Embolización transcatéter con dispositivo, una promisoria opción en el tratamiento del secuestro pulmonar: casos clínicos / Transcatheter embolization device as a promising option in the treatment of pulmonary sequestration: case reports

Introducción: El secuestro pulmonar (SP) ha sido tratado por muchos años con cirugía convencional efectuando remoción del tejido pulmonar ectópico y ligadura de los vasos sanguíneos aberrantes que nacen desde la aorta. Existe evidencia establecida, especialmente en literatura de habla inglesa que apoya el uso de la embolización arterial transcatéter mediante dispositivo para ocluir el vaso anómalo, como una opción de tratamiento seguro y definitivo para el SP intralobar. Objetivo: Mostrar nuestra experiencia pionera de la técnica de tratamiento del SP por medio de embolización transcatéter. Caso clínico: Presentamos los casos clínicos de dos adolescentes, de 13 y 14 años y de un recién nacido de 26 días de vida, portadores de SP intralobar, cuyos diagnósticos se realizaron a través de Tomografía Axial Computarizada (TAC) con contraste, tratados mediante embolización arterial transcatéter, con buen resultado y sin complicaciones en el seguimiento precoz y tardío. Conclusión: Con este tratamiento se logra en los pacientes afectados de SP resultados definitivos, menos invasivos y sin complicaciones al seguimento.

Introduction: Pulmonary sequestration (PS) has been treated for many years with conventional surgical removal of the ectopic lung tissue and ligation of aberrant vessels that arise from the aorta. There is evidence, especially in English-language literature that supports the use of transcatheter arterial embolization through a device for occlusion of the anomalous vessel, as a safe option and definitive treatment for intralobar PS. Objective: To show our experience pioneering the technique of PS treatment through transcatheter embolization. Case report: The case reports of two teenagers aged 13 and 14 and a 26-day-old newborn that developed intralobar PS are described. The diagnosis was made through computerized axial tomography (CT scan) and successfully and without complication, during early and long term follow-up, treated by arterial embolization transcatheter. Conclusion: The use of transcatheter arterial embolization is a less invasive and definitive treatment for patients with PS.

[Transcatheter embolization device as a promising option in the treatment of pulmonary sequestration. Case reports]. / Embolización transcatéter con dispositivo, una promisoria opción en el tratamiento del secuestro pulmonary. Casos clínicos.

INTRODUCTION: Pulmonary sequestration (PS) has been treated for many years with conventional surgical removal of the ectopic lung tissue and ligation of aberrant vessels that arise from the aorta. There is evidence, especially in English-language literature that supports the use of transcatheter arterial embolization through a device for occlusion of the anomalous vessel, as a safe option and definitive treatment for intralobar PS. OBJECTIVE: To show our experience pioneering the technique of PS treatment through transcatheter embolization. CASE REPORT: The case reports of two teenagers aged 13 and 14 and a 26-day-old newborn that developed intralobar PS are described. The diagnosis was made through computerized axial tomography (CT scan) and successfully and without complication, during early and long term follow-up, treated by arterial embolization transcatheter. CONCLUSION: The use of transcatheter arterial embolization is a less invasive and definitive treatment for patients with PS.

Impacto de la contaminación del aire por PM10 sobre la mortalidad diaria en Temuco / Impact of air pollution by fine particulate matter (PM10) on daily mortality in Temuco, Chile

Background: Temuco (304,000 inhabitants) has high levels of air pollution, mainly due to fine particulate matter of less than 10 µm (PM10). The effects of this pollution on population health have not been studied. Aim: To study the short-term effects of PM10 on daily mortality in Temuco, in Southern Chile, due to respiratory and cardiovascular causes. Material and methods: We followed the APHEA methodology (Air Pollution and Health European Approach) by estimating poisson multivariate regression models and controlling by trends, seasonality and meteorology. The PM10 variable was introduced after controlling by the confounders and checking by statistical adjustment and autocorrelation of errors. Mortality data was obtained from the Ministry of Health, registering age, gender, place of residence and cause of death. Cancer, respiratory and cardiovascular deaths, occurring between 1997 and 2002, were recorded for this study. Results: There was a significant and positive association between PM10 concentration and daily mortality caused by respiratory disease (p-value=0.046, relative risk (RR) 1.236, 95% confidence interval (CI) 1.004-1.522) and cardiovascular diseases in people aged 65 years and more (p-value=0.042; RR 1.176 95% CI 1.006-1.374). Conclusions: There is a significant association between daily air pollution by PM10 particulate matter and mortality in Temuco, Chile.

Estudio epidemiológico de 5114 pacientes con esguinces de tobillo atendidos en el servicio de urgencia del Hospital del Trabajador de Santiago / Epidemiologic study of 5114 patients wiht ankle sprains attended at the emergency room of the Hospital del Trabajador de Santiago

El esguince de tobillo constituye una de las lesiones musculoesqueléticas más frecuentes. Su incidencia se estima en 1 por cada 10.000 habitantes por día, lo que para nuestro país significa alrededor de 1.300 casos nuevos diarios. Se realizó un estudio retrospectivos y descriptivos en 5.114 pacientes con diagnósticos de esguinces de tobillo, que consultaron en el Servicio de Urgencia del Hospital del Trabajador Santiago entre Enero y Diciembre de 1995. La mediana de edad fue de 30 años. No hubo diferencias significativas en la distribución por sexo y el lado lesionado. El mecanismo de lesión más frecuente resultó ser la torsión a nivel con un 34,1 por ciento. El 82,4 por ciento de las lesiones fue catalogada como esguince grado I, el 17,1 por ciento como grado II y el 0.2 por ciento como grado III. El día de mayor consulta por esta patología fue el Lunes con un 23,3 por ciento. En el 91,7 por ciento de los casos estaba comprometido el complejo ligamentoso lateral. El tratamiento inicial con yeso se realizó en el 55,5 por ciento de los pacientes y un 40,1 por ciento se trató con venda elástica. La duración promedio del tratamiento con yeso fue de 11,7 días. Sólo el 15,7 por ciento de los casos analizados requirió terapia física. El 99,4 por ciento de los paciente evolucionó sin complicaciones, un 03 por ciento presentó dolor crónico, el 0,1 por ciento con trombosis venosa profunda y el 0,1 por ciento con distrofia simpático refleja. El promedio de alta al trabajo fue de 13 días. Se solicitó estudio radiográfico en algún momento de su evolución al 56 por ciento de los pacientes, siendo negativas el 97,2 por ciento de las radiografías. Creemos que el estudio radiográfico en los pacientes con diagnóstico clínico de esguinces de tobillo no se justifica o al menos no se debe solicitar en forma rutinaria

Prevalencia de anticuerpos anti hantavirus en 10 comunas de la Novena Región de Chile donde se han diagnosticado casos de infección clínica por hantavirus / Seroprevalence of antibodies anti-hantavirus in 10 communities of the IX region of Chile where hantavirus cardiopulmonary syndrome cases were reported

Background: Thirty six cases of clinical Hantavirus Cardiopulmonary Syndrome occurred in the IX Region of Chile. Most of these patients were young males, farm or timber workers, who lived near the Andes Mountain chain. Aim: To conduct an epidemiological and serosurvey study to determine the seroprevalence of IgG antibodies against Hantavirus in the general adult population living in rural and urban areas of 10 endemic communities of the IX region of Chile. Material and methods: A total of 400 subjects were included, 40 of each community, 20 rural residents and 20 urban residents, 20 males and 20 females. Results: Seroprevalence was 7.5 percent in Melipeuco, 5.0 percent in Lonquimay, 2.5 percent in Curacautin, 2.5 percent in Puc-n and 0.0 percent in the remaining communities. Seroprevalence was higher in rural population (2.5 percent) than in the urban areas (1 percent). All seropositive subjects worked in farms or forests and observed rodents near their homes or working places. Females were affected the same as males and no differences were observed between Chilean natives and Hispanics. Conclusions: Prevalence of Hantavirus antibodies correlated with the geographic zone (Andes Mountain chain), overgrowth of wild rodents and exposure to rodent-infested environments

Mortalidad diaria en Santiago y su relación con la contaminación del aire / Daily mortality in Santiago and its relationship with air pollution

Background: Santiago de Chile, due to meteorological and topographic factors, is one of the most polluted cities in the world. The adverse effects of contamination on health are relatively well known, but they may be overvalued. Aim: To evaluate the short term effects of exposure to air pollution on mortality of people over 65 years old. Material and methods: Daily mortality data in Santiago, from 1988 to 1993, was obtained from the National Statistics Institute. Daily concentrations of contaminants in Santiago and meteorological variables, were obtained from SESMA the Metropolitan Envinonmental Health Services. An association between contamination and mortality due to respiratory or cardiovascular diseases in subjects over 65 years old was searched, using temporal series analysis. Results: There was a significant association between air pollution, meteorological variables on the same and previous days and mortality. PM10 had the strongest association with mortality. The relative risk of a 100 µg/m3 increment in PM10 was 1.052 for the elderly, 1.025 for cardiovascular and 1.061 for respiratory mortality. The relative risk of SO2 was 1.006 for all deaths and 1.017 for respiratory deaths. The figures for O3 were 1.015 for all deaths and 1.008 for cardiovascular deaths. Conclusions: This work confirms a consistent association between air pollution and daily mortality, specially for particulate matter, even for levels below Chilean norms

[Comparative study of famotidine vs ranitidine in critically ill patients in mechanical ventilation]. / Estudio comparativo de famotidina vs ranitidina en pacientes críticos en ventilación mecánica.

Stress ulcers are frequent in critically ill patients. Gastric mucosa protection with antacids, H2 blockers or sucralphate decrease the incidence of stress ulcers and upper gastrointestinal bleeding but may have adverse effects. The present study compares the efficacy of continuous infusions of famotidine on gastric pH control and bleeding prevention in critically ill patients receiving mechanical ventilation. Fifty six patients (aged 55 +/- 22 years, 26 male) were randomly assigned to receive famotidine 40 mg/day (n = 27) or ranitidine 150 mg/day (n = 29) during 5 days. Gastric pH was measured every 6 hours and when it was below 5, aluminum hydroxide (30 ml every 2 hours) was administered to obtain values over 5. Patients receiving famotidine had higher mean gastric pH (6.3 +/- 0.2 and 93% of measurements over 5 vs 5.8 +/- 0.6 and 83% of measurements over 5 (p < 0.05), and required lower amounts of aluminum hydroxide (1.880 vs 2.770 ml). No patient had evidence of gastrointestinal bleeding and one had a mild psychomotor agitation. No other adverse reactions were observed. It is concluded that famotidine was more effective than ranitidine on gastric pH control in mechanically ventilated critically ill patients.

[Infectious endocarditis: clinical and echocardiographic initial follow-up]. / Endocarditis infecciosa: seguimiento inicial clínico-ecocardiográfico.

We analyzed the clinical and echocardiographic features of 24 patients with infective endocarditis followed for a mean of 20.2 month (range 3-84) after discharge. Mean age was 38 years, male to female ratio was 2:1 and 87% of cases had a subacute clinical course; 17% of patients had late prosthetic endocarditis. Positive blood cultures were obtained in only 50% of patients. Vegetations were detected by echocardiography in 88%, 66% of them located at the aortic valve. Heart failure (62%) was the main complication, leading to valve replacement in 4 patients. Four patients died during follow up, 3 males due to heart failure and a female from systemic emboli. Twenty patients survive at the end of follow up (84%), 50% of them in FC I or II, 40% in FC III or IV (2 lost to follow up). Eleven patients had a late echocardiogram at a mean of 12 months after discharge: 6 of them showed persistence of vegetations (55%).

Un caso de xeroderma pigmentoso con compromiso ocular. / A case of xeroderma pigmentosum with ocular involvement

Se presenta el caso de una paciente de cinco anos de edad, portadora de xeroderma pigmentoso con severo compromiso dermatologico y ocular; destacando el estudio histopatologico, que revela lesiones cancerosas. Se recuerdan las caracteristicas generales de esta afeccion vinculada a la fotosensibilidad

A randomized double blind study of two oral contraceptives.

To study the question of whether one brand of oral contraceptives may be as acceptable as another for use of publicly-assisted family planning programs, a double blind study of two well-known brands, Ovral and Norinyl, was undertaken in Costa Rica and Trinidad. The pills were randomly assigned to 1,200 women. Common side effects - nausea, dizziness, vomiting, headaches - were associated with both Norinyl and Ovral. Differences in event rates for these conditions were much more marked by country than by the pill used. Ovral was associated with increases in skin problems, notably chloasma, in Cost Rica. A higher percentage of women using Norinyl reported intermenstrual bleeding and spotting in both countries. In Costa Rica continuation rates for Norinyl were adversely affected by this. With these exceptions there appear to be no important differences between the brands that would affect their use in family planning programs.

PIP: A double-blind study of 2 well-known brands of contraceptives, Ovral and Norinyl, was performed in Trinidad and Costa Rica to determine if 1 brand of oral contraceptive were as acceptable as another. Differences in race and ethnic origin were large between the 2 study populations. There were no significant differences in reporting of gastrointestinal side effects for the 2 formulations. Women using Ovral in Costa Rica reported acne and chloasma in significantly greater (P .001) numbers than did women using Norinyl. Participants in Trinidad were virtually free of such complaints. Overall in both study populations, Ovral affected significantly more users (P .05) both with regard to chloasma and all skin conditions than did Norinyl. A moderate excess of cervicitis and cervical erosion among Ovral users in Trinidad was seen; in Costa Rica, cervical erosion occurred in 13% of users of either drug, whereas cervicitis was noted in 3% of each group. Both brands reduced the average number of days of menstrual bleeding in the 2 countries, and both formulations effected a reduction in the % of women reporting relatively heavy menstrual flow. Intermenstrual spotting or bleeding was strongly (P .001 overall) associated with the use of Norinyl; in both countries, the % of women using Norinyl reporting intermenstrual bleeding was at least 2 times that of Ovral users. In Costa Rica, continuation rates for Norinyl were badly affected by the frequency of intermenstrual bleeding (27.9 for Norinyl and 8.2 for Ovral). Otherwise, it is concluded that there were no important differences between the 2 formulations.