Resultados del tratamiento de la hepatitis crónica por virus C en un hospital público, en Chile / Results of chronic hepatitis C treatment in a public hospital

Background: Chronic hepatitis C is an important health problem in Chile. In 2005, the Ministry of Health started a pilot treatment program with peg interferon and ribavirin, to be developed in public hospitals all over the country. Aim: To report the results ofhepatitis C treatment obtained at our institution. Patients and Methods: Between 2005 and 2009, 63 patients were referred for treatment. In all, the viral load and genotype were determined. Peg interferon alpha-2a or alpha-2b plus ribavirin were used for therapy for up to 48 weeks in genotypes (G) 1 or 4 or 24 weeks in genotypes 2 or 3. If at the end oftreatment, viral load measured by polymerase chain reaction (PCR) was negative, it was repeated 6 months later. A negative viral load at that time was considered a sustained viral response (SVR). Results: Among the 51 patients who started treatment, 42 (80.4%) were G1,1 was G2,1 was G4 and 7 were G3. A SVR was reached in 51.1% ofG 1 and 4 and in 87.5% in G 3 and 2. In a univariate analysis, the variables significantly associated with a positive viral response were the degree offibrosis and body mass index. Conclusions: These results are similar to those obtained in other international series, demonstrating that Hispanic ethnicity does not influence the response to treatment. Our good results could be explained by the excellent compliance of the patients to the treatment. A higher degree offibrosis and a higher BMI were associated with a poor response.

Gastritis varioliforme y daño hepático crónico: Una inesperada asociación / Association between varioliform gastritis and cirrhosis

Background: Varioliform gastritis (VG) is found in approximately 0.3 to 2.8 percent of upper gastrointestinal endoscopies. Its etiology is not known. We have observed a higher frequency of VG in patients with liver cirrhosis. Aim: To confirm if there is an association between VG and liver cirrhosis. Patients and Methods: Two case-control studies were done. A retrospective study, reviewing the endoscopy database of a gastroenterological unit. A prospective study, identifying cases with the endoscopic diagnosis of VG among all patients referred for upper gastrointestinal endoscopies. The presence of liver cirrhosis, based on clinical, laboratory, ultrasonographic and endoscopic features was registered among patients with VG. Results: VG was found in 549 of 11.659 upper gastrointestinal endoscopies. Fourteen percent of patients with VG had cirrhosis compared to 5.6 percent in control patients (c² 29,8; p < 0.01). The odds ratio (OR) for having cirrhosis of patients with VG was 9.3 (95 percent confidence intervals 3.4-25.5, p < 0,01), according to a logistic regression analysis. In the prospective study, that included 1.498 upper gastrointestinal endoscopies, VG was also significantly more common among patients with liver cirrhosis. Conclusions: A higher frequency of VG was found among patients with liver cirrhosis. Therefore, the endoscopic finding of VG should alert physicians to look for the presence of a coexistent liver cirrhosis.

Fenómeno de acomodación inmunológica: Trasplante hepático ABO incompatible. Caso clínico / Accomodation process: ABO-incompatible liver transplantation. Report of one case

We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accomodation opens the possibility of using ABO-incompatible organs as a definitive grafts.

Manejo del estrabismo en el alto miope / Management of strabismus in high myopia

Se analiza un grupo de 12 personas con estrabismo asociado a alta miopía, en términos de su presentación clínica, cirugía realizada y sus resultados. En 7 de éstos pacientes se realizó un tipo de unión entre los músculos rectos superior y lateral (técnica de Yokohama), pero se consideraron diferentes enfoques quirúrgicos sobre el recto medio. Se obtuvieron buenos resultados en la mayoría de los casos, observándose solamente 2 casos que requirieron reoperación.

A group of 12 patients with strabismus associated to high myopia is analyzed in terms of clinical presentation, surgery performed and its results. In 7 of these patients a type of muscular union between superior and lateral rectus (Yokoyama's technique) was done, but different approaches to the medial rectus were considered. Good results were obtained in most cases with only 2 patients requiring reoperations.

Estrabismo en orbitopatía / Strabismus in orbitopathy

Introducción: la fibrosis y contractura muscular determina la aparición de un estrabismo restrictivo. Objetivo: describir aspectos clínicos-radiológicos y resultados quirúrgicos en una serie de pacientes. Materiales y métodos: estudio retrospectivo de 22 pacientes operados en 2 centros clínicos entre 1990 y 2005 con tabulación de datos clínicos, mediciones en 9 posiciones, ducciones, resultados quirúrgicos y complicaciones. Además análisis doble-ciego clínico radiológico. Resultados: mayor prevalencia en mujeres (88 por ciento), (x) edad 57 años, síntoma inicial diplopia (100 por ciento). Compromiso muscular RI (72 por ciento), RM (63 por ciento), RS (22 por ciento), RL (9 por ciento). Grupos más frecuentes: RM bilateral (18.2 por ciento) y RI unilateral (16 por ciento). Resultado postoperatorio excelente (sin diplopia) 75 por ciento, satisfactorio (sin diplopia con prismas) 23 por ciento y malo (diplopia permanente) 2 por ciento. Correlación clínico-radiológica exacta (45 por ciento) y del principal músculo afectado (100 por ciento. Complicaciones: 33 por ciento ptosis palpebral inferior y 9.5 por ciento neuropatía óptica compresiva. Conclusión: el manejo estrabológico adecuado en orbitopatía de graves otorga en un alto porcentaje una mejoría de sus síntomas y mejor calidad de vida.

Introduction: fibrosis and muscular contracture results in restrictive strabismus. Objective: describe clinical-radiological features and surgery results in a group of patients. Methodology: retrospective study of 22 surgical patients treated in 2 ophthalmology institutes between 1990 and 2005. Ciinical data, 9 positions and duction study, surgical results and finally incidence of complications were all assesed. Also a double-blind clinical-radiological correlation was performed. Results: female were more affected (88 percent), mean age 57 years, initial sympton was diplopia en every case. Muscle involvement IR (72 percent), MR (63 percent), SR (22 percent), LR (9 percent). Most frequently muscle associations: both MRs (18.2 percent) and unilateral IR (16 percent). Postoperative results: excellent (diplopia free) 75 percent, satisfactory (diplopia corrected with prisms) 23 percent, bad (persistent diplopia) 2 percent. Exact clinical-radiological correlation (45 percent), mayor affected muscles correlation (100 percent). Complications: inferior palpebral ptosis (33 percent) and comprenssive optic neuropathy. Conclusions: adequate strabismus management in graves orbithopathy gives the patient symptomatic relief and better life quality in a high percentage of cases.

Correlación entre ecobiometría y refracción en pacientes portadores de LIO / Correlation between echobiometry and refraction in patients with IOL

El valor dióptrico del LIO es determinado por una fórmula matemática cuyos valores se obtienen de una ecobiometría. Se efectuó un estudio retrospectivo de 50 casos operados por los autores. Se analizó la efectividad del método matemático relacionándolo con la refracción al aire a los 30 días del postoperatorio