (Phe) diet. Aim: To evaluate the evolution of early diagnosed PKU children, receiving direct breast feeding, and a special formula without Phe, during their first six months of life. Patients and methods: Nineteen PKU children diagnosed in the neonatal period (19.29±13.8 days of age), treated with breast feeding and formula without Phe since diagnosis, were studied. Intake of calories, proteins and dietary Phe were quantified. Blood Phe, nutritional status and psychomotor development were also measured. Results: The diet that these children received during the 6 months period of study, had a mean of 127±19.9 Kcal/kg/day, 1.95±0.3 g protein/kg/day and 35.3±9.5 mg Phe/kg/day. Fifteen children maintained the blood level of Phe under 8 mg/dl, considered an excellent metabolic control. Only 4 cases had intermittently high levels, between 10-12 mg/dl. At 6 months of age, 74% of the children maintained breast feeding as the only source of Phe. Sixty three percent had a normal nutritional status, 5.2% were at nutritional risk and 31.6% were overweight. Eighty one percent had a normal mental development. Conclusions: The use of direct breast feeding allows a good metabolic control and improves growth and development of early diagnosed PKU children (Rev Méd Chile 2003; 131: 1280-87) <![CDATA[<I>Bone mineral density in school age infants born preterm</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100009&lng=&nrm=iso&tlng= The age at which children born preterm normalize their bone mineral density, is not well known. Aim: To study if children born preterm have normalized their bone mineral density at age 5 to 7 years. Patients and methods: Twenty six infants born preterm (14 male), were studied at age 5 to 7 years. Birth weight, present weight and height, bone age, calcium and phosphate intake at the first year of life and at the current age were assessed. Bone mineral density was measured by single photon X ray absorptiometry in the dominant forearm. A blood sample was obtained to measure insulin growth factor 1 (IGF-1). As a control group, 105 healthy age-paired infants born at term, were studied. Results: Bone mineral density was significantly lower in infants born preterm than in their term counterparts (0.273±0.01 g/cm² and 0.302±0.01 g/cm² respectively, p <0.001). There was a positive correlation between bone mineral density and IGF-1 (r=0.49, p=0.01). No correlation with the other measured parameters was observed. Conclusions: Infants that were born preterm have a lower bone mineral density at 5 to 7 years of age than their term controls. Bone mineral density correlates with IGF-1 (Rev Méd Chile 2003; 131: 1289-94). <![CDATA[<B><I>Presence of the yeast Malassezia in patients with seborrheic dermatitis and subjects without skin lesions</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100010&lng=&nrm=iso&tlng= The yeast Malassezia spp has an established etiological role in pityriasis versicolor, folliculitis, systemic infections and onychomycosis. Aim: To assess the presence of Malassezia spp in patients with seborrheic dermatitis (SD), to find a correlation between Malassezia spp count and the severity of the disease and to compare the prevalence of the different Malassezia species in SD patients and subjects without skin lesions. Patients and methods: Scrapings of the face from 81 patients with SD (69 males) and 79 subjects (54 males) without skin lesions were obtained for a direct microscope examination and yeast culture. Results: The yeast Malassezia was found in 76% of SD patients and in 82% of subjects without skin lesions. There was a positive correlation between the number of yeasts found on direct examination and the clinical severity of lesions in SD patients. Although this correlation was statistically significant (p=0.046), the degree of association (rho=0.22) was weak. Fifty Malassezia species were identified. M globosa was found in 67% of SD patients, followed by M furfur and M sympodialis, each present in 16.5% of the SD patients. In subjects without skin lesions, the most prevalent species were M globosa (77%), followed by M sympodialis (12%), M slooffiae (7%) and M furfur (4%). Conclusions: The presence of the yeast Malassezia is not associated with the presence of skin lesions (Rev Méd Chile 2003; 131: 1295-300) <![CDATA[<I>Acute liver failure in a patient with liver amyloidosis associated to multiple myeloma</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100011&lng=&nrm=iso&tlng= We report a 67 years old woman admitted to the hospital for the study of a cholestatic jaundice and massive hepatomegaly. On admission, the patient did not have liver failure. During hospital stay, the patient experienced a progressive deterioration of liver function and a monoclonal gammopathy was detected. An IgG Kappa myeloma was diagnosed. A fine needle liver biopsy disclosed the presence of amyloid. The patient developed acute liver failure and died three weeks after admission (Rev Méd Chile 2003; 131: 1301-04) <![CDATA[<I>Diabetic mastopathy</I>: <I>Report of one case</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100012&lng=&nrm=iso&tlng= Diabetic mastopathy is a rare condition that occurs in type I diabetic patients and that may mimic a breast cancer due to its intense fibrosis and inflammation. We report a 34 years old female consulting for a firm, painless and mobile retroareolar breast lump measuring 3.5 x 4 cm, that lead to the suspicion of a breast cancer. Mammography, mammary ultrasound and fine needle cytology were unspecific. A core biopsy confirmed the diagnosis of diabetic mastopathy. The patient continues under periodical assessments (Rev Méd Chile 2003; 131: 1305-08 ) <![CDATA[Combined liver-kidney transplantation: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100013&lng=&nrm=iso&tlng= End stage renal disease is not an absolute contraindication for liver transplantation (LT) in patients with end stage liver disease. Actuarial patient and graft survival are comparable for children and adults who undergo LT alone and liver-kidney transplantation (LKT). The most common indications for LKT are the primary hyperoxaluria type I (PH1) and the liver and renal polycystic disease. We report a 12 years old boy with congenital hepatic fibrosis with severe portal hypertension, encephalopathy and polycystic kidney disease with end stage renal disease on dialysis that underwent LKT. During the second postoperative week, he had a biopsy-proven acute liver and renal rejection, that had a good response to corticosteroids. Thirty days after surgery, the liver biopsy was without rejection. No other complications were observed (Rev Méd Chile 2003; 131: 1309-12) <![CDATA[<I>Antimicrobial resistance of Helicobacter pylori</I>: <I>Clinical and molecular aspects</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100014&lng=&nrm=iso&tlng= Helicobacter pylori is a relevant pathogen for gastroduodenal diseases in human beings. Although its eradication often improves gastroduodenal diseases, H pylori is acquiring an elevated rate of resistance to various antimicrobials, such as metronidazole, clarithromycin, tetracycline and amoxicillin. Multi-drug resistance is a major problem to select the appropriate treatment of infectious diseases. To improve our understanding on the com-plexity of the problem, in this article we review the resistance mechanisms and give an update on H pylori antimicrobial resistance (Rev Méd Chile 2003; 131: 1313-20) <![CDATA[<I>Potential health benefits of phytoestrogens</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100015&lng=&nrm=iso&tlng= Human diet contains a series of bioactive vegetal compounds that can improve human health. Among these, there has been a special interest for phytoestrogens. This article reviews the evidence about the potential benefits of phytoestrogens for human health. Forty eight manuscripts were selected for their study design and relevance to human health. The cell growth inhibitory effects of phytoestrogens and their implication in breast cancer are reviewed. Also the effects of these compounds on serum lipid levels and the effectiveness of a phytoestrogen derivate, ipriflavone, on the prevention of osteoporosis are analyzed. Although these compounds have a great potential for improving health, there is still not enough evidence to recommend the routine use of phytoestrogens (Rev Méd Chile 2003; 131: 1321-28) <![CDATA[<I>Bioethical Aspects of Health Care Reform in Chile</I>: <I>II. Discrimination, free election and informed consent</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100016&lng=&nrm=iso&tlng= Bioethical issues emerge each time health care reform projects are discussed. These affect diverse moral values and principles and have an impact on cultural, social and political areas. Thus, they demand more than just organizational, financial or administrative solutions. This review analyses discrimination, free election of professionals and informed consent. All three concepts are alluded in the legislative debate raised upon the actual process for health reform. Having clear ideas about these subjects is crucial to foresee the reactions expected to arise among physicians and the general public, when confronting the proposed changes (Rev Méd Chile 2003; 131: 1329-36) <![CDATA[<B><I>Fifty years of the heart-lung machine</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100017&lng=&nrm=iso&tlng= In 1953 DNA was discovered and the Everest was conquered but also a great invention was developed: the heart-lung machine, which allowed the treatment, and in many cases, the cure of most cardiovascular illnesses. In fact, on May 6, 1953 John Gibbon crowned with success the work of his entire life closing for the first time an atrial septal defect in a young woman using a heart-lung machine of his own invention. Before that, surgeons had explored other roads like hypothermia, cooling the patient in a cold water tub and then rapidly performing the surgical correction of a heart malformation. After his first success, the following 4 patients of Gibbon died, which led him to abandon heart surgery and produced a generalized pessimism about extracorporeal circulation. However, a year later Walton Lillehei reverted this situation with the introduction of controlled cross-circulation in which a patient, usually a child, was connected to a "donor", usually his father or mother, whose heart and lung served as a pump and oxigenator, allowing the performance of open heart surgery. Finally, it was Lillehei again who a year later introduced the bubble oxigenator, simple and inexpensive, opening the doors of open heart surgery to all surgeons around the world. For this, and many other reasons, Walton Lillehei is considered by most surgeons as the "Father of Open Heart Surgery". Lillehei visited Chile in 1963 and operated on a patient in the surgical theaters of the Hospital Clínico de la Universidad Católica and was named an Honorary Member of the School of Medicine of this University. Before that, in 1957 Helmut Jaeger at the Hospital Luis Calvo Mackenna performed the first successful surgical closure of an atrial septal defect with extracorporeal circulation in Chile using a De Wall-Lillehei bubble oxigenator (Rev Méd Chile 2003; 131: 1337-44) <![CDATA[<B><I>Comments on possible consequences of health reform plans in Chile</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001100018&lng=&nrm=iso&tlng= In 1953 DNA was discovered and the Everest was conquered but also a great invention was developed: the heart-lung machine, which allowed the treatment, and in many cases, the cure of most cardiovascular illnesses. In fact, on May 6, 1953 John Gibbon crowned with success the work of his entire life closing for the first time an atrial septal defect in a young woman using a heart-lung machine of his own invention. Before that, surgeons had explored other roads like hypothermia, cooling the patient in a cold water tub and then rapidly performing the surgical correction of a heart malformation. After his first success, the following 4 patients of Gibbon died, which led him to abandon heart surgery and produced a generalized pessimism about extracorporeal circulation. However, a year later Walton Lillehei reverted this situation with the introduction of controlled cross-circulation in which a patient, usually a child, was connected to a "donor", usually his father or mother, whose heart and lung served as a pump and oxigenator, allowing the performance of open heart surgery. Finally, it was Lillehei again who a year later introduced the bubble oxigenator, simple and inexpensive, opening the doors of open heart surgery to all surgeons around the world. For this, and many other reasons, Walton Lillehei is considered by most surgeons as the "Father of Open Heart Surgery". Lillehei visited Chile in 1963 and operated on a patient in the surgical theaters of the Hospital Clínico de la Universidad Católica and was named an Honorary Member of the School of Medicine of this University. Before that, in 1957 Helmut Jaeger at the Hospital Luis Calvo Mackenna performed the first successful surgical closure of an atrial septal defect with extracorporeal circulation in Chile using a De Wall-Lillehei bubble oxigenator (Rev Méd Chile 2003; 131: 1337-44)