Plastrón apendicular y manejo clínico actual: una decisión a reconsiderar: a propósito de un caso / Appendicular mass and current clinic management: a decision to reconsiderate: about a case

Introducción: La apendicitis es uno de los principales motivos de consulta e intervención quirúrgica en los servicios de urgencias. Debe tratarse oportunamente dado que puede evolucionar hacia una perforación apendicular y con ello a una peritonitis o un plastrón apendicular, en aproximadamente un 10%, e incrementando las morbilidades, como tiempo de reposo o estadía hospitalaria. Actualmente no existe consenso acerca del tratamiento del plastrón apendicular, por ello, el objetivo del presente trabajo es respaldar y promover la alternativa quirúrgica diferida, versus el manejo médico, como el tratamiento más idóneo del plastrón apendicular. Presentación del caso: Se derivó al Hospital Base Valdivia a una escolar, de 8 años y 11 meses de edad, por dolor en hemiabdomen inferior de 3 semanas de evolución acompañado de sensación febril no cuantificada, vómito y diarrea; se diagnosticó un plastrón apendicular, optándose por el manejo médico; evolucionó favorablemente, dándole el alta. En controles posteriores se planificó una apendicectomía, llevándose a cabo con éxito meses después. La biopsia del apéndice extraído evidenció un carcinoma de apéndice cecal, por lo que se inició el estudio de extensión de neoplasia sin encontrar hallazgos patológicos. Discusión: Actualmente el manejo del plastrón apendicular depende del médico tratante y su criterio. Existen ventajas y desventajas entre la elección de un tratamiento médico o quirúrgico, sea inmediato o diferido; dentro de las ventajas del último destacan la prevención de apendicitis recurrentes y detección temprana del carcinoma apendicular, como en el caso presentado, permitiendo de esta forma un mejor pronóstico para el paciente y evitando el uso de terapias más agresivas.

Introduction: Appendicitis is one of the main reasons for consultation and surgery in the emergency department. It must be treated promptly because it can evolve into a ruptured appendix and thus to peritonitis or an appendiceal plastron, by approximately 10%, and increasing the morbidity, as downtime or hospital stay. There is currently no consensus on the treatment of appendicular plastron, therefore, the objective of this work is to support and promote alternative deferred surgical versus medical management, as the most suitable treatment of appendiceal plastron. Case presentation: A girl of 8 years 11 months old consult for pain in lower abdomen of three weeks of evolution, accompanied by feverish feeling, unquantified, vomiting and diarrhea; Is diagnosed a plastron appendiceal opting for medical management, evolving favorably and giving the discharge. In subsequent controls was planned appendectomy, taking place successfully months later. Biopsy of removed appendix showed a appendix cancer, reason why an extension study of neoplasia was initiated without pathological findings. Discussion: Currently the management of appendicular plastron is dependent on the treating physician and judgment. There are advantages and disadvantages of choosing a medical or surgical treatment, immediate or delayed, inside the advantages of the latter include the prevention of recurrent appendicitis and early detection of appendiceal carcinoma, as in the case presented, thus allowing better prognosis for the patient and avoiding the use of more aggressive therapies.

Factores asociados a insuficiencia renal postoperatoria en cirugía de revascularización miocárdica / Factors associated to postoperative kidney failure following myocardial revascularisation

Objetivos: Determinar qué antecedentes clínicos del paciente y factores del procedimiento quirúrgico se asocian con la aparición de insuficiencia renal postoperatoria en pacientes sometidos a cirugía de revascularización miocárdica. Métodos: estudio llevado a cabo entre enero de 2005 y diciembre de 2013, de casos y controles anidado en una cohorte, en la que se incluyeron pacientes sometidos a cirugía de revascularización miocárdica electiva que presentaron insuficiencia renal postoperatoria durante el postoperatorio inmediato hasta el egreso. Los controles estuvieron conformados por pacientes sometidos a cirugía de revascularización miocárdica electiva que no desarrollaron insuficiencia renal postoperatoria inmediata hasta el egreso. Se realizó un modelo de regresión logística para determinar los factores asociados a insuficiencia renal postoperatoria. Las asociaciones se expresaron en razones de disparidad con sus respectivos intervalos de confianza. Resultados: la edad avanzada {OR 1,03 IC95% (1,01-1,04){, la presencia preoperatoria de diabetes mellitus {OR 1,8 IC95% (1,9-3,4){, la insuficiencia cardiaca {OR 2,7 IC 95% (1,1-6,7){ y el mayor tiempo de perfusión {OR 1,02 IC 95% (1,01-1,03){ se asociaron con mayor riesgo de insuficiencia renal postoperatoria, en tanto que el mayor hematocrito {OR 0,86 IC95% (0,82-0,91){ y la mayor fracción de eyección {OR 0,94 IC95% (0,92-0,96){ se relacionaron con disminución del riesgo de insuficiencia renal postoperatoria. Conclusiones: En quienes se realizó revascularización miocárdica los factores asociados a la presentación de insuficiencia renal postoperatoria fueron comorbilidades que se relacionaron con daño renal progresivo dentro y fuera del contexto de la cirugía. Esto implica que las estrategias para minimizar este evento estarán enfocadas a identificar de manera oportuna a estos pacientes y proporcionarles nefroprotección adecuada.

Motivation: To determine which medical history and surgical procedure factors are associated to the onset of postoperative kidney failure in patients undergoing myocardial revascularisation. Methods: Case-control cohort study carried out between January 2005 and December 2013 which included patients who had undergone elective myocardial revascularisation and showed postoperative kidney failure immediately after surgery and until discharge. Controls consisted of patients who had undergone elective myocardial revascularisation and did not develop postoperative kidney failure immediately after surgery. A logistic regression model was used to determine the factors associated to postoperative kidney failure. Associations were expressed as grounds of disparity with their corresponding confidence intervals. Results: old age {OR 1.03 CI 95% (1.01-1.04){, preoperative presence of diabetes mellitus {OR 1.8 CI 95% (1.9-3.4)}, cardiac insufficiency {OR 2.7 CI 95% (1.1-6.7)} and a longer perfusion time {OR 1.02 CI 95% (1.01-1.03)} were associated to a higher risk of postoperative kidney failure, while higher hematocrit {OR 0.86 CI 95% (0.82-0.91)} and higher ejection fraction {OR 0.94 CI 95% (0.92-0.96)} were associated with a decrease of the risk of postoperative kidney failure. Conclusions: In patients who had undergone myocardial revascularisation, risk factors associated to postoperative kidney failure where comorbidities related to internal and external gradual kidney damage outside the context of the surgery. This implies that strategies to minimise this event should be focused on identifying these patients in a timely manner and offering appropriate nephroprotection.

Caracterización epidemiológica de cáncer de esófago en Hospital Base Valdivia, período 2002-2011 / Epidemiologic characterization of esophagus neoplasm, Valdivia Hospital, 2002-2011

INTRODUCCIÓN: El cáncer de esófago posee para el 2007 una tasa de incidencia estimada en Chile de 5,7x100.000 habitantes. Los tipos histológicos más frecuentes son carcinoma de células escamosas y adenocarcinoma, esta última ha experimentado un aumento de su incidencia. OBJETIVOS: Caracterizar población de pacientes diagnosticados con cáncer de esófago, entre los años 2002 y 2011, del Hospital Base de Valdivia (HBV). METODOLOGÍA: Estudio descriptivo retrospectivo, cuyos datos se obtuvieron por revisión de libros de biopsias del Servicio de Anatomía Patológica de Hospital Base Valdivia entre los años 2002-2011 registrando datos sobre sexo, edad y tipo histológico. Los datos fueron tabulados y graficados en programa Excel 2010. RESULTADOS: Se analizaron 151 biopsias, con promedio de edad 70 años. La incidencia promedio fue de 4,14/100.000 habitantes con una relación 5:3 para sexo masculino y femenino respectivamente. La incidencia anual para hombres fue de 1,7 en 2002 y 7,2 en 2011. La incidencia anual promedio para carcinoma escamoso fue de 3,4/100.000 habitantes, para adenocarcinoma 0,58/100.000 habitantes, y otros tipos histológicos 0,2/100.000 habitantes. DISCUSIÓN: La incidencia por género fue más baja para varones que las cifras nacionales, pero con tendencia al alza. El tipo histológico más frecuente fue carcinoma escamoso. A diferencia de lo esperado el adenocarcinoma no tiene tendencia al alza.

INTRODUCTION: The year 2007 the esophageal neoplasms has an estimated incidence in Chile of 5,7/100.000. The most frequently histologic kinds are the Squamous Cell Carcinoma and the Adenocarcinona, the last one has shown an incidence rise. OBJECTIVES: Epidemiologic characterization of esophagus neoplasm cases for the 2002-2011 period. METODOLOGY: Retrospective descriptive study, where the data was obtained by biopsy books revision from the anatomy department at Valdivia hospital. Tabulation and analysis performed whit excel 2010. RESULTS: 151 cases were analyzed, average age were 70 years. The average incidence for men cases: 1,7/100.000 in 2002 and 7,2/100.000 in 2011. The Squamous Cell Carcinoma average incidence: 3,4/100.000 and for the adenocarcinoma: 0,58/100.000. DISCUSSION: The average incidence was lower for men than the national rates, but it's increasing. The mostcommon histologic kind is the quamous Cell Carcinoma. The adenocarcinoma isn't increasing as was expected.

Epidemiología del cáncer papilar de tiroides: Hospital Regional deAntofagasta y Valdivia: período 2005–2011 / Epidemiology of the papillary thyroid cancer: Regional Hospital of Antofagasta and Valdivia: period 2005-2011

El Cáncer de Tiroides constituye la neoplasia del sistema endocrino más prevalente en el mundo (1 por ciento de cánceres totales); el tipo morfológico más común corresponde al Carcinoma Papilar de Tiroides (CPT). Chile cuenta con pocas caracterizaciones epidemiológicas de esta patología, generando un verdadero problema de salud pública al subvalorarla. OBJETIVO: Obtener una visión global del CPT y comparar datos epidemiológicos entre Hospital Regional de Antofagasta (HRA) y Hospital Regional de Valdivia (HRV). MATERIAL Y MÉTODO: Se realizó un estudio de tipo descriptivo retrospectivo de fichas clínicas con diagnóstico confirmado mediante biopsia de CPT, residentes en la II o XIV región de Chile, durante el período 2005-2011. Los datos recabados se tabularon según sexo, edad y región respectiva mediante Excel 2011, calculando adicionalmente la tasa anual de CPT por región. Los datos y valores obtenidos fueron descritos y comparados entre ellos. RESULTADOS: El HRA presentó 79 casos de CPT, con tasa anual promedio (TAP) de 2,03x100.000 hab.; 88,6 por ciento fueron mujeres y 11,4 por ciento hombres; 30,4 por ciento eran <45 años y 69,6 por ciento >45 años. El HRV presentó 88 casos, con TAP de 3,34x100.000 hab.; 84,1 por ciento fueron mujeres y 15,9 por ciento hombres; 52,3 por ciento eran ≤45 años y 47,7 por ciento >45 años. DISCUSIÓN: Según regiones la II presentó menos TAP de CPT que la XIV, existiendo en la última una tendencia al alza y en la II a la disminución, contrastando con la información conocida. Variaron los grupos etarios afectados, la II presentó mayor cantidad de casos >45 años, en cambio, en la XIV la mayoría fue <45 años, contrastando con la literatura...

Thyroid cancer is the more prevalent endocrine neoplasia in the world (1 percent of total cancers); the most common morphological type corresponds to Papillary Thyroid Carcinoma (CPT). Chile has few epidemiologic characterization of this pathology, creating a real public health problem because the underestimating of it. OBJECTIVE: Get an overview of CPT and compare epidemiological data, between Antofagasta Regional Hospital (HRA) and Valdivia Regional Hospital (HRV).METHODS: We performed a retrospective descriptive study of medical records with biopsy-confirmed diagnosis of CPT, residents of the II or XIV region of Chile, during the period 2005-2011. The collected data was tabulated by sex, age and region concerned by Excel 2011, additionally calculating the annual rate of CPT by region. The data and values obtained were described and compared with each other. RESULTS: The HRA presented 79 cases of CPT, with average annual rate (TAP) of 2.03x100.000 pop., 88.6 percent were women and 11.4 percent men, 30.4 percent were ≤45 years and 69.6 percent percent>45 years. The HRV presented 88 cases, with TAP of3.34x100.000 pop., 84.1 percent were women and 15.9 percent men, 52.3 percent were <45 years and 47.7 percent >45 years. DISCUSSION: The second region had less TAP CPT compared to the XIV region. In the last one there is an increased incidence in general, while in region II tends to decrease, contrasting with the existing information. A variation in the affected age groups was found, the II Region had more cases >45 years, however, in XIV region the majority was <45 years, in contrast to the literature...

Hipotensión ortostática en enfermedad de Parkinson / Orthostatic hypotension in Parkinson's disease

The current concept of Parkinson’s disease comprises a group of non-motor symptoms: neuropsychiatric disorders, sleep disturbances and dysautonomia, among others. Orthostatic hypotension is a frequent problem that impairs the patient’s quality of life. We review the symptoms of this disorder, its pathogeny and the available diagnostic tools. We emphasize the early suspicion and show the treatment options, based on the available evidence and our experience.

Cinética de crecimiento in vitro de dos cepas de Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) en células miocárdicas de roedores con diferente susceptibilidad / In vitro growth kinetics of two Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) clones in myocardial cells from rodents of different susceptibility

In vitro growth kinetics of two Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) clones in myocardial cells from rodents of different susceptibility. Two Trypanosoma cruzi isolates, TCR-4 from Costa Rica and UES-1 from El Salvador, were studied in vitro to compare their infectivity or resistance and intracellular replication in myocardial cells in three strains of mice and rats: NGP white mice, C3 H mice and Sprague Dowley rats. Myocardial cells were cultured on coverslips at 37 degrees C in a humid 10% CO2 atmosphere and then infected at a ratio of one tripomastigote per cell. Samples were studied after 24, 72, 96 and 120 h of infection to determine parasite infection capacity and intracellular multiplication. Both parasites had the highest infection capacity in C3 H mice, followed by NGP mice cells with a very low infection rate. Lastly, almost no Trypanosoma cruzi multiplication was observed in Sprague Dowley rats, suggesting a strong natural resistance in this animal to both strains of the parasite. The UES-1 isolate presented higher multiplication and greater invasion than the TCR-4 strain, showing greater virulence of UES-1 in heart cells, at least in vitro.

Factores de riesgo de enfermedades crónicas no transmisibles en funcionarios de una empresa de servicios financieros de la Región Metropolitana / Risk factors for non communicable chronic diseases among workers of a financial company

Background: The epidemic of cardiovascular diseases in Chile, requires the development of strategies in health promotion and prevention. Aim: To assess the prevalence of risk factors for chronic non communicable diseases among workers of a financial company in Metropolitan Santiago. Material and Methods: Assessment of 2,225 workers (1,383 males with a median age of 49 years and 842 females with a median age of 43 years). All answered an enquiry about education, medical history, smoking habits and physical activity. Body mass index and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipid levels. Logistic repression models were used to determine the main risk factors for hypertension, diabetes, obesity, hypercholesterolemia and hyperuricemia. Results: Sixteen percent of studied subjects were obese, 49% had overweight, 57% had hypercholesterolemia, 28% had high blood pressure, 4% were diabetic, 4% had hyperuricemia, 45% smoked and 83% were sedentary. Each worker had a mean of 2.4±1.1 risk factors. This figure was significantly higher among men, obese subjects, those older than 40 years and those with a lower educational level. Conclusions: There is an important disease burden among the studied subjects, specially among obese and older individuals. Healthy lifestyles should be promoted in this population.

Prevalencia de factores de riesgo de enfermedad cardiovascular en una población de empleados chilenos / Prevalence of cardiovascular risk factor among chilean employees

Cardiovascular diseases are the main causes of death in Chile and there is a high prevalence of cardiovascular risk factors in the population. Aim: To assess the prevalence of those risk factors in a group of employees. Subjects and methods: We studied 2,219 individuals, 1,378 males with a mean age of 46.2ñ10.4 years and 841 females with a median age of 41.9ñ10.3 years. Results: High blood pressure was observed in 39.7 percent of men and in 21.8 percent of women. A serum cholesterol between 200 and 239 mg/dl was observed in 38 percent of men and 31.3 percent of women. A cholesterol over this value was seen in 23.7 percent of men and 18.8 percent of women. A low proportion of those with high blood pressure, or elevated cholesterol, were under treatment. Prevalence of smoking was high in men and women: 43.5 and 48.9.2 percent, respectively. Eighty four percent of men and 61.3 percent of women over 54 years were overweight or obese. The prevalence of diabetes mellitus was 4.5 percent. Twenty percent of men and 13 percent of women exercised regularly, at least 3 times a week. Conclusions: There is a high prevalence of untreated cardiovascular risk factors in this population

Microspiridiosis: una parasitosis de reciente adaptación al hombre

Se hace un análisis general de la literatura y del trabajo de los autores sobre microsporidiosis, una parasitosis que se ha puesto en boga a raíz de los problemas de inmunosupresión, especialmente en personas infectadas con el virus del SIDA. Se hace una revisión histórica, se describe básicamente la morfología de los géneros más importantes de los microsporidios y se comentan algunos aspectos de la epidemiología. Se revisan los cambios patológicos debidos a la infección con estos parásitos, los métodos de diagnóstico más usados, el tratamiento y la prevención contra esta parasitosis. Se enfatiza sobre el hallazgo por primera vez en Costa Rica y probablemente en Centro América, de casos humanos de infección con Enterocytozoon bieneusi y con el género Nosema. Palabras claves: Microsporidia, microsporidiosis, Enterocytozoon, Encephalitozoon, Pleisthphora, Nosema

Susceptibilidad de la rata Sigmodon hispidus (Rodentia: Cricetidae) al Toxoplasma gondii (Eucoccidia: Sarcocystidae) / Susceptibility of Sigmodon hispidus (Rodentia: Cricetidae) to Toxoplasma gondii (Eucoccidia: Sarcocystidae)

Sigmodon hispidus, a cotton rat, was inoculated with tachyzoites or oocysts of Costa Rican strains of Toxoplasma gondii to demonstrate the resistance to this parasite, as compared with mice, hamster and white rat infection. Susceptibility to tachyzoite inoculation was higher in this animal than in white rats but lower than in the other animals. Independent to the Toxoplasma strain studied, oocyst infection was less lethal for S. hispidus when compared with mice and hamsters; the results were similar to those observed for white rats. There is a probable participation of this wild animal in the natural Toxoplasma life cycle.

Rotura espontanea de aneurisma de arteria esplenica durante el embarazo. / Spontaneous rupture of a splenic artery aneurysm during pregnancy

Se presenta un caso letal de rotura espontanea de aneurisma de arteria esplenica en una embarazada de tercer trimestre. Se revisa la bibliografia, y se senalan pautas de diagnostico y tratamiento basados en la literatura internacional, por no encontrar referencias en la bibliografia nacional

Ensayo de una asociacion anabolica-antibiotica en cervicopatias benignas. / Trials of an anabolic-antibiotic association in benign cervicopathies

1. 40 pacientes portadores de cervicopatias benignas fueron tratados mediante dos esquemas terapeuticos, con el fin de evaluar el tiempo de curacion del ectropion. Un grupo, constituido por 20 pacientes, recibio como unico tratamiento diatermocoagulacion. 2. El segundo grupo, tambien constituido por 20 pacientes, fue tratado con diatermocoagulacion, mas la asociacion clostebolneomicina (trofoderminR) durante un periodo de 24 dias aplicando 2g. diarios en el fondo vaginal. 3. Ambos grupos de pacientes fueron evaluados cada 7 dias durante 2 semanas y luego cada tres dias mediante estudio colposcopico seriado.Los resultados demostraron que las mujeres tratadas con diatermo-coagulacion mas crema de clostebol-neomicina curaron mas rapidamente (27,60 +/- 3,5 dias) que las tratadas con diatermo-coagulacion sola (33,60 +/- 4,5 dias)