Esclerosis múltiple recurrente remitente en el sector público de salud de Chile: Descripción clínica de 314 pacientes / Clinical features of 314 patients with relapsing-remitting multiple sclerosis

Background: Immunomodulatory drugs (IMD), Interferon β1a, β1 b and glatiramer acetate are available in the Chilean public health system since June 2008 for patients with relapsing-remitting multiple sclerosis (RR-MS). Diagnostic confirmation and programmed follow up of these patients is carried out at a public national reference center. Aim: To describe the epidemiological and clinical features of 314 patients evaluated in this center between 2008 and 2012. Patients and Methods: Review of clinical records, to obtain information about demographic background, medical history, expanded disability status scale of Kurtzke (EDSS), multiple sclerosis functional composite (MSfic), intensity fatigue scale of Krupp, Rao’s Brief Repeatable Battery of Neuropsychological Tests (BNR-R) and anxious-depressive manifestations using Hamilton and Beck questionnaires. Results: The ages of patients ranged from 12 to 63 years and 67% were women. The initial symptoms were sensory disturbances in 20%, motor alterations in 18% and optical neuritis in 16%. In 9% of patients, the disease began with several manifestations. The EDSS was 4 or less in 73% of patients and cognitive impairment was observed in 34%. Treatment failure during the first and second years, occurred in 23 and 26% of patients, respectively. Male gender, age under 40 and brainstem malfunction at the onset of disease, were predictive of treatment failure during the second year. Conclusions: The features of these patients are very similar to those reported abroad.

Evaluación neuropsicológica en 129 pacientes chilenos con esclerosis múltiple recurrente remitente previo a inicio de fármacos inmunomoduladores / Neuropsychological assessment of patients with relapsing remitting multiple sclerosis prior to the use of immunomodulatory drugs

Background: The detection of cognitive changes (CC) and psychiatric disorders in relapsing remitting multiple sclerosis (MS-RR) contributes to patient clinical monitoring. Aim: To assess the frequency and characteristics of CC and psychiatric disorders in Chilean patients with MS-RR, before starting immunomodulatory treatment. Patients and Methods: Retrospective review of data that was obtained following a standard assessment protocol. It consisted in the application of the Expanded Disability Status Scale of Kurtzke (EDSS), Multiple Sclerosis Functional Composite (MSFC), fatigue intensity scale of Krupp, brief repeatable battery of neuropsychological Rao (BRN-R) and Hamilton's depression and anxiety questionnaires. Results: We evaluated 129 patients aged between 12 and 60 years of age (69% women). Ninetyfour percent of patients had eight or more years of schooling. The average EDSS score was 2.83. CC were detected in 62% of participants, in at least one subtest of the BRN-R. The main changes were verbal memory and speed in the processing information. The frequency of cognitive impairment (CI), defined as at least two BRN-R subtests altered, was 36%. The figures decreased to 17% when significant major depression or associated fatigue were excluded. Depressive symptoms were observed in 58% and anxiety in 76.7%. Conclusions: The results are consistent with those described in the literature. The type of instruments used in the investigation of CC and the definition of CI in MS should be standardized.

Secuelas de las fisuras labiopalatinas / Cleft palate sequelae

Se analiza la secuencia histórica de dos período de tratamiento de fisuras labiopalatinas en el Hospital Barros Luco Trudeau, en un total de 251 enfermos. Se ha notado una importante disminución de los casos tratados por años (4 contra 10), del grado lesional decreciente residual o secuelar y del aumento de las correcciones secundarias del orden estática. Se atribuye como explicación a este progreso el mejoramiento de la atención pediátrica multidisciplinaria ofrecida en el Hospital Base del Area

Fractura por estallido (Blow-out) de órbita / Blow out orbital fractures

Se presentan 18 pacientes con fractura de órbita por estallido, de un total de 300 enfermos que consultan por algún rasgo de fractura de la órbita. El diagnóstico se basó en el estudio radiológico y en los hallazgos intraoperatorios. Su tratamiento quirúrgico, a través de una incisión habitualmente subpalpebral, consistió en la reparación del piso orbitario con diferentes materiales biológicos o sintéticos. Como complicación tardía un paciente presentó rechazo al silastic, 2 casos de persistencia de la limitación de los movimientos oculares y un paciente con enoftalmo, diplopia y descenso pupilar

Fibrodisplasia craneofacial / Craniofacial fibrous dysplasia

Entre los años 1970 y 1988 se han tratado 28 pacientes con fibrodisplasia ósea craneofacial. Esta enfermedad, de etiología incierta, evoluciona preferentemente en las primeras dos décadas de la vida; corresponde a un tumor que deforma estructuras óseas, estrechando conductos y cavidades y provocando varios signos y síntomas. El diagnóstico se basa en el cuadro clínico y caracteres radiológicos, confirmándose con el estudio histopatológico de la lesión. Hemos realizado remodelación del área tumoral deformada mediante resección parcial del tumor en 11 pacientes y resección amplia en 17 pacientes, de los cuales 14 debieron ser rehabilitados con injertos óseos autólogos. En 7 se practicó más de un procedimiento resectivo. Como resultado de esta actitud terapéutica se obtuvo la detención del deterioro funcional y morfológico provocado por el tumor. La apariencia estética postoperatoria fue buena o satisfactoria en el 90% de los pacientes controlados por más de nueve meses