Medición de los niveles de ruido ambiental en la ciudad de Santiago de Chile / Environmental noise levels measurement of the city of Santiago, Chile

Introducción. Un estudio realizado en Santiago en 1989, estimó que 1.300.000 personas estaban sometidas a niveles de ruido inaceptables por las normas internacionales. Considerando que no existen publicaciones sobre ruido ambiental realizadas por otorrinolaringólogos, y que el tema no ha sido revisado en los últimos 15 años, quisimos actualizar la información al respecto. Material y método. Se evaluó el ruido en lugares que afectan la rutina del ciudadano común, independiente de su profesión: Barrio residencial, parques, discotecas, bar-discoteque, calles principales, buses de transporte urbano habituales, buses de transporte urbano del proyecto transantiago y Metro. Las mediciones se realizaron con un sonómetro integrador, según lo establecido por la normas de la Comisión Nacional del Medio Ambiente (CONAMA), durante los meses de julio a septiembre del 2006. Resultados. Las discotecas son el lugar con mayor contaminación acústica. En relación a la Avda . Bernardo O'Higgins (Alameda), el nivel de ruido: 80.5 dB(A), se mantiene constante en diferentes puntos de medición. Entre el transporte público, el metro tiene los niveles de ruido más altos: 87 dB (A). No existen diferencias entre los buses antiguos o micros amarillas y los del proyecto transantiago. Conclusiones. Nuestros resultados ponen una nota de alerta mostrando que el nivel de ruido en Santiago, para la gran mayoría de los parámetros, son superiores a las normas establecidas.

Introduction. A study carried out in Santiago in 1989 estimated that 1,300,000 people were exposed to noise levels unacceptable by international standards. Considering that there are no reports of environmental noise evaluations performed by otorhinolaryngologists, and that the subject has not been reviewed in the past 15 years, in this paper we present up-to-date information on the topic. Materials and methods. Noise levels were evaluated in several places that are part of the common citizen life, disregarding their profession: Residential neighborhoods, parks, discos, pubs, main streets, city buses (old and new system), and subway. Measurements were taken using an integrating sound level meter, according to CONAMA standards, between the months of July and September, 2006. Results. The highest noise pollution was found in discos. With regard to the main avenue in Santiago, Libertador B. O'Higgins, noise levels (80 dB (A)) remained constant in different measured points. As of public transportation, the subway had the higher noise levels (87 dB (A)). There were no differences between the old and new public transit buses. Conclusions. Our results raise an environmental alert, showing that the noise level in Santiago, for most parameters, is above international standards.

Endocarditis infecciosa actinomicótica de la válvula mitral: caso de autopsia y revisión de la literatura / Actinomycotic infective endocarditis of the mitral valve: anatomoclinical case and review of literature

La infección actinomicótica del corazón es una enfermedad poco común, especialmente cuando el compromiso endocárdico valvular es primario. Sólo unos pocos casos han sido publicados. Comunicamos un caso de endocarditis primaria por Actinomyces sp de la válvula mitral, diagnosticada en la necropsia de un hombre de 34 años con antecedentes de valvulopatía reumática crónica, que falleció con una endocarditis infecciosa.

Actinomycotic infections of the heart is an uncommon disease, especially if the infection affects the valvular endocardium as primary focus. Just a few cases have been reported previously. We report a case of primary endocarditis of the mitral valve caused by Actinomyces sp diagnosed at necropsy in a 34 year-old man with history of chronic rheumatic disease presenting as a usual case of infective endocarditis.

Clostridium Perfringens: agente etiológico de queratitis infecciosa / Clostridium perfringens: etiologic agent of infectious keratitis

Clostridium perfringens es un raro agente causal de queratitis infecciosa, usualmente produce enfermedades necrotizantes severas. Presentación del caso: Agricultor de 32 años, procedente de General Artigas, Paraguay consultó en un servicio debido a un trauma con metal, cable en ojo derecho. Fue tratado con cicloplégico, AINES (antiinflamatorio no esteroideo) y aplicación de lente de contacto terapéutico. Después de 18 días sin mejoría acudió al Departamento de Oftalmología del Hospital de Clínicas de la Universidad Nacional de Asunción. El paciente presentó ausencia de percepción luminosa en el ojo afecto, quemosis, hipopion y ulcera central de cornea (5 mm). Se tomó muestra por raspado de cornea y el examen directo reveló bacilos Gram positivos. Se realizó cultivo en placas de agar sangre, agar chocolate y en caldo tioglicolato incubados a 37°C y en agar Sabouraud incubados a 28°C. Después del informe laboratorial se inició tratamiento con cefazolina 50 mg/ml y gentamicina 14 mg/ml cada hora. Del medio de enriquecimiento fue aislado Clostridium perfringens después de tres días. Desafortunadamente el paciente no asistió a su control.

Clostridium perfringens is a rare cause of infectious keratitis and usually produces severe necrotizing diseases. Case report: A 32 years old, male farmer from General Artigas, Paraguay consulted because of a history of trauma in the right eye, with a metal wire and was treated by cyclopegic NSAIDs (non­steroid anti­inflammatory) and therapeutic contact lenses for 18 days with no improvement He consulted to Ophthalmology Department of the National University of Asunción. The patient presented absence of light perception, chemosis, hypopyon and a deep central corneal defect (5 mm). Samples were collected by corneal scraping and Gram positive rods were revealed by direct examination. The culture was performed on sheep blood agar plate, chocolate agar plate and thioglycolate medium broth, incubated at 35°C. After laboratory results, the patient was treated with topic cefazolin (50 mg/ml) and gentamycin (14mg/ml) every hour. Clostridium perfringens grew in the thioglycolate medium broth after three days. Unfortunately, the patient did not return for control.

Conocimientos y hábitos de exposición solar de la población chilena / Sun exposure behaviors and knowledge among Chileans

Background: Ultraviolet light exposure has a pathogenic effect on the development of skin cancer, whose prevalence increases worldwide. In Chile and the rest of the world, preventive educational campaigns are carried out to change high risk sun exposure behaviors. Aim: To study the behavior of the Chilean population towards skin cancer prevention and to identify erroneous preventive practices and concepts. Material and methods: A survey containing 17 questions about sun exposure behaviors, photoprotective measures and knowledge about ultraviolet radiation and skin cancer was used. It was applied during January and February 2004, to 1,143 subjects (mean age 30 years, 409 males), taking vacations in beach resorts in Chile. Results: The hours of higher sun exposure ranged from 12 AM to 4 PM. Thirty seven percent of subjects were exposed more than 2 hours during this high risk lapse. Women and subjects aged less than 25 years were those with the riskiest behaviors. Fifty four percent used some type of photoprotection and 50% used ocular protection. Seventy percent used creams with sun screen and 74% used a sun protection factor higher than 15. Seventy percent applied the sun screen as recommended. Thirty eight percent had at least one sun burn in the last two years. More than 90% of subjects were aware of the relationship between sun exposure and skin cancer but 60% did not know the hours of higher ultraviolet radiation. The information about sun exposure was obtained from television in 57% of surveyed individuals. Conclusions: More educational campaigns about the risk of sun exposure are needed to reduce risky behaviors in the Chilean population.

Recurrencia de feocromocitoma en escolar de 11 años diagnosticado por I-131 MIBG / Recurrence of pheocromocytoma in 11 years old school child, diagnosed by I-131 MIBG

Pheocromocytoma is a paraganglioma with an incidence of arterial hypertension approximately of 1 percent ,but its diagnosis has several important issues from the clinical point of view. 1-The tumor resection frecuently cure the hypertension. 2.-Its manifestations might simulates other diseases like carcinoid Sx, hypertiroidism,etc. 3.-It is a familiar disease transmitted by an autosomic dominant way. It is 10 percent ilateral, 10 percent extraadrenal, 10 percent occur in children and 10 percent are malignant. We present a case of pheocromocytoma recurrency in a young girl,11 y.o. operated 8 months before, at the Clinical Hospital, National University of Paraguay, School of Medicine for a right suprarrenal gland pheocromocytoma of 2cms of diameter, who consults the Pediatryc Department for arterial hypertension and cefalea. She also had a Von Hippel Sx and Glaucoma. Nuclear Medicine is a non invasive method that use the I-131M ethayodobencylguanidine(MIBG-I-131) with high accuracy to diagnose and treat both neuroblastoma and pheocromocytoma I-131 MIBG is the gold standard for the diagnosis of both entities with a sensitivity between 94-100 percent and specificity of 100 percent being the best method to evaluate these diseases in the pre and post operatory

Estudio comparativo de técnicas para la evaluación funcional de leucocitos polimorfonucleares humanos / Comparative study of technics for the evaluation functional of leucocytes polimorfonucleares human

Los neutrófilos constituyen uno de los principales efectores de la respuesta inmune innata, ejerciendo una función eminentemente bactericida y protegiendo al organismo de las infecciones. Sin embargo, existen trastornos de la funcionalidad neutrofílica, en los que se observan alteraciones en la función fagocitaria, como consecuencia de deficiencias enzimáticas de las vías metabólicas involucradas en la destrucción bacteriana. Por ello, es necesario contar con pruebas que permitan determinar la funcionalidad neutrofílica. Así se procedió a la determinación de la prueba del NAT en sangre periférica de donadores normales con la finalidad de establecer su rango de referencia para nuestro medio, siendo este de 56 a 84 por ciento. Alternativamente se estandarizó la determinación del escore de fosfatasa alcalina granulocitica (FAG) con el mismo fin, encontrando un rango de referencia encontrados entre 80 a 148. En ambos casos, los valores de referencia encontrados son considerablemente más elevados que los reportados en la literatura. Además se ensayaron ambas pruebas en pacientes con infecciones diversas; se observó en todos los casos que los escores de FAG son significativamente más elevados con relación a los donadores normales (P<0,001), comportamiento no observado en todos los casos con la prueba del NAT

Evaluación de revascularización coronaria: comparación entre perfusión con Tc99m sestamibi-dipiridamol gatillado y ecografía-amrinona como predictores de viabilidad / Assessment of coronary revascularization: comparison between perfussion with Tc99m sestamibi-dipyridamol spect and echography-amrinone as predictors of viability

We studied left ventricular perfusion and motility in 37 patients with coronary artery disease and disturbances of parietal motility, aged 57 ñ 9 years old, before and after revascularization. Perfusion was assessed with dipyridamole-Tc99m SPECT and motility was assessed with 2 dimentional echocardiography with amrinone. Myocardial segments were defined as normal, viable or necrotic in both studies. Eighteen subjects were subjected to angioplasty and 19 to coronary bypass surgery. Submitted SPECT and echography were repeated 64 ñ 15 and 69 ñ 23 days after revascularization respectively. The concordance between SPECT and echocardiographic prerevascularization diagnosis was 60.1 percent. Eighty one percent of segment considered viable with SPECT and 71 percent thus considered with echocardiography improved after revascularization. Likewise, 50 percent of segments considered necrotic with SPECT and 68 percent of segment thus considered with echocardiography did not improve. It is concluded that althought there is a good concordance between both methods, they have limitations on the study of myocardial viability and should be considered as second choice

Tromboembolismo pulmonar masivo tratado con infusión selectiva de estreptoquinasa: comunicación de 2 casos / Massive pulmonary thromboembolism treated with selective infusion of streptokinase: report of 2 cases

We report 2 patients who developed massive pulmonary embolism with > 50% occludion of the pulmonary arterial circulation. Hypotension, syncope and right sided failure were the clinical manifestations. Immediately after diagnostic pulmonary arteriography, 20,000 U of streptokonase (SK) were delivered in the pulmonary artery nest to the thrombotic mass. A continous infusion of SK, 10,000 U/h was maintained for 24h in one patient and 72h in the other. Rapid clincial improvement was observed in the following 24h. Control angiography showed lysis of the embolus with residual obstructions of segmentary branches. The clinical value of this form of treatment for pulmonary embolism is discussed