Becas para la formación de médicos especialistas académicos del Hospital Clínico de la Universidad de Chile / Academic residents fellowship program at the University of Chile Clinical Hospital

The mission of the University of Chile Clinical Hospital is to be the main University Hospital in the country. Along with training of health professionals in clinical practice and research, the Hospital provides comprehensive health solutions to the community. Since its foundation, it played an important role in the training of health professionals and specialists. To fulfill this mission, it is important to have outstanding academics and a system that allows their renewal and replacement. From January 25, 2001, the University of Chile approved the regulations that rule the Residents Program Fellowship, aimed to train the new generations of clinical academics. These regulations allow the financing of training programs in basic or primary specialties (such as internal medicine, surgery, obstetrics and gynecology, among others) or in specialties derived from them (such as cardiology, gastroenterology and reproductive medicine, among others.) The different clinical departments and the Hospital Direction define each year how many places will be offered and in which specialties. The Faculty of Medicine Graduate School carries out the formal selection of the applicants. This article reviews the results of this program between 2013 and 2021, analyzing in detail the traceability of each graduate over the years.

Histeroscopía quirúrgica: experiencia, resultados y complicaciones según clasificación Clavien-Dindo / Surgical hysteroscopy: experience, results and complications according to Clavien-Dindo classification

OBJETIVO: Describir y analizar la experiencia clínica, resultados y complicaciones según Clavien-Dindo de las histeroscopías quirúrgicas realizadas en pabellón. MÉTODOS: Estudio descriptivo retrospectivo de las histeroscopías quirúrgicas realizadas entre el 1 de enero de 2012 y 1 de enero de 2018 en el Hospital Clínico de la Universidad de Chile. RESULTADOS: Hubo 613 histeroscopías quirúrgicas en el período analizado, de las cuales 593 cumplieron con los requisitos para incluirse en este estudio. Las indicaciones para realizar el procedimiento fueron: pólipo endometrial (56,3%), miomas uterinos (22,1%), sangrado uterino anormal (4,3%) y otras (17,7%). Hubo un 89,2% de concordancia entre el diagnóstico intraoperatorio y el estudio histopatológico. Se pesquisaron 11 hiperplasias endometriales sin atipías, 3 con atipías y 10 neoplasias malignas. Cabe destacar que, del total de pólipos resecados, hubo 8 casos (2,5%) con potencial malignidad (atipías o neoplasia maligna). Según la clasificación Clavien Dindo, hubo 22 complicaciones intraoperatorias (3,7%) grado I o II, cuyo diagnóstico fue realizado en el acto quirúrgico. No hubo complicaciones grado III o más (severas, con reintervención). CONCLUSIÓN: La tasa de éxito, correlación histeroscópica - anatomopatológica final y complicaciones fue similar a lo publicado en la literatura disponible. El diagnóstico intraoperatorio de la lesión y su reparación en el mismo acto quirúrgico, disminuye el riesgo de morbimortalidad de las pacientes, haciéndolo similar al de una paciente sin complicación. Utilizar la clasificación Clavien Dindo para evaluar las complicaciones nos permitirá en adelante, objetivar, mejorar aspectos del procedimiento quirúrgico y plantear estrategias de prevención y manejo de dichos eventos adversos.

OBJECTIVE: To describe and analyze the clinical experience, results and complications according to Clavien-Dindo of surgical hysteroscopies performed in the ward. METHODS: Retrospective descriptive study of surgical hysteroscopies performed between January 1, 2012 and January 1, 2018 at the Hospital Clinico of the University of Chile. RESULTS: There were 613 surgical hysteroscopies in the analyzed period of which 593 fulfilled the requirements to be included in this study. The indications to perform the procedure were: endometrial polyp (56.3%), uterine fibroids (22.1%), abnormal uterine bleeding (4.3%) and others (17.7%). There was an 89.2% agreement between the intraoperative diagnosis and the histopathological study. Eleven endometrial hyperplasias without atypia, 3 with atypia and 10 malignant neoplasms were investigated. It should be noted that, of the total of resected polyps, there were 8 cases (2.5%) with potential malignancy (atypia or malignant neoplasm). According to the Clavien Dindo classification, there were 22 intraoperative complications (3.7%) grade I or II, the diagnosis of which was made during surgery. There were no grade III or more complications (severe, with reoperation). CONCLUSION: The success rate, final hysteroscopic-pathological correlation and complications was similar to that published in the available literature. The intraoperative diagnosis of the lesion and its repair in the same surgical act, reduces the risk of morbidity and mortality of the patients, making it similar to that of a patient without complication. Using the Clavien Dindo classification to assess complications will henceforth allow us to objectify, improve aspects of the surgical procedure and propose strategies for the prevention and management of such adverse events.

Lesiones musculares deportivas: correlación entre anatomía y estudio por imágenes / Muscle injuries in sports: imaging study

Un gran segmento de la población participa en actividades deportivas. Las lesiones musculares corresponden a aproximadamente un tercio de las lesiones deportivas. Las demandas recreacionales y profesionales de la sociedad moderna exigen un diagnóstico precoz y preciso, para un adecuado tratamiento y seguimiento, dadas las implicancias económicas y mediáticas, especialmente en deportistas de elite. La imagenología tiene un rol fundamental en la evaluación de estas lesiones. Permite evaluar localización, extensión, severidad y estimar pronóstico, así como también el seguimiento para determinar el retorno deportivo. En este artículo se revisa la anatomía microscópica y macroscópica muscular, la fisiología, los tipos de lesiones y su representación en imágenes, tanto en ultrasonido (US), como en resonancia magnética (RM). Se mencionan distintas clasificaciones descritas en la literatura y se propone una nueva nomenclatura y descripción, basada principalmente en la anatomía muscular, la localización y cuantificación de las lesiones.

A large segment of the population participates in sporting activities. Muscle injuries account for approximately one-third of the injuries. The recreational and professional demands of modern society require an early and precise diagnosis of these, for an adequate treatment and follow-up, given the economic and media implications, especially in elite athletes1. Imaging plays a fundamental role in the evaluation of these lesions. It allows evaluation location, extent, severity and estimations of prognosis, as well as the follow-up to determine the return to sport. This article reviews the microscopic and macroscopic muscle anatomy, the physiology, types of lesions and their representation in images, both in ultrasound (US) and magnetic resonance (MRI). Different classifications described in the literature are mentioned and a nomenclature and description is proposed, based mainly on the muscle anatomy, localization and type of injury.

La música como una herramienta terapéutica en medicina / Music as a therapeutic tool in medicine

La música es un poderoso estímulo para nuestro cerebro y no solo una excelente fuente de disfrute, aprendizaje o relajante. Durante los últimos 20 años, hay nuevas evidencias considerables de la extensa Circuitos involucrados en el procesamiento de la música y en los procesos morfológicos, neuroquímicos y electrofisiológicos. Cambios que la música puede inducir. Nuestra población está envejeciendo y habrá un aumento en la prevalencia de enfermedades neurodegenerativas como las demencias que aún no tienen cura. Ahí está en consecuencia, una necesidad urgente de desarrollar tratamientos y actividades que puedan aliviar los síntomas. de la demencia. La evidencia acumulada muestra que las personas con demencia disfrutan de la música. La capacidad de responder a la música se conserva potencialmente incluso en las etapas tardías o graves de la demencia. Cuando la comunicación verbal puede haber cesado. A pesar de que los diversos estudios que reportan beneficios de la musicoterapia en condiciones como la demencia, el parkinson, la epilepsia, el cáncer, etc., tienen defectos metodológicos, la música puede tener un papel como herramienta terapéutica en estas condiciones. Aquí, analizamos la evidencia actual que puede apoyar el uso de la música en diferentes condiciones en medicina. (AU)

Music is a powerful stimulus to our brain and not only an excellent source of enjoyment, learning or relaxing. During the last 20 years there is new considerable evidence of the extensive neural circuits involved in music processing and the morphologic, neurochemical and electrophysiological changes that music can induce. Our population is aging and there will be an increase in the prevalence for neurodegenerative conditions like dementias that still have no cure. There is consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Even though the diverse studies reporting benefits of music therapy in conditions such as Dementia, Parkinson, Epilepsy, Cancer, etc. have important methodologic flaws, Music can have a role as a therapeutic tool in these conditions. Herein, we analyze the current evidence that may support the use of Music in different conditions in Medicine. (AU)

Abordaje vaginoscópica para la realización de histeroscopía oficinal: experiencia, resultados y revisión de la literatura / Vaginoscopic approach to perform officinal hysteroscopy: experience, results and literature review

OBJETIVO: Presentar nuestra experiencia y una revisión de la literatura sobre la utilización de la vaginohisteroscopia oficinal. Describir las principales indicaciones, su tolerancia, los procedimientos realizados y las complicaciones resultantes. MÉTODO: Estudio descriptivo de todos los procedimientos vaginohisteroscópicos ambulatorios realizados en la Unidad de Medicina Reproductiva e Infertilidad del Departamento de Obstetricia y Ginecología del Hospital Clínico de la Universidad de Chile, entre el 1° de enero de 2008 y el 31 de enero de 2014. RESULTADOS: Se realizaron un total de 632 vaginohisteroscopias: 63,7% diagnósticas y 36,2% quirúrgicas. El tiempo promedio de realización fue de 13 ± 8 minutos. La percepción de dolor presentó una mediana de EVA 4 con intercuartiles de 3 y 6. La principal indicación fue por sospecha de pólipos endometriales (33%) y engrosamiento endometrial en un 12%. El hallazgo histeroscópico más frecuente fue cavidad endometrial normal (27%) y pólipos endometriales (27%). Los procedimientos más frecuentes fueron polipectomías (27%) y biopsias endometriales (20%). Se registraron 17 complicaciones (2,6%): 14 reacciones vasovagales (2,2%) y 3 lipotimias (0,4%). CONCLUSIONES: El abordaje vaginohisteroscópico ha demostrado ser una técnica segura, resolutiva, bien tolerada por las pacientes y de menor costo.

OBJECTIVE: To present our experience and a review of the literature of the vaginohysteroscopic technique. To describe the main indications, the tolerance, the procedures performed and their complications. METHOD: This is a descriptive study of all outpatient procedures performed with the vaginohysteroscopic technique in the Reproductive Medicine and Infertility Unit of the Department of Obstetrics and Gynecology at University Hospital of Chile between 1st January of 2008 and 31st January of 2014. RESULTS: A total of 632 vaginohysteroscopys were performed: 63.7% diagnostic and 36.2% surgical. The average procedure time was 13 ± 8 minutes. Pain showed a median of VAS of 4. The main indication was suspected endometrial polyps (33%) and endometrial thickening (12%). The most frequent finding was normal endometrial cavity (27%) and endometrial polyps (27%). The most common procedures were polypectomy (27%) and endometrial biopsies (20%). We registered 17 complications (2.6%): 14 vasovagal reactions (2.2%) and 3 lipothymias (0.4%). CONCLUSIONS: vaginohisteroscopy approach has proven to be a safe and very resolutive technique, well tolerated by patients and considerably cost-effective.

Variables que afectan la satisfacción con la alimentación según nivel socioeconómico: un estudio exploratorio en el sur de Chile / Variables affecting food satisfaction according to socioeconomic status: an exploratory study in southern Chile

In order to identify variables that influence in food satisfaction for people belonging to different socioeconomic status (SES) in southern Chile, a survey was administered to a sample of 400 people living in the major cities of this region. The questionnaire included the SWFL (Satisfaction with Food-related Life) scale and the IQLRH (Index of Quality of Life Related to Health). Demographic characteristics and dietary habits were also consulted. Four ordinal logit models were proposed, where the dependent variable was satisfaction with food-related life, considering the total sample and three subsamples: medium and medium-high strata (ABC1), medium-medium (C2) and medium-low (C3), low (D) and very low (E) as a whole. The four models were significant (p<0.001), but differed in the explanatory variables that were significant. Regardless of SES, satisfaction with food-related life decreases if the person does not have a good perception of their own health. Other variables that influence satisfaction with food-related life, which differed according to the SES, are related to the gender, the family composition, the time available for family dining, frequency of consumption of meat and use of fast food outlets and the restriction of alcohol consumption.

Con el objetivo de identificar variables que influyen en la satisfacción con la alimentación en personas pertenecientes a distintos niveles socioeconómicos (NSE) del sur de Chile, se aplicó una encuesta a 400 personas residentes en las principales ciudades de esta parte del país. El cuestionario incluyó la escala SWFL (Satisfaction with Food-related Life) y el Indice de Calidad de Vida relativo a la Salud (ICVRS). Se consultaron características demográficas y hábitos alimentarios. Se plantearon cuatro modelos logit ordinales, en los cuales la variable dependiente fue la satisfacción con la alimentación, considerando la muestra total y tres submuestras: estratos alto y medio-alto (ABC1), medio-medio (C2) y en conjunto los niveles medio-bajo (C3), bajo (D) y muy bajo (E). Los cuatro modelos resultaron significativos (p<0,001), pero difirieron en las variables explicativas significativas. Independientemente del NSE, la satisfacción con la alimentación disminuye si la persona no tiene una buena auto percepción de su salud. Otras variables que influyen en la satisfacción con la alimentación, que difirieron según el NSE, corresponden al género, composición de la familia, tiempo disponible para cenar en familia, frecuencia de consumo de carne y en locales de comida rápida y, la restricción del consumo de alcohol.

Tipologias de consumidores según el estilo de vida en relación a la alimentación: un estudio exploratorio en el sur de Chile / Consumer typology according to food-related lifestyle: an exploratory study in southern Chile

Con el objetivo de distinguir y caracterizar tipologías de consumidores en base a su estilo de vida en relación a la alimentación en forma exploratoria, se aplicó una encuesta a una muestra de 316 personas de las principales ciudades del sur del Chile. El instrumento de recogida de información incluyó una adaptación del cuestionario de estilos de vida en relación a la alimentación (FRL) y la escala SWFL (Satisfaction with Food-related Life). Mediante análisis cluster se distinguieron tres tipologías principales. La mayoritaria (30,1%) prefiere alimentos fáciles de preparar, planifica su alimentación y mantiene sus hábitos alimentarios. La segunda (17,4%) disfruta de salir a comer fuera y de cenas con amigos en casa, pero prefieren alimentos conocidos, son planificados y constantes en sus hábitos de alimentación. La tercera tipología (14,6%) disfruta compartir con amigos una comida, pero no le gusta cocinar ni utilizar alimentos de fácil preparación. Las tipologías presentaron distinto perfil demográfico. Difirieron en la frecuencia de consumo de alimentos en el hogar y en la frecuencia de comidas fuera del hogar. Se evidenciaron diferencias en la restricción de comidas y aderezos por motivos de salud y en la satisfacción con su alimentación.

With the aim of characterizing consumer typologies on the basis offood-related lifestyle in an exploratory manner, a survey was applied to a sample of 316 people in the main cities of southern Chile. The instruments for collecting data included an adaptation of the Food-related Lifestyle (FRL) questionnaire and the Satisfaction with Food-related Life (SWFL) scale. Three main typologies were distinguished using a cluster analysis. The majority (30.1 %) preferred easily prepared food, planned their diet and maintained their eating habits. The second group (17.4%) enjoyed eating out and dinners with friends at home, but they preferred known foods,and were programmed and constant in their eating habits. The third typology (14.6%) enjoyed sharing a meal with friends, but did not like cooking or using easy-to-prepare foods. The typologies displayed different profiles based on demographics. They differed in the food consumption frequency in the home and in the frequency of eating out. Differences were observed in the restriction of meals and dressings for health reasons and in the satisfaction with their food-related life.

Satisfacción con la alimentación en personas mapuches de la región de la Araucania, Chile / Food-related life satisfaction in mapuches from the Araucanía region, Chile

In order to identify variables which have an influence on satisfaction with food-related life among mapuches a survey was applied to 400 mapuche subjects in the Araucanía Region. The questionnaire included the SWFL (Satisfaction with Food-related Life) scale. It was found that 39.5% were satisfied and 332% extremely satisfied with their food-related life. A multinomial probit model was proposed in which the dependent variable was food-satisfaction, which resulted significant (p<0.01) overall. The probability of high food-related satisfaction increases as fewer people live in the subject's household, more is spent on food, children express their opinion aboutfoodstuffs, he/she consumes "catutos" (a mapuche food), aged 55 or over, not widowed, performs regular exercise, tries not to eat industrialized foods, but does not try to eat foods without additives. Food-related satisfaction in mapuche persons in the Araucanía Region is related to demographic, feeding and life-style variables.

Con el objetivo de identificar variables que influyen en la satisfacción con la alimentación en personas mapuche, se aplicó una encuesta a 400 sujetos de esta etnia en la Región de La Araucanía. El cuestionario incluyó la escala SWFL (Satisfaction with Food-related Life). Se obtuvo que el 39,5% está satisfecho y el 33,2% extremadamente satisfecho con su alimentación. Se planteó un modelo probit multinomial en que la variable dependiente fue la satisfacción con la alimentación, el cual resultó significativo (p<0,01) en su conjunto. La probabilidad de una alta satisfacción con la alimentación aumenta en la medida que en el hogar del individuo viven menos personas, se gasta más en alimentación, los niños opinan respecto a los alimentos, consume catutos, tiene 55 años de edad o más, no es viudo, realiza regularmente ejercicio, procura no comer alimentos industrializados, pero no procura comer alimentos sin aditivos. La satisfacción con la alimentación en mapuche de La Araucanía se relaciona con variables demográficas, alimentación y estilo de vida.

Diferencias étnicas y de aculturación en el consumo de alimentos en la Región de la Araucanía, Chile / Ethnic and acculturation differences in food consumption of the Araucania Region of Chile

In order to detect differences in consumption habits according to ethnic background and degree of acculturation in mapuche people, a survey with a sample of 400 people, stratified by ethnicity, was performed in the city of Temuco, Araucania Region. Taking the food groups covered by the Family Budget Survey in consideration, the monthly amount spend is lower in mapuche households compared to non/mapuche. Differences were observed in the consumption frequency of milk, cheese, eggs and herbal tea according to ethnicity. However, ethnic origin is strongly associated only with the consumption of herbal tea. The degree of acculturation did not reveal any differences in the consumption frequency of these foods, but acculturation is strongly associated with the consumption offish and seafood, herbal tea and soft drinks. The degree of acculturation is also strongly associated with the consumption of foods traditional to the ethnic group; bicultural mapuches have higher probability of consuming traditional foods than acculturated mapuches.

Con el objetivo de detectar diferencias en los hábitos de consumo y gasto en alimentos según la etnia del consumidor y grado de aculturación en personas mapuche, se aplicó una encuesta personal a una muestra de 400 personas, estratificada por etnia con afijacion simple, en la ciudad de Temuco, Región de La Araucanía. Considerando los grupos de alimentos que contemplan las Encuestas de Presupuestos Familiares, el gasto mensual en alimentos es menor en los hogares mapuche. Según etnia se observaron diferencias en la frecuencia de consumo de leche, queso y huevos y hierba mate. No obstante, el origen étnico se asocia significativamente sólo al consumo de hierba mate. Según el grado de aculturación no se observaron diferencias en la frecuencia de consumo de estos alimentos, pero la aculturación está significativamente asociada al consumo de pescados y mariscos, hierba mate y bebidas. El grado de aculturación está significativamente asociado al consumo de alimentos tradicionales de la etnia, los mapuche biculturales tienen mayor probabilidad de consumir estos alimentos que los mapuche aculturados.

Selección de ovocitos competentes, utilizando el factor de crecimiento nervioso (NFG) y el factor de crecimiento vascular endotelial (VEGF), con el fin de aumentar las posibilidades de embarazo en pacientes que se encuentran en tratamientos de fecundación in vitro: [revisión] / Competent oocytes selection, using nerve growth factor (NGF) and vascular endothelial growth factors (VEGF), with the purpose of to increase the possibilities of pregnancy in patients who are in treatments of fertilization in vitro: [review]

The attention from embryologist toward the assessment of oocyte quality in human in vitro fertilization (IVF) is increasing every day. Oocyte selection and the identification of the best oocytes, in fact, would help to limit embryo overproduction and to improve the results of oocyte cryostorage programs. Multiple methods have been proposed; but a good correlation between specific biochemical characteristics and measurable oocyte quality-linked, embryo-related variables has not been established to date. In IVF programs that include oocyte selection, levels of vascular endothelial growth factor (VEGF) and neural growth factor (NGF) could be used as an index to exclude oocytes that developed in a hypoxic follicle. The presence of both ovarian angiogenic factors provides an ideal environment to maintain the cyclical changes in vascular density that occurs during follicular development. NGF would act within a short time-frame to replenish the supply of VEGF required for the vascularization of growing preovulatory follicles and perhaps newly formed corpora lutea. Levels of these angiogenic factors can predict the necessary vascular changes within the follicles and the competence of the oocytes. A hypoxic status at this level could be responsible for the high intrafollicular and plasma concentrations of VEGF and for the low quality of the oocytes.

Estudio de imágenes de articulación patelofemoral: ¿en qué estamos?: [revisión] / Imaging studies of the patellofemoral joint: current reality: [review]

La disfunción patelofemoral (DPF) es causa frecuente de consulta clínica y se refiere, a grandes rasgos, a una patología en la cual la patela falla en la correcta entrada en la tróclea. Es un tema en el que la terminología suele ser ambigua y confusa, debido entre otras cosas a la discrepancia entre la clínica y la imaginología. Además, la etiología de la DPF es multifactorial, incluyendo factores anatómicos locales, rotacionales y dinámicos, no existiendo tampoco claridad acerca de su real influencia. Desde el punto de vista imaginológico, existen innumerables publicaciones, con diferentes clasificaciones y mediciones descritas para las distintas técnicas, sin embargo, no hay un consenso amplio en relación a cuáles son las alteraciones anatómicas o los valores normales que el reporte imaginológico debiera incluir. Se realiza una revisión de la literatura existente y se propone para los pacientes con DPF, un estudio radiológico que considera los factores etiológicos anatómicos y un estudio tomográfico de segunda línea, que incluye estudio rotacional de extremidades inferiores, sistematizando las mediciones y puntos relevantes en una plantilla de informe.

Patellofemoral dysfunction (PFD) is a common cause for medical consultation and in a broad sense it refers to a condition in which the patella fails to engage securely in the trochlear groove. This is a topic in which terminology is often ambiguous and confusing due, inter alia, to the discrepancy between symptomatology, imaging findings and physical examination. In addition, PFD has a multifactorial etiology that includes local anatomical, rotational and dynamic factors, with no certainty about its real influence. From the imaging point of view, there are countless publications proposing different classifications and measurements obtained trough different imaging techniques; however, there is no consensus regarding what are the anatomical alterations or the normal values that imaging reports should include. A review of the existing literature is performed and we propose that patients with PFD should undergo both a radiological study comprising etiologic and anatomic factors and a second-line tomographic exploration including lower extremity rotational profiles. From the radiological and clinical viewpoints, relevant issues to be considered as well as assessments performed should be systematized and recorded in a report sheet.

Detection of caliciviruses associated with acute infantile gastroenteritis in Salvador, an urban center in Northeast Brazil

Acute gastroenteritis caused by viruses is one of the leading causes of infantile morbidity. The aim of the present study was to investigate the presence of human caliciviruses of the genera norovirus and sapovirus in children up to 3 years of age with acute gastroenteritis from low-income communities in the city of Salvador, Brazil. This study is an extension of previous work carried out to establish the profile of the most prevalent enteric pathogens present in these communities. In this report, 139 fecal samples, collected from July 2001 to January 2002 were analyzed by RT-PCR and 13 (9 percent) were positive for human caliciviruses. By sequencing, seven isolates were characterized as norovirus genogroup GII and one as sapovirus genotype GII/1. Sequencing of the previously detected group-A rotaviruses and human astroviruses was also performed and revealed the circulation of rotavirus group A genotypes G1P[8] and G9P[8], and human astrovirus genotypes 6, 7, and 8. No mixed infection was observed. Community-based studies provide geographically representative information on disease burden. However, there are only a few reports in developing countries concerning the genotypes of the most important gastroenteric viruses detected in such communities. The present findings demonstrate the wide diversity of genotypes of the most important viruses responsible for acute gastroenteritis circulating in low-income communities.

Sarcoma sinovial intraoral primario monofásico / Monophasic synovial sarcoma of the oral cavity: report of one case

El sarcoma sinovial es un tumor maligno de partes blandas, bien diferenciado y que representa entre 5.6 por ciento a 10 por ciento de todos los sarcomas. Su localización en cabeza y cuello no es común, y representa cerca de un 9 por ciento, con menos de 100 casos reportados en la literatura. La localización intraoral es muy peculiar, existiendo 32 casos previamente descritos en el mundo, de los cuales 3 corresponden al tipo monofásico. Se presenta un caso de un paciente varón de 16 años con un caso de sarcoma sinovial intraoral monofásico y una revisión de la literatura disponible.

Synovial sarcoma is a well-differentiated malignant tumor of soft tissues, that corresponds approximately 10 percent of all soft tissue sarcomas. Its location in the head and neck uncommon and the location in the oral cavity is really peculiar, with only 32 previously described cases, of which only three corresponded to the monophasic type. We report a 16 years old male patient consulting for a lump in the right oral mucosa. The patient was operated in two occasions excising the tumor with radical lymph node dissection and parotid gland excision. The pathological diagnosis was a monophasic intraoral synovial sarcoma. Postoperative radiotherapy was recommended but not done. After 16 months of follow up the patient is without evidence of relapse.

Biopsia estereotáxica mamaria: 2 años de experiencia / Directional vacuum-assisted stereotatic breast biopsy: a 2-year experience

Introduction: Directional vacuum-assisted stereotactic breast biopsy (DVAB), represents an excellent method for obtaining pathological diagnosis, being in many cases an alternative to surgery. Objectives: To present our 2-year experience in DVAB at the University of Chile's Clinical Hospital. Materials and methods: a descriptive retrospective study of DVAB was conducted in our Hospital from March 2005 to November 2007. Morphology of lesions, BI-RADS classification, pathology reports, complications as well as epidemiological data were recorded. Results: We included 79 patients with 95 lesions. Mean age 55 years. Of the 95 biopsies, 95.7 percent were microcalcifications. The sensitivity was 92.8 percent and specificity 100 percent. The positive predictive value was 100 percent, while negative PVwas 98.7 percent, with 8 percent of subestimation and complication rate of 3,1 percent. Conclusions: Our results confirm the advantages of said procedure in our Center, proving DVAB as highly reliable, with good histological correlation and minimal complications.

Introducción: La biopsia estereotáxica digital mamaria (BED), representa un excelente método para obtener diagnóstico histológico, siendo alternativa de elección frente a la cirugía en muchos casos. Objetivo: Presentar nuestra experiencia en la aplicación de la BED en el Hospital Clínico de Universidad de Chile. Material y método: Estudio descriptivo, retrospectivo de BED realizadas en el Hospital Clínico de la Universidad de Chile (marzo 2005-noviembre 2007). Se registró morfología de las lesiones, clasificación BI-RADS, informes de anatomía patológica, complicaciones y datos epidemiológicos. Resultados: Se incluyó a 79 pacientes con 95 lesiones. Edad promedio 55 años. De las 95 biopsias, 95,7 por ciento correspondieron a microcalcificaciones. La sensibilidad fue 92,8 por ciento y la especificidad 100 por ciento. El valor predictivo positivo fue 100 por ciento y negativo 98,7 por ciento. La subestimación fue de 8 por ciento y la tasa de complicaciones 3,1 por ciento. Conclusiones: Nuestros resultados confirman las ventajas del procedimiento en nuestro Centro, demostrando la BED como altamente confiable, con buena correlación histológica y mínimas complicaciones.

Concordancia imaginológica-patológica en biopsia core de mama / Breast lesions with imaging-histologic concordance during automated core biopsy

The purpose of this study was to determine the frequency, concordance and discordance of breast lesions during automated core biopsy. A US-guided 14 -gauge automated core needle biopsy was performed on 188 lesions. Only in 1 of 120 benign diagnosed cases imaging-histologic discordance was present. This lesion underwent surgical excision and the case was diagnosed as having carcinoma in situ, as a definitive histological diagnosis. Assessment of correlation between imaging studies and histologic findings, as well as determinaron of concordance, are required to minimize diagnostic errors.

El propósito de nuestro estudio fue determinar la frecuencia, concordancias y discordancias de las lesiones mamarias. Se realizaron 188 biopsias core con aguja de 14G. Sólo 1 de las 120 lesiones benignas diagnosticadas fue discordante; se recomendó escisión quirúrgica cuyo resultado definitivo demostró carcinoma in situ. Para minimizar errores diagnósticos, se requiere evaluar la correlación entre las imágenes y el resultado histológico, además de establecer la concordancia.

Vaginohisteroscopia en consultorio: histeroscopio de Bettocchi, nueva técnica de diagnóstico y tratamiento ginecológico / Vaginal hysteroscopy in medical center: hysteroscope of Bettocchi, new diagnosis technique and gynecologic treatment

The global trend in surgical procedures is to be as least invasive as possible, causing minor injury to tissues, to reduce the days of hospitalization, to minimize post-operative pain and an early work reintegration. With endoscopy this has achieved and particularly with the hysteroscopy, which is a surgical procedure that allows you to visualize the uterine cavity, to diagnose and resolve the pathologies. The use of the Bettocchi hysteroscope, has revolutionized the gynecological diagnosis and treatment, because it is an ambulatory procedure, without hospitalization nor use of anesthesia. This article aims to describe this technique, its indications and contraindications.

Trombosis venosa cortical aislada: Comunicación de dos pacientes / Isolated cortical vein thrombosis: Report of two cases

Isolated cortical vein thrombosis is an uncommon presentation of central venous thrombosis. We report two females, aged 29 and 40 years, with isolated cortical vein thrombosis. Both presented with a focal neurological deficit and focal seizures that became generalized. The diagnosis was made with magnetic resonance imaging. Both had a history of oral contraceptive use. Both had a rapid response to unfractionated heparin. One patient had an antiphospholipid syndrome as a possible etiology. The most common manifestations of this disease are a transient or recurrent neurological deficit, visual disturbances and focal or generalized seizures, usually without intracanial hypertension. Neuroimages show ischemic abnormalities that do not follow an arterial vascular territory, often with an early hemorrhagic component. There is a good clinical response to heparin.

Endometriosis e la pared abdominal / Endometriosis and the abdominal wall

ANTECEDENTES: La presencia de endometriosis de la pared abdominal (EPA) suele confundirse con otras patologías médico-quirúrgicas que aparecen en la misma zona. OBJETIVO: Evaluar las características clínicas de la EPA. MÉTODO: Se realizó un estudio retrospectivo de todas las pacientes hospitalizadas con el diagnóstico histopatológico de EPA entre enero de 1997 y diciembre de 2005. RESULTADOS: Se encontraron 14 pacientes, con edad promedio de 33,2 años. Los principales síntomas fueron: dolor cíclico (71,4%), masa abdominal (100%), dispareunia (21,4%) y dismenorrea (42,8%). Todas la pacientes tuvieron al menos una cirugía ginecológica (2 con procedimientos laparoscópicos) u obstétrica (85,7% cesárea). Sólo una paciente se había diagnosticado previamente de endometriosis. Los síntomas comenzaron en promedio 3,5 años posteriores a la última cirugía. Las EPA tenían un tamaño promedio de 3,2 cm. El diagnóstico pre-operatorio fue correcto en el 64,3% de las pacientes. Los diagnósticos incorrectos correspondieron a 3 granulomas, una hernia inguinal y un lipoma. Todas las pacientes requirieron cirugía y en el 64,3% fue necesario la utilización de mallas polytetrafluoethyleno. Cuatro pacientes (28,5%) presentaron recurrencias. 60% de los diagnósticos iniciales incorrectos v/s 11,1% de los acertados recurrieron. CONCLUSIONES: La EPA puede encontrarse en cicatrices tanto ginecológicas como obstétricas. Los síntomas comunes son masas con dolor cíclico. La ecografía de pared abdominal fue suficiente para enfrentar el diagnóstico diferencial. El diagnóstico pre-operatorio es importante para planificar la cirugía porque redujo las recurrencias. El tratamiento de elección es la cirugía con resección amplia de los bordes.

BACKGROUND: The presence of abdominal wall endometriosis (AWE) used to be confused with other surgical pathologies that may appear in these zones. Objective: To evaluate the AWE clinical characteristics. METHOD: Retrospective study of all the patients hospitalized with the histopathologycal diagnosis of AWE, between January 1997 and December 2005. RESULTS: There was found AWE only in 14 patients. Their mean age was 33.2 years old. The symptoms were: cyclic pain (71.4%), abdominal wall mass (100%), dyspareunia (21.4%) and dysmenorrhea (42.8%). All patients had at least one gynecologic (2 patients with laparoscopic procedures) or obstetric surgery (85.7% had previous cesarean section). Only one patient had previously been diagnosed with pelvic endometriosis. Their symptoms started after an average of 3.5 years after surgery. The AWE had a mean size of 3.2 cm. The preoperative diagnosis was correct in 64.3%. The incorrect preoperative diagnoses were 3 granuloma, 1 inguinal hernia and 1 lipoma. All patients required surgery. 64.3% of the patients it was necessary a polytetrafluoethylene mesh. Four patients (28.5%) had AWE recurrences. 60% of the wrong initial diagnosis recurred versus 11.1% of the correct ones. CONCLUSION: AWE may be present in gynecologic or obstetric scars. Their common symptoms are masses with cyclic pain. Ultrasonography is enough to approach the differential diagnosis. The correct preoperative diagnosis is important to plan surgery and reduce recurrences. The surgical wide excision is the preferable treatment. Establishing clear endometriosis limits reduce the recurrences.