Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720040012&lang=es vol. 132 num. 12 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<B>Prevención y adherencia</B>: <B>Dos claves para el enfrentamiento de las enfermedades crónicas</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200001&lng=es&nrm=iso&tlng=es Over 50% of adults in Chile have a high cardiovascular risk. Thus, non communicable chronic diseases may surpass the capacity of the health systems. Therefore the prevention and treatment of their risk factors is urgent. Unfortunately, the low patient's compliance with prescribed treatment, reduces their efficacy. The best interventions to improve compliance with chronic treatment programs are: to simplify daily doses of medications and to do complex behavioral interventions. Risk factor prevention is a highly recommended action that has obtained promising results in Chile with the program «Mírame». To modify health behavior is also necessary to give people more power in their own care and to increase behavioral and social science contents into medical curricula (Rev Méd Chile 2004; 132: 1453-5) <![CDATA[<B>Evaluación de una maniobra nutricional tendiente a reducir los niveles de colesterol en pacientes portadores de enfermedad coronaria en el sistema público de salud chileno</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200002&lng=es&nrm=iso&tlng=es Background: The mainstay of cholesterol reduction therapy is the diet. But the lack of compliance and prescription problems limit its usefulness. Aim: To compare the effectiveness of a nutritional intervention given by a nutritionist with the usual recommendations given by a physician to reduce the LDL cholesterol levels in patients with coronary artery disease, treated at the Regional public hospital in Temuco. Material and Methods: One hundred and forty patients with coronary heart disease (last acute episode at least three months before), without nutritional interventions nor cholesterol-lowering drugs, who gave informed consent, were randomized to receive either instructions by their physician or to take part in a nutritional program. The nutritional intervention consisted in five educational sessions, adapted from the NCEP and from a program of the Nutrition Department of the Catholic University of Chile. Patients randomized to the medical intervention received the standard written recommendations about diet. Lipid profile was measured before the intervention and after a three and twelve months follow up. Results: After one year the group on the nutritional program reduced LDL cholesterol by 11.1% (p=0.03). There were no changes in the medical group. However, only 10% patients on the nutritional intervention group and 8% of those with medical recommendations achieved LDL cholesterol levels less than 100 mg/dl. There were no changes in triglycerides, weight or body mass index during the period. Conclusions: Although this nutritional intervention proved to be more effective than usual medical instructions, most patients on secondary prevention did not achieve acceptable LDL cholesterol levels (Rev Méd Chile 2004; 132: 1457-65) <![CDATA[<B>Trombofilia primaria</B>: <B>detección y manifestación clínica en 105 casos</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200003&lng=es&nrm=iso&tlng=es Background: Thrombophilia is defined as an altered hemostasis that predisposes to thrombosis. It can be primary when there is a family clustering of the disease or secondary, when it is associated to an acquired risk factor. Aim: To report clinical features in a series of patients with primary thrombophilia. Material and methods: Review of clinical records of patients with thrombotic episodes that lead to the suspicios of primary thrombophilia. Analysis of asymptomatic adult close relatives of these patients. Results: We report 93 subjects (56 females, age range 14-77 years) with repeated episodes of thrombosis and a family history of thrombosis and 12 asymptomatic close relatives. Seventy one percent had the first thrombotic episode before the age of 40 years, 62% had more than one thrombotic episode and 37% had a family history of thrombosis. Twenty four percent had protein C deficiency, 24% had antithrombin III deficiency, 18% had resistance to activated C protein by factor V Leiden, 10% had protein S deficiency, and 10% had the G20210 mutation of prothrombin gene. Among acquired defects studied simultaneously, 30% had lupus anticoagulant and 11% had hyperhomocysteinemia. Twenty four percent of cases had more than one thrombophilic risk factor. Among asymptomatic relatives, five had factor V Leiden, four had protein C deficiency and three had the G20210 mutation of prothrombin gene. Conclusions: Thrombophilia must be suspected in young subjects with thrombotic episodes and a family history. The type of coagulation defect will determine prognosis, and the type of treatment (Rev Méd Chile 2004; 132: 1466-73) <![CDATA[<B>P<SUB>450</SUB> arom y microambiente estrogénico en endometrios eutópicos de mujeres con endometriosis</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200004&lng=es&nrm=iso&tlng=es Background: Endometriosis, a common gynecologic disorder characterized by endometrial glands and stroma outside the uterus, is diagnosed by direct visualization of peritoneal and ovarian implants during laparoscopy. Aim: To study the estrogenic microenvironment in eutopic endometria of women with and without endometriosis. Patients and methods: Eutopic endometria, obtained during laparoscopy from 23 women with endometriosis and 20 fertile cyclic women undergoing tubal sterilization, was studied. P450Arom mRNA expression (RT-PCR) was measured. Also, P450Arom activity was assessed measuring testosterone conversion to estradiol and the concentration of this last hormone in cultured endometrial explants. Results: Age and body mass index was similar in both groups studied. Seventy nine percent of endometria from women with endometriosis and in 29.4% from control group expressed P450Arom mRNA (p <0.01). The intensity of the band was higher in secretory endometria from women with endometriosis when compared to controls (p <0.01), but it was similar during the proliferative phase. Estradiol secretion to the culture media by proliferative endometria explants from women with endometriosis was 3-fold higher than secretory endometria (p <0.01) and endometria from control women in both phases. P450Arom activity, in the presence of testosterone, was 7-fold higher in endometrial cultures from women with endometriosis, when compare with the basal culture (p <0.01). However, in endometrial explant cultures from control women, this activity was not statistical different. Conclusions: These results indicate that in women with endometriosis, the microenvironment in the endometria is estrogenic as a consequence of an increased expression and activity of the P450 Arom (Rev Méd Chile 2004; 132: 1475-82). <![CDATA[<B>Talla de mujeres adultas gestantes en muestras de los sistemas de salud público y privado de Chile</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200005&lng=es&nrm=iso&tlng=es Background: Adult height has increased around the world, especially in developed countries, probably due to the improvement in life conditions. Aim: To assess differences in women's height in two population samples of different socioeconomic status coming from the public and the private health system in Chile, and the influence of the year of birth on height. Material and methods: Data from 5,416 pregnant women attended in the public health system and 1,658 women attended in the private system, were analyzed. Among women attended in the private system, the association of maternal height with anthropometric indices of the newborn were also studied. Results: Mean height difference in the two systems reached 3,78 cm. The correlation coefficient of maternal height and year of birth was significant although weak in the two health systems, but mean height differences between decades of birth were significant only in the public sector: 0.7 and 1 cm in each of the two most recent decades. Association of maternal height was significant although weak, with both weight and height at birth, controlling for newborn's sex. Conclusions: Socioeconomic factors influence maternal height. Maternal height has an influence on fetal growth (Rev Méd Chile 2004; 132: 1483-8). <![CDATA[<B>Detección de micrometástasis en médula ósea de pacientes con cáncer de vesícula biliar</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200006&lng=es&nrm=iso&tlng=es Background: There is a very strong documented correlation between the appearance of cancer cells in blood and occurrence of metastasis in gastrointestinal cancer. Aim: To determine MUC1, CK19, CK20 and CEA mRNA expression in bone marrow of patients with gallbladder cancer and evaluate its clinical significance. Material and methods: Sixty eight samples were analyzed, 38 bone marrow samples of gallbladder cancer patients, 20 healthy donors, and 10 frozen samples of gallbladder cancer. Nested reverse transcriptase-polymerase chain reaction (nested RT-PCR) was used to analyze mRNA expression. Results: All frozen tumors were positive for CEA, CK19, and MUC1 mRNA and 70% were positive for CK20. Seventeen of 20 donor samples were positive for MUC1 and only one sample from donors was positive for both CK20 and CK19 mRNA. Among the 38 blood and bone marrow samples of gallbladder cancer patients, the expression of MUC1, CK19, CK20, and CEA, mRNA was 60.5% (23/38), 31.6% (12/38), 7.9% (3/38), and 7.9% (3/38), respectively. Disregarding the MUC1 results. 37% (14/38), 13% (5/38) and 5% (2/38) were positive for one, two and three markers respectively. Not significant differences were found in survival with a follow up to 12 months. Conclusion: Our results indicate that the molecular detection of tumor cells in bone marrow in patients with gallbladder carcinoma is technically possible, being CEA, CK19 and CK20 gene expression the best markers. The MUC1 gene expression marker was highly unspecific and it should not been considered. The detection of bone marrow micrometastasis might be helpful in prognosis and the selection of clinical treatment but a larger series with a longer follow-up should be studied (Rev Méd Chile 2004; 132: 1489-98). <![CDATA[<B>Trauma infanto juvenil y psicopatología adulta</B>: <B>un estudio empírico</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200007&lng=es&nrm=iso&tlng=es Background: Childhood trauma and battering have been associated with adult psychopathology. Aim: To explore the relationship between childhood trauma, somatization, post traumatic stress disorder (PTSD), affective disorder and borderline personality disorder in hospitalized patients of four Chilean hospitals. Material and methods: Five hundred five patients were screened by a short seven item trauma recollection scale (70 from San Bernardo Hospital, 193 from Salvador Hospital, 97 from El Trabajador Hospital and 147 from Curico Hospital). A random sample of 85 cases was studied in depth using the CIDI 2.1, depression, PTSD and somatization scales, Inventory of Personality Organization (IPO) and the OQ 45.2 scale. Results: Forty five percent of patients did not report traumatic experiences, 38.4% recalled one or two events and 16.3% three or more traumatic experiences. The most remembered event was physical punishment (28.7%), followed by traumatic separation from parents (27.1%), alcohol and drug use by an adult at home (22%) and presence of family violence (22%). Thirty two percent of the 85 selected cases met CIDI criteria for affective disorder, 20% for post traumatic stress disorder and 11.8% for somatization disorder. There were statistically significant correlations between the frecuence of trauma and post traumatic stress disorder (p <0.001), as well as somatization and depressive disorder (p <0.007 and 0.008). Conclusions: This study supports the concept that traumatic psychosocial environments during chilhood are a risk factor for diverse psychiatric syndromes during adulthood (Rev Méd Chile 2004; 132: - ). <![CDATA[<B>Abdomen agudo en el adulto mayor</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200008&lng=es&nrm=iso&tlng=es Background: Nearly 10% of emergency consultations are due to acute abdominal pain. In people over 65 years old, it can have atypical presentations, that retard the correct diagnosis and worsens prognosis. Aim: To study the causes, evolution and prognosis of acute abdomen in the elderly. Material and methods: Prospective study of 45 patients aged more than 65 years old (mean age ± SD, 75.7±7.7, 51% men) and 221 patients of less than 65 years old (mean age ± SD, 36.7±14.0, 48% men), consulting for acute abdomen in the emergency room. Results: Sixty six percent of elderly patients had concomitant diseases, that were multiple in 63%. In this age group, the causes accounting for 71% of acute abdominal pain were bilio-pancreatic diseases (31.1%), intestinal adhesive obstruction (17.7%), complicated abdominal wall hernia (13.7%), and complications of peptic ulcer disease (8.9%). Sixty four percent required surgical treatment and, in almost 50% the surgical risk was classified in ASA III or IV, according to the American Society of Anesthesiology. Thirty one percent had postoperative complications. Compared with their younger counterparts, elderly patients required significantly (p<0.05) more admissions to intensive care units (2.7 and 24.2% respectively), more connections to mechanical ventilation (1.4 and 8.9% respectively) and longer hospital stays (5.4±7.4 and 12.4±10.9 days, respectively). In this series overall mortality was 6.7%, being 0.6% for young patients and 11.1% for the surgical group over 65 years old. Conclusions: Acute abdomen in the elderly has a high rate of complications and mortality. According to the causes of acute abdomen in this group, evaluation in the emergency setting with an ultrasonography may be very useful. In the elderly, elective correction of potential causes of acute abdomen should be done (Rev Méd Chile 2004; 132: 1505-12) <![CDATA[<B><I>Ausencia de mutaciones del exón 10 del gen p53 en tumores tiroideos</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200009&lng=es&nrm=iso&tlng=es Background: p53 is a nuclear protein that exerts an important role in the negative control of cellular proliferation, as well as in masterminding signaling cascades important in DNA repair and/or apoptosis. Mutations of p53 have been reported with high frequency in many cancer types and are highly prevalent in poorly differentiated and undifferentiated thyroid carcinomas, but they are not found in benign tumors and are infrequent in well-differentiated cancer. Most mutations are located in exons 5-8 of the gene. Recently, a germline mutation in the seldom investigated exon 10, on codon 337 of p53 was described in Brazilian children who had adrenocortical tumors. Aim: To study codon 337 of exon 10 of p53 mutation in thyroid tumors. Material and methods: Seventy four thyroid tumors were studied (5 follicular carcinomas including 3 widely invasive, 22 papillary carcinomas including 6 tall cell variants, 11 follicular adenomas, 1 medullary carcinoma and 35 benign goiters). DNA was extracted from a central part of all tumors and contralateral normal thyroid tissue samples or blood from 38 of these patients. The products of PCR for exon 10 of p53 were examined by single strand conformation polymorphism (SSCP) analysis. We sequenced 2 samples suspected of presenting aberrant migrating bands and 3 additional PCR products from tumor samples with normal SSCP patterns but all were wild type. Results: In all samples studied, a wild type sequence was found. Conclusions: Exon 10 of p53 gene does not present mutations in thyroid tumors, suggesting that this mutation is specific of adrenocortical cancers. (Rev Méd Chile 2004; 132: 1513-6) <![CDATA[<B>Hepatocarcinoma con invasión cardiovascular</B>: <B>comunicación de 5 casos y revisión de la literatura</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200010&lng=es&nrm=iso&tlng=es The diagnosis of hepatocellular carcinoma in cirrhotic patients has increased, mainly due to early detection using newer imaging techniques. The therapeutic approach depends on the tumor staging and the liver function. Cardiac involvement has a very bad prognosis. We report three males aged 59, 75 and 76 years and two females, aged 64 and 79 years. All had cirrhosis of diverse aetiologies with hepatocellular carcinoma and tumoral invasion of the inferior vena cava and right atrium. Three patients died during hospital stay and two were discharged for conservative management at home. This rare complication has to be considered in cirrhosis (Rev Méd Chile 2004; 132: 1517-22) <![CDATA[<B>Síndrome del creciente temporal</B>: <B>Reporte de un caso y revisión de la literatura</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200011&lng=es&nrm=iso&tlng=es The temporal crescent syndrome or half-moon syndrome is a rare mono ocular retrochiasmatic visual field defect that can be correlated to a lesion along the contralateral parieto-occipital sulcus. This field defect may be missed in automated perimetry. We report a 45 years old man, consulting for sudden loss of the peripheral temporal field in his right eye. The magnetic resonance imaging and the spectroscopy studies confirmed an ischemic lesion on the left anterior occipital cortex. Control imaging studies six months later did not show changes in the lesion (Rev Méd Chile 2004; 132: 1523-6) <![CDATA[<b>¿ Pseudohipoparatiroidismo o déficit de vitamina D?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200012&lng=es&nrm=iso&tlng=es Pseudohypoparathyroidism is characterized by a resistance to parathormone, with variable phenotypical and biochemical manifestations. Its diagnosis is difficult. We report a 28 years old male presenting with a hypokalemic periodic paralysis. His serum PTH was elevated to 1,343 and 1,101 pg/ml with concomitant hypocalcemia of 7.9 and 6.7 mg/dl. Twenty four hour urinary calcium and serum 25 hydroxy vitamin D were normal. Bone mineral density was normal. The patient was managed with calcitriol in doses of 1 to 2 µg/d, associated to calcium 2 g/day. Serum calcium levels and PTH normalized after two months and six months of treatment respectively (Rev Méd Chile 2004; 132: 1527-31) <![CDATA[<B>Indicadores de gestión de servicios de salud públicos y asignación de recursos desde el Ministerio de Salud de Chile</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200013&lng=es&nrm=iso&tlng=es Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadísticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificación y Cooperación (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05%. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined (Rev Méd Chile 2004; 132: 1532-42). <![CDATA[<B>Evolución de las universidades chilenas 1981-2004</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200014&lng=es&nrm=iso&tlng=es In 1981, a supreme decree allowed the creation of private universities in Chile. As a consequence, 50 new universities were created in one decade, under the surveillance of the Council for Superior Education. This paper analyzes the evolution of this expansion process, that resulted in an admission of 370,000 students to 60 universities along the country, during 2004. At the moment, 42% of the universities, designed as traditional, receive state financing and 58% are private. Twenty six percent are owned by the state, 52% are secular and 22% are confessional. The 25 traditional universities are complex organizations of a high academic level. New private universities are only devoted to teaching and some have obtained their autonomy. Some have improved the quality of their academic staff, perform research and impart doctorate degrees. However, most are small and with a limited academic staff. Traditional universities are stratified in a superior level. Eight private universities and some regional institutions, that are becoming complex and performing research activities, are stratified in a middle level. Two thirds of the private universities are in the lower level. The expansion of superior education is a sign of the social and cultural progress that Chile has experienced (Rev Méd Chile 2004; 132: 1543-9) <![CDATA[<B>La bioética en el diván</B>: <B>¿Puede Freud ayudarnos en los dilemas de la ética médica?</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200015&lng=es&nrm=iso&tlng=es Only recently, bioethics has crystallized into a full-fledged discipline. The aim of this article is to analyze whether Freud is competent to deal with bioethics. Freudian psychoanalysis is reviewed as a global theory that touches culture as a totality. And it is by way of a global theory of culture that Freud takes up the phenomenon of morality. Freud gives not an alternative answer to unchanged questions in bioethics, but delivers a new manner of asking moral questions. The ground rule establishes the conditions for treatment. And secondly, it is a radical elimination of any position of moral existence. Ethics is simply bracketed (put in parenthesis) in the sense that in its regard no position is taken either for or against. What is at stake is self-recognition and Freudian itinerary runs from misunderstanding to recognition. If Freud offers a technique, it is not included in the cycle of techniques of domination; it is a technique of veracity (Rev Méd Chile 2004: 132: 1550-6) <![CDATA[<B>Importancia de la intención de tratar y el seguimiento en la validez interna de un estudio clínico randomizado</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200016&lng=es&nrm=iso&tlng=es Only recently, bioethics has crystallized into a full-fledged discipline. The aim of this article is to analyze whether Freud is competent to deal with bioethics. Freudian psychoanalysis is reviewed as a global theory that touches culture as a totality. And it is by way of a global theory of culture that Freud takes up the phenomenon of morality. Freud gives not an alternative answer to unchanged questions in bioethics, but delivers a new manner of asking moral questions. The ground rule establishes the conditions for treatment. And secondly, it is a radical elimination of any position of moral existence. Ethics is simply bracketed (put in parenthesis) in the sense that in its regard no position is taken either for or against. What is at stake is self-recognition and Freudian itinerary runs from misunderstanding to recognition. If Freud offers a technique, it is not included in the cycle of techniques of domination; it is a technique of veracity (Rev Méd Chile 2004: 132: 1550-6) <![CDATA[<B>Análisis crítico de un artículo</B>: <B>Critical appraisal: Band ligation and propranolol are equally effective for primary prevention of variceal bleeding. <I>Schepke M, Kleber G, Nurnberg D, Willert J, Koch L, Veltzke-Schlieker W et al; German Study Group for the Primary Prophylaxis of Variceal Bleeding. Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 2004; 40: 65-72.</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200017&lng=es&nrm=iso&tlng=es In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n=75) or PPL (n=77). The groups were well matched with respect to baseline characteristics (age 56±10 years, alcoholic etiology 51%, Child-Pugh score 7.2±1.8). The mean follow-up was 34±19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment <![CDATA[<B>¿Se puede usar morfina en pancreatitis aguda?</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001200018&lng=es&nrm=iso&tlng=es In this randomized controlled multicenter trial, we compared endoscopic variceal banding ligation (VBL) with propranolol (PPL) for primary prophylaxis of variceal bleeding. One hundred fifty-two cirrhotic patients with 2 or more esophageal varices (diameter >5 mm) without prior bleeding were randomized to VBL (n=75) or PPL (n=77). The groups were well matched with respect to baseline characteristics (age 56±10 years, alcoholic etiology 51%, Child-Pugh score 7.2±1.8). The mean follow-up was 34±19 months. Data were analyzed on an intention-to-treat basis. Neither bleeding incidence nor mortality differed significantly between the 2 groups. Variceal bleeding occurred in 25% of the VBL group and in 29% of the PPL group. The actuarial risks of bleeding after 2 years were 20% (VBL) and 18% (PPL). Fatal bleeding was observed in 12% (VBL) and 10% (PPL). It was associated with the ligation procedure in 2 patients (2.6%). Overall mortality was 45% (VBL) and 43% (PPL) with the 2-year actuarial risks being 28% (VBL) and 22% (PPL). 25% of patients withdrew from PPL treatment, 16% due to side effects. In conclusion, VBL and PPL were similarly effective for primary prophylaxis of variceal bleeding. VBL should be offered to patients who are not candidates for long-term PPL treatment