Usos de cámara hiperbárica en otorrinolaringología / Uses for hyperbaric chambers in otolaryngology

Resumen En la terapia con oxígeno hiperbárico (HBO) se utiliza oxígeno al 100% de concentración en una cámara presurizada con presiones supraatmosféricas, que corresponden de 2 a 3 atmósferas. Los mecanismos por los cuales funciona esta terapia se relacionan con propiedades físicas de los gases y su comportamiento fisiológico en el organismo, lo que lleva finalmente a la hiperoxia, evento fisiológico que permite la obtención de diversos efectos beneficiosos. La evidencia en medicina ha demostrado su utilidad mayormente en la enfermedad por descompresión, infecciones cutáneas graves e intoxicación por monóxido de carbono. En el ámbito de la otorrinolaringología ha probado ser útil en algunas enfermedades como la hipoacusia súbita idiopática, tanto como terapia única como asociada al uso de corticosteroides, como en la osteomielitis refractaria del oído externo, la que en conjunto con antibioticoterapia y manejo quirúrgico presenta un evidente aumento en la tasa de mejoría. Cabe mencionar que la terapia con HBO ha demostrado también beneficios en los tratamientos y complicaciones posteriores a la radiación en pacientes con cáncer de cabeza y cuello. Es importante mencionar que la terapia con HBO no está exenta de riesgos y requiere que los pacientes cumplan con características específicas para su utilización, por lo que su indicación debe ser juiciosa y en casos seleccionados.

Abstract In hyperbaric oxygen therapy, 100% pure oxygen is used in a pressurized chamber with super atmospheric pressures which correspond to 2-3 atmospheres. The mechanism by which this treatment works is related to the physical properties of gases and their physiological behavior in the body, which leads to hyperoxia, the physiological event which allows for diverse beneficial health effects. The evidence in medicine has proven its utility mainly in decompression sickness, severe skin infections and carbon monoxide poisoning. In the otolaryngology field it has been proven useful in diseases like idiopathic sudden sensorineural hearing loss, both as the only treatment and as a concurrent treatment along with corticosteroids, in malignant otitis externa which in conjunction with antibiotic treatment and a surgical approach presents a clear increase in improvement rates. It must be mentioned that hyperbaric chamber treatment has also shown benefits in radiation treatment and post radiation complications in head and neck cancer patients. It is important to note that hyperbaric oxygen therapy is not without risks and patients must meet specific criteria for it to be applied, therefore it must be indicated using careful judgement and only in necessary cases.

Timpanoplastías en el Hospital San Vicente de Arauco: Revisión de 3 años / Tympanoplasties in San Vicente de Arauco Hospital: 3 years review

Resumen Introducción: La timpanoplastía es el tratamiento de elección en la otitis media crónica simple. En Chile se han realizado diversos estudios para evaluar el éxito de la timpanoplastía. En nuestro centro evaluamos el resultado anatómico y funcional, correlacionando los resultados con la demografía de nuestra población. Objetivo: Realizar una descripción epidemiológica de los pacientes con diagnóstico de otitis media crónica simple, sometidos a timpanoplastía en el Hospital San Vicente de Arauco entre los años 2017 y 2019. Material y Método: Estudio retrospectivo y descriptivo. Se revisaron las fichas clínicas de pacientes con cirugía realizada entre enero de 2017 y noviembre de 2019. Este estudio cuenta con la aprobación del comité de ética del servicio de salud Arauco. Resultados: Se realizaron 77 timpanoplastías. 56 oídos cumplieron los criterios de inclusión. 71,43% fueron de sexo femenino. El rango de edad es de 8 a 64 años. 92,86% corresponde a timpanoplastía tipo I. Se utilizó un abordaje endoauricular en el 58,93%. El injerto utilizado fue predominantemente compuesto (cartílago-pericondrio) en un 75%. Se usó una técnica medial en un 94,94%. Se obtuvo un éxito anatómico 85,71% de los pacientes. Se obtuvo una ganancia sobre 10 dB en un 60,71% de los pacientes. Conclusión: No se encontraron diferencias significativas importantes que relacionan las elecciones quirúrgicas con los resultados anatómicos y auditivos del procedimiento a mediano plazo.

Abstract Introduction: Tympanoplasty is the treatment of choice for chronic otitis media. In Chile, several studies have been carried out to evaluate the success of tympanoplasty. Here, we assesed the anatomical and functional outcomes, correlating the results with the demographics of our population. Aim: To carry out an epidemiological description of patients with a diagnosis of chronic otitis media who underwent tympanoplasty at our hospital between 2017 and 2019. Material and Method: Retrospective, descriptive study. We reviewed clinical records of patients who underwent surgery between January 2017 and November 2019. This study has been approved by the ethics committee of Arauco health service. Results: 77 tympanoplasties were performed, of which 56 ears met the inclusion criteria. 71.43% were female. The age range is 8 to 64 years. 41% had chronic pathologies. 51.79% were left ear surgeries. 92.86% were type I tympanoplasty. An endoauricular approach was performed in 58.93%. A cartilage - perichondrium composite graft was used in 75% of the surgeries. A medial technique was performed in 94.94%. Anatomical success was achieved in 85.71% of patients. An average gain over 10 dB was obtained in 60.71% of the patients. Conclusion: There were no significant differences regarding the surgical choices with the anatomical and auditory results.

Comparison of aquatic macrophyte community structure between natural wetlands and rice fields with different cultivation ages / Comparação da estrutura da comunidade de macrófitas aquáticas entre áreas úmidas naturais e arrozais com diferentes tempos de cultivo

Abstract Recent studies indicate that rice fields contribute to the conservation of aquatic plants, however, repeated cultivation can reduce the species diversity harbored by rice fields. Repeated tillage, agrochemical application and environmental homogeneity can reduce plant diversity and select for species more tolerant to disturbance. Our hypotheses were: 1) macrophyte richness and biomass decrease with increased rice crop age; and 2) macrophyte species of rice fields are a subsample of natural wetlands and species loss will increase with crop age. We investigated three rice fields of each different ages (old, intermediate and new ones) and three natural intermittent wetlands for this study. Each area was sampled four times throughout the rice cultivation cycle (off-season, initial growth, final growth and post-harvest). Our results showed that the mean macrophyte richness and biomass were similar between rice fields of different ages and lower than that of natural wetlands. Although species composition in the different-aged rice fields was not markedly different, there was nestedness in the rice fields as age increased. In this study, we verified that macrophyte richness and biomass in rice fields was lower than natural wetlands and the species composition was different among wetland types (rice fields and natural wetlands), however our hypothesis that species richness and biomass will decrease with crop age was not confirmed. All rice crops had similar macrophyte assemblage structure (richness, biomass and species composition). However, the another hypothesis tested was confirmed, macrophyte assemblage of rice fields is a subset of natural wetlands and as, the age of a rice field increases, the species that occur in older rice field are subsets of species that occur in younger ones.

Resumo Estudos recentes indicam que arrozais contribuem para a conservação de plantas aquáticas, entretanto cultivos repetidos podem reduzir a diversidade de espécies nos arrozais. Cultivos repetidos, aplicação de agrotóxicos e homogeneização ambiental podem reduzir a diversidade de plantas e selecionar espécies mais tolerantes a perturbações. Nossas hipóteses foram: 1) a riqueza e a biomassa de macrófitas reduzem com o aumento do tempo de cultivo dos arrozais; e 2) as espécies de macrófitas aquáticas dos arrozais são subamostras das áreas úmidas naturais e a perda de espécies aumentará com o tempo de cultivo. Nós investigamos três arrozais de cada uma das diferentes idades (antigos, intermediários e novos) e três áreas úmidas naturais temporárias. Cada área foi amostrada quatro vezes ao longo do ciclo de cultivo (resteva, crescimento inicial, crescimento final e pós-colheita). Nossos resultados indicaram que a riqueza e a biomassa média de macrófitas foram similares entre os arrozais de diferentes idades e menor do que nas áreas úmidas naturais. Embora a composição de espécies nos arrozais de diferentes idades não tenha sido marcadamente diferente, houve aninhamento nos arrozais e este aumentou com tempo de cultivo do arrozal. Neste estudo, nós verificamos que a riqueza e biomassa de macrófitas nos arrozais eram menores que nas áreas úmidas naturais e a composição de espécies era diferente entre os tipos de áreas úmidas (arrozais e áreas úmidas naturais), entretanto nossa hipótese de que a riqueza e a biomassa de macrófitas diminuiriam com a idade do cultivo não foi confirmada. Todos os arrozais foram similares quanto à estrutura da assembleia de macrófitas (riqueza, biomassa e composição de espécies). No entanto, a outra hipótese testada foi confirmada, a assembleia de macrófitas dos arrozais é um subconjunto das áreas úmidas naturais e, conforme aumenta a idade do arrozal, as espécies que ocorrem nos arrozais mais antigos são subconjuntos das espécies que ocorrem nos mais jovens.

Implementación de un sistema de imagenología infrarroja para la detección vascular del antebrazo y mano / Implementation of an infrared imaging system for vascular detection in the forearm and hand

RESUMEN: En el área clínica son procedimientos comunes la venopunción, la colocación de catéteres, inyecciones intravenosas, etc. La visualización de las venas en algunas personas es compleja. En este trabajo se presenta el desarrollo de un sistema capaz de realzar la distribución de las venas en el antebrazo de una persona para, en un trabajo futuro, ayudar de forma no invasiva a localizar las venas en los procedimientos de venopunción. Para llevar a cabo el desempeño de esta tarea se utilizó una cámara web, a la cual se le ha extraído el filtro que impide el paso de luz infrarroja y es sustituido por otro que lo permite. Para mejorar la detección de las venas se le agregó a la cámara un arreglo de LEDs emisores de luz infrarroja (830nm). Las imágenes obtenidas fueron procesadas mediante la ecualización del histograma adaptable y clasificadas por dos métodos, el primero basado en el algoritmo Fuzzy C-Means, el segundo basado en un modelo probabilístico de tipo Bayes, técnicas del área de inteligencia artificial, presentadas como alternativa en el procesamiento de imágenes. Para la obtención de las imágenes se consideraron las regiones anteriores y exteriores del antebrazo izquierdo y derecho de cada sujeto generando una base de datos. Este sistema también tiene aplicación en la detección de venas varicosas debido a que se puede dar un seguimiento a la dilatación de las venas.

ABSTRACT: The venipuncture, the catheterization and intravenous (IV) injections are some of the common procedures in the clinical practice. The location of the veins may be complex in some patients. In this paper a system able to enhance the vein distribution in a patient's forearm in order to help, in future works, to locate the veins in a non-invasive way and accomplish the IV procedures, is described. To carry out this work a web cam was used, the filter that blocks out the infrared light has been removed and replaced for one who does not. To increase the vein detection an array of infrared LEDs (830 nm) was attached. The resulting images were processed using the adaptive histogram equalization and then classified by two methods, the first one based on the Fuzzy C-Means Algorithm, and the second based in a Bayesian probabilistic model. For the image acquisition, the anterior-exterior regions of the left and right forearm of each subject were considered to generate a data base. This system also has relevance in the detection of varicose veins since is able to monitor the vein dilatation.

Comparison of aquatic macrophyte community structure between natural wetlands and rice fields with different cultivation ages

Abstract Recent studies indicate that rice fields contribute to the conservation of aquatic plants, however, repeated cultivation can reduce the species diversity harbored by rice fields. Repeated tillage, agrochemical application and environmental homogeneity can reduce plant diversity and select for species more tolerant to disturbance. Our hypotheses were: 1) macrophyte richness and biomass decrease with increased rice crop age; and 2) macrophyte species of rice fields are a subsample of natural wetlands and species loss will increase with crop age. We investigated three rice fields of each different ages (old, intermediate and new ones) and three natural intermittent wetlands for this study. Each area was sampled four times throughout the rice cultivation cycle (off-season, initial growth, final growth and post-harvest). Our results showed that the mean macrophyte richness and biomass were similar between rice fields of different ages and lower than that of natural wetlands. Although species composition in the different-aged rice fields was not markedly different, there was nestedness in the rice fields as age increased. In this study, we verified that macrophyte richness and biomass in rice fields was lower than natural wetlands and the species composition was different among wetland types (rice fields and natural wetlands), however our hypothesis that species richness and biomass will decrease with crop age was not confirmed. All rice crops had similar macrophyte assemblage structure (richness, biomass and species composition). However, the another hypothesis tested was confirmed, macrophyte assemblage of rice fields is a subset of natural wetlands and as, the age of a rice field increases, the species that occur in older rice field are subsets of species that occur in younger ones.

Resumo Estudos recentes indicam que arrozais contribuem para a conservação de plantas aquáticas, entretanto cultivos repetidos podem reduzir a diversidade de espécies nos arrozais. Cultivos repetidos, aplicação de agrotóxicos e homogeneização ambiental podem reduzir a diversidade de plantas e selecionar espécies mais tolerantes a perturbações. Nossas hipóteses foram: 1) a riqueza e a biomassa de macrófitas reduzem com o aumento do tempo de cultivo dos arrozais; e 2) as espécies de macrófitas aquáticas dos arrozais são subamostras das áreas úmidas naturais e a perda de espécies aumentará com o tempo de cultivo. Nós investigamos três arrozais de cada uma das diferentes idades (antigos, intermediários e novos) e três áreas úmidas naturais temporárias. Cada área foi amostrada quatro vezes ao longo do ciclo de cultivo (resteva, crescimento inicial, crescimento final e pós-colheita). Nossos resultados indicaram que a riqueza e a biomassa média de macrófitas foram similares entre os arrozais de diferentes idades e menor do que nas áreas úmidas naturais. Embora a composição de espécies nos arrozais de diferentes idades não tenha sido marcadamente diferente, houve aninhamento nos arrozais e este aumentou com tempo de cultivo do arrozal. Neste estudo, nós verificamos que a riqueza e biomassa de macrófitas nos arrozais eram menores que nas áreas úmidas naturais e a composição de espécies era diferente entre os tipos de áreas úmidas (arrozais e áreas úmidas naturais), entretanto nossa hipótese de que a riqueza e a biomassa de macrófitas diminuiriam com a idade do cultivo não foi confirmada. Todos os arrozais foram similares quanto à estrutura da assembleia de macrófitas (riqueza, biomassa e composição de espécies). No entanto, a outra hipótese testada foi confirmada, a assembleia de macrófitas dos arrozais é um subconjunto das áreas úmidas naturais e, conforme aumenta a idade do arrozal, as espécies que ocorrem nos arrozais mais antigos são subconjuntos das espécies que ocorrem nos mais jovens.

Cierre de fístula oroantral con injerto óseo y con rotación y avance de colgajo palatino / Surgical repair oroantral fistula with a rotation and advancement palatal flap and autologous bone graft

La fístula oroantral se presenta entre otras causas como resultado de la extracción de un molar en relación al maxilar Como consecuencia el paciente presenta episodios de sinusitis de evolución tórpida y refractaria a tratamiento médico, siendo la reparación quirúrgica su mejor solución, existiendo distintas técnicas. El objetivo de este caso es mostrar la experiencia de un paciente operado mediante la utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se trata de una mujer de 32 años que dos semanas después de extracción de molar superior izquierdo presenta reiterados episodios de sinusitis unilateral izquierda. Al examen físico y estudio con tomografía computarizada se diagnostica sinusitis maxilar izquierda, secundaria a fístula oroantral por extracción de pieza dentaria del maxilar. Se realiza reparación quirúrgica con utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se realizó seguimiento por 6 meses con resultados óptimos, sin complicaciones ni recidivas. Las fístulas oroantrales son un problema que tiene múltiples opciones de tratamiento quirúrgico. La utilización de injertos óseos autólogos y la utilización de un colgajo de rotación y avance palatino, pretende ser una buena opción quirúrgica, permitiendo un cierre definitivo del defecto.

Oroantral fistula occurs between other causes as a result of the extraction of a molar in relation to the maxillary bone. As a result the patient experiences episodes of sinusitis refractory to medical treatment. Surgical repair remains the best solution, there are different techniques. The aim is to show our experience of one case operated using a rotation and advancement palatal flap and autologous bone graft. The clinical case is a 32 year old woman that two weeks after removal of upper left molar suffers repeated episodes of unilateral sinusitis. Physical examination and computed tomography shown left maxillary chronic sinusitis secondary to an oroantral fistula, due to tooth extraction from maxillary bone. Surgical repair is performed using a rotation and advancement palatal flap and autologous bone graft. Six months following there was no complication neither recurrent sinusitis, with optimal results. Oroantral fistula is a problem that has multiple options for surgery. The use of autologous bone graft and rotation and advancement palatal flap intended to be a good surgical option, allowing closure of the defect.

Parâmetros eletrocardiográficos de equinos desclassificados por exaustão em competições de enduro / Electrocardiographic parameters of horses disqualified from exhaustion in endurance competitions

Foram examinados, por meio de eletrocardiografia, 14 equinos Puro Sangue Árabe, 12 machos e duas fêmeas, desclassificados por exaustão em provas de enduro entre 60 e 160km. Foi observado predomínio de taquicardia sinusal, seguido de arritmia sinusal e complexo atrial prematuro com a frequência cardíaca variando de 48 a 78bpm e 93 a 111bpm, respectivamente. Ocorreu aumento da amplitude das ondas P, R, S e T e redução nas suas durações, bem como redução nos intervalos e segmentos, porém o complexo QRS quase não se alterou. O alongamento observado do QTc indicou fadiga miocárdica moderada em resposta ao exercício, e o supradesnível ST foi indicativo de hipovolemia. O eixo elétrico no plano frontal apresentou desvio à direita, aumento de câmara e hipertrofia secundários ao treinamento.

By using electrocardiographic examination, 14 Purebred Arabian horses, 12 males and two females, disqualified due to exhaustion in endurance races from 60 and 160km were evaluated. Predominance of sinus tachycardia, followed by sinus arrhythmia and atrial premature complex, with the heart rate ranging from 48 to 78bpm, and 93 to 111bpm, respectively, were observed. There was increase in the amplitude of waves P, R, S, and T, and decrease in their durations, as well as reduction in the intervals and segments; nevertheless, the QRS complex was not almost altered. The QTc lengthening pointed to a moderate myocardial fatigue in response to exercise, and the elevation of ST was indicative of hypovolemia. The electrical axis in frontal plane presented deviation to the right, chamber increase, and hypertrophy secondary to training.

Muerte encefálica: la necesidad de una causa suficiente y necesaria: a propósito de un caso de deseferentación completa por síndrome de Guillain Barré / Brain death: the need for sufficient and necessary cause: apropos of a complete deseferentation case from Guillain Barre syndrome

La muerte encefálica es una causa válida en la certificación del deceso de un paciente, especialmente en condiciones de donación de órganos. Existen escasas situaciones en las que el legislador ha propuesto la realización de exámenes complementarios para su certificación. Presentamos el caso de un paciente con un síndrome de Guillain Barré, que llegó a simular un estado de muerte encefálica, debido al compromiso motor completo, incluyendo musculatura ocular intrínseca. La falta de una condición suficiente y necesaria para declarar la muerte del paciente lleva a la solicitud de exámenes complementarios, en este caso un electroencefalograma, los que determinan la normalidad de la actividad eléctrica cerebral. Se recalca la necesidad de cumplir estrictamente los criterios para determinar la muerte encefálica y el no inhibirse de solicitar exámenes complementarios en condiciones de duda, aún cuando la ley no siempre lo contemple.

Brain death is a valid cause of death certification in a patient, especially in terms of organ donation. There are few situations in which the legislator has proposed further examination for certification. We report the case of a patient with Guillain Barré syndrome, which came to simulate a state of brain death due to motor impairment in full, including intrinsic ocular muscles. The lack of a necessary and sufficient condition for declaring the patient's death led to request additional examinations, in this case an electroencephalogram, which determine the normality of brain electrical activity. It emphasizes the need to comply strictly with the criteria for determining brain death and not to request additional examinations inhibited in a position of doubt, even though the law does not always contemplated.

Manejo del paciente con fisura labio-palatina en Arica: experiencia de 15 años / Management of cleft lip palate in Arica: 15 years experience

Introducción: Frente al alto número de pacientes con fisura labial y/o palatina ya existente en la ciudad de Arica y al incremento constante de nuevos casos, en 1987 decidimos abordar el problema desde un punto de vista multidisciplinario e interdisciplinario, integrando además la valiosa ayuda de los padres de los niños fisurados. Objetivo: Mostrar nuestra experiencia y sus resultados parciales en el manejo multidisciplinario del paciente fisurado en la ciudad de Arica entre los años 1987y 2002. Material y método: Mediante la creación y puesta en práctica del "Programa de Atención del Paciente Fisurado", en el Hospital Juan Noé de Arica entre los años 1987y 2002, se atienden 59 pacientes que siguen el programa. Resultados: A modo de resultado preliminar se entrega la experiencia de 59 casos que siguieron el protocolo del programa. Conclusión: El trabajo con el paciente fisurado, es un trabajo de largo aliento. Como factores de importancia se destacan el largo tiempo de seguimiento, el factor crecimiento y la observación atenta de la evolución en cada caso en particular. Resulta imprescindible el trabajo en equipo multidisciplinario, evaluando en conjunto cada caso, elaborando un claro y estructurado plan de acción con cada paciente, así como evaluar en forma periódica y en conjunto los resultados parciales.

Introduction: Due to the high prevalence of patients with cleft lip with or without cleft palate in the city of Arica Chile and the constant increase of new cases, in 1987 we decided to face the problem from a multidisciplinary and interdisciplinary point of view, incorporating the valuable help from the parents of the affected children. Aim: To show our experience in the multidisciplinary manage of cleft lip-palate in the city of Arica during the years 1987 to 2002 Material and method: By the creation and set up of the "Cleft Lip-Palate patient attention program", in the Juan Noé Hospital of Arica during the years 1987 to 2002, we follow 59 patients attending the program. Results: Some preliminary results are displayed, according to the experience of 59 cases of patients attending the program. Conclusion: Complete management of the cleflip patient is a longjob. As important factors outstand age, growth and careful observation ofevolution in every single case. Multidisciplinary team work is a must, evaluating each case together, developing a clear structured plan of action for each patient, as well as periodically evaluating partial results.

Programa piloto para pacientes beneficiarios de Fonasa, que padecen esclerosis multiple: tratamiento con inmunomoduladores en el sistema público de salud de Chile: Informe del primer año, 10 de julio 2008-30 de Junio 2009 / Pilot national treatment program for multiple sclerosis patients belonging to the public health care system of Chile (FONASA) with immunomodulating disease-modifying therapies: first year report from July 2008 to June 2009

Multiple Sclerosis (MS) is a chronic disease of the central nervous system. It is manifested in the young adult who presents at the beginning alternation between transient neurological dysfunction and normality, followed by a progressive level of disability. MS affects the quality of life in the young adults in their full productive and creative age limiting not only in their personal lives but also affects to the whole society in terms of "dreams and life projects". Besides, this illness also influences the family group who has to assume progressively the help and care for the patient. In healthcare aspect MS implies intensive and progressive resources. In Chile, although we don't have epidemiological studies that indicate which is the MS prevalence it exist a projection that states 14 per 100.000 inhabitants. Considering a population of 16.5 million of inhabitants our expectative of patients with MS is of 2310 cases in our country. The MS immunomodulating injectable disease-modifying therapies are of high cost and were not available in a regular way in the state health care system of Chile (FONASA) that attends the 70 percent of the population; the other 30 percent has different private health insurances. In 2008 the ministry of health decided to initiate and pilot (exploratory) program which had a great meaning and impact concerning to start offering immunomodulating therapies to relapsing remitting MS, for patients belonging to FONASA system. The pilot program was thought with a double mission, on the one hand to achieve that a very limited group of MS patients belonging to FONASA system (80 cases) from all over the country had access to immunomodulating injectable disease-modifying therapies of high cost in a regular way. The second objective was to obtain clinical and epidemiological information which let us to evaluate the clinical and administrative obstacles generated by the incorporation of this treatment in the public health...

Introducción El presente documento corresponde al informe del primer año de trabajo operativo del "Programa piloto de tratamiento con inmunomoduladores, para pacientes beneficiarios de Fonasa1, que padecen esclerosis múltiple (EM)", elaborado por el equipo del centro de referencia nacional, para este programa, con sede en el Servicio de Neurología del Complejo Asistencial Barros Luco (CABL) del SSMS2. Dado su origen no incluye antecedentes del proceso de gestión ni toma de decisiones del nivel Minsal3 o Fonasa. Este trabajo, no es ni aspira ser: un ensayo clínico, una guía de práctica clínica, una revisión bibliográfica, ni una puesta al día sobre el tratamiento de la Esclerosis Múltiple (EM), es simplemente el informe anual de un centro de referencia, para una tarea específica, a la autoridad ministerial competente. El informe incluye algunos antecedentes generales y referencias presentadas como "notas al pie", sólo para contextualizar la información presentada4. La EM es una enfermedad crónica del SNC, de origen incierto, inmunológicamente mediada, bien definida en sus características inmunopatogénicas, patológicas, imagenológicas y clínicas. Se expresa en el adulto joven, quien presenta inicialmente alternancia entre disfunción neurológica transitoria y normalidad y cuya progresión determina múltiples efectos discapacitantes. La EM afecta la calidad de vida de adultos jóvenes en plena edad productiva y creativa limitando tanto los "sueños y proyectos de vida" como el desarrollo laboral, social y afectivo. Además trasciende al grupo familiar, cuando deben asumir la asistencia del paciente. En lo sanitario, la EM, genera uso intensivo y progresivo de recursos. Las terapias inmunomoduladores para la EM, que tienen la posibilidad de detener o reducir la evolución de la modalidad recurrente remitente de la EM, no se encontraban disponibles en forma regular en el sector público de salud de nuestro país, por esto el presente programa piloto...

Infección profunda del cuello por Streptococcus grupo B en un paciente diabético: Caso clínico / Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient: Report of one case

We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.

Estudo eritroleucométrico e proteinograma sérico do sangue do cordão umbilical e jugular de eqüinos ao nascimento e de suas respectivas mães / Erythrocytometry and seric proteinogram of umbilical cord and jugular of foals at birth and respective mothers

Colheram-se amostras de sangue do cordão umbilical (SCU) e do sangue circulante de cinco eqüinos neonatos, imediatamente após o nascimento, e o sangue da própria mãe, utilizando-se um sistema a vácuo. O material foi submetido à contagem global de hemácias e leucócitos e à determinação do volume globular e da concentração de hemoglobina; à contagem diferencial de leucócitos em esfregaços sangüíneos; e ao cálculo dos índices eritrocitométricos. Foram realizadas a dosagem de proteínas séricas totais e a eletroforese das proteínas séricas em gel de agarose. Não houve diferenças significativas entre os parâmetros do SCU e do sangue da jugular dos potros. No SCU dos potros observaram-se valores mais elevados para contagem global de hemácias (9,75x10(6)/µl), dosagem de hemoglobina (14,65g/dl) e concentração de hemoglobina corpuscular média (37,23g/dl); e valores menores para volume corpuscular médio (40,50fl), proteína total (4,37g/dl), alfa-globulinas (0,65g/dl), beta-globulinas (1,10g/dl), gama-globulinas (0g/dl) e contagens global (5,40 x 10³/µl) e diferencial de leucócitos, exceto contagem de neutrófilos bastonetes e monócitos, quando comparados com os valores obtidos no sangue de suas mães

Umbilical cord blood (UCB) and systemic blood samples were collected from five equine neonates, immediately after birth. Systemic blood samples from their mothers were also collected at the same time, using a vacuum system. The samples were submitted to the following analyses: red blood cell and total white blood cell counts; determinations of packed cell volume and hemoglobin concentration; differential white cell count in blood smears; and determination of erythrocytometric values. Total serum proteins quantification and serum proteins electrophoresis in agarose gel were done. No significant difference (P<0.05) was noted between averages in neonate jugular blood and equine UCB. Equine UCB showed higher values of red blood cell count (9.75x10(6)/µ), hemoglobin determination (14.65g/dl), and mean corpuscular hemoglobin concentration (37.23g/dl); but lower values of mean corpuscular volume (40.50fl), total protein (4.37g/dl), alpha-globulin (0.65 g/dl), beta-globulin (1.10g/dl), gamma-globulin (0g/dl), total (5.40x10³/µl), and differential leukocytes count, except for band neutrophils and monocytes counts, when compared to the blood of the mares

Evaluación del apoyo nutricional a pacientes pediátricos graves / Evaluation of nutritional support to pediatric patients hospitalized due to severe illnesses

Introducción: Los niños gravemente enfermos presentan mayor riesgo de malnutrición, de complicaciones y de estadías más prolongadas. Objetivo: Evaluar el estado nutricional y el apoyo nutricional entregado a niños hospitalizados en una unidad de cuidados intermedios. Sujetos y método: Se estudiaron 123 niños, ingresados consecutivamente a un Hospital de Santiago. La evaluación nutricional se realizó al ingreso y al 5º día. La ingesta alimentaria se evaluó por pesaje de alimentos. Resultados: 46 por ciento de los niños presentó malnutrición por déficit, 10 por ciento déficit nutricional agudo, 11 por ciento sobrepeso u obesidad y 33 por ciento estado nutricional normal. El 20 por ciento de los niños cubría sus requerimientos energéticos, de estos 33 por ciento se encontraba con alimentación enteral, 42 por ciento por vía oral y 21 por ciento mixta (oral más enteral). Entre los niños que cubrieron menos del 100 por ciento de sus requerimientos, 19 por ciento sólo recibían soluciones glucosadas vía intravenosa. La ingesta proteica promedio fue 1,1 + - 0,7 g/kg peso, lo que equivale a un porcentaje de 8,9 + - 3,3. Conclusiones: Un porcentaje bajo de los niños ingresados a una unidad de cuidados intermedios cubren sus requerimientos energéticos (20 por ciento) y proteicos (32 por ciento). Los mejores aportes lo lograron aquellos niños con alimentación enteral o alimentación mixta.

Mucocele frontal lateral, tratamiento combinado endoscópico y externo: caso clínico / Frontal lateral mucocele, combined endoscopic and external treatment: clinical case

El mucocele frontal es la ubicación más frecuente de los mucoceles de senos paranasales, sin embargo aún no hay consenso respecto a la técnica quirúrgica adecuada para su tratamiento. El presente trabajo muestra un caso clínico de un mucocele frontal lateralizado, que desplaza el globo ocular y lóbulo cerebral frontal. Se muestra la técnica quirúrgica empleada (vía externa combinada con vía endoscópica). Se exponen las distintas técnicas de imagenología diagnóstica y técnicas computacionales que ayudan en el procedimiento quirúrgico.

Comparação entre duas técnicas de neurorrafia do digital palmar em eqüinos / Comparative study of two techniques of digital palmar neurorrhaphy in horses

Foram comparadas duas técnicas de neurorrafia em seis eqüinos, divididos em três grupos (G), conforme o tempo para a biópsia. Os animais foram submetidos a neurectomia dos nervos digitais palmares (NDP) e aplicaram-se duas suturas epineurais (SE) e suturas com tubos de silicone (STS) em cada animal. Avaliaram-se os animais mensalmente pelo teste de sensibilidade e exame do aparelho locomotor até a realização das biópsias dos NDP. Aos 30 dias pós-cirurgia foi realizada biópsia no GI, aos 60 dias no GII e aos 180 dias no GIII. Macroscopicamente, o NDP encontrou-se envolvido por tecido conjuntivo fibroso. Microscopicamente, constataram-se proliferação axonal em uma amostra do GI e neuromas nas amostras dos GI, GII e GIII. Houve proliferação de tecido conjuntivo em todos os grupos no local de reparação para SE e adentrando no interior do tubo na STS. Visibilizaram-se infiltrado de células inflamatórias, alterações no coto proximal e degeneração no coto distal na SE e na STS. As técnicas não apresentaram resultados satisfatórios quanto ao grau de regeneração do coto proximal até o coto distal.

Two neurorrhaphy techniques were compared using six horses divided in three groups (G), based on the biopsy time. After neurectomy of the palmar digital nerves (DPN), two epineural sutures (ES) and two sutures with silicone tube (STS) were applied in each animal. All animals were evaluated monthly by sensitivity test and locomotor apparatus examination until collection of the suture sites by biopsy. Biopsy procedure was performed at 30 days post surgery in G1, 60 days in G2 and 180 days in G3. Grossly, the digital palmar nerve was involved by fibrous connective tissue. Microscopically, axonal growth in one sample from G1 and neuroma in samples from G1, G2 and G3 were observed. Proliferation of connective tissue occurred in all groups in repaired areas of ES and penetrated in the interior of STS tubes. Inflammatory cells, alterations of the proximal stump and degeneration of distal stump in ES and in STS were observed. Both techniques showed no satisfactory results regarding the degree of regeneration from proximal to distal stump.

Análisis de resistencia insulínica, tolerancia a la glucosa y testosterona en mujeres con síndrome de ovario poliquístico agrupadas por índice de masa corporal / Insulin resistance, glucose and testosterone tolerance in women with polycystic ovary clustered by body mass index

Antecedentes: El síndrome de ovario poliquístico (SOP) es el desorden endocrino más común en las mujeres en edad reproductiva. Han sido asociadas al SOP resistencia a la insulina, obesidad y diabetes mellitus. Objetivo: Analizar en mujeres con SOP la relación entre testosterona, obesidad y problemas en el metabolismo de carbohidratos. Pacientes y Métodos: 60 pacientes, entre 14-32 años, fueron diagnosticadas según Consenso de Rotterdam. Se midió testosterona total (Ttotal), se realizó un test de tolerancia oral a glucosa e insulina (TTOG-I) y se calculó índice de masa corporal (IMC) en todas las pacientes. La distribución de cada variable y la relación entre testosterona y las otras variables fueron analizadas. Resultados: La media de Ttotal en todas las pacientes fue 2,2 nmol/L; 71,7 por ciento de los sujetos presentan IMC normal, 21,7 por ciento presentan IMC sobrepeso y 6,6 por ciento presenta IMC obeso. La media de Ttotal para cada grupo según IMC fue 2,2 nmol/L para normal y sobrepeso, y 2,75 nmol/L para obeso. Para TTOG-I, 43,3 por ciento tiene respuesta normal, con media de Ttotal = 2,2 nmol/L y media de IMC= 22,3 kg/m2, 56,7 por ciento tiene respuesta anormal, con media de Ttotal= 2,19 nmol/L e IMC= 23,1 kg/m2. Las pacientes normales y sobrepeso muestran respuesta similar al TTOG-I. Todas las pacientes obesas tienen TTOG-I alterado. Conclusiones: La alta prevalencia de desórdenes metabólicos apoya el hecho que éstos deben ser estudiados en estas pacientes. La ausencia de correlación significativa entre Ttotal y las otras variables sugiere que en el SOP múltiples factores están involucrados y que éste incluye diferentes subpoblaciones de pacientes, que requieren un diagnóstico adecuado. La clasificación de las pacientes con SOP en subgrupos podría ser útil antes del inicio del tratamiento.

Características físico-químicas e citológicas do líquido sinovial da bainha tendínea digital de eqüinos / Physical, biochemical and cytological characteristics of the equine digital flexor tendon sheath synovial fluid

Foram estudadas as características físico-químicas e citológicas do líquido sinovial da bainha tendínea digital de nove eqüinos hígidos. Verificou-se que o líquido é viscoso, amarelo claro, límpido, livre de partículas e que não coagula à temperatura ambiente. Sua concentração média de ácido hialurônico foi 60,20mg/dl, a taxa de glicose, similar à plasmática e sua concentração protéica não ultrapassou 1,74g/dl, com relação média albumina:globulina de 0,94. O número médio de células nucleadas foi de 313 células/æl, com predominância de grandes células mononucleares e linfócitos. Houve correlação significativa (r = - 0,649, P<0,01) entre o aumento da concentração de ácido hialurônico e a diminuição percentual de linfócitos. As mensurações das características pesquisadas no líquido sinovial da bainha tendínea digital de eqüinos são de execução simples e passíveis de implantação na rotina de atendimentos clínico-cirúrgicos.

Ventilación no invasiva como tratamiento de la insuficiencia respiratoria aguda en Pediatría / Pediatric non-invasive ventilation for acute respiratory failure in an Intermediate Care Unit

Background: Pediatric noninvasive ventilation (NIV) is infrequently used for acute respiratory failure (ARF), BiPAP/CPAP applied through nasal mask can be attempted if strict selection rules are defined. Aim: To evaluate the outcome of NIV in a Pediatric Intermediate Care Unit. Material and methods: The medical records of 14 patients (age range 1 month-13 years, six female), who participated in a prospective protocol of NIV from January to October 2004, were reviewed. Oxygen therapy, delivered through a reservoir bag attached to the ventilation circuit, was used to maintain SaO2 over 90%. Results: The main indication of BiPAP, in 80% of cases, was pulmonary restrictive disease. Indications of NIV were acute exacerbations in patients with chronic domiciliary NIV in three patients, hypoxic ARF in six and hypercapnic ARF in five. The diagnoses were pneumonia/atelectasis in seven patients, bilateral extensive pneumonia in three, RSV bronchiolitis in two, apnea in one, and asthma exacerbation in one. Only one patient required intubation for mechanical ventilation, all others improved. The procedures did not have complications. NIV lasted less than three days in 5 patients, 4 to 7 days in four patients and more than 7 days in five. One third of the patients required fiberoptic bronchoscopy for massive or lobar atelectasis and one third remained on domiciliary NIV program. Conclusions: NIV can be useful and safe in children with ARF admitted to a Pediatric Intermediate Care Unit. If strict inclusion protocols are followed, NIV might avoid mechanical ventilation.