Resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol: experiencia en dos centros universitarios / Videotoracoscopy resection of pulmonary nodules marked with lipiodol: experience in two university centers

INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.

BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.

Manejo de los nódulos pulmonares subsólidos: resultados quirúrgicos basados en algoritmo local / Pulmonary subsolid nodules: surgical outcomes based on institutional algorithm

INTRODUCCIÓN: en la actualidad no existe un consenso respecto al manejo de los nódulos pulmonares subsólidos (NPSS). OBJETIVO: describir los resultados del manejo quirúrgico de los NPSS, basados en un algoritmo local. MATERIAL Y MÉTODOS: estudio descriptivo de corte transversal. Se revisaron las fichas clínicas electrónicas de los pacientes operados por NPSS, sugerentes de ser malignos, a juicio de un equipo multidisciplinario, entre enero de 2014 y enero de 2018, en el Departamento de Cirugía de Adultos de Clínica Las Condes. RESULTADOS: se estudió un total de 35 pacientes. La edad promedio fue de 65,8 años. El tamaño promedio de los nódulos fue de 15 mm. Todos los pacientes fueron abordados por cirugía videotoracoscópica asistida. El 88,6% de las biopsias demostró la presencia de una neoplasia maligna. CONCLUSIONES: la adopción de un algoritmo local, instituido por un equipo multidisciplinario, es una alternativa para el manejo adecuado de los portadores de NPSS.

BACKGROUND: Nowadays, there is no consensus in the management of pulmonary subsolid nodules (SSNs). AIM: describe the results of surgical management of SSNs, based on institutional algorithm. MATERIAL AND METHODS: cross-sectional, descriptive study, with revision of clinical electronic records, that included all patients intervened for SSNs, suggestive of malignancy, by the judgment of a multi-disciplinary team, from January 2014 to January 2018 at the Department of Adult Surgery, Clinica Las Condes. RESULTS: 35 patients were studied. The average age was 65.8 years. The average size of the nodules was 15 mm. All patients were approached by video-assisted thoracoscopic surgery. 88.6% of biopsies turned out to be malignant neoplasm. CONCLUSIONS: the acquisition of a local algorithm established by a multidisciplinary team is an appropriate alternative for the management of the patients with SSNs.

Trasplante pulmonar ex vivo: primera experiencia en Chile y Latinoamérica / Lung transplant with ex vivo lung perfusion, Chilean and Latin American first experience

Background: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. Aim: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. Material and Methods: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. Results: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). Conclusions: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.

Cirugía torácica videoasistida uniportal en dos centros universitarios: experiencia inicial / Initial experience in uniportal video-assisted thoracoscopic surgery at two university campuses

Resumen Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva. Objetivos: Describir la experiencia en videotoracoscopía (VATS) Uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile). Materiales y Método: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6%) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2° puerto, uno se convirtió a minitoracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones postoperatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía. Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor postoperatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional. Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.

Objective: To describe the initial results with uniportal Video-Thoracoscopic Surgery (VATS) performed in two campuses by members of the Section of Thoracic Surgery of the University of Chile ("Clínica Las Condes" and University of Chile Clinical Hospital). Materials and Method: Between January 2016 and January 2019, a total of 105 patients underwent uniportal VATS. Clinical data was collected retrospectively from digital records including demographic (age, sex) and clinical variables (diagnosis, surgery, duration of the chest tube, length of stay, conversion rate and postoperative complications). Results: Uniportal VATS was performed on 105 patients during the study period. Twenty-eight cases (26.6%) corresponded to lobectomy or anatomic segmentectomy. In 4 cases a 2nd port was required, 1 patient had to be converted to mini-thoracotomy and 1 to thoracotomy (5.8% global conversion). Overall, the median length of stay was 3.07 ± 3.1 days and the median duration of chest tube drainage was 2.67 ± 1.61 days. Seven patients (6.6%) presented complications. One patient died due to progression of his disease, there were no deaths related to the procedures. Discussion: Uniportal VATS has similar indications than multiportal VATS. On experienced hands, uniportal VATS has a low morbidity rate. Uniportal VATS appears to produce less post-operative pain, with shorter hospital stay and a faster return to normal life compared to standard VATS. Conclusion: We present the first uniportal VATS series in Chile. Results were similar to published series. Implementation and development of uniportal VATS requires a learning curve similar to any new surgical procedure.

Efectos de la ingesta de los edulcorantes estevia y D-tagatosa sobre el metabolismo de la glucosa, ácido úrico y apetito-saciedad / Effects of stevia and D-tagatose sweeteners intake om glucose, uric acid metabolism and appetite-satiety

INTRODUCCIÓN: Si bien, los edulcorantes no nutritivos (ENN) estevia y D-tagatosa han sido reportados como seguros, han demostrado tener algunos efectos metabólicos tras su ingesta. OBJETIVO: Describir los efectos de la ingesta de estevia y D-tagatosa sobre el metabolismo de la glucosa y ácido úrico, y del apetito-saciedad, a partir de la evidencia disponible. MÉTODOS: Revisión descriptiva. Se realizó búsqueda en PubMed utilizando los siguientes términos y palabras clave: "stevia rebaudiana", "tagatose", "D-tagatose", "blood glucose", "insulin", "metabolic processes", "uric acid", "hyperuricemia", "appetite" o "satiety". El análisis de los estudios seleccionados fue discrecional. RESULTADOS: Existen estudios que demuestran efectos beneficiosos tras el consumo de estevia o D-tagatosa sobre el control glicémico, apetito y saciedad tanto en sujetos sanos como con alteraciones en el metabolismo de la glucosa. Por otra parte, un número importante de estudios que evalúan la ingesta de estevia reportan efectos nulos sobre dichos parámetros. En relación al ácido úrico, solo un estudio en sujetos con enfermedad renal crónica reporta aumento en la concentración de ácido úrico plasmático tras la ingesta de 500 mg/día de estevia. Pocos estudios han evaluado el efecto de la ingesta de D-tagatosa sobre uricemia, en sujetos sanos y diabéticos, reportando un aumento transitorio y significativo en los niveles de ácido úrico sérico, sin embargo, no se ha logrado demostrar un efecto hiperuricémico asociado. Es importante destacar que la metodología de los estudios revisados es heterogénea, especialmente en relación al tamaño muestral, tiempo, dosis y vía de adminitración del edulcorante. CONCLUSIÓN: La ingesta de estevia y D-tagatosa ha demostrado efectos beneficiosos sobre el metabolismo de la glucosa, el apetito y la saciedad. El efecto del consumo de D-tagatosa sobre ácido úrico sérico requiere mayor evidencia para demostrar su significancia clínica.

INTRODUCTION: No-nutritive sweeteners stevia and D-tagatose have been reported as safe according to their acceptable daily intake, however, they have been shown to have metabolic effects after their ingestion. OBJECTIVE: To describe the effects of stevia and D-tagatose intake on parameters associated to glucose, uric acid metabolism and on appetite-satiety, considering the available evidence. METHODS: Descriptive review. PubMed search was carried out to identify the totality of the published articles. The following terms and key words were used: "stevia rebaudiana", "tagatose", "D-tagatose", "blood glucose", "insulin", "metabolic processes", "uric acid", "hyperuricemia", "appetite" o "satiety". The analysis of the selected studies was discretionary. RESULTS: studies have shown beneficial effects of stevia and D-tagatose consumption on glycemic control, appetite and satiety in healthy subjects as well as subjects with impairment glucose metabolism. On the other hand, a significant number of studies evaluating estevia intake report null effects on these parameters. In relation to uric acid, only one study in subjects with chronic kidney disease reported an increase in plasmatic uric acid concentration after the intake of 500 mg/day of stevia. Several studies have evaluated the effect of D-tagatose intake on plasmatic uric acid, in healthy and diabetic subjects, reporting a transient and significant increase in serum uric acid levels, however, has not been able to demonstrate an associated hyperuricemic effect. It is important to highlight that the methodology of the studies reviewed is heterogeneous, especially in relation to sample size, dose administered, time and route of exposure to the sweetener. CONCLUSION: Stevia and D-tagatose intake has shown beneficial effects on glucose metabolism, appetite and satiety. The effects of the consumption of both sweeteners on uric acid require further study to demonstrate their clinic significance.

Caracterización de nódulos pulmonares resecados. Experiencia de manejo por un programa multidisciplinario / Features of excised pulmonary nodules in 100 patients

Background: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. Aim: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. Material and Methods: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. Results: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. Conclusions: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.

High frequency of HPV16 European variant E350G among Mexican women from Sinaloa

Background & objectives: Human papillomavirus (HPV) infections play a crucial role in the aetiology of cervical cancer (CC), and HPV16 is the primary viral genotype associated with CC. A number of variants of the HPV16 E6 gene are involved in the progression of CC, differing in their prevalence and biological and biochemical properties. This study was designed to determine the frequency of HPV types 16/18 and to identify the presence of HPV16 E6-variants in asymptomatic Mexican women. Methods: A total of 189 cervical Pap smears were collected from women attending public health services in three different cities in Sinaloa, Mexico. Viral DNA was identified by amplification of E6 viral gene fragments using polymerase chain reaction (PCR). Identification of variants was done by sequencing a DNA fragment (321bp) of the HPV16 E6 gene. Results: More than half of the women tested were HPV-positive (52.38%), with HPV16 being the most frequent genotype (21.16%), followed by HPV18 (8.99%). Sequence analysis of the E6-HPV16 PCR products showed that in all cases, the viruses corresponded to European variants. It was further observed that the E350G intra-variant was the most common (>76%). Interpretation & conclusions: This study showed a predominance of European lineage variants of HPV16 among asymptomatic women from Sinaloa, Mexico, predominantly with of the E350G variant. This variant has been shown to be associated with an increased risk of early development of CC. The use of molecular identification of carcinogenic HPV and Pap test screening may be a good strategy for monitoring women to prevent CC.

Pioderma gangrenoso post-quirúrgico: reporte de un caso en paciente con fibrosis retroperitoneal / Postoperative pyoderma gangrenosum: a case report of a patient with retroperitoneal fibrosis

El pioderma gangrenoso (PG), es una patología ulcerativa infrecuente de etiología desconocida, asociado ocasionalmente a enfermedades autoinmunes. Es una condición crónica, de curso clínico impredecible y puede ser invalidante. Al ser complejo su diagnóstico, el retraso del mismo puede ocasionar al paciente morbilidades añadidas, como: tratamientos incorrectos y períodos de hospitalizaciones prolongados. Se presenta el caso de un paciente de 52 años, sin antecedentes mórbidos, que ingresa a Urgencias en el Hospital el Pino, por dolor abdominal recurrente. Durante el estudio de imágenes se evidencia una masa retroperitoneal, asociada a hidro-uretero-nefrosis izquierda. Ingresa al Servicio de Cirugía para estudio, realizándose una laparotomía media exploratoria y toma de muestras para biopsia. Procedimiento realizado sin incidentes. El paciente pese a múltiples tratamientos otorgados en esa unidad, evoluciona con dehiscencia de suturas recurrentes por tres meses. Evaluado por Dermatología se inicia estudio y se diagnostica PG, teniendo una excelente respuesta al tratamiento indicado.

Gangrenous pioderma (PG) is an uncommon ulcerative pathology of unknown etiology associated with autoimmune diseases. It is a non-predictable chronic condition, that can be incapacitating and patients that suffer this disease can also present systemic compromise. As it is a diagnosed by exclusion it may lead to long periods of failed treatments. The present work deals with a case of a 52-year-old male patient with no prior record of disease, who was admitted to the ER of El Pino Hospital suffering from recurrent abdominal pain. During the imaging study a retroperitoneal mass was found, associated with a left hydro-uretero-nephrosis. He was admitted and a exploratory mid-laparotomy was performed and samples were taken for biopsy. The procedure was successful and the established protocol was followed. However, during the recovery period the patient developed repeated surgical wound dehiscences of the surgical wounds. An internal consultation with the Dermatology Service took place, and the diagnosis of PG was made; proper pharmaceutical treatment was provided attaining excellent results.

Experiencia Programa de Intercambio Residentes Neuropediatría Chile-Hospital de Niños de Boston / Interchange Program Experience Pediatric Neurology Residents of Chile-Boston Children's Hospital

Cada dos años, residentes de Neuropediatría de distintos centros en Chile visitan el Boston Children's Hospital a fin de dar vida a un intercambio académico bilateral, que se constituye como una valiosa instancia de aprendizaje bilateral. Pensamos que es importante relatar nuestra experiencia y al mismo tiempo hacer algunas reflexiones sobre esta instancia formativa. Palabras Claves: Residentes; Intercambio; Neuropediatría; Educación médica

Every two year, residents of pediatric neurology from different Chilean Universities visit the Boston Children's Hospital for a bilateral academic exchange, that constitutes a valuable learning instance. We think that it is important to relate our experience and share our thoughts about this interchange. Key words: Residents; Interchange; Pediatric Neurology; Medical Education.

Uropatía obstructiva recurrente en arteritis de Takayasu / Recurrent upper urinary tract obstruction in takayasu arteritis

La arteritis de Takayasu (AT) es una enfermedad inflamatoria infrecuente de vasos grandes. A menudo, el daño crónico originado en las grandes arterias requiere de revascularización mediante prótesis vasculares. Excepcionalmente la implantación de las prótesis origina lesiones en otros órganos, como los uréteres, los cuales pueden obstruirse por compresión extrínseca por el tejido fibroso retroperitoneal originado como reacción a la presencia de la prótesis vascular.Se comunica el caso de una mujer que presentó hidronefrosis bilateral en forma asincrónica después de los 2 años de la instalación de una prótesis aorto-ilíaca con insuficiencia renal aguda, la cual pudo revertirse mediante. (AU)

Takayasu's arteritis is a rare inflammatory disease of large vessels. Often, chronic damage resulting in large arteries stenosis requires revascularization with vascular prostheses. Exceptionally, the presence of prostheses causes lesions in other organs, such as ureters, which are subject to extrinsic compression caused by retroperitoneal fibrous tissue originated as a reaction to the presence of vascular prostheses. We report the case of a woman who presented bilateral asynchronous hydronephrosis after 2 years of the installation of an aorto- iliac graft with acute renal failure, which could be reversed by releasing the ureter from the periprosthetic fibrous retroperitoneal tissue.(AU)

Ingesta de hidratos de carbono y ácidos grasos de la dieta en sujetos con esquizofrenia y trastorno bipolar, y su asociación con parámetros antropométricos / Association of carbohydrate and fatty acid intake with anthropometric parameters in subjects with schizophrenia and bipolar disorders

Background: People with psychiatric disorders have higher rates of obesity, diabetes mellitus and dyslipidemia. These comorbidities are associated with the underlying psychopathology and drug therapy. Aim: To determine the quality and quantity of carbohydrates and fatty acids in the diet and their association with anthropometric parameters in subjects with schizophrenia and bipolar disorders. Patients and Methods: We studied 30 patients with schizophrenia and bipolar disorders in treatment with atypical antipsychotics or mood stabilizers. Three 24-hour recall dietary surveys were carried out. Glycemic index, intake of carbohydrates and fatty acids (g/day) were calculated, and the ratio of saturated, monounsaturated and polyunsaturated fatty acids was determined. Body mass index, waist circumference (WC) and body fat percentage were evaluated. Results: The average intakes of carbohydrates and fatty acids were 295 ± 111 and 73 ± 38 g/day respectively. The mean glycemic index was 59% ± 5.4, while the ratio of saturated, monounsaturated and polyunsaturated fatty acids was 2: 1.4: 0.6. No association between dietary and anthropometric variables was found. Patients using second-generation antipsychotics had a significantly higher waist circumference than those using mood stabilizing drugs. Conclusions: We found no association between the amount and quality of carbohydrate or fatty acid dietary intake and anthropometric parameters.

Trauma de tórax / Thoracic trauma

Thoracic trauma is a frequent medical consult in emergency rooms. The initial approach is no different than the one used in polytraumatized, oriented by current trauma guidelines resulting of surgery and emergency consensus. Most thoracic injuries can be managed with simple maneuvers such as tube thoracostomy; however, 10% to 15% of patients who present with thoracic trauma require definitive operative repair. This article reviews the most common trauma related thoracic injuries in our medical setting: hemothorax, simple pneumothorax, tension pneumothorax, open pneumothorax, rib fractures, flail chest, lung contusion and cardiac tamponade. We also describe different forms of thoracotomy depending on the physiological status of patient at the emergency room and new treatments. (AU)

¿Es la cobertura forestal conservada y restaurada por las zonas protegidas?: El caso de dos áreas silvestres protegidas en el Pacífico Central de Costa Rica / Is forest cover conserved and restored by protected areas?: The case of two wild protected areas in the Central Pacific of Costa Rica

Resumen:Cambios en el uso del suelo son principalmente consecuencia de las acciones antropogénicas. La actual transformación agrícola y urbana en Costa Rica ha generado preguntas acerca de la efectividad de la conservación y restauración dentro de las áreas protegidas. En este documento nosotros analizamos los patrones de cambio del uso del suelo entre tres periodos: 1997, 2005 y 2010 en términos de magnitud, dirección y velocidad a través de mapas categóricos generados por la foto-interpretación para dos áreas silvestres protegidas y sus áreas aledañas: Parque Nacional La Cangreja (LCNP), el Refugio de Vida Silvestre Rancho Mastatal (RMWR) y sus áreas aledañas (SA), esta última compuesta por área de un kilómetro de radio fuera de los límites de las áreas protegidas. La matriz que describe el paisaje dentro de las áreas protegidas es la cobertura natural, compuesta principalmente por la cobertura forestal y tacotales. Encontramos que la cobertura natural más abundante para ambas áreas protegidas fue cubierta forestal en todos los años estudiados. La estabilidad y las grandes áreas de la cubierta forestal en LCNP y RMWR para 2005 y 2010 reflejan que las políticas, las acciones de manejo y vigilancia tienen un impacto positivo en la conservación y restauración de los hábitats naturales en esta zona del Pacifico Central Costarricense. Sin embargo, la alta complejidad del paisaje de SA en 1997, 2005 y 2010 son una prueba de presión antropogénica sobre estas áreas protegidas y sugieren una ineficacia de los gobiernos locales para monitorear y disminuir los cambios de uso del suelo que podrían obstaculizar la gestión, conservación y restauración de especies dentro de las áreas protegidas.

Abstract:Changes in land use are mainly a consequence of anthropogenic actions. The current agricultural and urban transformations in Costa Rica have raised questions about the effectiveness of conservation and restoration within protected areas. Herein we analyzed the patterns of land use change between three periods: 1997, 2005 and 2010 in terms of magnitude, direction, and pace through categorical maps generated by the photo-interpretation for La Cangreja National Park (LCNP), Rancho Mastatal Wildlife Refuge (RMWR), and their surrounding areas (SA), this last compound of one kilometer radius outside the protected areas' boundaries. The matrix which describes the landscape within the protected areas is natural coverage, composed mainly by forest cover and thickets. We found that the most abundant natural cover for both protected areas was forest cover for all years tested. The stability and large areas of forest cover in LCNP and RMWR for 2005 and 2010, reflected that policies, management actions and vigilance, have a positive impact on the conservation and restoration of natural habitats in these Costa Rican Central Pacific areas. However, the high landscape complexity of the SA in 1997, 2005 and 2010 was an evidence of the anthropogenic pressure on these protected areas, and suggested the ineffectiveness of local governments to monitor and abate land use changes, that could hinder the management, conservation and restoration of species in the protected areas.

Enfermedad por depósito de cristales de pirofosfato de calcio como ejemplo de forma de manifestación de la enfermedad en el adulto mayor / Calcium pyrophosphate dihydrate crystal deposition disease as an example of illness presentation in the elderly

Illness presentation in the elderly may be entirely non-specific, with fatigue, loss of function or the presence of geriatric syndromes. We report a 90 years old male consulting in the emergency room for delirium that persisted throughout hospitalization without finding a cause. During the course of hospitalization mild fever appeared and a left knee swelling became apparent. A synovial fluid aspiration showed a leukocyte count of 360 per field with 60% polymorphonuclear cells. The culture was negative. With a presumptive diagnosis of pseudogout, cochicine and celecoxib were started with remission of the confusional state. The patient was discharged 13 days after admission in good conditions.

Resultados a 10 años en trasplantes renales con donantes vivos no relacionados: Experiencia de 22 años / Survival among renal allograft recipients from non related living donors

Background: There is a gap between the number of patients requiring a renal allograft and the number of potential deceased donors (DD). One alternative is using allografts from non-related living donors (NRLD). Aim: To compare survival and complications of renal allograft recipients from DD, related living donors (RLD) and NRLD. Material and Methods: Observational study of a cohort of renal allograft recipients. Of 253 transplants performed in a Chilean region between 1981 and 2003, 20 patients received and allograft from a NRLD. Graft and patient survival of these patients were compared with those of 93 patients receiving an allograft from a related living donor and 140 receiving it from a DD. Patients were followed for 10 years or until death or dialysis requirement. Results: No significant differences between groups in graft and patient survival, deaths with a functioning graft or return to dialysis were observed. Receptors of DD had more hospital admissions during the first years after receiving the graft, usually due to infections. Also a delayed graft function was more common among them. Glomerular filtration rate ten years after the graft was similar among the three groups. Conclusions: No differences in graft or patient survival was observed between patients receiving a renal allograft from NRLD, RLD or DD.

Síndrome aórtico agudo: Revisión de la literatura y actualización del tema / Acute aortic syndrome

Acute aortic syndrome (AAS) is a term that describes interrelated aortic emergencies with similar clinical characteristics and challenges. These are aortic dissection (AD), intramural hematoma (IH), and penetrating atherosclerotic ulcer (PAU). The incidence of AAS is three cases per 100.000 persons per year. Diverse genetic disorders and acquired conditions have been related to the pathogenesis of this disease. Clinical features of patients with any of the three conditions comprising AAS are very similar. A high degree of clinical suspicion and imaging studies are necessary for an accurate diagnosis. Prognosis is clearly related to underlying diagnosis and appropriate surgical repair, in the case of proximal involvement of the aorta. Involvement of distal segments of the aorta may require medical or endovascular therapy according to the presence of complications. After hospital discharge, patients require lifelong follow-up.

Lavado peritoneal laparoscópico como tratamiento de diverticulitis aguda perforada / Laparoscopic peritoneal lavage as treatment for acute perforated diverticulitis

Introduction: Sigmoid diverticular disease is common in the occidental world and it is responsible for a great number of hospitalizations. The prevalence of diverticular disease increases with age and only in few cases it is manifest as diverticulitis. Diverticulitis produces variable clinical manifestations, ranging from simple inflammation that only requires medical management, to a life threatening condition, due to a free perforation that requires urgent surgery. Clinical case: In this article we present a clinical case of complicated diverticulitis with free perforation treated with laparoscopic peritoneal lavage.

Introducción: La enfermedad diverticular es muy común en el mundo occidental y es responsable de un gran número de hospitalizaciones. La prevalencia de la enfermedad diverticular aumenta con la edad y sólo en pocos casos se presenta como diverticulitis. La diverticulitis produce manifestaciones clínicas variables que van desde la simple inflamación que sólo requiere tratamiento médico, a una condición potencialmente mortal, debido a una perforación libre que requiere cirugía de urgencias. Caso clínico: Se presenta un caso clínico de diverticulitis complicada con perforación libre manejado con lavado peritoneal laparoscópico.

Relación del consumo de alimentos de alto índice glicémico en la dieta y los niveles de HbA1c en individuos Diabéticos Tipo 2 en tratamiento con dieta y/o Metformina

En la actualidad aún no existe consenso acerca de recomendaciones claras sobre el uso de IG (índice glicémico) de los alimentos para el control dietético de la DM2 (diabetes mellitus 2). Distintas entidades proponen el uso de conteo de CHO (hidratos de carbono), pues no se cuenta con evidencia suficiente para la planificación dietética en base al IG. El objetivo de este estudio fue relacionar el consumo de alimentos de alto IG con el control glicémico de pacientes DM 2 del programa de salud cardiovascular de tres CESFAM (centro de salud familiar) de la comuna de Santiago, Chile. Se seleccionaron 40 sujetos a quienes se les realizó evaluación antropométrica y una encuesta de frecuencia de consumo alimentaria de 30 dias modificada. Se obtuvieron IG, CG (carga glicémica), número de porciones de alto IG consumidas/dia y cantidad de CHO totales consumidos/día. Éstos se correlacionaron con valores de HbA1c (hemoglobina glicosilada) de los últimos 3 meses obtenidos de la ficha clínica. La edad promedio total fue 58.6 ± 9.5 años. El porcentaje de obesidad fue 62,5% y el promedio IMC de 32.5. El valor promedio de HbA1c fue 7.08 ± 1.6, para HbA1c <7% fue 57.5%. La cantidad total de CHO ingerida/dia fue de 403.8 g. El promedio de IG y CG fue de 78.5 y 317.5 g respectivamente. El número total de porciones de alimentos con IG alto consumido al día fue 21.8. Se obtuvo correlación estadísticamente significativa entre HbA1c y número de porciones de alto IG (r= 0.56 p=0.002). Para el resto de las variables no se encontró correlación con significancia estadística (p>0.05). Por cada porción extra de alimentos con alto IG se observó un aumento de la HbA1c en un 0,9%. En nuestra población estudiada la cantidad de alimentos con alto IG consumidos/dia se correlacionó signicativamante con los valores de HbA1c.

Relationship of consumption of high glycemic index food in the diet and levels of HbA1c in type 2 diabetic patients treated with diet and / or Metformin. At present there is still no clear consensus on recommendations on the use of GI of foods for the dietary management of T2DM. Rather different entities propose the use of carbohydrate counting, because there is not even enough evidence for dietary planning based on this index. The aim of this study was to relate consumption of high GI food with glycemic control of type 2 diabetes patients from the cardiovascular health program of 3 CESFAM (Family Health Centers) in Santiago, Chile. Forty individuals were selected, anthropometric measurements were conducted as well as a modified poll of frequency of food consumption of 30 days. Data from GI, GL, number of servings with high GI consumed per day and total amount of CARB consumed per day. Correlations were determined with values of HbA1c of the last 3 month obtained from the medical record. The average age was 58.6 ± 9.5 years. The percentage of obesity was 62,5% and the average BMI was 32,5. The average HbA1c value was 7.08 ± 1.6, for HbA1c <7% it was 57,5%. The total amount of CARB ingested/day was 403,8 g. The average of GI and GL was 78.5 and 317.5 respectively. The total number of servings of food with high GI ingested per day was 21,8. There was a statistically significant correlation between HbA1c and number of servings with high GI (r= 0.56 p=0.002). For the remaining variables there was no statistically significant correlation (p>0.05). For each extra serving of high GI food there was an increase of 0.9% of HbA1c. In our research population the amount of food with high GI ingested per day was significantly correlated with values of HbA1c.