Epidemiología y características anatomoclínicas del melanoma maligno en un instituto oncológico / Epidemiology and clinical features of malignant melanoma. Analysis of 274 cases

BACKGROUND: Malignant melanoma (MM) is the most fatal cutaneous neoplasm. Its incidence is increasing progressively, which cannot be explained only by early diagnosis. Chilean population, due to the geography of the country, has a very varied solar exposure. AIM: To know the incidence of MM in a Chilean population, according to the level of sun exposure and to describe its clinical and histopathological characteristics. MATERIAL AND METHODS: Two hundred seventy-four surgeries for malignant melanoma with histological confirmation, carried out between 2016 and 2018 in an oncological institute were included. RESULTS: The annualized incidence of MM was 13.83 cases per 100,000 people over 15 years of age in the 2016-2018 period. The geographical distribution of the incidence did not have a clear relationship with sun exposure. The most frequent locations of the primary lesions were trunk, head/neck and lower limb. Sixty-one per cent of cases were invasive MM; lesion thickness and presence of ulceration were associated with a higher risk of sentinel node involvement. CONCLUSIONS: No association between the level of sun exposure and the incidence of MM was observed in this study.

Epidemiología del cáncer de tiroides en un Instituto Oncológico. Efecto de las nuevas recomendaciones clínicas / Incidence of thyroid cancer in an oncological clinic of Santiago, Chile

Background: In Chile, Thyroid cancer (TC) is included in a list of diseases that have a guaranteed access to treatment, endorsed by the Ministry of Health. The care burden of the disease will depend on its incidence. Aim: To estimate the incidence of TC in Chilean patients with access to thyroid surgery and describe its histopathological characteristics. Material and methods: Analysis of the registry of all thyroidectomies performed at a private oncological clinic in Metropolitan Santiago, between 2016 and 2018. Incidence was estimated the number of persons affiliated to an insurance system managed by the same clinic, separated by age and gender. Results: TC adjusted incidence varied from 60.8 cases per 100,000 persons/year in 2016 to 48.7 cases per 100,000 persons/year in 2018. The proportion of microtumors was 34% when the diameter of all foci was considered. Papillary and follicular carcinomas were the pathological diagnoses in 96 and 2% of cases respectively. Twenty-one percent of tumors had extra-thyroidal invasion. Conclusions: The TC incidence herein reported is higher than the figure of 7.9 cases per 100,000 persons/year reported by us in 2014. This difference could be due to a true increase in the incidence of TC, following worldwide trends or to differences in the methods used in both studies.

Recomendaciones para el uso correcto de densitometría ósea en la práctica clínica. Consenso de la Sociedad Chilena de Endocrinología y Diabetes / Guidelines of the Chilean Endocrinology Society for the correct clinical use of bone densitometry

Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.

Epidemiología del cáncer de tiroides en Chile: Resultados del estudio INCATIR / Estimation of thyroid cancer incidence in Chile based on pathological reports

Background: Thyroid cancer (TC) detection is increasing steadily. Aim: To determine the incidence of TC based on pathological reports of thyroidectomies. Material and Methods: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. Results: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. Conclusions: The incidence and features of TC in Chile are similar to the figures reported abroad.

Asociación entre malnutrición por exceso con caries temprana de la infancia / Association between overweight and early childhood caries

Objective: To determine whether overweight is a risk factor for the development of early childhood caries (ECC) in preschoolers. Patients and Method: An observational retrospective cohort study was performed in 196 children under 2 years of age at Calbuco Hospital, Los Lagos Region, Chile, who were admitted between 2007 and 2009. Patients were grouped based on their nutritional status at admission in the two following categories: eutrophic and overweighed children as a result of excessive intake. Information regarding caries incidence and nutritional status were annually retrieved from records until the age of 5 years, according to medical and dental records. Results: At the beginning of the study, 33.67% were overweight and 16.33% were obese, reaching 40% overweight and 20.56% obese at four years of age. The incidence of early childhood caries in overweighed children was 57.14% compared to 40.82% in normal weight children (p = 0.022), with 1.4 RR (95% CI, 1044-1.88). Conclusions: The increased risk of early childhood decay in overweighed patients makes necessary to create instances of timely mutual referral between the professional that diagnoses overweighed children and the pediatric dentist in order to develop preventive treatments for both diseases.

Objetivo: Determinar si la malnutrición por exceso es un factor de riesgo para el desarrollo de caries temprana de la infancia (CTI) en preescolares. Pacientes y Método: Se realizó un estudio observacional de cohorte retrospectivo en 196 niños de 2 años del Hospital de Calbuco, Región de Los Lagos, Chile, ingresados durante los años 2007 a 2009. Los pacientes fueron agrupados de acuerdo a su estado nutricional al ingreso en niños eutróficos y niños con malnutrición por exceso. La información respecto a incidencia de caries y el estado nutricional fueron recuperados de la ficha anualmente hasta la edad de 5 años, según registro de las fichas médicas y odontológicas. Resultados: El 33,67% estaba en sobrepeso al inicio de la cohorte y el 16,33% obeso, alcanzando 40% sobrepeso y 20,56% obesidad a los cuatro años de edad. La incidencia de caries temprana de la infancia en niños con malnutrición por exceso fue de 57,14% en relación al 40,82% de los niños eutróficos (p = 0,022) con RR de 1,4 (95% IC, 1.044-1,88). Conclusiones: El mayor riesgo asociado a CTI en pacientes con malnutrición por exceso invita a generar las instancias de derivación oportuna desde el profesional que pesquisa a niños con malnutrición por exceso hacia el odontólogo infantil, con el fin de desarrollar intervenciones preventivas para ambas patologías.

Efecto de los antagonistas de aldosterona en nefropatía diabética: revisión sistemática de la literatura / Systematic review of the effect of aldosterone antagonists on urinary albumin excretion in diabetic nephropathy

The beneficial effect angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) for diabetic nephropathy can be hampered by the phenomenon of aldosterone escape. Aldosterone antagonists such as espironolactone or epleronone could potentiate the effects of ACEI and ARA and avoid the later problem. We performed a systematic search of the literature on the effects of aldosterone antagonists on diabetic nephropathy. We searched for clinical trials and follow up studies measuring the effects of aldosterone antagonists on urinary albumin excretion among patients with diabetic nephropathy. We retrieved 1345 papers on the subject and 10 were selected for analysis. Among these, spironolactone was more effective than comparing drugs to achieve a reduction in urinary albumin excretion of approximately 30 to 40 percent. On the other hand epleronone was not superior to comparing drugs. All studies reported a modest reduction in glomerular filtration rate and an increase in serum potassium levels. In conclusion, spironolactone in doses of 25 to 100 mg/day reduces urinary albumin excretion but reduces also glomerular filtration rate and increases serum potassium levels.

Comparación del efecto de la terapia prolongada con antipsicóticos atípicos o convencionales en la incidencia de diabetes mellitus 2: Revisión sistemática y metaanálisis / Risk of type 2 diabetes mellitus among users of atypical antipsychotic drugs or conventional treatment: Systematic review

Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed.

Infección profunda del cuello por Streptococcus grupo B en un paciente diabético: Caso clínico / Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient: Report of one case

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.

Hiperparatiroidismo primario con compromiso esquelético grave: Un caso de carcinoma paratiroideo / Primary hyperparathyroidism with severe skeletal involvement in one patient with parathyroid carcinoma

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism; however, when this condition is severe, cancer must be suspected. We report on a 28-year-old male with severe hypercalcemia, cachexia, acute pancreatitis, urolithiasis, anemia and a severe skelletal involvement with multiple fractures. The patient had a 4-cm parathyroid tumor, that was surgically excised, along with the ipsilateral thyroid lobe. During the postoperative period, he had a severe and prolonged hungry bone syndrome, with a slow recovery of fractures, with functional and anatomical sequelae in the extremities. PTH levels were adequate for the serum calcium during the 16 months of follow-up.

Consenso de diagnóstico y manejo de los nódulos tiroideos no palpables / Consensus report on the diagnosis and management of non palpable thyroid nodules

With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term <>, is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the <> statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on tbe management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking.

Tuberculosis en pacientes trasplantados renales / Tuberculosis in renal transplant patients

We estudied the incidence of tuberculosis in 37 renal transplant patients. Mean age was 37 years and immune supression therapy had been used for a mean of 37 mounths. Tuberculosis free cases had received presnisone at a mean dose of 10 ñ 4 mg/day and azathyoprine, 96 ñ 35 mg/day. 28% of patients had a postive tuberculin test, 24% a healed tuberculous lung lesion and 40% received chemoprofilaxis. Four patients developed tuberculosis, 10 times the incidence expected for the general population. Fever was present in all patients. Two patients had a disseminated form and one a laryngeal location. None of the patients had recived chemoprophylaxis and the dose of prednisone was higher (18 ñ 9 mg/day) than that received by non-infected patients. Thus, chemoprofilaxis for tuberculosis appears warranted in all renal transplant recipients, regardiess of tuberculin test results or chest X ray findings

Quiste hidatídico hepático: características clínicas, factores pronósticos y resultados quirúrgicos / Liver hydatid cyst: clinical characteristics, pronostic factors and surgical results in 100 cases

Se revisaron las fichas de 100 pacientes con hidatidosis hepática para evaluar sus características clínicas, factores pronósticos y resultados del tratamiento quirúrgico. En el 94,7% de los casos se obtuvo el antecedente de contacto estrecho con perros. El dolor (85,9%), la hepatomegalia (49,5%), la presencia de masa abdominal (40,8%), la ictericia (26%) y la fiebre (21%) fueron las manifestaciones clínicas más frecuentes. La intradermorreacción de Casoni resultó positiva en el 78,3% y la hemaglutinación en el 31% de los casos, predominantemente de pequeña magnitud. Cintigrama hepático y ecografía abdominal presentaron una sensibilidad diagnóstica de 96,7% y 92,9%, respectivamente. El 60% de los casos presentaba quistes complicados, en especial por comunicación a la vía biliar (30%), o infectados (15%). De los 100 casos fueron operados 89, principalmente mediante técnicas de vaciamiento y drenaje (39,3%), Posadas (20,2)%, o la quistectomía (16,8%). Al agregarles coledocostomía a estos procedimientos se prolonga en forma notoria el lapso de hospitalización de los casos y su mortalidad. En el 68,5% de los pacientes intervenidos surgieron complicaciones postoperatorias, en especial por absceso de la cavidad residual (50%), pleuroneumopatías (45,9%), infección de la herida operatoria (39,3%) y fístula biliar externa (31,1%); la mayoría de estas complicaciones ocurrieron en los enfermos sometidos a procedimientos de vaciamiento-sutura-drenaje. La mortalidad postoperatoria fue de 13,5% y en relación a las técnicas quirúrgicas de 4,5% con las de tipo resectivo, 9% con las de Posadas y 22,4% con las de drenaje uni o bipolar externo. En suma, se asociaron significativamente a mayor mortalidad los siguientes factores: 1) Presencia de quiste ya complicado, 2) Aparición de absceso en la cavidad residual y 3) Empleo de procedimientos operatorios que implican dejar una cavidad residual comunicada al exterior. Estos constituyen aspectos pronósticos de importancia. Los resultados obtenidos permiten recomendar el uso de técnicas quirúrgicas resectivas para una proporción mayor de pacientes, siempre que se cuente con equipo convenientemente adiestrado en cirugía y adecuada infraestructura hospitalaria