Informe para el Tribunal Constitucional sobre los aspectos científicos y éticos del uso del levonorgestrel como anticonceptivo de emergencia / Report for the Constitutional Court on the scientific and ethical aspects of the use of the levonorgestrel like emergency contraceptive

Las normas de regulación de la fertilidad, propuestas en el documento del Ministerio de Salud de Chile, plantean diversos problemas biomédicos en el contexto de una cierta visión de la procreación humana, de la sexualidad y de la familia. Hay serias objeciones desde una antropología que respeta la naturaleza personal de la mujer y del hombre, especialmente en el riesgo que existe en la promoción de métodos que podrían afectar la vida de seres humanos inocentes en sus etapas iniciales de desarrollo. Del análisis de la literatura se ha concluido que existen antecedentes científicos importantes, que se analizan en este documento, y que indicarían que el uso de la llamada “píldora del día después” podría estar poniendo en riesgo la vida del embrión humano preimplantacional.

Fertility regulation rules, proposed by the Chilean Health Ministry, involve several biomedical problems within the context of a given view point of human procreation, human sexuality and family. There are serious objection from an anthropology that respects the personal nature of woman and man, particularly in the danger that the life and survival of preimplantational human embryo could be affected by such methods. From an exhaustive analysis of the scientific literature, that are discussed in this document, it was concluded that the so called “emergency contraception pill” could be jeopardizing the life and survival of the preimplantation human embryo.

75 años de la Facultad de Medicina de la Pontificia Universidad Católica de Chile / Seventy five years of the Medical School of the Pontifical Catholic University of Chile

Aiming to join academic excellence and an ethical and Christian approach to medical profession, the Medical School of the Pontifical Catholic University of Chile initiated its activities in 1930. Since then, the associated Health Care Network has incorporated all the technological breakthroughs in medicine and developed all the specialties. Undergraduate teaching is oriented to promote creativity and innovation. There is also a special concern about humanity of Medicine, throught the Program of Humanistic Medical Studies and the Bioethics Center. Post graduate education is also an important activity of the School, through specialty training, Master and Doctorate programs. Researchers have also obtained important grants and generated a great number of publications in high impact journals. Our University is defined as «complex¼, meaning that we must take important challenges, be creative and lead knowledge generation. We must also improve ourselves to serve in the best possible way our students and the Country. Paraphrasing the words of our founder, Monsignor Carlos Casanueva, we must train physicians that will serve our community not only with science but also with humanity.

Trasplante de médula ósea en el tratamiento de enfermedades hematológicas malignas / Allogenic bone marrow transplantation in patients with malignant hematological diseases

We have treated 28 patients (pts) with malignant hematological diseases with allogenic bone marrow transplantation (BMT). 18 pts had acute lymphoblastic (ALL) and non lymphoblastic leukemia (ANLL), 5 chronic myeloid leukemia (CML), 2 severe aplastic anemia (SAA), 1 myelodisplasia, 1 Fanconi's anemia and 1 advanced Non Hodgkin's lymphoma. All but three received the graft from HLA identical sibling donors. We used conditioning with total body irradiation and chemotherapy (cyclophosphamide, cytarabine and etoposide) in 17 pts and chemotherapy alone in 11.24 pts had a full hematological recovery 18 to 25 days post BMT. 15 pts died after BMT as a consequence of toxicity or early infection (4), graft failure (2), graft vesus host disease (4) or relapse (5). Actuarial event free survival for the group with favorable prognosis (SAA, ALL and ANLL in first or second remission and CML in chronic phase) is 57 percent at 36 months. Allogeneic BMT is an effective and feasing therapeutic procedure for selected patients with hematological malignancies

Imipenem - cilastatina versus ceftazidima - amikacina para el tratamiento de pacientes neutropénicos febriles / Imipenem - cilastatine versus ceftazidime - amikacin in the treatment of febril neutropenic patients

Aim: To compare the efficacy of imipenem - cilastatine and ceftazidime - amikacin in the treatment of febril neutropenic patients. Design: Open prospective and randomized clinical study. Patients: 52 patients (26 females) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive Imipenem - cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid. Results: Global response to initial therapy was 53 percent in patients receiving imipenem - cilastatine and 37 percent in those receiving ceftazidime - amikacin (p=ns). When other antimicrobial were added, a 90 and 85 percent infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem - cilastatine and 12 episodes in tha group receiving ceftazidime - amikacin had Gram positive cocci as the sole treatment outcome. Three patients receiving imipenem - cilastatine (10 percent) and 4 receiving ceftazidime - amikacin (13 percent) died. Superinfections and toxicity related to antibiotics were minimal in both groups. Conclusions: imipenem - cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febril episodes in neutropenic patients

Comparación de distintas soluciones para eritroferesis en la poliglobulia neonatal / Comparisson of several solutions for eritropheresis in neonatal polyglobulia

Se estudiaron prospectivamente 29 recién nacidos poliglobúlicos, que no presentaban enfermedades relevantes asociadas, asignándoles al azar a tratamiento de eritroferesis con solución NaCl 0,9 por ciento, plasma o albúmina al 5 por ciento. Se les midió hematocrito, viscocidad sanguínea y sodio plasmático antes y después de la eritroferesis. Las tres soluciones fueron igualmente efectivas en disminuir significativamente el hematocrito y la viscocidad sanguínea. En los tres grupos la disminución del hematocrito se mantuvo 12 a 24 horas después de la eritroferesis y el sodio plasmático se mantuvo estable, sin variaciones entre las cifras previas y posteriores al procedimiento. La solución de NaCl 0,9 por ciento tiene las ventajas de no ofrecer riesgos de transmitir infecciones, menor costo y no motivar objeciones religiosas, por lo que parece ser la mejor opción para la eritroféresis en recién nacidos con poliglobulia

Estudios citogenéticos en niños chilenos con leucemia linfoblástica aguda / Cytogenetic studies in chilean children with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is the most frequent childhood cancer. The leukemic cells of ALL patients show several well defined numeric and structural chromosomal abnormalities which are universally known for its prognostic implications. We studied a group of 44 children with ALL, to investigate the incidence of chromosome aberrations in ALL, its lymphocyte lineage and some clinical feature associations, ans the finding of non previously described aberrations. A high proportion of patients (79.5 per cent) showed chromosomal abnormalities. Most of them had a pseudodiploid karyotype (46 chromosomes), characterized mainly by a translocation. In relation to chromosome number, 27 percent of them were hyperdiploid with more than 50; 9 percent hyperdiploid between 47 - 50 and 7 percent hypodiploid (less than 46). Among structural aberrations found, were the following recurrent translocations: t(1;19), t(4;11), t(9;22) in 6.8 percent, 9.1 percent and 2.3 percent of cases respectively, all related to an early B immunophenotype. Other translocations found, compromised regions 7q22,9p21 -24. Two new translocations in ALL were found: 8(1;5)(q23;q33), apparently balanced and t(13;21)(q14;q22), unbalanced. Other recurrent structural changes found were: deletion (6q), (7q), (7q), (11q), (12q), inversion (3q), isochromosome (7q), maker chromosomes and double minutes. The distribution of chromosome abnormalities in this group of patients was in agreement with previous reports from other investigators

La anemia de la glomerulonefritis aguda post-estreptocócica / Anemia associated to acute post streptococcal glomerulonephritis

Thirty-three children with post-streptococcal acute glomerulonephritis, age x:8.3 years (range 6-12) were studied prospectively. Mean initial hematocrit (Hct) was 31.6 percent with 90 percent showing Hct under the normal lower limit for this age group. Reticulocyte index (RI) was <0.5 in half of the cases. Serum iron concentration, total iron binding capacity (TIBC) and percentaje of transferrin saturation were normal for this age group although 75 percent of the children had increased serum ferritin levels. At the time of discharge, Hct increased to 35.1 percent but 44 percent still had anemia. Hct increased spontaneously for 105 days stabilizing at 38 percent. Based on Hct changes, 3 groups were defined: Group I (3 individuals): normal upon discharge; Group II (19): partial recovery at discharge, slow recovery stabilizing after 105 days; Group III (11): lower Hct, slower recovery but with RI significantly higher than group II (0.96 vs 0.45 p<0.01). Our data suggest that although hemodilution is present in all, it may be considered the solely factor only in 3 cases (Group I). In group II, evidence of bone marrow depression was indicated by the low RI. On the other hand, the intense anemia that could not be justified only by hemodilution and marrow depression in group II, suggest other pathogenic factors

Embarazo en una paciente con falla ovárica prematura secundaria a quimioterapia / Pregnancy in a patient with ovarian failure due to chemotherapy

A 30 year old patient with idiopathic thrombocytosis received chemoterapy and developed amenorrhea and secondary ovarian failure. After discontinuation of chemotherapy, she became pregnant and recovered normal ovarian function 6 monthes after delivery

Mielodisplasias: experiencia clínica en 35 pacientes / Myelodysplasia: an analysis of 35 patients

Myelodysplasia, characterized by varied reductions of peripheral blood elements with normal or hypercellular bone marrow, is reltively frequent among older patients and may evolve to acute leukemia. We reviewed findings in 35 patients whon, according to the FAB classification were distributed as follows: simple refractory anemia (RA) 34%, sideroblastic refractory anemia (SRA) 14%, refractory anemia with excess blast forms (RAEB) 31%, chromic myelomonocytic leukemia (CMML) 12% and refractory anemia eith excess blast forms in transformation (RAEBT 9%). Cytogenetic studies performed in 16 patients were abnormal in 5(31%), al among patients with poor prognosis forms of the disorder. All patients had anemia; thrombopenia and neutropenia were more frequent in subtypes RAEB, CMML and RAEBT). Mean survival rate was 30 months, significantly greater in RA and SRA comapred to the other groups. Infections and development of acute leukemia were the causes of death