Disfunción endotelial. Mecanismos e implicancias en Covid-19 / Endothelial dysfunction. Mechanisms and implications on Covid-19

Endothelium is the inner layer of vessels that separates circulating blood from the rest of the body tissues. Since its discovery, it has been involved in various functions, both systemic and organ specific. Currently, endothelial damage and failure in its functions is considered a key element in pathophysiology of various clinical scenarios, among which we may find COVID-19.Hence, it has been a target in development of strategies that seek to maintain, enhance or repair its function. The purpose of the following review is to describe what an endothelial function is about, its relation with current medical practice, and its implications in the SARS- CoV-2 pandemic. (AU)

Caracterización del perfil clínico y funcional de pacientes con lesión medular en rehabilitación intrahospitalaria / Characterization of the clinical profile and function of patients with spinal cord injury in in-hospital rehabilitation

Spinal cord injury (SCI) is a pathology that generates great personal, family, economic and social impact. There are two main etiologies that are traumatic (T-SCI) and non-traumatic (NTSCI). These patients receive their rehabilitation in specialized hospital services in the acute and sub-acute phase. A retrospective, descriptive, observational study was designed, reviewing the clinical records of patients diagnosed with SCI at discharge, hospitalized in the Physical Medicine and Rehabilitation Service of the Clinical Hospital of the University of Chile. The general profile of admission of patients with SCI was a young men with NT- SCI, with higher education, paid work and incomplete injury (ASIA B, C, D). An improvement was observed for all patients for the severity of the injury, neurological level, motor level, sensory level and functionality. This is the first study conducted nationwide that provides epidemiological data and functional evolution of patients with SCI and are comparable to those found in the international literature. (AU)

Manejo de cicatrices patológicas excesivas en el Servicio de Rehabilitación / Management of excessive pathological scars in the Rehabilitation Service

The excessive pathological scars are subdivided into hypertrophic, keloid and contracted. They have a complex pathophysiology, not entirely known that only exists in humans. Although the frequency of presentation is not high, excessive pathological scars can affect several areas of human functioning, in the first level of functions and body structures and in the second level of activities of daily life and participation. The evaluation of patients must be complete, including the scar, and any other affected body system, together with psychological, functional and socioeconomic factors. In the treatment of excessive scars there are multiple options that must be combined for a better result. The non-surgical treatments of the most used scars are the pressotherapy, silicone plates, intralesional injections and laser. There are other rehabilitation treatments that although without solid evidence could have a role in patients. The referral to the rehabilitation service is recommended for patients with excessive pathological scars located in areas of folds or special areas and / or, which are accompanied by pain, alterations in the function of the body segment or limitations in activities of daily life, for comprehensive assessment and multidisciplinary management. (AU)

Reconstrucción en un tiempo del pabellón auricular en amputación parcial traumática con preservación del pedículo inferior: revisión de la literatura y presentación de dos casos / One-stage auricular replantation in traumatic partial ear amputation with inferior pedicle preservation: review of the literature and presentation of two cases

La amputación parcial traumática del pabellón auricular con preservación del pedículo inferior corresponde a una patología infrecuente. Su reconstrucción incluye el uso de diversas técnicas quirúrgicas. Presentamos dos casos de reimplante inmediato, sin uso de microcirugía, con resultados favorables y sin necesidad de reintervenciones, junto a una revisión de la literatura. La revisión bibliográfica realizada apoya el uso de esta técnica, basándose en la preservación del puente cutáneo bajo el tragus que incluye una rama de la arteria temporal superficial y que sería responsable de la irrigación del reimplante.

Partial auricle amputation with preservation of the inferior pedicle is an unusual pathology. The reconstruction in these cases includes many surgical techniques. We present two cases of immediate replantation, without the use of microsurgery, with favorable outcomes and without need of new interventions. The revision of the literature supports this technique based in the preservation of the cutaneus bridge under the tragus that includes a branch of the superficial temporal artery that is responsible of the perfusion of the reimplant.

Síndrome de túnel carpiano en el embarazo: revisión de literatura y presentación de un caso clínico / Carpal tunnel syndrome in the pregnancy: literature review and presentation of a clinical case

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the general population. In pregnant women the prevalence increases to 31-62 percent probably by edema secondary to the hormonal changes of pregnancy. The definitive treatment is surgical decompression, but in pregnant reserves only in exceptional cases where other treatments have failed. This population receives mainly conservative therapy consisting of splints, physical therapy and infiltration. Objective: To review the management of CTS in pregnant about a case. Methods: The clinical case of a pregnant patient with CTS managed conservatively was revised, based on this existing literature was reviewed. Results: 32 years old woman, studying 18 weeks pregnancy, consultation by paresthesia and loss of strength of both hands since1.5 months, more than right. Physical examination was consistent with bilateral CTS. Use of night splint is indicated. The electrodiagnostic evaluation reporting neuropathic sensitive-motor commitment severe intensity, subacute bilateral median nerve, with moderate denervation. Patient with symptoms persist, it is decided to perform infiltration of carpal tunnel steroid with good clinical and electrophysiological response. Conclusions: This case exemplifies the conservative treatment of CTS in pregnancy delivered good results. The literature supports the use of splints and steroid injections in this population...

Evolución neurológica y funcional en pacientes con polineuropatía de paciente crítico: revisión de literatura y reporte de casos / Neurological and functional evolution in critical illness polyneuropathy: literature review and report of cases

Patients with prolonged ICU stay may have a critical illness polyneuropathy (CIP) which corresponds to an acute sensory-motor axonal neuropathy that occurs in severely ill patients between 60 to 100 percent of cases. While most patients have good recovery, reports suggest that between 30 and 40 percent of patients with critical illness polyneuropathy have long-term sequelae, which generate motor limitations that could impact its functionality. The functional outcome of neurological pathology depends on clinical factors, familiy-social factors and access to rehabilitation. Knowing the functional prognosis of the disease is key to organizing the rehabilitation plans. The current literature only reports of neurological recovery as a factor associated with better function in patients with critical illness polyneuropathy. This article reviews clinical and pathogenic aspects of the CIP, neurological and functional changes described in the literature and presents 6 cases of patients admitted to rehabilitation last year.

Efecto de la actividad física en la calidad de vida de una población adulto mayor de Santiago / Effect of physical activity on quality of life of an elderly population of Santiago

Introduction: Aging involves the loss of functional reserve with alteration of multiple systems. This influences the deterioration of various aspects of health and quality of life. To improve these aspects there are different types of interventions in which physical activity has a prominent role. Objective: To evaluate the effectiveness of one type of physical activity in improving the quality of life of an elderly population of the community. Subjects and methods: We recruited 71 subjects aged 60 years attending a club of elderly. Were randomized into 2 groups (intervention and control) by a blinded observer. The intervention was aerobic physical activity for 30 minutes and calisthenics exercises for heating and cooling, for 10 weeks and 3 times a week. We evaluated 8 dimensions of quality of life at the beginning and end of the intervention by the SF-36. Results: Both groups had similar values at baseline. The intervention group improved clinically (5 to 25 points) and statistically significant (p <0.05) in the 8 dimensions of quality of life. The control group showed a modest improvement in 3 items exploring psychosocial aspects of quality of life. Conclusion: The physical activity in the community is a therapeutic alternative economic, easy to implement, safe to apply and produces a great impact on improving the quality of life of the population over 60 years.

Cólico renal en el embarazo: experiencia en Complejo Asistencial Barros Luco / Symptomatic urolithiasis in pregnancy: a Barros Luco Health Complex experience

Objetivos: Revisar nuestra experiencia en el diagnóstico y manejo de la patología litiásica urinaria sintomática durante el embarazo y exponer una revisión actualizada de la literatura. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo que incluyó a 37 pacientes. Se revisaron fichas clínicas de las pacientes embarazadas con diagnóstico de egreso hospitalario correspondiente a cólico renal, urolitiasis, nefrolitiasis o ureterolitiasis de la Unidad de Medicina Materno Fetal del Hospital Barros Luco, entre los años 2005 y 2007. Las variables extraídas y analizadas fueron: edad, paridad, la edad gestacional, el tipo de parto, prematuridad, antecedentes de urolitiasis, presentación clínica, lateralidad, laboratorio, imagenología, confirmación litiásica, ubicación del cálculo, tratamiento inicial y manejo posparto. Resultados: La edad promedio de las pacientes fue de 27,2 años. La edad gestacional promedio fue de 20 semanas. Multiparidad fue del 62 por ciento y el 35 por ciento tenía antecedentes de urolitiasis previa. El 97 por ciento de las pacientes presentó dolor lumbo-abdominal tipo cólico al ingreso, en 56,8 por ciento de casos al lado derecho. El 73 por ciento de los embarazos estaban en el 2° o 3er trimestre. El 8 por ciento presentó parto prematuro. El estudio imagenológico fue requerido en 24 pacientes (65 por ciento) incluyó a la ultrasonografía y una paciente además requirió de radiografía abdominal simple y RNM. De éstas se confirmó litiasis en el 30 por ciento (62,5 por ciento en el riñón, 25 por ciento uréter distal y 12,5 por ciento en ambas ubicaciones). Todas las pacientes se manejaron inicialmente con tratamiento médico. Una paciente requirió un catéter doble “J”, y sólo 2 pacientes requirieron ureterolitotomía después del parto. Conclusiones: La litiasis urinaria sintomática durante el embarazo, a pesar de un enfrentamiento multidisciplinario, continúa siendo un desafío diagnóstico y terapéutico. Los síntomas y...

Objectives: To review our experience in diagnosis and management of symptomatic urolithiasis during pregnancy and present an updated review of the literature. Materials and methods: A retrospective descriptive study including 37 patients was made. We reviewed medical records of pregnant patients with hospital discharge diagnosis of renal colic, urolithiasis, nephrolithiasis or ureterolithiasis from the Maternal Fetal Medicine Unit of Barros Luco Hospital, between 2005 and 2007. Extracted and analyzed variables were age, parity, gestational age, type of delivery, prematurity, history of urolithiasis, clinical presentation, laterality, laboratory findings, imaging, urolothiasis confirmation, location of calculi, initial treatment and postpartum management. Results: Patients average age was 27.2 years. Average gestational age was 20 weeks. Multiparity was 62 percent and 35 percent had prior history of urolithiasis. At admission, 97 percent of patients had lumbo-abdominal colic pain and 56.8 percent of cases was on the right side. 73 percent of pregnancies were in the 2nd or 3rd trimester. 8% had preterm labor. Imaging studies were required in 24 patients (65 percent) and included ultrasonography. Simple abdominal radiography and MRI were requires in one patient. Of these patients, calculi was confirmed in 30 percent (62.5 percent in the kidney, 25 percent distal ureter and 12.5 percent in both locations). All patients were managed initially with medical treatment. One patient required a double J stent and only 2 patients required ureterolithotomy after delivery. Conclusions: Symptomatic urolithiasis during pregnancy, despite multidisciplinary assess, remains a diagnostic and therapeutic challenge. Symptoms and signs are still the most important elements for establishing the diagnosis. If suspected, ultrasound evaluation is recommended. Conservative management is still the first choice of treatment because most cases resolve spontaneously. Installation of a...

Cistitis eosinofílica: ruptura vesical espontánea recurrente en un adulto / Eosinophilic cystitis: recurrent spontaneous bladder rupture in an adult

Introducción: La cistitis eosinofílica descrita por primera vez en 1960 por Brown, corresponde a una patología inflamatoria de la vejiga muy infrecuente, de etiología específica aún incierta. Puede variar desde inflamación moderada, hasta vejiga fibrótica con dilatación pielocalicilar y grados variables de insuficiencia renal. Si bien, tiene una presentación clínica variable, no se ha descrito previamente en la literatura la perforación vesical espontánea recurrente. Caso clínico: Presentamos el caso de una mujer de 35años con historia de hematuria, poliquiuria, tres perforaciones vesicales espontáneas y microvejiga fibrótica con hidroureteronefrosis bilateral que se maneja finalmente con ampliación vesical con segmento de íleon y además, exponemos una revisión actualizada de la literatura. Conclusión: La cistitis eosinofílica es una entidad de etiología incierta, con una historia natural impredecible. Su incidencia y prevalencia son desconocidas y si bien, no ha sido descrita previamente en un adulto en nuestro medio, es recomendable considerarla entre los diagnósticos diferenciales de una hematuria macroscópica o síndrome de irritación vesical persistente. La ruptura vesical espontánea recurrente es una presentación clínica no descrita previamente en la literatura. Se deben continuar periódicamente controles imagenológicos y de laboratorio y su tratamiento aún no está estandarizado.

Introduction: Eosinophilic cystitis was first described in 1960 by Brown, it is an inflammatory disease of the bladder that is extremely rare where etiology remains uncertain. It ranges from a mild inflammation to a fibrotic bladder with pielocalycilar dilatation and varying degrees of renal failure. While it has a variable clinical presentation, recurrent spontaneous bladder perforation has not been described previously in the literature. Case report: We report the case of a 35 years old women with a history of hematuria, polyaquiuria, three spontaneous bladder perforations and fibrotic microbladder with bilateral hydroureteronephrosis that is finally managed by bladder augmentation made of an ileum segment. Additionally, we present an updated revision of the literature. Conclusion: Eosinophilic cystitis is an entity of unknown etiology with an unpredictable evolution. Incidence and prevalence are unknown and although it has not been previously reported in our adult patients, it should be considered as differential diagnosis of gross hematuria or persistent bladder irritation syndrome. Recurrent spontaneous bladder rupture is a clinical presentation not previously described in the literature. Periodic monitoring and laboratory imaging should be established and treatment is not yet standardized.

Metástasis testicular de cáncer prostático: reporte de un caso y revisión de literatura / Testicular metastasis from prostate cancer: report of a case and review of the literature

Introducción: El cáncer de próstata es la neoplasia más frecuente en hombres, y en Chile representa la tercera causa de mortalidad por cáncer en el sexo masculino. Cuando presenta metástasis, lo hace más frecuentemente a ganglios ilíacos, hueso, pulmón e hígado y muy raramente a testículo. Caso clínico: Hombre de 80 años sometido a una prostatectomía radical hace 11 años por adenoarcinoma próstatico con Score de Gleason 8. Asintomático, presenta aumento de volumen testicular izquierdo, pétreo e indoloro. Los marcadores tumorales testiculares resultaron normales, elantígeno prostático (APE) elevado y ecodoppler sugerente de tumor testicular. Tras orquiectomía radical, la biopsia con tinción inmunohistoquímica detecta APE intenso en las células tumorales, develando su origen. La tomografía computarizada abdominal y cintigrafía ósea descartan diseminación a otros órganos. Discusión: A pesar de la alta incidencia del cáncer prostático, las metástasis a testículo son muy raras. Desde 1938, se han reportado en la literatura internacional poco menos de 200 casos. Pueden detectarse como hallazgo o simulando un tumor primario testicular. Para diferenciarlos es necesaria una adecuada historia, examen físico y marcadores tumorales, sobre todo en el examen histológico. El pronóstico del cáncer prostático con metástasis testicular es desconocido, pero en estudios recientes se ha establecido que conferiría un peor pronóstico, debiéndose considerar como signo de enfermedad diseminada y por lo tanto, instaurar tratamiento sistémico y controlar estrictamente a estos pacientes. El caso expuesto ilustra la infrecuente presentación de una metástasis de cáncer de próstata como masa testicular. Además, sin metástasis en otros órganos, lo cual es aún más infrecuente. Además, recalca la necesidad de una evaluación adecuada para asegurar el estadio tumoral. Conclusión: Aunque la metástasis testicular es infrecuente, y no ha sido descrita previamente en nuestro medio, debiese...

Introduction: Prostate cancer (PCa) is the most frequent neoplasia in males. In Chile, PCa is the third cause of mortality by cancer in males. The most frequent metastatic sites are iliac lymphnodes, bone, lungs and liver. Testes are rarely affected. Case report: An 80 year old male submitted to radical prostatectomy 11 years ago for Gleason 8 adenocarcinoma. He was asintomatic until he presented with a painless hard left testicular mass. Serum tumor markers were negative. PSA level was elevated and a testicular Doppler ultrasonogram was consistent with a testicular tumor. Radical orquiectomy was performed. Immunohistochemistry on the biopsy material showed strong staining for PSA. Thus, a metastatic PCa was confirmed. Abdominal CT scan and bone scans ruled out involvement of other organs. Discussion: Despite the high incidence of PCa, testicular metastases are rare. Since 1938, less than 200 cases have been internationally reported. These cases might be an incidental finding or they may simulate a primary testicular tumor. Differential diagnosis can be achieved with an adequate clinical history, physical exam and tumor markers, including immunohistochemistry in the biopsy material. The prognosis of PCa with testicular metastasis is unknown. Recent studies suggest poor prognosis. This should be considered a sign of systemic disease. This report shows a rare presentation of metastatic PCa without metastases in other organs. Also, we emphasize the need for thorough evaluation to ensure adequate staging. Conclusion: Testicular metastases from PCa are infrequent; no other cases have been reported in Chile. It should be considered in the differential diagnosis of patients with a testicular mass especially if they have a history of PCa.

Polimorfismos no receptor Scavenger classe B tipo I e sua relação com perfil lipídico sérico e resposta a atorvastatina em indivíduos brasileiros / Scavenger receptor class B type I polymorphisms and its relation with serum lipids profile and response to atorvastatin in Braszilian individuals

O receptor scavenger BI (SR-BI) é um componente chave do transporte reverso do colesterol. Polimosfismos no gene SCARB1 foram associados com variações no perfil lipídico e outros de risco cardiovascular. Os polimosfismos de nucleotídeo único In5C>T e Ex8C>T no SCARB1 e medidas de lípides e apolipoproteínas foram avaliadas em 79 hipercolesterolêmicos (HC) e 173 normolipidêmicos (NL) provenientes do Brasil. Pacientes HC foram tratados com atorvastatina (10mg/dia/4semanas). Os polimosfismos foram identificados por PCR-RFLP. Os indivíduos HC portadores dos genótipos In5CC+TT mostraram concentrações mais elevadas de LDL-C, apoB, e menores da relação apoAI/apoB. No grupo NL, os genótipos In5CC+TT foram associados com concentrações maiores de LDL-C. Os indivíduos HC portadores de genótipo Ex8CC tiveram uma variação menor da razão apoAI/apoB em resposta à atorvastatina (p<0,05). Nos Hc portadores do haplótipo Ex8CC+CT/In5CT+TT tiveram valores basais elevados de LDL-C e relação apoAI/apoB diminuída. Após o tratamento com atorvastatina, os indivíduos Hc portadores do haplótipo Ex8CC/In5CC tiveram uma variação menor na relação apoAI/apoB. Os genótipos In5CT+TT no SCANB1 conferem um perfil lipídico mais aterogênico. O genótipo Ex8CC e o haplótipo Ex8CC estão associados com uma resposta à atorvastatina menor da razão apoAI/apoB na nossa população.

Malformación congénita de la vía aérea pulmonar: reporte de un caso adulto / Congenital pulmonary airway malformation: an adult case report

Congenital pulmonary airway malformation or CPAM (congenital cystic adenomatoid malformation) that involve the lung is an embryonic anomaly. CPAM is a rare condition in chilhood, and even more so in adulthood. In this article we report the case of a young adult man with CPAM and present a brief review about this condition. Case study: 23 years old man with several episodes of pneumonia and obstructive bronchial syndrome during his childhood. The patient complained of pleuritic chest pain, malaise and fever. On physical examination lung sound was diminished in the lower right zone of the chest, abundant coarse crackles were detected and there was dullness on percussion. Chest roentgenogram and computed tomography (CT) revealed a complex image of multiple cysts with air and fluid in the right lung. Because of the lack of response to medical treatment a right lower lobectomy was performed. Histopathology revealed a type 1 CPAM. After being discharged from the hospital the patient developed a broncho-pleural fistula, that was succesfully treated by a second surgical intervention. Three years after surgery the patient is free of symptoms. Discussion: CPAM is a rare congenital hamartomatous condition. This malformation in adults it is exceptional. Chest CT is the choice diagnostic technique. Considering the high neoplastic potential of this malformation, its treatment should be the surgical resection, even in asymptomatic patients.

La malformación congénita de la vía aérea pulmonar (MCVAP), llamada también malformación congénita adenomatoidea quística que compromete al pulmón es una anomalía embrionaria. La MCVAP es de rara presentación en la infancia y es excepcional en los adultos. En este artículo comunicamos el caso de un hombre adulto con MCVAP y presentamos una breve revisión sobre esta condición. Caso clínico: Hombre de 23 años de edad con varios episodios de neumonía y de síndrome bronquial obstructivo en su niñez. El paciente se quejaba de dolor torácico pleurítico, malestar general y fiebre. En el examen físico se encontró disminución del murmullo pulmonar en la parte inferior del hemitórax derecho, abundantes crepitaciones y matidez. La radiografía y la tomografia computada de tórax (TC) revelaron múltiples imágenes hidro-aéreas complejas en el pulmón derecho. Debido a la falta de respuesta al tratamiento médico, se practicó una lobectomía inferior derecha. La histopatología demostró una MCVAP tipo 1. Después de ser dado de alta el paciente presentó una fístula broncopleural, la cual fue tratada exitosamente con una segunda intervención quirúrgica. Tres años después de la cirugía el paciente está asintomático. Discusión: La MCVAP es una malformación congénita hamartomatosa muy poco frecuente. En adultos es excepcional. La técnica diagnóstica de elección es la TC de tórax. Considerando el alto potencial neoplásico de esta malformación, su tratamiento debe ser la resección quirúrgica, incluso si el paciente está asintomático.

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...

Resistencia antimicrobiana en Helicobacter pylori: aspectos clínicos y moleculares / Antimicrobial resistance of Helicobacter pylori: clinical and molecular aspects

Helicobacter pylori is a relevant pathogen for gastroduodenal diseases in human beings. Although its eradication often improves gastroduodenal diseases, H pylori is acquiring an elevated rate of resistance to various antimicrobials, such as metronidazole, clarithromycin, tetracycline and amoxicillin. Multi-drug resistance is a major problem to select the appropriate treatment of infectious diseases. To improve our understanding on the com-plexity of the problem, in this article we review the resistance mechanisms and give an update on H pylori antimicrobial resistance (Rev Méd Chile 2003; 131: 1313-20).

La quimiotaxis y la adaptación al medio ácido asisten a helicobacter pylori en la colonización del estomago / Chemotaxis and adaptation to acid environment helps the helicobacter pylori in stomach colonization

El pH ácido de la mucosa gástrica es probablemente una característica que hace a este nicho inaccesible a otras bacterias que no sea Helicobacterpylori. La bacteria debe estar bien adaptada a crecer en estas condiciones de acidez y emplear mecanismos especializados de protección al ácido. La capacidad de sobrevivir bajo estas condiciones de pH bajo y las propiedades quimiotácticas de H. pylori le permiten colonizar el estómago. Algunos aspectos acerca de los mecanismos de sobrevivencia en medio ácido y las propiedades quimiotácticas de H. pylori se discuten.

Tropisetrón en la prevención de náuseas y vómitos por quimioterapia: estudio clínico multicéntrico / Tropisetron in the prevention of nausea and vomiting due to chemotherapy: multicentric clinical study

The antiemetic effect of tropisetron was studied in 97 cancer patients (67 men, 30 women) receiving cisplatin in doses of 75 mg/m² or higher. On 279 chemotherapy cycles studied (max 6 per patient) 5 mg of tropisetron was admonistered once a day i.v. on day 1 and p.o. on day 2 to 6. Efficacy preventing vomiting and nausea was measured in 24 hour period as: complete control 0 episodes, major control 1 to 2 episodes, minor control 3 to 4 episodes and no control 5 or more episodes. Satisfactory vomiting control (complete and major) was 69 percent, 63 percent, 82 percent,88 percent, 96 percent and 96 percent in days 1 to 6 of cycle 1. Satisfactory nausea control (complete and major) for the same day was 70, 66, 72, 85 92 and 97 percent. Similar data was obtained for the subsequeny cycles. Complete vomiting control was obtained in 47, 35, 56, 72, 81 and 84 percent and for nausea in 42, 39, 48, 64, 81 and 87 percent. 19 patients presented adverse effects (19,6 percent). Only 2 headache episodes had a definitive relation with antiemetic drug. 12 patients discontinued the medication; 6 due to drug inefficacy, 2 to illness unrelated to the drug, 1 to lack of collaboration, and 3 due to other reasons. We conclude that tropisetron allows satisfactory control of acute and delayed vomiting in a high percentage of patients treated with high doses of cisplatin. The drug does not have significant secondary effects. Tropisetron administration in only 1 daily dose implies an evident advantage and a treatment cost reduction

Quimioterapia preoperatoria en cáncer de mama / Preoperatory chemotherapy in breast cancer

El uso de la quimioterapia preoperatoria (Qx preop) en cáncer de mama localmente avanzado ha disminuido la tasa de pacientes consideradas inoperables y las recidivas locaes, aumentando según algunos la sobrevida libre de enfermedad y la sobrevida total. El objetivo de este trabajo es medir la respuesta del tumos de mama primario a la Qx preop y evaluar la influencia de ésta en la elección del tipo de tratamiento quirúrgico. Entre mayo de 1990 y marzo de 1995, ingresaron al protocolo de Qx preop del IOCPC, 93 pacientes con diagnóstico de cáncer de mama localmente avanzado, siendo evaluables para este estudio 80 pacientes. La Qx preop consistió en 3 ciclos de drogas con los esquemas de (CMF) o (FEC/FAC). La respuesta fue evaluada en comité oncológico al finalizar el tercer ciclo, en que se decidió la secuencia a seguir con el tratamiento, ya sea primero radioterapia (RT) o cirugía dependiendo de la respuesta clínica. La Qx preop tuvo una respuesta clínica completa o parcial en un 39 por ciento de las pacientes, permitiendo realizar un tratamiento conservador en un 16 por ciento de ellas. Con la adición de RT preoperatoria es posible reducir significativamente el número de pacientes consideradas inoperables en el momento de la evaluación inicial

Demandas judiciales contra médicos en Chile / Lawsuits against physicians in Chile

Lawsuits against physicians are becoming relevant in Chile. We analized 18 trials against physicians that occured between 1977 and 1985 and that were ruled by Metropolitan Region courts. The causes of demands were death of patients in 8 trials and severe lesions in the rest. Twelve trials originated from surgical procedures (6 from gynecological interventions) and 9 came from private clinics. Nine trials lasted less than 2 years and 3, more than 5 years. Sentences was pronounced by criminal courts in 12 cases and by appealing courts in six

Pérdida recurrente del embarazo en pacientes con anticuerpos anticardiolipinas; AACL / Recurrent pregnancy lost in patients with anticardiolipin antibodies

Se presenta la experiencia en 7 pacientes con antecedentes de pérdida recurrente del embarazo (x=3,7 rango 2-6) con AACL(+) en las cuales se descartó otra etiología; éstas pacientes totalizaban 26 gestaciones no tratadas concluidas en 24 pérdidas fetales (constando en 9 la muerte fetal in útero) y 2 RN vivos. La duración promedio de esas gestaciones fue 17,4 semanas (rango 8-37). Fueron tratadas con prednisona 20 mg/día y ASA 100 mg/día obteniéndose 7 RN vivos y 1 mortinato. En todas las pacientes se obtuvo descenso de los AACL. La duración promedio de las gestaciones tratadas fue de 31,7 semanas (rango 26-28). Se concluye que la presencia de AACL se correlaciona con alta mortalidad y bajo peso fetal y que con el tratamiento se obtiene gestaciones significativamente más largas que en las no tratadas y mayor relación de niños vivos respecto al número de embarazos