Resultados clínicos inmediatos y alejados del implante de stents metálicos no recubiertos: ¿Se justifica un reemplazo total por los stents liberadores de drogas? / Acute and long-term clinical results of bare metal coronary stenting

Background: Since the introduction of stents in 1994, improved clinical results have boosted the development of coronary angioplasty in Chile. Drug eluting stents, that have a reduced rate of restenosis, are being increasingly used. Aim: To assess the acute and long-term results of bare metal stent implantation. Patients and Methods: Acute and long-term clinical, procedural and angiographic results were assessed in non acute myocardial infarction patients undergoing coronary stent implantation between August 1996 and December 2003. Results: During the study period, 932 patients aged 30 to 87 years (194 women) had at íeast one stent implanted. Twenty two percent were diabetic, 33 percent had recent myocardial infarction, 53 percent unstable angina and 22 percent stable angina. Angiographic and clinical success were 99.6 percent and 98.2 percent, respectively. In hospital death was 0.5 percent. During a mean follow-up of 19.1 months, all cause mortality was 3.9 percent, cardiac death 1.9 percent and survival free of major cardiac ischemic events was 85.3 percent. Only 6.4 percent of lesions underwent target vessel revascularization (TVR). Independent predictors of TVR were previous surgery, íeft anterior descending artery, small post stent minimum luminal diameter. Ostial location, in-stent restenosis, and younger age were non significant predictors. Conclusions: Acute and long-term results of bare metal stents in this population were excellent. An intriguingly low rate of TVR was seen. Selective bare metal stenting should continue in lesions and patients with a low risk of clinical restenosis.

Consideraciones sobre el uso de rayos X en la práctica médica convencional para la necesaria aplicación de normas básicas de seguridad / Considerations about the use of X-rays in the conventional medical practice for necesary aplication of basic security rules

The application maintained and increasing of the explorations with X-rays, consequence of significant development of the engineering together with evolved computacionals methodologies has allowed to reach to the great anatomical majority of locus where it seats the disease. The consequence immediate has been the increase of the exhibition of the patients to ionizing radiations. Different organizations, worried about the health publish, including with it to important societies of Radiology and also to tie international organizations directly related to the governments like the WHO and the OPS. They have emphasized the necessity to generateregulatory conducts destined to introduce the basic rules of the good medical practice. In our country a situation of smaller development in this particular area still persists. Contingencies experienced by general doctors in his professional practice in small town are described. Some situations derived from the use of conventional radiological procedures like mammography and axial computed tomography are presented commenting aspects that do necessary to prevent the doses that receive the patients in order to avoid the expression of stochasticor deterministic effects with high doses of radiation applied with medical intentions. General aspects of radiological procedures related to practices in pediatric patient emphasizing the conditions of increased risk for iatrogenic effects of radiation, particularly in those premature or new borns.