Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720050006&lang= vol. 133 num. 6 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Intrathoracic blood volume versus pulmonary artery occlusion pressure as estimators of cardiac preload in critically ill patients</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600001&lng=&nrm=iso&tlng= Background:Monitoring of cardiac preload by determination of pulmonary artery occlusion pressure (PAOP) has been traditionally used to guide fluid therapy to optimize cardiac output (CO). Since factors such as intrathoracic pressure and ventricular compliance may modify PAOP, volumetric estimators of preload have been developed. The PiCCO system is able to measure CO and intrathoracic blood volume (ITBV) by transpulmonary thermodilution. Aim: To compare a volumetric (ITBV) versus a pressure (PAOP) determination to accurately estimate cardiac preload in severely ill patients. Patients and Methods: From June 2001 to October 2003, 22 mechanically ventilated patients with hemodynamic instability underwent hemodynamic monitoring with pulmonary artery catheter (PAC) and PiCCO system. ITBV index (ITBVI), PAOP and CI were measured simultaneously by both methods. One hundred thirty eight deltas (D) were obtained from the difference of ITBVI, PAOP, CI-PAC and CI-PiCCO between 6-12 am and 6-12 pm. Linear regression analysis of DITBVI versus Ð CI-PiCCO and Ð PAOP versus DCI-PAC were made. Results: Mean age of patients was 60.8 ± 19.4 years. APACHE II was 23.9 ± 7. Fifteen patients met criteria for acute respiratory distress syndrome (ARDS). Delta ITBVI significantly correlated with DCI-PiCCO (r=0.54; 95% confidence interval = 0.41-0.65; p <0.01). There was no correlation between DPAOP and DCI-PAC. Conclusion: ITBVI correlated better with CI than PAOP, and therefore it seems to be a more accurate estimator of preload in unstable, mechanically ventilated patients <![CDATA[<b>Free protein S (PS) in normal pregnancy</b>: <b>A comparison between two analytical methods</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600002&lng=&nrm=iso&tlng= Background: Pregnancy is a physiological hypercoagulable state with an increased incidence of thromboembolic phenomena. There is an increase in the concentrations of most clotting factors, a decrease in concentration of some of the natural anticoagulants and reduced fibrinolytic activity. Changes in PS levels have also been reported. Aim: To establish referral range values of functional PS and free PS antigen, during the second (2nd T) and third trimester (3rd T) of normal gestation. Patients and methods: Forty one normal pregnant women were included in our study, 20 during the 2nd T (22-24 weeks) and 21 during the 3rd T (29-38 weeks). Functional PS was measured by a clot based test and free PS antigen by ELISA. Results: Free PS Antigen was 65.8±18.3% during the 2nd T and 62.3±16.5% during the 3rd T. The figures for normal controls were 106±6.5%. Functional PS was 43.8±13.3 and 25.9±14.6% during the 2nd T and 3rd T, respectively. The figures for normal controls were 97±24% (p <0.001 compared with pregnant women). Free PS antigen did not change from the 2nd to the 3rd T (p=NS), however functional PS fell significantly from the 2nd to the 3rd T (p <0.001) and was significantly lower than free PS antigen in both trimesters (p <0.001). Conclusions: Pregnancy is associated to a decrease in PS. This abnormality is more pronounced for functional PS than free PS antigen and functional PS falls progressively during pregnancy. These assays should not be used to screen for PS deficiency during pregnancy because they could lead to a misdiagnosis <![CDATA[<b>Detection of human papilloma virus in cytologic samples or biopsies of the cervix</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600003&lng=&nrm=iso&tlng= Background: The DNA quality for the detection and typification of Human Papilloma Virus (HPV) varies according to the type of sample in which it is studied. This may affect the sensitivity and specificity of the method employed. Aim: To study the yield and specificity of HPV detection and typification in uterine cervical samples obtained by cervical brushing fresh frozen and formalin fixed tissue. Material and methods: Cytological, fresh frozen and fixed tissue samples from 44 patients (nine with low grade lesions and 35 with high grade lesions) were studied. Nested polymerase chain reaction for genes E6/E7 was used to typify HPV groups as low risk or high risk. Results: Of all the cytological samples obtained by brushing 84% of fixed samples and 43% of fresh frozen samples were positive for HPV. The yields were significantly different when comparing brushing with fixed tissue or fresh frozen tissue and fixed tissue with fresh frozen tissue (p <0.05). The frequency of high risk HPV fluctuated from 41% in fresh frozen tissue to 98% in cytological samples. Low risk HPV was detected in 16% of fresh frozen tissue and 68% of cytological samples. A mixed infection was detected in 66%, 41% and 14% of cytological, fresh frozen and fixed tissue samples respectively. Conclusions: Cytological samples obtained by brushing had the highest yield for the detection of cervical infection with HPV <![CDATA[<b>Detection of IgM antibodies against hepatitis E virus</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600004&lng=&nrm=iso&tlng= Background: Hepatitis E virus is the main enterically transmitted non A non B hepatitis agent. The host IgM response in the acute infection phase is short lived. Therefore, only IgG antibodies against E virus are usually investigated. Aim: To measure IgM antibodies against virus E in serum samples. Material and Methods: IgM antibodies against virus E were measured by ELISA in 35 positive and 18 negative serum samples for IgG antibodies against hepatitis virus E, without evidence of infection with hepatitis A, B or C virus. Measurement of the same antibodies in 25 additional samples positive for IgM antibodies against hepatitis A virus but without study for hepatitis virus B or C. Results: IgM antibodies against virus E were detected in 12 of the 35 samples positive for IgG antibodies (34%) and in five of the 25 samples positive for antibodies against virus A (20%). Conclusions: An acute hepatitis E virus infection was detected in 34% of samples positive for IgG antibodies against this virus. The absence of IgM antibodies in the rest of the IgG positive samples could be due to an old or a recent virus E infection in the stage of antibody titer reduction. The detection of IgM antibodies against virus E in samples positive for virus A antibodies, could be due to co infection by virus A and E or a cross reaction of assays <![CDATA[<b>Indirect cystic fibrosis carrier detection in two Chilean families by analysis of DNA polymorphisms closely linked to the CFTR gene</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600005&lng=&nrm=iso&tlng= Background: Molecular genetic analysis is the only method that allows accurate detection of Cystic Fibrosis (CF) carriers. Nevertheless, its application is restricted to those families in which the affected child holds known mutations. Since most Chilean CF patients already studied are heterozygous and carry a mutation not yet characterized, direct identification of carriers is limited. Linkage analysis of Restriction Fragment Length Polymorphisms (RFLP), using DNA markers closely linked to the CFTR gene, is a useful tool for the detection of carriers in families in which the patient carries an unknown mutation. Aim: To emphasize the usefulness of KM19 and MetH markers for RFLP analysis in extended genealogies in order to identify carriers of unknown mutations. Material and Methods: Selection of three families, in which a sibling of an index case, identified as ÐF-508/unknown mutation, could not be identified as heterozygous carrier or a normal homozygous. Haplotypic characterization for KM19 and MetH markers was performed by PCR amplification of genomic DNA followed by allele specific restriction enzymatic digestion. Results: The siblings of two families were identified as carriers and the sibling of the third family was identified as normal. Conclusions: KM19 and MetH haplotypic analysis provided a rapid method for carrier detection in the families under study. The analysis may be used as a supplement to direct genetic diagnosis and be helpful in genetic counseling <![CDATA[<b>Clinical features of patients with the pathological diagnosis of amyloidosis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600006&lng=&nrm=iso&tlng= Background: Amyloidosis is characterized by the extracellular deposit of an insoluble fibrillar protein that leads to tissue atrophy and necrosis. Aim: To report the clinical features of cases of amyloidosis diagnosed in a public hospital in Santiago, Chile, from 2000 to 2004. Material and methods: Retrospective review of all pathology reports of biopsies obtained from 2000 to 2004. In all cases reported as "amyloidosis", the clinical features of such patients were obtained from their medical records. Results: The medical records of 11 patients with amyloidosis were obtained (aged 35 to 71 year old, seven females). Seven had a systemic and four a localized disease. Six patients had primary amyloidosis and in one, it was secondary to a disseminated tuberculosis. Five patients with the generalized disease consulted for anarsarca, three for weight loss and 2 for chronic diarrhea. Patients with localized disease consulted for tonsil enlargement, dysphonia and skin lesions. Five patients with generalized disease had renal involvement and five had cardiac involvement. Three patients had malabsorption. Conclusions: The most common presentation of systemic amyloidosis is anasarca and renal involvement is common <![CDATA[<b>Sun exposure behaviors and knowledge among Chileans</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600007&lng=&nrm=iso&tlng= Background: Ultraviolet light exposure has a pathogenic effect on the development of skin cancer, whose prevalence increases worldwide. In Chile and the rest of the world, preventive educational campaigns are carried out to change high risk sun exposure behaviors. Aim: To study the behavior of the Chilean population towards skin cancer prevention and to identify erroneous preventive practices and concepts. Material and methods: A survey containing 17 questions about sun exposure behaviors, photoprotective measures and knowledge about ultraviolet radiation and skin cancer was used. It was applied during January and February 2004, to 1,143 subjects (mean age 30 years, 409 males), taking vacations in beach resorts in Chile. Results: The hours of higher sun exposure ranged from 12 AM to 4 PM. Thirty seven percent of subjects were exposed more than 2 hours during this high risk lapse. Women and subjects aged less than 25 years were those with the riskiest behaviors. Fifty four percent used some type of photoprotection and 50% used ocular protection. Seventy percent used creams with sun screen and 74% used a sun protection factor higher than 15. Seventy percent applied the sun screen as recommended. Thirty eight percent had at least one sun burn in the last two years. More than 90% of subjects were aware of the relationship between sun exposure and skin cancer but 60% did not know the hours of higher ultraviolet radiation. The information about sun exposure was obtained from television in 57% of surveyed individuals. Conclusions: More educational campaigns about the risk of sun exposure are needed to reduce risky behaviors in the Chilean population <![CDATA[<b>Features of subjects purchasing Sildenafil at community pharmacies in Concepción, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600008&lng=&nrm=iso&tlng= Background: Erectile dysfunction is a public health problem. Millions of men worldwide experience this condition, affecting their quality of life. Sildenafil, a phosphodiesterase type 5 inhibitor, is the treatment of choice for erectile dysfunction. Aim: To study the characteristics of Sildenafil use among costumers of community pharmacies in Concepcion Chile. Material and methods: A structured interview about Sildenafil use was applied to subjects purchasing the drug in community pharmacies and that consented to participate. Results: One hundred thirty eight males were studied. Forty six percent of patients were fifty years old or older. Most (47.1%) used Sildenafil for one year or more and 60.5% had no adverse events. Among those experiencing side effects, headache was experienced by 38.9%, flushing by 16.6% and gastrointestinal effects by 16.7%. Ninety percent of patients had a good evaluation of the drug in terms of benefits and tolerance. Thirty two percent of the subjects, had diseases associated to erectile dysfunction. Among these, 45% had diabetes mellitus, 29.5% had hypertension, and 18.2% had prostatic diseases. In 54% of cases, the drug was prescribed by a physician. Twenty two percent of patients experienced changes in the effect of the drug when it was simultaneously used with other drugs or meals. Thirty four percent of patients used other drugs. Among these, 43.3% were using antihypertensives, and 26.7% were using antidiabetic drugs. Conclusions: Considering the elevated age and the number of associated disease of patients using Sildenafil, the use of the drug under medical prescription must be emphasized to avoid untoward effects <![CDATA[<b>Radiofrequency ablation of ventricular tachycardia in a patient after surgery for Tetralogy of Fallot</b>: <b>Case report</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600009&lng=&nrm=iso&tlng= Ventricular tachycardia is one of the most feared complications after surgical repair of Tetralogy of Fallot and it is associated with sudden death. We report a 26 years old female with a history of surgical repair of Tetralogy of Fallot at age of 4 year-old, who developed sustained ventricular tachycardia despite antiarrhythmic drugs. She was successfully treated with radiofrequency catheter ablation. Radiofrequency catheter ablation is a valid treatment for these patients <![CDATA[<b>Rituximab (anti-CD20 monoclonal antibody) for refractory systemic lupus erythematosus</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600010&lng=&nrm=iso&tlng= New therapeutic approaches that include depletion of B cells using rituximab, a chimeric monoclonal antibody directed against the B cell specific antigen CD-20 have been developed for the treatment of systemic lupus erythematosus (SLE). We report the case of a 18 years old girl with SLE that did not respond and experienced adverse effects with the use of hydroxycloroquine, methotrexate, mycophenolate mofetil, azathioprine and high-dose steroids. Rituximab was given weekly at 375 mg/m² for four doses. The drug was well tolerated and the patient had no adverse reactions. She remains asymptomatic three months later <![CDATA[<b>Assessment of cervical cancer screening in the Health Service of Valdivia, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600011&lng=&nrm=iso&tlng= Background: One of the best Public Health achievements in Chile has been the coverage of the program for detection and treatment or cervical cancer. Aim: To evaluate the results of the Cervical Cancer Screening Program in Valdivia Health Service (Southern Chile) between 1993 and 2003. Material and methods: Retrospective review of the number of women in whom a Papanicolau smear was obtained in the last three years. The incidence of the disease was calculated using pathological diagnoses of precursor or invasive lesions. Mortality for cervical cancer was calculated using data from death certificates. Results: During 2003, 79% of women age 25 to 64 years, and 77% of women aged 35 to 63 years (considered the highest risk group) were screened. We confirmed that the number of precursor lesions detected were increased along with the increasing screening coverage. The diagnosis of carcinoma in situ increased almost three times when compared with 1990 figures. Likewise, the diagnosis of early invasive cervical cancer behaved similarly. Mortality by cervical cancer also experienced a decrease, reaching 4.6 per 100.000 women over 15 years old in the Health Service of Valdivia. Conclusions: The sustained increase in cervical cancer screening coverage has had a favorable impact in the morbidity and mortality caused by the disease <![CDATA[<b>Truth telling in medicine</b>: <b>Psychological perspective</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600012&lng=&nrm=iso&tlng= Truth telling in medicine is difficult and stressful. Medical training teaches to mitigate pain and suffering, but death and health deterioration causes feelings of frustration among physicians. Physicians tend to conceal bad news to avoid the suffering caused by such adverse information. However, veracity is an integral part of a respectful relationship and is the basis of confidence between patients and health providers. However, confusing truthfulness with a mere exposure of all the available information is an oversimplification of the problem. Therefore the real issue drifts from "how convenient is to communicate the truth" to "how to share the information with my patient" in a setting in which he can express his feeling and thoughts. Communicating the truth is an ethical imperative. The patient has the right to be informed and the physician must provide this information timely and taking into account the capacity, interest and emotional status of the patients. Therefore prudence, warmth and bioethical reasoning are required for a good medical practice <![CDATA[<b>A proposal of guidelines for surgical management of obesity</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600013&lng=&nrm=iso&tlng= Obesity is a chronic disease with an increasing prevalence in all groups of age, and is associated to increased general mortality and cardiovascular risk. The multidisciplinary non surgical approach must be the treatment of choice for obese subjects. However, the results of such approach among subjects with severe or morbid obesity, are unsatisfactory. In this group of patients, bariatric surgery and specifically gastric bypass achieves good long term results, maintaining a low body mass index, reducing complications and improving quality of life. Considering the widespread practice of bariatric surgery in Chile, the Nutrition Unit of the Ministry of Health formed a task force to propose update guidelines for the surgical treatment of obesity. These guidelines were proposed after a thorough literature review and discussion with groups that practice bariatric surgery using defined protocols. This document provides a summarized version of the guidelines. The first section discusses the background for bariatric surgery and the second part give specific recommendations for patient management and the formation of reference centers for surgical management of obesity <![CDATA[<b>Doctors' strategies to cope with the crisis in medical profession</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600014&lng=&nrm=iso&tlng= This article reviews the strategies of doctors to face the crisis perceived in medical practice. The results of a descriptive study are compared with current data in medical literature. In that preliminary report, where physicians in different settings of practice were interviewed, the authors found a great variety of strategies, from passive resignation and escape behaviors, to a proactive conduct of information search and analysis of the changes under way. All groups interviewed reported the importance of systematic reflection, the need of life options, of adopting healthy life styles and spirituality, as strategies to cope with professional frustrations <![CDATA[<b>Is there still place for conservative treatment of obesity?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600015&lng=&nrm=iso&tlng= In Chile and other countries the actual prevalence of obesity is reaching 30% in selected populations (low income women). Nowadays bariatric surgery appears to be the treatment of choice. However, it is only indicated in selected patients and is not the first line treatment, since it does not prevent or reduce the appearance of this condition, a crucial challenge in its clinical management. The contemporary medical management of obesity should include changes in lifestyle habits and diet together with a behavioral therapy. However, this optimal management requires a multidisciplinary team. A challenge for contemporary medicine is to design efficient interventional strategies to change lifestyles among the obese. These interventions are the only way to reduce the adverse health consequences of obesity <![CDATA[<b>Strategies for the surgical treatment of gallbladder cancer</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600016&lng=&nrm=iso&tlng= There is controversy in some aspects of the surgical treatment of non-mucosal gallbladder carcinoma. An accurate staging based on T (wall) involvement is crucial, otherwise understanding may yield falsely pessimistic results. The decision about the type of resection to be performed should be based on patient status (age, performance, comorbidities, etc) and tumor characteristics (histological type, vascular, neural or lymphatic spread, cell differentiation, tumor involvement of surgical margins in cystic duct, etc). For muscular (T1b) involvement, there is a great controversy about performing a simple cholecystectomy or en-block radical resection. For T2 there is consensus that an en-block radical surgery including liver resection (IVb - V) and lymphonodal clearance should be performed, since this approach has a great impact in survival. The role of surgical excision for tumors with serosal or liver involvement is controversial, due to the poor survival of these patients. However we have observed a 13% actuarial survival at 5 years, in this subset of patients <![CDATA[<b>A personal view of endocrinology in Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600017&lng=&nrm=iso&tlng= In a short historical review of the outstanding changes occurred in the whole of endocrinology and particularly in Chile over the last 60 years -with the background of an infant mortality drop from 200 per thousand in 1940 to 8 per thousand today and a mean life expectancy increase from 42 to 76 years- the author outlines major achievements in this country. He comments on the use in former days of biological tests on urine extract to measure hormones for diagnostic procedures replaced by hormone determinations in blood by radioimmunoassays; today's medication with synthetic hormones instead of opotherapeutic preparations obtained from organ extracts; the identification of new hormones, receptors and new knowledge that enables us to understand the role of neurotransmitters and neuromodulators, the interaction of neurological, endocrine and immunological systems and the involvement of stress in various diseases. Finally the description of DNA and the international cooperative project to establish the human genome map with unpredictable potential applications in medicine. The author underlines the importance of collaborative work in all branches of medicine, often making cooperation more effective than competition. The enormous expansion of biological information demands that direct application of scientific knowledge to clinical medicine is prevented as being insufficient for an optimal clinical judgment, since a bio-psychosociological perspective of the patient and the doctor's clinical experience are essential factors in the doctor-patient relationship <![CDATA[<b>ß-Lactamases other than TEM and SHV among strains of <i>Klebsiella pneumoniae</i> subsp <i>pneumoniae</i> isolated from Chilean hospitals</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600018&lng=&nrm=iso&tlng= In a short historical review of the outstanding changes occurred in the whole of endocrinology and particularly in Chile over the last 60 years -with the background of an infant mortality drop from 200 per thousand in 1940 to 8 per thousand today and a mean life expectancy increase from 42 to 76 years- the author outlines major achievements in this country. He comments on the use in former days of biological tests on urine extract to measure hormones for diagnostic procedures replaced by hormone determinations in blood by radioimmunoassays; today's medication with synthetic hormones instead of opotherapeutic preparations obtained from organ extracts; the identification of new hormones, receptors and new knowledge that enables us to understand the role of neurotransmitters and neuromodulators, the interaction of neurological, endocrine and immunological systems and the involvement of stress in various diseases. Finally the description of DNA and the international cooperative project to establish the human genome map with unpredictable potential applications in medicine. The author underlines the importance of collaborative work in all branches of medicine, often making cooperation more effective than competition. The enormous expansion of biological information demands that direct application of scientific knowledge to clinical medicine is prevented as being insufficient for an optimal clinical judgment, since a bio-psychosociological perspective of the patient and the doctor's clinical experience are essential factors in the doctor-patient relationship <![CDATA[<b>A national birth weight distribution curve according to gestational age in Chile from 1993 to 2000</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600019&lng=&nrm=iso&tlng= In a short historical review of the outstanding changes occurred in the whole of endocrinology and particularly in Chile over the last 60 years -with the background of an infant mortality drop from 200 per thousand in 1940 to 8 per thousand today and a mean life expectancy increase from 42 to 76 years- the author outlines major achievements in this country. He comments on the use in former days of biological tests on urine extract to measure hormones for diagnostic procedures replaced by hormone determinations in blood by radioimmunoassays; today's medication with synthetic hormones instead of opotherapeutic preparations obtained from organ extracts; the identification of new hormones, receptors and new knowledge that enables us to understand the role of neurotransmitters and neuromodulators, the interaction of neurological, endocrine and immunological systems and the involvement of stress in various diseases. Finally the description of DNA and the international cooperative project to establish the human genome map with unpredictable potential applications in medicine. The author underlines the importance of collaborative work in all branches of medicine, often making cooperation more effective than competition. The enormous expansion of biological information demands that direct application of scientific knowledge to clinical medicine is prevented as being insufficient for an optimal clinical judgment, since a bio-psychosociological perspective of the patient and the doctor's clinical experience are essential factors in the doctor-patient relationship