Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720030012&lang= vol. 131 num. 12 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<B><I>Long-term results of mitral valve repair for degenerative mitral insufficiency</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200001&lng=&nrm=iso&tlng= Background: Mitral valve repair is probably the procedure of choice for the surgical treatment of degenerative mitral insufficiency. Aim: To evaluate the late results of mitral valve repair in degenerative mitral insufficiency. Patients and method: The records of 88 patients who underwent mitral valve repair for degenerative mitral insufficiency from December 1991 through June 2002 were reviewed. Mean age was 59.9 years (range 22 to 82). At least moderate mitral insufficiency was present in every patient. Mean left atrial diameter was 55 mm and mean end diastolic and end systolic left ventricular diameters were 61 and 37 mm respectively. Results: The most common underlying lesion was ruptured chordae tendineae (66%) and posterior leaflet prolapse (68%). The surgical procedure most frecuently performed was quadrilateral resection of the posterior leaflet (68%). A Carpentier-Edwards ring was placed in 97% of patients. An associated procedure was performed in 34%. Operative mortality was 2.3%. A complete follow up was obtained in 93% of cases with a mean of 54±36 months. Overall survival rate was 98% at one year, 88% at 5 and 82% at 10 years. Free of cardiac death rates were 94% at 5 and 89% at 10 years. Only 2 patients were reoperated during follow up, resulting in a 98% reoperation free rate follow up. Functional class improved in all patients at the end of follow up. Late echocardiographic evaluation showed absent or minimal mitral regurgitation in 83% and mild mitral regurgitation in 17%. Conclusion: Good late results have been obtained with mitral valve repair, avoiding the inconveniencies of prosthetic replacement. Therefore, mitral valve repair should be the procedure of choice to treat degenerative mitral insufficiency (Rev Méd Chile 2003; 131: 1355-64). <![CDATA[<B><I>Microsatellite instability and loss of heterozygosity in chronic gastritis</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200002&lng=&nrm=iso&tlng= Background: Multifocal chronic gastritis, associated to intestinal metaplasia, is considered a preneoplastic lesion, closely associated to intestinal type gastric cancer. Aim: To study the frequency of microsatellite instability (MSI) and loss of heterozygosity (LOH) in areas of chronic gastritis and intestinal metaplasia in gastric biopsies of patients without cancer. Material and methods: Gastric biopsy samples from 34 patients without cancer (22 with multifocal atrophic gastritis and 12 with diffuse antral gastritis), were studied. Glands from areas of chonic gastritis and intestinal metaplasia and lymphocytes, were collected using laser microdissection of paraffin embedded samples. The analysis of 15 mono and dinucleotide microsatellites was used to assess LOH and MSI. Results: LOH and MSI were found in some of the markers in 55% (12/22) and 59% (13/22) of cases with intestinal metaplasia, respectively. Only one of 12 areas with diffuse atrophic gastritis had MSI and a different area had LOH (p <0.05 or less, when compared with areas of multifocal atrophic gastritis). Three areas of normal epithelium in patients with multifocal atrophic gastritis, also had alterations. Most of these alterations were concordant with adjacent areas with intestinal metaplasia. Conclusions: LOH and MSI was found in areas of intestinal metaplasia in more than half of the studied cases and in few areas of atrophic gastritis without intestinal metaplasia. These findings suggest that genotypic alterations may precede phenotypic modifications and that intestinal metaplasia is a preneoplastic lesion (Rev Méd Chile 2003; 131: 1365-74). <![CDATA[<B><I>Expression of heat shock proteins HSP72 and HSP73 in Epstein-Barr positive or negative Hodgkin lymphoma</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200003&lng=&nrm=iso&tlng= Background: The expression of heat shock proteins (HSP70) in tumor cells or virus infected cells is important for the induction of specific cellular immune response. They are implicated in transport of immunodominants peptides in the endoplasmic reticulum, activation of antigen presenting cells and cross priming of CD8 T cells. Aim: To analyze the expression of HSP70 protein in its constitutive (HSP73) and inducible forms (HSP72) in Hodgkin's lymphoma (HL), infected or not by Epstein Barr virus (EBV) and to assess its relationship with pathological subtype, clinical stages and treatment response. Material and methods: The analysis of HSP73 and HSP72 was done by immunoperoxidase on routinely processed paraffin sections with prior antigen retrieval. Results: Sixty seven cases were studied. The expression of HSP73 and HSP72 was detected in 19.4 and 17.9% of samples respectively. The infiltrating lymphocytes expressed HSP72 in 58% of cases. The pathological subtypes with the higher expression in lymphocytes were mixed cellularity and nodular sclerosis. No differences in HSP70 expression were observed, according to clinical stage, treatment response or the presence of EBV. Conclusions: The expression of HSP72 on lymphocytes suggests that this protein plays an important role in the induction and amplification of anti-tumor immune response (Rev Méd Chile 2003; 131: 1375-81). <![CDATA[<B><I>Human papilloma virus (HPV) typing in preneoplastic and neoplastic lesions of the uterine cervix in the IX region-Chile</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200004&lng=&nrm=iso&tlng= Background: Uterine cervical cancer (UCC) is an important public health problem in Chile. Although HPV infection has been established as the main cause of UCC, little is known of its frequency and distribution in our population. Aim: To determine the presence and frequency of viral genotypes in uterine cervical specimens with preneoplastic and neoplastic lesions. Material and Methods: Two nested consensus PCRs followed by identification of amplified product by dot-blot hybridization and restriction fragment length polymorphism (RFLP) were used to analyze 175 biopsies. Results: Detection of HPV was 40% in cases without histological lesion, 88% in low grade lesions, 89% in high grade lesions (HGL) and 93.5% in invasive carcinoma. Of all HPV positive cases, 89.5% were classified as high risk and only a 4.9% of HPV cases were of low risk type. Six percent of cases had multiple infections. Distribution of viral genotypes according to RFLP was: HPV33 (25.3%), 16 (18.7%), 52 (13.3%), 31 (12%), 35 (6.6%), 18 (2.7%). Conclusions: Most HPV found in biopsies with HGL and UCC were of high risk genotype. The elevated presence of high risk HPV in patients without cervical lesions may be a factor that explains the high percentage of UCC cases in our region. Most common viral types were: HPV16, 31, 33 and 52. Viral detection and typing may provide valuable information for patient selection and follow up and for allocation of resources (Rev Méd Chile 2003; 131: 1382-90). <![CDATA[<B><I>Iodine nutrition in school children of four areas of Chile during the year 2001</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200005&lng=&nrm=iso&tlng= Background: In Chile, the recommendation for salt iodination was reduced from 100 to 40 ppm, after detecting high urinary iodine excretion in school age children. Aim: To assess iodine nutrition in school age children after the modification of salt iodination. Subjects and methods: Iodine nutrition was studied in 3712 school age Chilean children of primary level in 4 areas (Calama, Santiago, Temuco and Punta Arenas) through palpation of thyroid gland, urinary iodine excretion and iodine concentration in salt for human consumption of the surveyed areas. Results: A 6.4% goiter prevalence was found (5,9% in boys and 6,8% in girls). Grade Ia goiter was more common (5.0%), without detecting differences between areas (7.3% in Calama, 5.9% in Santiago, 5.9 in Temuco and 6.7 in Punta Arenas). Iodine concentration in salt for human consumption of the areas was adequate according to the recent modification of Chilean legislation (25.4 mgI/g salt in Calama, 36.2 in Santiago, 27.7 in Temuco and 33.4 in Punta Arenas). Urinary iodine excretion was very high according to recommendation in boys and girls (2838 and 2852 mgI/g salt in Calama, 700 and 837 in Santiago, 1318 and 1438 in Temuco, 407 and 312 in Punta Arenas). Conclusions: Endemic goiter is not longer a problem in Chile. Salt iodination is in agreement with present legislation. However, urinary iodine excretion increased in Calama and Temuco, did not change in Santiago and decreased only in Punta Arenas in spite of the changes in the legislation. It is necessary to investigate the causes of the high urinary iodine excretions detected in school age children, and it is very important to have a continuous surveillance of iodine nutrition in Chile (Rev Méd Chile 2003; 131: 1390-8). <![CDATA[<B><I>Frequency of C677T polymorphism of 5, 10-methylenetetrahydrofolate reductase (MTHFR) in Chilean mothers of spina bifida cases and controls</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200006&lng=&nrm=iso&tlng= Background: Several population studies have shown that patients with neural tube defects (NTD), have a higher frequency of a genetic mutation related with thermolability of the enzyme 5,10-metylentetrahydrofolate reductase (MTHFR). There are regional and ethnic variations in the genotypic or allelic frequency of this mutation and its possible relationship with NTD and others congenital anomalies. Aim: To estimate the frequency of the C677T polymorphism of MTHFR in control women and mothers of spina bifida cases. Patients and Methods: We analyzed 58 blood samples from mothers who had a child diagnosed with spina bifida. A group of 184 healthy mothers matched by age and with no NTD offspring served as controls. We determined the C677T polymorphism on the MTHFR gene by means of PCR and the analysis of the digestion pattern of HinfI restriction enzyme. Results: The genotypic frequencies showed concordance with Hardy-Weinberg equilibrium, in controls (p=0.35), and in mothers of the cases (p=0.95). The odds ratio to the TT genotype compared with the CC genotype (reference category) was estimated as 1.54 (IC 95%: 0,66-3,61), while the odds ratio for the TC genotype compared with CC genotype was 1.06 (IC 95%: 0,48-2,33). Conclusion: No differences in the C677T polymorphism of the MTHFR were observed between mothers who had a child diagnosed with spina bifida and control mothers (Rev Méd Chile 2003; 131: 1399-404). <![CDATA[<B><I>Mutations in the Fibroblast Growth Factor Receptor 3 gene (FGFR3) in Chilean patients with idiopathic short stature, hypochondroplasia and achondroplasia</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200007&lng=&nrm=iso&tlng= Background: Achondroplasia and hypochondroplasia are skeletal dysplasias of autosomal dominant inheritance that represent different degrees of severity of the same pathological entity. Both dysplasias are caused by mutations in the Fibroblast Growth Factor Receptor 3 (FGFR3) gene. In achondroplasia more than 95% of the cases studied to date carry the same mutation (G380R). Hypochondroplasia represents a greater clinical and genetic heterogeneity, possibly being confused with "idiopathic short stature". The N540K mutation has been detected in 50-70% of cases of hypochondroplasia and mutations at the 650 locus in approximately 2.8%. Aim: To assess the frequency of N540K and G380R mutations, and changes at the 650 locus in Chilean patients with idiopathic disproportionate short stature, hypochondroplasia and achondroplasia. Patients and Methods: We studied 21 patients referred for idiopathic short stature, 5 with clinically suspected hypochondroplasia and 4 with achondroplasia. The G1138A, G1138C (G380R), and C1620, C1620A (N540K) mutations and the nucleotide changes at the 650 locus were studied using PCR and restriction analysis of genomic DNA. Results: Three out of five hypochondroplasia patients were heterozygous for the N540K mutation. All of the 4 patients with achondroplasia presented the G1138A mutation. None of these mutations were found in patients with idiopathic short stature. Conclusion: Chilean patients with hypochondroplasia and achondroplasia have the same mutations described in other ethnic groups. The identification of mutations in 3 out of 5 patients with hypochondroplasia shows that this analysis is a useful tool for its diagnostic confirmation. In short stature the molecular study should only be indicated in those cases presenting other clinical and/or radiological features of hypochondroplasia (Rev Méd Chile 2003; 131: 1405-10). <![CDATA[<B><I>A diagnostic approach to hepatic abscess</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200008&lng=&nrm=iso&tlng= Background: The non invasive diagnosis of amebic liver abscess allows the use of empirical therapy without the requirement of invasive diagnostic procedures. Aim: To determine the discriminatory capacity of clinical, laboratory and ultrasound studies for the etiological diagnosis of liver abscess. Patients and methods: Sixty one patients were initially included in this prospective study, but 12 did not comply with the inclusion criteria. Of the rest, 29 (59%) had an amebic liver abscess, 16 (33%) had a pyogenic liver abscess and four (8%) had an abscess of mixed etiology. Blood cultures were done in 42 patients. Ultrasound guided needle aspiration was done in 7 patients with amebic liver abscess and 13 patients with non amebic liver abscess. Results: The clinical picture and ultrasound fndings were similar in all types of amebic abscess. ELISA test for IgG anti-Entamoeba histolytica antibodies were positive in 100% of patients with amebic liver abscess. Antibodies measured by gel diffusion were positive in 93%. All patients with mixed liver abscess had positive antibodies and some of them positive culture. Blood cultures were positive for anaerobic bacteria in five patients. Cultures of aspirated material were positive in 7 patients (obligate anaerobic bacteria in 3 and facultative anaerobic bacteria in the rest). The most common complications, whatever the etiology, were right pleural effusion and systemic inflammatory response. Conclusions: A final model of binomial regression analysis revealed that age under 40 years, an hematocrit greater than 35% and an elevation in prothrombin time of less than 1.5 seconds had enough discriminatory capacity for the diagnosis of amoebic liver abscess (Rev Méd Chile 2003; 131: 1411-20). <![CDATA[<B><I>Assessment of clinical diagnostic accuracy for skin cancer</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200009&lng=&nrm=iso&tlng= Background: There is an increase in the incidence rates of skin cancer in Chile. Aim: To study the clinical diagnostic accuracy (CDA) for skin cancer. Material y methods: CDA was defined as the percentage of agreement between clinical and pathological diagnosis. Approximately 600,000 pathological reports from five hospitals in Santiago were reviewed. A total of 2,593 skin tumours; 230 Malignant Melanoma (MM); 412 Squamous Cell Carcinoma (SCC) and 1,951 Basal Cell Carcinoma (BCC) were studied. These tumours were clinically diagnosed and surgically treated by dermatologists. The CDA was studied for each tumour, by the anatomical localization of the tumour, Breslow Index in MM, by age and sex of the patient. Results: The highest CDA was observed for BCC (76.2%); followed by MM (64.3%) and SCC (34.7%). By anatomical localization, for MM the highest CDA was observed in the soles (p <0.05); for BCC, the hightest CDA was in the face (p <0.05). No significant differences were observed in SCC. By age, for MM, the CDA was higher in patients aged less than 50 years. No differences in CDA by age were observed in the other two tumours. By sex, no differences were found. A higher CDA was found in MM with Breslow indexes III and IV than for MM with Breslow indexes I and II. Conclusions: CDA is affected by the clinical variables analyzed in this study. A more accurate clinical diagnosis of skin cancer could be obtained taking into account these variables (Rev Méd Chile 2003; 131: 1421-7). <![CDATA[<B><I>Orthostatic hypotension as an unusual manifestation of pheochromocytoma</B></I>: <B><I>Report of one case</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200010&lng=&nrm=iso&tlng= Pheochromocytoma, though an uncommon cause of hipertension, can be a lethal condition. Because of this it is mandatory to diagnose it or rule it out in presence of suggestive symptoms. Typical symptoms are palpitations, sweating, severe headaches and hypertension. However, there are other suggestive symptoms of this dangerous endocrine entity, one of which is the orthostatic hypotension. We report the case of a 65 years old female patient with long standing hypertension in whom the pheochromocytoma was suspected after episodes of orthostatic hypotension. Although this manifestation was described almost fifty years ago, its frequency and pathophysiology has not yet been well established and fully elucidated. Moreover, it has meaningful implications in relation to preoperatory management and the timing of surgery (Rev Méd Chile 2003; 131: 1429-33) <![CDATA[<B><I>Decompressive craniectomy in a patient with an herpetic encephalitis and refractory intracranial hypertension</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200011&lng=&nrm=iso&tlng= Herpetic encephalitis is the most common cause of viral encephalitis in our country. Pathological studies show progressive necrosis and edema in specific territories of the brain. The mortality of herpetic encephalitis was reduced from 70% to 20% with the use of intravenous aciclovir in the first three days of illness. However, almost 50% of patients develop a neurological deficit. One of the most important causes of death in herpetic encephalitis is the refractory intracranial hypertension. There are anecdotal reports of patients with refractory intracranial hypertension due to herpetic encephalitis that were treated with decompressive craniectomy with good results. We report a 21 years old female patient with herpetic encephalitis and refractory intracranial hypertension that was successfully treated with a decompressive craniectomy (Rev Méd Chile 2003; 131: 1434-8). <![CDATA[<B><I>Acquired aplastic anemia of the adult</B></I>: <B><I>Report of two cases</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200012&lng=&nrm=iso&tlng= Severe aplastic anemia has an elevated mortality if treatment is unsatisfactory. Immunosuppression is the treatment of choice in adults, comparable with allogeneic bone marrow transplant in children. We report two adult patients (both males, aged 59 and 67 years old) who were treated successfully with lymphoglobulin and cyclosporine. The initial response started within 3 months of treatment and was almost complete after 2 years, when cyclosporine was stopped. After three years, both patients have almost normal blood counts, with minor sequels: avascular necrosis of both femoral heads due to the use steroids, that recovered spontaneously in 1 patient and reduced vision due to thrombocytopenic retinal hemorrhages, in the other (Rev Méd Chile 2003; 131: 1439-43). <![CDATA[<B><I>Biological therapy based on the use of last generation monoclonal antibodies</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200013&lng=&nrm=iso&tlng= The fusion of a murine B cell and a myeloma cell generates a hybridoma that produces monoclonal antibody (mAb). These murine mAb induce the HAMA (human anti-mouse antibodies) response. Murine mAb have been modified by genetic engineering, producing molecules with a higher proportion of human protein. At present, chimeric, humanized and fully human mAb are available. mAb block interactions between target molecules and their ligands or trigger the lyses of mAb-coated tumor cells. Numerous mAb have been developed using the recombinant DNA technology and several are available in the market. Trastuzumab, against HER2/neu, is useful in breast cancer; rituximab, against CD20 in B lymphocytes is useful in lymphoma; alemtuzumab, against CD52 is used in lymphoma and leukemia; daclizumab and basiliximab block the IL-2 receptor interaction and reduce acute rejection in kidney transplantion; abciximab, an antagonist of GPIIb/IIIa platelet receptor, is used in patients undergoing acute coronary syndromes. In autoimmunity diseases, blocking tumor necrosis factor by infliximab and adalimumab has demonstrated excellent results. Thus, infliximab is useful in the treatment of rheumatoid arthritis (RA), Crohn's disease and ulcerative colitis while adalimumab is the first fully human mAb available for RA. Infliximab and adalimumab reduce signs and symptoms in RA and they also interfere with progression of joint damage. Finally, the direct benefits of antagonist treatment can occur at the expense of a major adverse effect in some other biological function (Rev Méd Chile 2003; 131: 1445-53). <![CDATA[<B><I>The impact of domestic violence on children's health</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200014&lng=&nrm=iso&tlng= Background: There is close association between maltreatment during pregnancy and child abuse after birth. Aim: To compare anthropometric growth and use of health services of children whose mothers suffered maltreatment with children coming from families without domestic violence. Subjects and methods: A longitudinal study of two cohorts. An index groups formed by 76 children whose mothers experienced maltreatment and control group of 46 children coming from families without domestic violence. Data was obtained from patient files in private health centers. Results: Respiratory diseases were the most prevalent cause of consultation and hospital admission. Children in the index group had a 2.8 times higher risk of bronchopneumonia in the post natal period and a poor attendance to health care controls. In four children, cerebral contusion was registered as the cause of hospital admission. Conclusions: Domestic violence is associated with a higher risk of respiratory diseases and hospital admissions in children. New strategies are necessary to detecte and prevent child abuse and neglect (Rev Méd Chile 2003; 131: 1454-62). <![CDATA[<B><I>The physician and the conflicts of interest</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200015&lng=&nrm=iso&tlng= Conflicts of interest are frequent in medical practice. They occur when a secondary interest unduly influences professional medical judgment, over and above the patients' benefit, his first real interest. Most of these secondary interests come from particular businesses of the physicians or their relationships with the industry. They may become a threat to the confidence that is established in the patient-physician relationship or to the medical profession as a whole. These conflicts of interest vary in types and magnitude and are not recognized by physicians on most occasions. Solutions are inevitably related to the honesty and integrity of each physician. Due to the absence of specific national ethical references, it is necessary to discuss the issue and conclude recommendations that guide interns, residents, clinicians, researchers, medical educators, medical and scientific associations to resolve these types of conflicts (Rev Méd Chile 2003; 131: 1463-8). <![CDATA[<B><I>On the ownership of medical records</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200016&lng=&nrm=iso&tlng= Conflicts of interest are frequent in medical practice. They occur when a secondary interest unduly influences professional medical judgment, over and above the patients' benefit, his first real interest. Most of these secondary interests come from particular businesses of the physicians or their relationships with the industry. They may become a threat to the confidence that is established in the patient-physician relationship or to the medical profession as a whole. These conflicts of interest vary in types and magnitude and are not recognized by physicians on most occasions. Solutions are inevitably related to the honesty and integrity of each physician. Due to the absence of specific national ethical references, it is necessary to discuss the issue and conclude recommendations that guide interns, residents, clinicians, researchers, medical educators, medical and scientific associations to resolve these types of conflicts (Rev Méd Chile 2003; 131: 1463-8). <![CDATA[<B><I>Pedophilia seen by endocrinologists</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200017&lng=&nrm=iso&tlng= Conflicts of interest are frequent in medical practice. They occur when a secondary interest unduly influences professional medical judgment, over and above the patients' benefit, his first real interest. Most of these secondary interests come from particular businesses of the physicians or their relationships with the industry. They may become a threat to the confidence that is established in the patient-physician relationship or to the medical profession as a whole. These conflicts of interest vary in types and magnitude and are not recognized by physicians on most occasions. Solutions are inevitably related to the honesty and integrity of each physician. Due to the absence of specific national ethical references, it is necessary to discuss the issue and conclude recommendations that guide interns, residents, clinicians, researchers, medical educators, medical and scientific associations to resolve these types of conflicts (Rev Méd Chile 2003; 131: 1463-8). https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200018&lng=&nrm=iso&tlng= <![CDATA[Etimología y Fonética Neohelénica del vocabulario médico: Autoaprendizaje mediante la práctica <B><I>Diccionario Griego-Español según la ortografía monotónica de 1982</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003001200019&lng=&nrm=iso&tlng= Conflicts of interest are frequent in medical practice. They occur when a secondary interest unduly influences professional medical judgment, over and above the patients' benefit, his first real interest. Most of these secondary interests come from particular businesses of the physicians or their relationships with the industry. They may become a threat to the confidence that is established in the patient-physician relationship or to the medical profession as a whole. These conflicts of interest vary in types and magnitude and are not recognized by physicians on most occasions. Solutions are inevitably related to the honesty and integrity of each physician. Due to the absence of specific national ethical references, it is necessary to discuss the issue and conclude recommendations that guide interns, residents, clinicians, researchers, medical educators, medical and scientific associations to resolve these types of conflicts (Rev Méd Chile 2003; 131: 1463-8).