Representaciones sociales de madres con hijos de ambos sexos abusado sexualmente por un familiar o conocido cercano / Social representations of mothers with children sexually abused

En el presente estudio se presentan los resultados de una investigación cualitativa cuyo objetivo fue reconstruir las Representaciones Sociales del abuso sexual intrafamiliar de mujeres adultas habitantes de dos comunas de la Región Metropolitana, Chile. Fueron entrevistadas 52 mujeres adultas: madres con hijos abusados sexualmente por un familiar o conocido cercano, mujeres sin hijos y mujeres con hijos sin ser abusados. Las entrevistas fueron transcritas textualmente y analizadas según los procedimientos metodológicos formulados por Glaser y Strauss en la Teoría Fundada Empíricamente. La sección resultados incluye un Análisis Descriptivo de la información recolectada, de la cual se desprenden cuatro categorías: antecedentes contextuales, antecedentes de género, experiencias de su historia sexual y reacción a la develación de abuso sufrida por un menor; Análisis Relacional entre los antecedentes y reacción; y finalmente un Modelo Hipotético Interpretativo donde se explican los factores asociados al abuso intrafamiliar en las mujeres adultas.

This study presents the results of a qualitative research whose objective was to reconstruct the social representations of intrafamilial sexual abuse of adult women living in two municipalities of the Metropolitan Region, Chile. We interviewed 52 adult women: mothers with children sexually abused by a family member or close acquaintance, childless women and women with children without being abused. The interviews were transcribed verbatim and analyzed according to the methodological procedures formulated by Glaser and Strauss in empirically grounded theory. The results section includes a descriptive analysis of the data collected, from which emerge four categories: contextual history, gender history, experiences of sexual history and reaction to the unveiling of abuse suffered by a minor; Relational Analysis between the background and reaction, and finally an Interpretive hypothetical model which explains the factors associated with domestic abuse in adult women.

Infecciones en pacientes con lupus eritematoso sistémico / Infections in patients with systemic lupus erythematosus

Despite the availability of newer therapeutic interventions to improve clinical outcome in patients with Systemic Lupus Erythematosus (SLE), the incidence of infections as a cause of morbidity and mortality has not changed over the past 30 years. SLE itself increases the risk of infection, due to genetic (complement deficiencies) and acquired factors such as functional asplenia (humoral immunodepression) and the use of immunosuppressive drugs. These medications increase the risk of opportunistic infections that are associated with an altered cellular immune response. The main etiologic infectious agents in SLE patients are common bacterial pathogens, especially capsulated ones. The most common sites are lung, skin, bladder, brain and systemic infections. The main risk factor for infection is the history of a previous one. The clinical approach to SLE patients with suspected infectious diseases must consider the possibility of a flare up of the underlying disease, posing an additional problem to the clinician.

Reconstrucción después de pancreatoduodenectomía proximal mediante anastomosis pancreatoyeyunal simplificada. Resultados operatorios en 198 pacientes / Reconstruction following proximal pancreatoduodenectomy by simplified pancreatojejunal anastomosis. Operation results in 198 patients

Introducción: La dehiscencia de la anastomosis pancreatoyeyunal es la complicación más temida de la pancreatoduodenectomía proximal (PDP) y puede ocasionar la muerte del paciente. Objetivo: Presentamos nuestra experiencia acumulada en 198 PDPs reconstruídos utilizando la técnica simplificada de la anastomosis pancreatoyeyunal. Técnica Operatoria: Consiste en realizar una sutura en bolsa de tabaco alrededor del borde libre del yeyuno para introducir 4cm de muñon pancreático guiado por dos suturas transfixiantes entre el páncreas y el intestino, cerrar el yeyuno sobre el páncreas ajustando la sutura en bolsa de tabaco y colocar 4 puntos separados para "anclar" la anastomosis. Se descomprime las anastomosis pancreática y biliar mediante yeyunostomía. Material y métodos: Estudio prospectivo de 198 pacientes consecutivos que tuvieron PDP en el Instituto de Enfermedades Neoplásicas en el periodo 1995-2005. Resultados: La morbilidad post operatoria global fue 38.4 por ciento (76 de 198 pacientes). Trece pacientes (6.6 por ciento) presentaron dehiscencia de anastomosis pancreatoyeyunal. La mortalidad post operatoria a 30 días y la mortalidad hospitalaria fue 2 por ciento y 3.5 por ciento, respectivamente. Conclusión: Nuestra técnica modificada de anastomosis pancreatoyeyunal es simple, aplicable a todo tipo de páncreas y sobretodo segura, logrando reducir de manera importante la incidencia de dehiscencia de la anastomosis pancreatoyeyunal, la morbilidad y la mortalidad post operatorias.

Introduction: Pancreatojejunal anastomosis dehiscence is the most feared complication of proximal pancreatoduodenectomies and it is the cause of other complications, including death. OBJECTIVE: We present our cumulative experience gathered with 198 proximal pancreatoduodenectomies reconstructed by using the simplified pancreatojejunal anastomosis technique.OPERATION TECHNIQUE: It consists of performing a tobacco-pouch suture around the free edge of the jejunum in order to introduce 4 cm of the pancreatic stump guided by two transfixing sutures between the pancreas and the intestine, closing the jejunum over the pancreas tighteningthe tobacco-pouch suture and making four separate stitches to ìanchorî the anastomosis. The pancreatic and bile anastomoses are decompressed by jejunostomy. MATERIAL AND METHOD: Prospective study in 198 consecutive patients who had proximal pancreatoduodenectomies at the Institute for Neoplastic Diseases during the 1995 - 2005 period. RESULTS: Overall post-operative morbidity was 38.4 per cent (76 out of 198 patients). Thirteen patients (6.6 per cent) showed pancreatojejunal anastomosis dehiscence. Post-operative mortality after 30 days and hospital mortality were 2 per cent and 3.5 per cent, respectively. CONCLUSIONS: Our modified pancreatojejunal anastomosis technique is simple, applicable to alltypes of pancreata and, most importantly, safe. It greatly reduces incidences of pancreatojejunal anastomosis dehiscence as well as post-operative morbidity and mortality.

Programa de transtornos de alimentación en adolescentes y jóvenes chilenos: variaciones a seis meses de tratamiento / Multidisciplinary treatment of eating disorders in Chilean adolescents and young adults: Six months outcome

Background: Eating disorders may have serious organic consequences derived from under nutrition, specific nutrient deficiencies and electrolytic disturbances and reach a mortality as high as 12 percent. Aim: To describe the features and outcome after six months of treatment of patients attending the Eating Disorders Unit at the Catholic University Hospital in Chile. Material and methods: Review of medical records of patients with eating disorders that received a multidisciplinary treatment by a team of nutritionists, psychiatrists and psychologists and were seen at least twice in a period of six months. Results: The records of 81 patients (mean age 16.3±3 years, only one male) were included in the review. Forty nine patients had Anorexia Nervosa of the restricting type, five of the purging type, 22 had Bulimia Nervosa of the purging type and two of the non purging type and three patients had an eating disorder not otherwise specified. Eighty percent consulted within the first year of symptom appearance. Sixty five percent came from families with both parents living together, 57 percent had a rigid and agglutinated family structure and 65 percent had occult crises. Depression or dysthymia was found in 45 percent of patients and drug therapy was required at the beginning of treatment in 25 percent. Obsessive traits (40.4 percent) were significantly related to restrictive eaters. A past history of obesity or overweight was common. After six months of treatment, body mass index increasing significantly in restrictive eaters with obsessive traits and occult family crises was noticed. Conclusions: A multidisciplinary therapeutic intervention improved body mass index and family symptoms in patients with restrictive eating disorders.

Estudio del polimorfismos de receptores Fcylla en pacientes chilenos con lupus erimatoso sistémico / Polymorphisms of Fcylla receptors in chilean patients with systemic lupus erythematosus

Background: Polymorphisms of Fc receptors for IgG (FcgR) have been proposed as a genetic factor that influences susceptibility for systemic lupus erythematosus (SLE). Human FcgRIIa has 2 codominantly expressed alleles, H131 and R131, which differ at amino acid position 131 in the second extracelular domain (histidine or arginine respectively) and differ substantially in their ability to bind human IgG2. The H131 allele binds IgG2 efficiently, whereas R131 binds it poorly. Because IgG2 is a poor activator of the classical complement pathway, the H131 is essential for the disposal of IgG2 immune complexes. Aim: To determine the distribution of FcgRIIA genes in a cohort of Chilean SLE patients, with or without a history of lupus nephritis. Patients and methods: We studied 52 Chilean SLE patients fulfilling the 1982 American College of Rheumatology (ACR) criteria, 20 of whom had a history of nephritis, and 44 ethnically matched disease-free controls. FcgRIIa allotypes were genotyped by PCR. Results: No significant association was observed between the low affinity FcgRII receptor (FcgRIIa-R131) and the presence of SLE or lupus nephritis. However, genotype frequencies in SLE patients but not in controls, departed from the proportions predicted by the Hardy-Weinberg equilibrium, suggesting this locus might be related to the disease. Conclusions: Our results suggest that in Chilean patients with SLE, as well as in many other populations, the R131 allotype is not a major factor predisposing to the development of SLE or lupus nephritis

Fascitis eosinofílica: experiencia en tres casos / Eosinophilic fasciitis: report of 3 cases

Eosinophilic fasciitis (EF) is a scleroderma-like disease of unknown etiology characterized by cutaneous swelling and induration that affects predominantly the extremities, elevated immune globulins, and peripheral eosinophilia. We report three patients with clinical, laboratory and pathologic characteristics of EF. The main symptoms were cutaneous and included "peau d' orange", groove signs and induration of the affected extremities. Two patients had skin changes after exercising and one had a hypothyroidism. None had extra-cutaneous manifestations. All patients had peripheral eosinophilia. Pathologic findings were thickening and inflammation of the fascia and normal epidermis. Only one patient was treated with prednisone 30 mg daily and showed only moderate improvement. There is no follow up information about the other two cases. EF is a rare disorder classified at times as scleroderma variants. However, its clinical picture, capillary microscopy findings, pathology and prognosis differentiate it from systemic sclerosis

Efectos de la bromocriptina en pacientes con artritis reumatoide activa / Effects of bromocriptine in patients with active rheumatoid arthritis

Background: Neuroendocrine factors play an important role in the expression of autoimmune disease. Proclatin (PRL) can induce T-cell proliferation and macrophage activation. Elevated PRL levels have been described in patients with rheumatoid arthritis and (RA). Aim and Methods: We studiend immunological and clinical effects of PRL suppression in 9 RA patients with active disease, treated for 3 months with bromocriptiner (BRC), an inihibitor of PRL secretion. Results: BRC induced a significant depression of the peripheral blood mononuclear cells response to antigen (p=0.008) and mitogen (p=0.008) which was significantly correlated with improvements in the HAQ disability index (r=0.68; p=0.04) and grip strength (r=0.7; p=0.02). Also, the in-vitro production of IL-2, nitric oxide and poliamines -that are critical for the proliferative response of lymphoid cells- decreased significantly. The group experienced significant improvement of grip strength (p=0.028) and the HAQ disability index (p=0.025), whereas 4 individuals archieved clinical improvement according to the American College of Rheumatology preliminary definition. We conclude that BRC treatment induces a significant depression of in-vitro immune function in RA patients and these changes are related to parameters of disease activity. The effects of BRC on immune function and disease activity in RA patients warrant further investigation

Tratamiento con ciclosporina de la artritis reumatoídea refractaria / Treatment of refractory rheumatoid arthritis with cyclosporine

Cyclosporine may be useful in the treatment of rheumatoid arthritis refractory to other immunosupressive agents, in doses of less than 10 mg/kg/day to minimize its nephrotoxic potential, that is enhanced with prolonged use of concomitant administration of antiinflammatory drugs. We report 15 patients aged 50 ñ 12 years with erosive rheumatoid arthritis lasting 5 ñ 4 yeras and refractory to other immunosupressive agents. They were studied during one year and received cyclosporine in initial doses of 2.5 mg/kg/day that were increased to 5 mg/kg/day, assessing clinical response, blood pressure and serum creatinine. Nine patients, that received a maximal dose of 3.4 ñ 0.7 mg/kg/day during 7 ñ 4 months, improved; a 30 percent increase in creatinine was observed in 3, blood pressure raised in six and 2 bad hepatic toxicity. in the 6 patients that did not improve, the mean treatment lapse was 4 ñ 3 months and the maximal dose achieved was 2.7 mg/kg/day; creatinine increased in one and blood pressure increased in 4. It is concluded that although the clinical response to cyclosporine was good, only 4 patients completed one year of treatment, due to the frequent secondary effects of the drug

Hereditary essential tremor in Buenos Aires, Argentina

Consideramos esta publicación como la primera sobre Temblor Esencial en América Latina. Todos nuestros pacientes eran inmigrantes o hijos de inmigrantes de los orígenes más comunes en nuestro país (España, Italia, Francia y Polonia). No se incluyeron pacientes indoamericanos. El reducido número de indoamericanos puros en Buenos Aires y sus alrededores debe tenerse en cuenta. El temblor hereditario esencial es entidad monosintomática, conocida durante más de cien años. Sus elementos más importantes se describen progresivamente aquí y también, las dificultades terapéuticas que presenta. Durante un período de quince años, los autores pudieron seleccionar un total de 16 familias, con 39 casos de temblor esencial, estudiados básicamente desde el punto de vista clínico. Esto nos permitió confirmar el carácter del temblor, de tipo rítmico (4 a 10 c/seg), preponderante en maños, especialmente en los dedos pulgar e índice, extensión del temblor a la boca, cabeza y eventualmente, a todo el cuerpo. La característica dominante y autosómica de la herencia también se demostró en nuestros pacientes. La edad de comienzo de esta entidad oscila entre los 20 y los 40 años, con una exacerbación en la quinta década de la vida. No hubo predominancia de ninguno de los sexos, ni de longevidad ni multiparidad. Esta enfermedad no produce la muerte y la incapacidad que acarrea no es muy importante. No parece existir una asociacicón entre esta entidad y otras enfermedades, excepto aquellas patologías desencadeantes como la tensión emocional y eventualmente, el alcoholismo como tratamiento aparente propuesto por el propio paciente para aliviar su sintomatología. La ubicación nosológica de esta enfermedad debe estar junto con los trastornos extrapiramidales, a pesar de los 5 casos existentes en la bibliografía mundial sobre anatomía patológica, los que no presentaron alteraciones tales que justificaran el temblor en el sistema nervioso central...

Síndrome de Banti: a propósito de un caso clínico / Banti syndrome: apropos of a clinical case

Se presenta el estudio realizado en una paciente joven con esplenomegalia masiva, hiperesplenismo y hemorragia digestiva alta severa. Se hizo el diagnóstico de Hiperesplenismo teniendo en cuenta la esplenomegalia aunada a pancitopenia y médula ósea reactiva halladas en el estudio hematológico. Por el antecedente de Hepatitis viral en la infancia y de episodios de hemorragia digestiva alta se sospechó Várices Esofágicas por Síndrome de Hipertensión Portal, confirmadas por estudio endoscópico y posteriormente por la presencia de Antígeno australiano y Proteinograma electroforético sugerente de Cirrosis Hepática. Se concluyó se trataba de una paciente de la segunda década portadora de Síndrome de Banti tributaria de tratamiento quirúrgico para mejorar su pronóstico de vida, realizándose esplenectomía y posteriormente derivación mesentérico-renal