Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720060003&lang= vol. 134 num. 3 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Pathogenic role of PTEN tumor suppressor gene in ovarian cancer associated to endometriosis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300001&lng=&nrm=iso&tlng= Background: Endometrioid carcinoma and clear cell carcinoma of the ovary are associated to endometriosis. Somatic mutations of PTEN (10q23.3) are present in endometrial endometrioid carcinoma. Therefore, these mutations could be also present in ovarian tumors. Molecular studies show that solitary endometriotic cysts are monoclonal, have aneuploid DNA, have a loss of 9p,11q and 22q heterozygosity (LOH) and a higher cellular proliferation index of the epithelial component. Aim: To determine the cellular proliferation index using Ki 67, the immunohistochemical expression of PTEN and LOH in patients with ovarian endometriosis without atypia (EN), ovarian endometriosis with atypia (EA) and endometriosis with adjacent ovarian carcinoma (ET). Material and methods: Paraffin embedded samples of 37 endometrioid and clear cell carcinomas of the ovary (CC/CE), 15 solitary ovarian EN and 15 ovarian EA, were studied. Expression of Ki 67 and PTEN was measured by immunohistochemistry. LOH of 10q23.3 locus was measured by polymerase chain reaction. Results: Ki 67 was 5.5 and 2.3% in EA and EN, respectively (p <0.005). There was a histological correlation between EA and a higher cellular proliferation index. PTEN was negative in 5 of 15 EN, 9 of 15 EA and 30 of 37 CE/CC. There was a correlation between LOH and loss of PTEN protein in EN, EA and ET (60%). Conclusions: Negative expression on PTEN in EN; EA; ET and CE/CC is a manifestation of the inactivation of this gene. The mechanisms that cause this inactivation, must be elucidated <![CDATA[<b>Effect of oral zinc administration on insulin sensitivity, leptin and androgens in obese males</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300002&lng=&nrm=iso&tlng= Background: Zinc is important for insulin synthesis, storage and secretion. When zinc concentration decrease, there is a concomitant reduction in insulin secretion and peripheral insulin sensitivity Aim: To assess the effects of zinc sulfate on insulin sensitivity, leptin and androgens in obese individuals. Material and methods: A randomized, double-blind, placebo-controlled clinical trial was performed in 14 obese volunteers between 21 and 30 years old, with body mass index (BMI) ³ 27 kg/m2. During one month, seven subjects received 100 mg/day of zinc sulfate orally (ZnG) and the other seven received placebo, as control group (CG). At baseline and after the intervention, insulin sensitivity was measured using a euglycemic-hyperinsulinemic clamp technique. Blood glucose, serum lipids, zinc, androgens and leptin were also measured in a fasting blood sample. Results: After the intervention, a rise in zinc concentrations from 11.8 to 16.9 umol/L; p=0.001 and in leptin levels from 15.2 to 27.7 ng/mL; p=0.029, was observed in the ZnG. No changes were observed in the CG. There were no significant changes in insulin sensitivity and androgens after the intervention with zinc sulfate. Conclusions: Zinc increased the leptin concentrations in obese individuals, but did not modify insulin sensitivity and androgens <![CDATA[<b>Effects of gastric <i>bypass</i> on erosive esophagitis in obese subjects</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300003&lng=&nrm=iso&tlng= Background: Obesity is an important risk for pathological gastroesophageal reflux. Aim: To assess the effects of gastric bypass on obese subjects with erosive esophagitis. Patients and methods: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus. Results: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up. Conclusions: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity <![CDATA[<b>Esophageal manometry in patients with non cardiac chest pain</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300004&lng=&nrm=iso&tlng= Background: Non cardiac chest pain can be caused by esophageal problems such as gastroesophageal reflux or smooth muscle motor disorders. Aim: To perform esophageal manometry in patients with non cardiac chest pain. Material and methods: One hundred patients with chest pain in whom coronary problems were discarded, were studied. A computerized esophageal manometry was performed in all and 24 hours esophageal pH measurement was done in 21 patients. Results: Esophageal manometry was normal in eight patients. Nutcracker esophagus was the most common finding, in 36 patients. Twenty eight had a hypotensive sphincter, 16 had unspecific motor disorders, nine had diffuse esophageal spasm, two had a non achalasic esophageal aperistalsis and one had a hypertensive sphincter. Conclusions: Only eight of 100 patients referred to esophageal manometry for non cardiac chest pain, had a normal study <![CDATA[<b>Brain natriuretic peptide in primary pulmonary hypertension</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300005&lng=&nrm=iso&tlng= Background: Primary pulmonary hipertension (PPH) is a progressive disease leading to right heart failure and death. Right heart catherization and maximal or submaximal tests are employed to assess the course of the disease. A neurohormonal parameter such as pro-brain natriuretic peptide (BNP) would be helpful in the assessment of these patients. Aim: To study the correlation of BNP with functional status and non-invasive hemodynamic determinations in patients with PPH. Material and methods: Twelve patients (mean age: 48 years; 58% female) were evaluated with 6 minutes walk distance test (6-min WT), plasma BNP, systolic pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and cardiac output (CO) determined by echocardiogram. Plasma BNP levels were compared with normal subjects. Results: BNP levels were increased in PPH patients (1270±547 vs 48±8 pg/ml, p-value <0.01). Mean PAPs was 82±27 mmHg and the mean distance walked in 6 minutes was 407±113 meters. BNP levels were positively correlated with PVR (r=0.58, p-value=0.006) and negatively correlated with 6-min WT (r=-0.83, p-value <0.001). No correlation was found between BNP levels, PAPs and CO. Conclusions: In PPH patients, BNP levels are increased and correlate with functional class and PVR. Follow-up studies are needed to evaluate the role of BNP as a marker of progression and therapeutic response in PPH patients <![CDATA[<b>Renal scars after one year of follow up in children with a first episode of acute pyelonephritis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300006&lng=&nrm=iso&tlng= Background: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. Aim: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. Patients and methods: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. Results: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. Conclusions: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up <![CDATA[<b>Lack of assertiveness in patients with eating disorders</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300007&lng=&nrm=iso&tlng= Background: Low self-assertion has been noted as an important feature among patients with eating disorders. Aim: To verify, in a female population, if assertiveness is related or has a predictive capacity for the development of eating disorders. Subjects and methods: An structured clinical interview, the Eating Attitudes Test (EAT-40) and the Rathus Assertiveness Scale (RAS) were administered to 62 patients that fulfilled the DSM-IV diagnostic criteria for eating disorders and to 120 female students without eating problems. Results: Patients with eating disorders ranked significantly higher on the EAT-40 and its factors (p <0.001) and showed a lower level of assertiveness on the RAS (p <0.001). Assertiveness measured by RAS and its factors was inversely related to EAT-40 and its items (r= -0.21). The predictive capability of the lack of self-assertion in the development of an eating disorder reached 53%, when patients with eating disorders and subjects at risk were considered together and compared to students without such disorder. Conclusions: Lack of assertiveness is a significant trait in patients with eating disorders; it may worsen its outcome and even perpetuate symptoms. Low self-assertion may be considered a predictive factor in the development of an eating disorder and must be managed from a preventive or therapeutic point of view <![CDATA[<b>Infliximab in the treatment of patients with Crohn's disease</b>: <b>Preliminary report</b> ]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300008&lng=&nrm=iso&tlng= Background: Tumor necrosis factor alpha, interleukin 6 and 1 have a pathogenic role in Crohn's disease. Infliximab, a monoclonal antibody against tumor necrosis factor, is useful in the treatment of Crohn's disease, specially when the disease is active and associated to fistula formation. Aim: To assess the effectiveness of Infliximab in patients with Crohn's disease. Material and methods: Twelve patients with Crohn's disease (aged 16 to 63 years, 10 women) refractory to treatment with steroid, 5-aminosalicylic acid, antimicrobials and immunomodulatory drugs, were studied. A single intravenous 5 mg/kg dose Infliximab was administered. The Crohn's disease activity index (CDAI) was measured before and one week after the administration of the drug. Results: CDAI before and after Infliximab administration was 357±62 and 138±122 score points, respectively (p <0.005). According to this score, five patients had a severe and seven a moderate disease flare. The disease remitted in 7 (58%) and a clinical response was observed in 75%. Conclusions: A single dose of Infliximab was effective to induce remission of the disease in 75% of this selected group of patients with Crohn's disease <![CDATA[<b>Efficacy of infliximab in patients with moderate and severe psoriasis treated with infliximab (Remicade<sup>®</sup>)</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300009&lng=&nrm=iso&tlng= Background: Psoriasis has a moderate or severe course in 25% of patients, requiring systemic therapy that is not always successful. Infliximab is a human-murine monoclonal anti tumor necrosis alpha (TNF-a) antibody. This mediator has a role in the pathogenesis of psoriasis. Aim: To evaluate the use of infliximab in psoriatic patients resistant to conventional therapies. Material and Methods: An open prospective study including eight patients with extensive plaque or erythrodermic psoriasis. They were treated with infliximab 5 mg/kg/dose on weeks 0,2 and 6. Patients were evaluated every 2 weeks for a median lapse of 50.1 weeks. Physical examination, PASI scores (Psoriasis Area Severity Index) and a photographic control, were done in each visit. Results: All the patients responded in the first 10 weeks of follow-up. The mean reduction in PASI score was 86.6%. Six patients received fourth infusion of infliximab at 37.3 weeks, on average. The most common adverse events were pruritus and headache. Conclusions: This group of patients with extensive plaque or erythrodermic psoriasis resistant to conventional therapies, had a good response to infliximab <![CDATA[<b>Identification of infectious agents in cases suspicious of Hantavirus infection but with negative serology</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300010&lng=&nrm=iso&tlng= Background: The diagnosis of acute respiratory illness caused by Hantavirus is based in the rapid and progressive clinical course, epidemiological background and the serological confirmation of the virus. When the presence of the virus is not confirmed a differential diagnosis must be made with other infections. Between 1999 and 2001, the Chilean Public Health Institute received 1063 blood samples from patients with a suspicious clinical picture, to study the presence of Andes strain of Hantavirus. In 134 of these samples, the presence of the virus was confirmed. Aim: To study the presence of other infections in sera from patients with suspected Hantavirus acute respiratory illness but serologically negative for Hantavirus. Material and methods: A retrospective study of 98 serum samples, received at the National Public Health Institute, of patients with negative serology for Hantavirus. The presence of antibodies against influenza virus, Mycoplasma pneumoniae, Leptospira and Streptococcus pneumoniae was determined using Latex techniques. Results: Leptospira was detected in 23 patients, influenza virus in 13, Streptococcus pneumoniae in six and Mycoplasma pneumoniae in one case. Leptospira infections were confirmed in four cases by ELISA determination of IgM antibodies. Influenza virus infection was confirmed in three cases by Hemmaglutation Inhibition Assay. Conclusions: In suspected cases of Hantavirus acute respiratory infection, but with negative serology, other infectious agents such as Leptospira, influenza virus and Streptococcus pneumoniae, must be sought <![CDATA[<b>Pyoderma gangrenosum</b>: <b>Report of three cases in plastic surgery</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300011&lng=&nrm=iso&tlng= Pyoderma Gangrenosum is a rare disease whose etiology is probably autoimmune. We report two males aged 48 and 49 years and one female aged 54 years, with lesions in the right thigh, right leg and in the borders of a surgical incision in the chest. This article gives a brief description of the lesions, tips for diagnosis and help for the initial management and treatment <![CDATA[<b>Ascites and renal failure caused by a bladder fistula</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300012&lng=&nrm=iso&tlng= Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized <![CDATA[<b>Thrombotic thrombocytopenic purpura with neurological involvement</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300013&lng=&nrm=iso&tlng= Neurological manifestations, secondary to perfusion problems, vasogenic edema or small infarcts, are common in thrombotic purpura. Moreover, they are the first symptoms of the disease in 50% of patients. We report a 50 year-old woman who presented with focal intermittent neurological signs with aphasia and right hemiparesis, who then developed progressive impairment of consciousness with stupor and generalized tonic-clonic seizures. Despite the severe neurological impairment, first neuroimaging studies were normal. A second magnetic resonance imaging showed small cortical infarcts, that were visible only with the technique of diffusion weighted imaging. The standard electroencephalograms showed focal left temporal slowing and low voltage first and then diffuse slowing accordind to the clinical condition of the patients. She was treated with plasmapheresis and had a partial neurological recovery at the fifth day, but died at the twelfth day of therapy <![CDATA[<b>Application of marketing strategies for the management of public hospitals from the viewpoint of the staff members</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300014&lng=&nrm=iso&tlng= Background: The implementation of the marketing strategies in public hospitals provides management advantages and improves the relationship between customers and staff. Aim: To analyze the application of marketing strategies in a public hospital, from the perspective of the staff. Material and methods: A structured survey that asked about perceptions in 50 items about communication between personnel and customers/users, customer satisfaction, participation in the development of new policies and incentives for efficiency was applied to a stratified sample of the staff. Factorial and regression analyses were performed to define the impact of marketing strategies on the degree of preoccupation and orientation of the organization towards the satisfaction of customer needs. Results: The survey was applied to 74 males and 122 females. The survey showed that the orientation of the hospital towards the satisfaction of its beneficiaries basically depends on the generation of an organizational culture oriented towards them and the implementation of adequate policies in staff management and quality of service. These basic aspects can be accompanied with practices associated to the new marketing approaches such as a market orientation, customer orientation and relational marketing. All these factors presented positive and significant relations. Conclusions: New marketing strategies should be applied, to achieve an efficient and customer oriented hospital management <![CDATA[<b>Improving the management of celiac disease</b>: <b>An urgent challenge</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300015&lng=&nrm=iso&tlng= Anti endomysial and anti transglutaminase (EMA/TTG) antibodies measurements in large population groups, show that celiac disease is significantly more common than previously thought and 0.5-1% of the population suffer this condition. The recognition of atypical clinical presentations by active screening of high risk groups is a successful global initiative. In Chile there is little awareness of the enormous changes occurred in this field. Available national information on typical presentation of the disease shows that it is found in 1:1836 live births, figure that is comparable to European societies. Two urgent tasks are required in our country. First, to asses the Chilean population using EMA and/or TTG. Second, to improve the legal aspects that regulate consumer information about gluten content in processed foods. We here review the most relevant aspects to be considered to improve the management of celiac patients and the tasks that require the participation of health authorities for their implementation <![CDATA[<b>Cystic fibrosis</b>: <b>facing patient transition from the pediatrician to the internist</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300016&lng=&nrm=iso&tlng= The increased survival of patients with cystic fibrosis (CF) resulted in the appearance of new pulmonary and non-pulmonary complications. Even though subjects with CF present with inflammatory pulmonary changes at birth, several pathogens such as Staphyloccocus aureus, Haemophilus influenzae and Pseudomona aeruginosa contribute to the progression of pulmonary injury. Clinical presentations vary according to patient age; even though mild forms exist, patients with severe forms, develop respiratory insufficiency and end-stage disease at an early stage. Today, new diagnostic and therapeutic tools, increase the possibility of an early diagnosis and of greater survival. Successful management will depend on the timely selection of adequate antimicrobials, the use of pancreatic enzyme supplementation and early institution to respiratory physiotherapy. The transition from pediatric care to adult care must occur according to development of each patient. This timing must be flexible and there should be a constant communication and coordination within the different specialists in internal medicine. Thus, it is crucial to recognize the disease progression as a continuous process, giving the appropriate physiologic support and evaluating the needs of the patient and close relatives <![CDATA[<b>Fatty acid binding protein 2 (FABP-2) polymorphism, obesity and insulin resistance</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300017&lng=&nrm=iso&tlng= The genetic components of insulin-resistance, diabetes and obesity have been largely studied. These conditions are determined by multiple polygenic and environmental factors. Certain candidate genes, that have common functional variants in the general population, may be important determinants of inter-individual differences in the response to dietary changes. This review focuses in one of the major candidate genes, the gene encoding for the FABP2, an intracellular protein expressed only in the intestine, involved in the absorption and intracellular transport of dietary long chain fatty acids. Carriers of the Thr54 allele in FABP2 have a 2-fold greater affinity for long chain fatty acids than Ala54 carriers. The increased flux of dietary fatty acids (FA) into the circulation, among carriers of FABP2 Ala54Thr, supports a role of the polymorphism of this allele in the etiology of metabolic disorders. The frequencies of the polymorphism in different populations fluctuate between 18% and 40%. FABP2 Ala54Thr variant has been associated with an increased fasting insulin concentration, fasting fatty acid oxidation and reduced glucose uptake. This evidence, although not conclusive, sustains an association between FABP-2 genotype and metabolic abnormalities <![CDATA[<b>Medical professionalism</b>: <b>Historical and religious aspects</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300018&lng=&nrm=iso&tlng= The essence of the medical profession resides in the medical act, whereupon a sick human being meets another with the power to heal him or her. The source of this power has evolved from the divinity itself through magic to science or acquired knowledge. This power implies acknowledgement of values that are inherent to the profession as well as responsibility toward one's own conscience and toward society, elements considered constitutive of what we now call professionalism. From antiquity these principles have evolved into behavioral codes containing variable components according to the different ages and cultures, but also permenent core values such as respect for life, altruism, and honesty, among others. Scientific and technological advances have magnified medical power but at the same time they have required that the philosophical and ethical principles that ought to inform professional practice be made explicit. This happens at a time when certitudes are questioned or abandoned, relativism and secularism pervade culture, and traditional medical values are challenged. Therefore, consensus attainment appears for some as the only legitimation of the ethics of professional medical acts, while for others the ancestral principles and values of medicine have permanent validity as objective goods based on the dignity of the human person <![CDATA[<b>Communicating evidence to the patients</b>: <b>Physicians as risk communicators</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300019&lng=&nrm=iso&tlng= The essence of the medical profession resides in the medical act, whereupon a sick human being meets another with the power to heal him or her. The source of this power has evolved from the divinity itself through magic to science or acquired knowledge. This power implies acknowledgement of values that are inherent to the profession as well as responsibility toward one's own conscience and toward society, elements considered constitutive of what we now call professionalism. From antiquity these principles have evolved into behavioral codes containing variable components according to the different ages and cultures, but also permenent core values such as respect for life, altruism, and honesty, among others. Scientific and technological advances have magnified medical power but at the same time they have required that the philosophical and ethical principles that ought to inform professional practice be made explicit. This happens at a time when certitudes are questioned or abandoned, relativism and secularism pervade culture, and traditional medical values are challenged. Therefore, consensus attainment appears for some as the only legitimation of the ethics of professional medical acts, while for others the ancestral principles and values of medicine have permanent validity as objective goods based on the dignity of the human person <![CDATA[Critical appraisal: Intensive lipid lowering with atorvastatin in patients with stable coronary disease]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300020&lng=&nrm=iso&tlng= Abstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). Methods: A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P <0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P <0.001). There was no difference between the two treatment groups in overall mortality. Conclusions: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels <![CDATA[<b>Student's scientific journals in Latinamerica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300021&lng=&nrm=iso&tlng= Abstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). Methods: A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P <0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P <0.001). There was no difference between the two treatment groups in overall mortality. Conclusions: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels <![CDATA[<b>Fe de Erratum</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000300022&lng=&nrm=iso&tlng= Abstract: Previous trials have demonstrated that lowering low-density lipoprotein (LDL) cholesterol levels below currently recommended levels is beneficial in patients with acute coronary syndromes. We prospectively assessed the efficacy and safety of lowering LDL cholesterol levels below 100 mg per deciliter (2.6 mmol per liter) in patients with stable coronary heart disease (CHD). Methods: A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day. Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results: The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P <0.001). A primary event occurred in 434 patients (8.7 percent) receiving 80 mg of atorvastatin, as compared with 548 patients (10.9 percent) receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P <0.001). There was no difference between the two treatment groups in overall mortality. Conclusions: Intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day. This occurred with a greater incidence of elevated aminotransferase levels