Consenso chileno de diagnóstico y manejo de neoplasias quísticas pancreáticas. Club de páncreas Chile-SCHGE / Chilean consensus on diagnosis and management of pancreatic cystic neoplasms

Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.

Plasticity in primary somatosensory cortex resulting from environmentally enriched stimulation and sensory discrimination training

We studied primary-somatosensory cortical plasticity due to selective stimulation of the sensory periphery by two procedures of active exploration in adult rats. Subjects, left with only three adjacent whiskers, were trained in a roughness discrimination task or maintained in a tactile enriched environment. Either training or enrichment produced 3-fold increases in the barrel cortex areas of behaviorally-engaged whisker representations, in their zones of overlap. While the overall areas of representation expanded dramatically, the domains of exclusive principal whisker responses were virtually identical in enriched vs normal rats and were significantly smaller than either group in roughness discrimination-trained rats. When animals were trained or exposed to enriched environments with the three whiskers arrayed in an are or row, very equivalent overlaps in representations were recorded across their greatly-enlarged whisker representation zones. This equivalence in distortion in these behavioral preparations is in contradistinction to the normal rat, where overlap is strongly biased only along rows, probably reflecting the establishment of different relations with the neighboring cortical columns. Overall, plasticity phenomena are argued to be consistent with the predictions of competitive Hebbian network plasticity.

Non-homogeneous spatial configuration of vibrissae cortical representation in layer IV of the barrel somatosensory cortex

In the present experiments we studied exclusive and overlapping cortical representational areas of the vibrissae in layer IV cells, across the entire barrel subfield of the rat somatosensory cortex, looking for evidences that would challenge the present assumptions of homogeneity and symmetry among cortical columns in this sensorial system. Our main findings were that in layer IV of the rat barrel cortex: A) Size of vibrissae cortical representational areas (X=0.4174mm²; SD=0.025) was not homo geneous, vibrissae in dorsal rows (A-B) had significantly smaller areas than those in ventral rows (D-E), a pattern that repeated itself in arcs 1-4. B) This difference arises from vibrissal representational overlap, and not from variations in exclusive zones, which are surprisingly homogeneous in size across the barrel cortex (X=0.079mm²; SD=0.0075); C) The extent of overlapping cortical areas varied systematically, with intra-row overlapping areas having a predominant bias (71.4 percent of total overlapping) independent of area sizes. Accordingly, vibrissae shared receptive fields with an average of 1.15 vibrissae in the same row and 0.38 in the same are. Barrel cortex has been viewed operationally as a conglomerate of essentially homogenous cortical columns that interact equivalently in the are and row dimensions. Our simple but global cortical reconstructions show that this predominant view should be revised. We postulate that the vibrissae/barrels spatial disposition in rows and ares has a relevant functional meaning, related to different sensory capabilities.

Perfil población consultante en Policlínico de ETS, Consultorio Nº 1, Los Andes, 2001-2003 / Profile of consulting population at the sexually transmitted diseases (STD) polyclinic, dispensary Nº 1, Los Andes, 2001-2003

El objetivo fue caracterizar al grupo de pacientes inscritos en el policlínico de enfermedades de transmisión sexual (ETS) de esta provincia, determinando factores de riesgo, patologías de mayor prevalencia y cobertura de tratamiento en la atención primaria. Estudio descriptivo realizado en el Centro de Salud Cordillera Andina durante julio de 2004. Se recolectaron datos de 254 fichas, correspondientes al total de pacientes inscritos alguna vez en el programa desde el año 2001 al 2003. Las variables estudiadas fueron: edad al ingreso al programa; sexo; ocupación; domicilio; escolaridad; orientación sexual; número de parejas y uso de preservativo; consumo de alcohol y drogas; exámenes clínicos; diagnóstico principal y tratamiento. La edad promedio de ingreso fue de 30 años, el 78% de los pacientes correspondían al sexo masculino. De ellos un 38,1% era obrero, con una menor frecuencia de otras ocupaciones; sólo 47% completó la enseñanza media. Respecto a los hábitos: 8,6% refería orientación homo/bisexual; 48,9% tuvo 2- 4 parejas el último año; 57% nunca usó preservativo, 75,3% consumía alcohol y 39% otras drogas. De los diagnósticos realizados la gonorrea ocupó el 36,9%, la uretritis no gonocócica el 30,6%, y la sífilis el 18,9%. Se logra caracterizar esta población observándose una franca mayoría del sexo masculino, mientras entre las mujeres hay una frecuencia relativa de dueñas de casa. Destacan los elevados porcentajes de promiscuidad, consumo de alcohol y drogas, el bajo uso del preservativo y la baja escolaridad.

The objective was that of characterizing the group of patients registered at the Sexually Transmitted Disaeases (STD) Polyclinic of this province, determining risk factors, higher prevalence pathologies and treatment coverage in primary care. This is a descriptive studycarried out in the Cordillera Andina Health Center during July 2004. Data were collected from 254 medical record cards corresponding to the total number of patients registered in the program at any time from 2001 to 2003. The variables studied were: age at insertion into the program; sex; occupation; place of residence; schooling; sexual orientation; number of couples and use of preservatives; alcohol and drug consumption; clinical examinations; principal diagnosis and treatment. The average age of insertion was 30 years; 78% of the patients being males. Of these, 38.1% were manual workers with a lower frequency of other occupations; only 47% had completed middle school. As far as habits are concerned: 8.6% admitted homosexual/bisexual orientation; 48.9% had 2-4 couples during the last year; 57% never used a preservative, 75.3% consumed alcohol and 395 other drugs. Of diagnoses performed, gonorrhea was 36.9%, nongonococcal urethritis, 30.65 and syphilis, 18.9%. Characterization of this population is accomplished, finding in it a clear majority of males, while among women there is a relative frequency of housewives. High percentages of promiscuity, alcohol and drug consumption, low use of preservatives and low schooling stand out.

Hamartoma endobronquial: a propósito de un caso / Endobronchial hamartoma: case report

El hamartoma es el tumor pulmonar benigno más frecuente. En su mayoría se encuentran en el parénquima pulmonar, pero en algunos casos se presentan en bronquios. Los hamartomas endobronquiales pueden ser hallazgos radiológicos, aunque en ocasiones pueden producir tos crónica o neumonías a repetición. El manejo es la resección endoscópica, pero debido al difícil diagnóstico diferencial con las neoplasias malignas pulmonares, la resección pulmonar juega un papel importante. Se presenta el caso de una paciente de 72 años con un cuadro de tos crónica. Se pesquisó en estudio radiológico una masa en lóbulo superior derecho con compromiso bronquial. La fibrobroncoscopía con biopsia y citología no pudo determinar diagnóstico. Se realizó lobectomía superior derecha. El estudio histológico intraoperatorio y diferido confirmaron el diagnóstico de hamartoma.

Características neuropsicológicas del trastorno bipolar I / Neuropsychological Characteristics of the Bipolar Disorder I

La neuropsicología es la disciplina que estudia la relación cerebro-mente-conducta por medio del analisis de la estructura y los procesos cerebrales que están en la base de las funciones psicológicas superiores como la conciencia, la atención, el aprendizaje, la memoria, el pensamiento, el lenguaje, la motivación y la afectividad. Las alteraciones neuropsicológicas en los pacientes con trastorno bipolar han sido poco evaluadas en comparación con otros trastornos psiquiatricos como la esquizofrenia. Sin embargo, se ha incrementado el interés por las implicaciones etiológicas, de tratamientos, de prevención y de pronóstico, como predictores de ajuste, competencia social y de calidad de vida en estos pacientes. En este artículo se pretende hacer una revisión de las investigaciones que se han realizado hasta la fecha, y que relacionan el trastorno bipolar con anormalidades neuropsicológicas. Se revisaron investigaciones realizadas en diferentes fases del trastorno, como manía, depresión o eutimia, así como estudios comparativos con pacientes esquizofrénicos, y además se discute la posible influencia de los psicofármacos...