Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720080003&lang=pt vol. 136 num. 3 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b><i>Assessment and follow up of diabetic patients in hemodialysis</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300001&lng=pt&nrm=iso&tlng=pt Background: Despite a better management of the variables that influence the development of diabetic nephropathy there is a progressive increase in the prevalence of terminal renal failure among diabetics, whose cause is not clear. Aim: To study in a group of patients in hemodialysis, the quality of diabetes control previous to the entry to dialysis, their physical condition and their evolution. Material and methods: Diabetic patients with at least three months of hemodialysis answered a questionnaire about diabetes control quality previous to dialysis and had physical and laboratory assessment. They were followed for at least four years thereafter. Results: Fifty seven patients aged 62±11 years were studied. Eighty four percent had some degree of disability. Eighty seven percent had high blood pressure and 73% had to enter dialysis as an emergency. Mean glycosilated hemoglobin was 7.7% and 58% had a dialysis dose with a Kt/Vofless than 1.2. Fifty eight percent died during follow up. No relationship between mortality and age, blood pressure, glycosilated hemoglobin of Kt/V, was observed. Conclusions: There is an inadequate management of blood glucose and blood pressure of diabetic patients before entry to dialysis. They are referred ¡ate to the nephrologist, the dialysis dose is insufficient and they have a high mortality <![CDATA[<b><i>Cardiac myxoma</i></b>: <b><i>Clinical characterization, diagnostic methods and late surgical results</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300002&lng=pt&nrm=iso&tlng=pt Background: Cardiac myxoma is the most common primary cardiac tumor. Aim: To evaluate clinical aspects, diagnostic methods and surgical outcomes in patients with cardiac myxoma. Patients and Methods: AH patients who underwent surgical resection of a cardiac myxoma between January 1973 and December 2004 at our institution, were identified and their medical records and diagnostic data reviewed. Results: Thirty seven patients identified (24 women), with a median age of 54 years (range 2-74). The most common symptom was dyspnea (51%), followed by embolism (24%) and cardiac murmurs (16%). The diagnosis was made by echocardiogram in 84% of patients. The mean tumor size was 4.9 ± 1.3 cm. The tumor was located in the ¡eft atrium in 83% of the patients, right atrium in 8% and ¡eft ventricle in 3%. Two patients had multiple tumors. Surgical approach was transeptal in 51%, left atriotomy in 22%, combined transeptal and roof of the left atrium in 19% and right atriotomy in 8%. The tumor and its attachment base were excised in one piece. There were two operative deaths and five late deaths. The mean follow-up was 11.5 years. The 5, 10, 15 and 20 years survival was 89%, 83%, 75% and 64%, respectively. Two patients had recurrence (5.4%), at 2 and 25years after surgery, respectively, and the recurrence free survival at 10 and 25years was 97% and 73%, respectively. Conclusions: Dyspnea was the most common symptom and echocardiogram the main diagnostic method. Surgical treatment was highly effective, with low mortality and recurrence rate, with good long term survival <![CDATA[<b><i>Diagnosis and clinical presentations of celiac disease</i></b>: <b><i>A multicenter study</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300003&lng=pt&nrm=iso&tlng=pt Background: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed <![CDATA[<b><i>Accompanying a patient as an experience to learn the meaning of disease</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300004&lng=pt&nrm=iso&tlng=pt Background: Due to technical advances and progressive specialization, patient physician relationship evolved from being based on confidence and comprehension to be impersonal and contractual. Aim: To evaluate the change produced in medical students' concept of the meaning of disease, after living an experience of accompanying a patient and their family environment. Material and methods: We used a qualitative research methodology based on participative-action to evaluate an educational method in which a group of third year medical students accompanied a previously selected chronic patient during two months. We performed two focal groups, one previous to the experience and the second one a month later. Additionally, every student wrote a personal narration of the experience. We compared the students' perception of the meaning of disease for the patients and their relatives, before and after the experience. Results: The students confirmed their previous conception about chronic disease, but they also discovered the ways in which some patients and their families overcome their ¡imitations. They pointed out their belief that the physician's comprehension of the meaning of disease for the patient and the family, a need to practice a good medicine and that this knowledge change the physician-patient relationship. Conclusions: This experience was an effective way of ¡earning the meaning of disease, which might be a part of medical student' training, with the corresponding adjustments and changes <![CDATA[<b><i>Diagnosis and management of colon perforation after colonoscopy</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300005&lng=pt&nrm=iso&tlng=pt Background: Colon perforation is an uncommon but feared complication of colonoscopy. The treatment is usually surgical but occasionally it does not require an operation. Aim: To report our experience in the diagnosis and management of colon perforation after colonoscopy. Material and methods: Retrospective review of the database of 11,720 colonoscopies. The medical records of those patients that had a perforation were reviewed. Results: Twelve perforations in patients aged 26 to 92 years (six women), were identified with a global perforation rate of 0.1%. Five occurred during diagnostic and seven during therapeutic procedures. All perforations were confirmed by a plain X ray or CT scan of the abdomen. Four patients, without signs of initial diffuse peritoneal irritation, were medically treated. One of these, finally required surgery. Among operated patients, a primary suture was done in five, a primary excision without colostomy in three and a Hartmann procedure due to a severe peritoneal contamination in one. No patient died. Conclusions: There is a higher risk of colon perforation during therapeutic colonoscopies. Selected cases may be safely treated without surgery <![CDATA[<b><i>Family influence as a protective factor against risk behaviors in Chilean adolescents</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300006&lng=pt&nrm=iso&tlng=pt Background: Family is an important protective factor in the prevention of risk behaviors in Chilean adolescents. Aim To determine the prevalence of risk and protective factors and behaviors in Chilean students, and to study the association between family functioning and adolescent risk behaviors. Material and methods: Descriptive cross sectional study of 815 adolescents aged 15 ± 2 years (51% male), studying 7th to 12th grade in three educational facilities in Santiago, Chile. They answered the Adolescent Risk Behavior Score, adapted from the Adolescent Health Survey and the "How is your family" survey of the Pan American Health Organization. Results: Tobacco, alcohol and marihuana consumption was reported by 31%, 27% and 24% of students, respectively. Twelve percent reported being sad all the time, 23% being desperate and 13% being anxious. Forty four percent have had a sexual intercourse. The risk to have these behaviors was greater in adolescents who perceive their families as dysfunctional. Conclusions: In this sample, there was a high prevalence of risk behaviors, emotional symptoms and premature sexual intercourse. The risk of having these behaviors is higher among students who perceive their families as dysfunctional. The study emphasizes the protective function of family in the prevention of risk behaviors in Chilean students <![CDATA[<b><i>Quality of life of elderly subjects living in basic social dwellings</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300007&lng=pt&nrm=iso&tlng=pt Background: In Chile, the government is providing basic dwellings to poor elderly subjects that do not have a place to live. These dwellings may be located in buildings or in codominiums. Aim: To assess the quality of life perception of elderly subjects whose dwellings are located in buildings or in condominiums. Material and methods: The brief version of the quality of life questionnaire designed for the elderly by the World Health Organization (WHOQoL-BREF) was applied to elderly subjects of seven poor communities of Metropolitan Santiago, that lived in basic dwellings located in buildings or condominiums. The questionnaire includes questions about physical, psychological, social relations and environment domains. Results: The questionnaire was answered by 124 elderly subjects aged 60 to 90 years, living in condominiums and 152 subjects aged 62 to 94 years, living in buildings. Satisfaction was of moderate or high level for physical, psychological and social relations domains. Those living in condominiums had a better satisfaction level in this last domain. The level of satisfaction of the environment domain was moderate and better for those living in condominiums. The perception of quality of life deteriorated along with age. Conclusions: Elderly subjects living in basic dwellings located in condominiums have a better quality of life perception than those living in buildings <![CDATA[<b><i>Subgaleal lipomas</i></b>: <b><i>Ultrasound findings</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300008&lng=pt&nrm=iso&tlng=pt Background: Lipomas are frequent benign soft tissue tumors. They are classified as superficial or deep. In the head, they are localized under the galea or epicraneal aponeurosis. Clinically they present as non symptomatic smooth tumors. Aim: To describe ultrasound (US) findings of subgaleal lipomas. Material and methods: Retrospective review of seven patients aged between 31 and 52 years (five males) with subgaleal lipomas. Results: AH lipomas were localized in the forehead. At US, they appeared as solid masses; 43% were isoechoic and 47% hyperechoic compared to subcutaneous tissue. The average size was 13 mm. They had a semi spherical shape, with a flat base and a convex surface, a regular margin, no vascular vessels at Doppler ultrasound and were surrounded by the galea. Discussion: In this series of patients, all masses had a similar US appearance that suggested the diagnosis of lipoma <![CDATA[<b><i>Multiplex PCR assay in spinal fluid to identify simultaneously bacterial pathogens associated to acute bacterial meningitis in Chilean children</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300009&lng=pt&nrm=iso&tlng=pt Background: Acute bacterial meningitis (ABM) is a serious disease that needs rapid diagnosis for an accurate treatment. The most important etiological agents are: Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. Overall pathogen detection rate in patients with ABM in Chile is 83%. Aim: To evaluate a Polymerase Chain Reaction (PCR) protocol for simultaneous detection of several pathogens in patients with ABM. Material and methods: We designed and evaluated a multiplex PCR protocol for simultaneous specific genes identifications of S pneumoniae (¡ytA and ply genes), N meningitidis (ctrA, crgA) and H influenzae (bexA) in cerebrospinal fluid (CSF) samples from pediatric patients with suspected diagnosis of ABM. Sensitivity, specificity and minimum detection levels of DNA were determined. Amplifications ofrDNA 16S gene was done to confirm extraction of bacterial DNA. Results: Ninety nine CSF samples were studied, 90 from children with fever and negative CSF culture, and 9 from ABM and positive culture patients. The PCR protocol had a sensitivity of 89%, specificity of 100%, positive predictive value 100% and negative predictive value 99%. Conclusions: We observed a high concordance (89%) between bacteriological cultures and the PCR protocol results. This diagnostic tool could increase identification of agents in specific settings such as patients previously treated with antibiotics <![CDATA[<b><i>Charle Bonnet syndrome</i></b>: <b><i>Report of one case managed with haloperidol</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300010&lng=pt&nrm=iso&tlng=pt Charles Bonnet syndrome is an underrecognized condition characterized by complex visual hallucinations, ocular problems causing visual deterioration and preserved cognitive status. Its prevalence is 5/1000 in ambulatory ophthalmologic patients. Generally occurs in elderly people in whom it may be confused with delirium or dementia. The first management step is to improve vision, if possible. Hallucinations may be managed pharmacologically. We report a 94 year-old woman with the characteristic clinical picture of the syndrome that improved with haloperidol <![CDATA[<b><i>Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300011&lng=pt&nrm=iso&tlng=pt We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam <![CDATA[<b><i>Acute pulmonary edema as a first manifestation of hyperthyroidism in a pregnant woman. Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300012&lng=pt&nrm=iso&tlng=pt We report a 36 year-old pregnant woman who presented with acute pulmonary edema in the absence of preexisting cardiac disease. On admission she was on sinus rhythm and her blood pressure was mildly elevated. No cardiac abnormalities were detected by color Doppler echo car diography and no ischemic changes were seen on the electrocardiogram. Cardiac enzymes were normal. Thyroid function tests were diagnostic for hyperthyroidism. She was treated with propylthiouracil and propranolol and discharged in good conditions seven days after admission. This case emphasizes the need to consider hyperthyroidism as the cause of unexplained pulmonary edema in young patients with no history of heart disease who present with heart failure <![CDATA[<b><i>Right ventricular assistance with a centrifugal pump. Report of two cases</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300013&lng=pt&nrm=iso&tlng=pt Acute right ventricular failure after cardiac surgery occurring in the first postoperative hours is associated with a bad prognosis. We have used a centrifugal pump either for ¡eft, right or biventricular assistance. However, the use of this device for pure right ventricular assistance is rare. We report a 30 year-old female undergoing a mitral valve replacement and a 42 year-old male undergoing a cardiac transplantation, who had a successful right ventricular assistance using a centrifugal pump, due to a failing right ventricle, as the result of insufficient myocardial protection and severe pulmonary hypertension. These two cases illustrate the value of the mechanical ventricular assist device for the treatment of right heart failure <![CDATA[<b><i>Inflammatory bowel diseases</i></b>: <b><i>An immunological approach</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300014&lng=pt&nrm=iso&tlng=pt Inflammatory bowel diseases (IBD) are inflammatory diseases with a multifactorial component that involve the intestinal tract. The two relevant IBD syndromes are Crohn's disease (CD) and ulcerative colitis (UC). One factor involved in IBD development is a genetic predisposition, associated to NOD2/CARD15 and Toll-like receptor 4 (TLR4) polymorphisms that might favor infectious enterocolitis that is possibly associated to the development of IBD. The identification of specific immunologic alterations in IBD and their relationship to the etiology of the disease is a relevant research topic. The role of intra and extracellular molecules, such as transcription factors and cytokines that are involved in the inflammatory response, needs to be understood. The relevance of immunologic molecules that might drive the immune response to a T helper (Th) 1, Th 2 or the recently described Th 17 phenotype, has been demonstrated in animal models and clinical studies with IBD patients. CD and UC predominantly behave with a Th 1 and Th 2 immune phenotype, respectively. Recently, an association between CD and Th 17 has been reported. The knowledge acquired from immunologic and molecular research will help to develop accurate diagnostic methods and efficient therapies <![CDATA[<b><i>Current therapeutic options for liver metastasis</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300015&lng=pt&nrm=iso&tlng=pt The liver is a common site of hematogenous metastasis, especially from gastrointestinal malignancies. Liver metastasis are generally classified as stage IV disease. Previously treatment in such patients was met with great skeptiscism. However, advances in surgical and medical therapies during the last two decades have provided effective therapeutic options for selected patients. Since major hepatic resections are now performed with acceptable morbidity and a mortality rate <3%, colorectal cancer metastasis to the liver are associated with 5-year survival rates of 30% or more. Meanwhile, a variety of new therapies have been developed, including hepatic artery infusion of chemotherapy; alcoholic, crio and radiofrequency ablation and novel strategies of systemic chemotherapy with the development of molecular targeted new products. These new therapeutic armamentarium have been used mostly in liver metastasis from colorectal cancer patients. However, liver metastasis of neuroendocrine tumors and selected cases of non colorectal cancer liver metastasis are benefited from the same strategies. This report summarizes the different therapeutic tools, their advantages and results mainly on colorectal cancer liver metastasis. These results are expected to improve even further with multimodality approaches <![CDATA[<b><i>Zoonoses with wildlife reservoirs</i></b>: <b><i>A threat to public health and the economy</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300016&lng=pt&nrm=iso&tlng=pt The world is experiencing an increase in emergent infections as a result of anthropogenic changes of the biosphere and globalization. Global warming unrestricted exploitation of natural resources such as forests and fisheries, urbanization, human migration, and industrialization of animal husbandry cause environmental destruction and fragmentation. These changes of the biosphere favor local emergence of zoonoses from their natural biotopes and their interaction with domestic animals and human populations. Subsequently, international commerce, human and animal migration and travel, favor the dissemination of these zoonotic pathogens worldwide. Chile is undergoing an important degradation of many wild-life biotopes, affecting their diversity and contributing to the dissemination of zoonoses such as Chagas disease, Hantavirus, rabies, fish tapeworms, and marine vibriosis. Moreover, agents of many other zoonoses such as ¡eptospirosis, hydatidosis, salmonellosis, rabies, brucellosis and anthrax have been detected in different wild-life environments in the country. The intensification and accelerations of the anthropogenic deterioration of the biosphere in Chile, as results of the unrestricted utilization of natural resources and global climate change, suggests that emergence of new zoonoses in the near future will lead to important public health and economic problems. Forestalling of these problems will require active epidemiológica! surveillance of wild and domestic animals with a wide range of modern molecular and ancillary epidemiológica! tools. This also demands government and private sector (i.e., animal husbandry) intervention, funding and the collaboration of professionals in human and veterinary medicine with those in the environmental sciences including ecology, climatology and oceanography <![CDATA[<b><i>Role of health professionals in the prevention of domestic violence against women</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300017&lng=pt&nrm=iso&tlng=pt Domestic violence against women is an important public health problem that cannot be ignored. Health professionals need to take part in the prevention, detection and treatment processes, acting in a coordinate way with other professionals and institutions. This paper analyzes the consequences of domestic violence against women, and underscores the fact that health professionals are part of the social circle surrounding the victims, playing an important role in its detection and prevention. Several response strategies from the health services are examined and, finally, the paper considers screening as a mechanism for early detection of domestic violence, paying special attention to the important controversies that surround this issue <![CDATA[<b><i>Validity of diagnostic tests</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300018&lng=pt&nrm=iso&tlng=pt Domestic violence against women is an important public health problem that cannot be ignored. Health professionals need to take part in the prevention, detection and treatment processes, acting in a coordinate way with other professionals and institutions. This paper analyzes the consequences of domestic violence against women, and underscores the fact that health professionals are part of the social circle surrounding the victims, playing an important role in its detection and prevention. Several response strategies from the health services are examined and, finally, the paper considers screening as a mechanism for early detection of domestic violence, paying special attention to the important controversies that surround this issue <![CDATA[<b>Critically appraised article</b>: <b>Fetal pulse oximetry and cesarean delivery</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300019&lng=pt&nrm=iso&tlng=pt Background: Knowledge of fetal oxygen saturation, as an adjunct to electronic fetal monitoring, may be associated with a significant change in the rate of cesarean deliveries or the infant's condition at birth. Methods: We randomly assigned 5341 nulliparous women who were at term and in early labor to either «open» or «masked» fetal pulse oximetry. In the open group, fetal oxygen saturation values were displayed to the clinician. In the masked group, the fetal oxygen sensor was inserted and the values were recorded by computer, but the data were hidden. Labor complicated by a nonreassuring fetal heart rate before randomization was documented for subsequent analysis. Results: There was no significant difference in the overall rates of cesarean delivery between the open and masked groups (26.3% and 27.5%, respectively; p = 0.31). The rates of cesarean delivery associated with the separate indications of a nonreassuring fetal heart rate (7.1% and 7.9%, respectively; p = 0.30) and dystocia (18.6% and 19.2%, respectively; p = 0.59) were similar between the two groups. Similar findings were observed in the subgroup of 2168 women in whom a nonreassuring fetal heart rate was detected before randomization. The condition of the infants at birth did not differ significantly between the two groups. Conclusions: Knowledge of the fetal oxygen saturation is not associated with a reduction in the rate of cesarean delivery or with improvement in the condition of the newborn <![CDATA[<b><i>Recommendations on medical legal lesions reports</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000300020&lng=pt&nrm=iso&tlng=pt Background: Knowledge of fetal oxygen saturation, as an adjunct to electronic fetal monitoring, may be associated with a significant change in the rate of cesarean deliveries or the infant's condition at birth. Methods: We randomly assigned 5341 nulliparous women who were at term and in early labor to either «open» or «masked» fetal pulse oximetry. In the open group, fetal oxygen saturation values were displayed to the clinician. In the masked group, the fetal oxygen sensor was inserted and the values were recorded by computer, but the data were hidden. Labor complicated by a nonreassuring fetal heart rate before randomization was documented for subsequent analysis. Results: There was no significant difference in the overall rates of cesarean delivery between the open and masked groups (26.3% and 27.5%, respectively; p = 0.31). The rates of cesarean delivery associated with the separate indications of a nonreassuring fetal heart rate (7.1% and 7.9%, respectively; p = 0.30) and dystocia (18.6% and 19.2%, respectively; p = 0.59) were similar between the two groups. Similar findings were observed in the subgroup of 2168 women in whom a nonreassuring fetal heart rate was detected before randomization. The condition of the infants at birth did not differ significantly between the two groups. Conclusions: Knowledge of the fetal oxygen saturation is not associated with a reduction in the rate of cesarean delivery or with improvement in the condition of the newborn