Historia natural de la colelitiasis: incidencia de colecistectomía en un área urbana y una rural mapuche, en la última década / Natural history of cholelithiasis and incidence of cholecystectomy in an urban and a Mapuche rural area

Background: Cholelithiasis is the second cause of hospital admissions in Chile. Aim: To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. Patients and methods: In the period 2000-2001, we contacted to 71 percent (1127 subjects) and to 61 percent (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. Results: In 1993, 30-35 percent of gallstone patients were symptomatic (&70 percent women). During the lapse 1993-2001, only 50 percent of subjects from La Florida and 25 percent of patients from Huapi Island were cholecystectomized (p <0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40 percent of all cholecystectomies performed in the National Health Service Hospitals. Conclusions: This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5 percent of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510

Composición genética de la población chilena: distribución de polimorfismos de DNA mitocondrial en grupos originarios y en la población mixta de Santiago / Genetic composition of the chilean population: analysis of mitochondrial DNA polymorphisms

Background: The analysis of mitochondrial DNA restriction site polymorphisms assigns most Latin American aborigines to four haplogroups. These are characterized by determined polymorphic restriction sites and a deletion of 9 base pairs in the intergenic region V. Aim: To study the distribution of mitochondrial DNA haplogroups in Chilean aboriginal groups, as well as in the mixed population of Santiago. Material and methods: One hundred twenty Aymara subjects and 23 Atacame-o subjects from the Northern part of Chile and 162 randomly chosen subjects residing in Santiago were studied. DNA was extracted from peripheral lymphocytes. Mitochondrial DNA was amplified by means of polymerase chain reaction. Results: The frequency of haplogroup B decreases from north to south. Aymaras in the north have the highest frequency (64 percent) and it is absent among the Yamanas (previously studied) in the extreme South. Haplogroups C and D show an inverse tendency. It is noteworthy that 84 percent of mitochondrial haplogroups of the mixed population of Santiago are of Amerindian origin whereas the Y-chromosomes are mainly European. Conclusions: The peculiar distribution of haplotypes indicate that the population of Santiago is the result of an asymmetric mating system in which the females ancestors were mainly Amerindian and the male ancestors mainly European

Cáncer de la vesícula biliar en Chile / Gallbladder cancer in Chile

This issue of the Revista brings two articles related to gallbladder cancer (GC), a highly prevalent cancer among Chileans. The first paper relates to therapy for Stage II N0 GC. Authors from Universidad de la Frontera corroborate the bad results usually obtained with adjunct chemiotherapy and radiotherapy, associated to a second operation. The second paper discusses the negative influences that the new Xth Edition of the International Classification of Diseases might have on GC control. This cancer appears now with a dramatic 100 percent decrease in mortality rate in the last 3 years, associated to a simultaneous increase of the digit related to biliary tract cancer of undefined origin, which in the great majority of cases truly corresponds to GC throughout the world. This involuntary bias could have a strong negative effect on health policy makers, because health resources will not be derived to perform more cholecystectomies needed to significantly decrease the number of gallbladders at risk. This is a major issue for the Chilean health system, since GC represents the first cause of deaths due to cancer among Chilean women

Enfermedad vesicular inaparente o microlitiasis en pacientes con pancreatitis aguda: una situación clínica frecuente / Occult gallbladder disease or microlithiasis in patients with acute pancreatitis: a frequent clinical situation

Patients admitted with the diagnosis of AP to a clinical hospital were included in the study. According to an abdominal ultrasound study, patients were classified as having or not cholelithiasis. A duodenal biliary drainage was performed in 15 patientes with AP and without gallbladder stones. Results: Patients without cholelithiasis had recurrent AP more often than patients with biliary AP (53 and 3.3 percent respectively). Excessive alcohol ingestion did not rule out the possibility of biliary etiology. In 6 patients, the analysis of duodenal bile showed cholesterol crystals, and cholecystectomy confirmed the existence of gallbladder disease in 54. All of them remained asymptomatic during a follow-up period of four years. One patient refused surgery, with subsequent development of galls tones and recurrent episodes of AP. In other 4 patients, gallbladder disease was confirmed by percutaneous gallbladder puncture or during cholecystectomy. No recurrence of AP were observed during the follow-up. Conclusions: Microlithiasis or "occult" gallbladder disease accounts for at least 67 percent of the original "non-biliary" AP. Duodenal bile analysis is a useful and necessary technique for the evaluation of patients with "non-biliary" actue pancreatitis. Careful clinical and echographic follow-up of this subgroup of patients with AP is mandatory

Disolución de cálculos vesiculares de colesterol por infusión percutánea transhepática con Metil-Tert-Butil-Eter / Gallstones dissolution with metil-butil-eter via percutaneous transhepatic infusion

Se evaluó el tratamiento de colelitiasis sintomática de cálculos de colesterol o mixtos con escaso contenido de calcio, mediante infusión directa de metil-tert-butil-éter (MTBE) a través de colecistostomía transhepática en 10 pacientes con extracción complementaria de fragmentos residuales en 3 de ellos. La colecistostomía se realizó por vía transhepática bajo visión ecográfica o fluoroscópica. Se infundió MTBE durante 2 a 15 horas, en uno a cinco días, hasta lograr disolución de todos los cálculos, controlando el procedimiento con colecistografía directa, determinación colorimétrica de colesterol en el líquido recuperado y ecografías horarias. Se logró disolución completa en 7 pacientes (70 ciento por ciento). En los 3 restantes, portadores de cálculos que contenían calcio, se extrajeron fragmentos residuales con canastillo de Dormia. Sólo hubo complicaciones menores durante el procedimiento en 2 pacientes (náuseas y vómitos), que cedieron espontáneamente al suspender la infusión. A todos los pacientes se les indicó tratamiento de mantención con ácido Ursodeoxicólico. Se realizó seguimiento ecográfico cada 3 meses por un período de 10 meses, sin observar recurrencias. Esta técnica demuestra ser efectiva y de baja morbilidad en pacientes con indicaciones específicas, aunque su rol como tratamiento definitivo está aún por dilucidar