Recomendaciones para el uso correcto de densitometría ósea en la práctica clínica. Consenso de la Sociedad Chilena de Endocrinología y Diabetes / Guidelines of the Chilean Endocrinology Society for the correct clinical use of bone densitometry

Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.

[Guidelines of the Chilean Endocrinology Society for the correct clinical use of bone densitometry]. / Recomendaciones para el uso correcto de densitometría ósea en la práctica clínica. Consenso de la Sociedad Chilena de Endocrinología y Diabetes.

Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.

Homogeneously catalysed conversion of aqueous formaldehyde to H2 and carbonate.

Small organic molecules provide a promising solution for the requirement to store large amounts of hydrogen in a future hydrogen-based energy system. Herein, we report that diolefin-ruthenium complexes containing the chemically and redox non-innocent ligand trop2dad catalyse the production of H2 from formaldehyde and water in the presence of a base. The process involves the catalytic conversion to carbonate salt using aqueous solutions and is the fastest reported for acceptorless formalin dehydrogenation to date. A mechanism supported by density functional theory calculations postulates protonation of a ruthenium hydride to form a low-valent active species, the reversible uptake of dihydrogen by the ligand and active participation of both the ligand and the metal in substrate activation and dihydrogen bond formation.

Oxidative formation of phosphinyl radicals from a trigonal pyramidal terminal phosphide Rh(i) complex, with an unusually long Rh-P bond.

A rhodium complex containing a tetrapodal triolefin ligand (trop3P) and a phosphanyl ligand (PPh2-) has been prepared and characterised. The special structural confinements of the tetradentate ligand impose an unusually long Rh-PPh2 bond. Chemical oxidation of the complex with FcOTf affords [Rh(OTf)(trop3P)] and plausibly phosphanyl radicals, which react instantly with a spin trap reagent forming a nitroxide-based persistent radical, undergo HAT with silanes or dimerise to the corresponding diphosphine (PPh2)2. Chemical oxidation with a peroxide leads to complex [Rh(POPh2)(trop3P)] which is photolabile and loses the Ph2PO moiety upon irradiation with UV/Vis light in CH2Cl2.

Visión global de la medicina preventiva en Chile / Visión global de la medicina preventiva en Chile

Es importante considerar que la población envejece y debido a la mayor esperanza de vida, es necesario establecer estrategias eficaces de prevención sanitaria que permitan alcanzar la contención de costos en salud. Es necesario mejorar el modelo actual con el objetivo de mejorar el desempeño guiándose a través de parámetros de calidad de la salud de la población. La medicina preventiva se establece en el siglo XXI como un área prioritaria para la salud pública y privada. Esto está reflejado en la presencia cada vez mayor de programas de salud pública y el desarrollo de unidades de medicina preventiva en el sector privado. Se revisan las estrategias de medicina preventiva en las áreas pública y privada, haciendo énfasis en la importancia de los programas de medicina preventiva en el nivel primario y en las personas con enfermedades crónicas

It is important to consider that the population is aging, and because of the increased life expectancy, it is necessary to establish effective preventive health strategies that achieve cost containment in health. It is necessary to improve the current model with the aim of improving performance guided by population health quality parameters. Preventive medicine is established as a priority area for public and private health in the twenty-first century. This is shown by the increasing number of public health programs and the development of preventive medicine units in the private health area. We review the strategies of preventive medicine at public and private areas, emphasizing the importance of preventive medicine programs at the primary level and in people with chronic diseases

Detección precoz de trastornos endocrinológicos / Early detection of endocrinological disorders

Se revisan los trastornos más comunes del sistema endocrino que se detectan en la consulta no especializada. Se hace énfasis en: a) Trastornos tiroideos tales como hipo o hipertiroidismo, nódulos de la tiroides y la importancia de la enfermedad de la tiroides durante el embarazo, b) la enfermedad adrenal en la hipertensión y el enfoque de la incidentaloma suprarrenal c) hiperparatiroidismo primario y la deficiencia de vitamina D d) Trastornos gonadal y la importancia de la detección precoz de la enfermedad hormonal, tanto en la disfunción ovárica y testicular

We review the most common disorders of the endocrine system that are detected in non-specialist consultation. Emphasis is placed on: a) thyroid disorders such as hypo-or hyperthyroidism, thyroid nodules and the importance of thyroid disease during pregnancy, b) adrenal disease in hypertension and the approach to the adrenal incidentaloma c) metabolic disorders such as primary hyperparathyroidism and vitamin Ddeficiency d) gonadal disorders and the importance of early detection of hormonal disease in both ovarian and testicular dysfunction

Tiroides y climaterio / Thyroid gland in the climacteric

Durante el climaterio, las enfermedades tiroideas constituyen una preocupación creciente, esto se debe a la mayor prevalencia de patología tiro idea observada en esta etapa de la vida. Para comprender mejor los trastornos tiroideos durante el climaterio se efectúa una revisión de la fisiopatología de la glándula tiroidea para posteriormente describir los trastornos más frecuentes en este período, su etiopatogenia manifestaciones clínicas y conducta terapéutica recomendada.

During the climacterium, thyroid diseases are a growing concern, this is due to the high prevalence of thyroid disease observed in this stage of life. In this article, the author reviewed the pathophysiology of the thyroid gland and then describe the most common thyroid disorders in this period, its pathogenesis, clinical and therapeutic recommended.

Retinoblastoma en pediatría, experiencia en un hospital pediátrico / Retinoblastoma in children, experience at a pediatric hospital

Methods: Retrospective analysis of clinical charts of 41 children (59 eyes) diagnosed with retinoblastoma and treated by a multidisciplinary team at Hospital Luis Calvo Mackenna in Santiago-Chile, between 1999 and 2007. The information included gender, laterality, diagnosis age, presenting signs, tumor spread, treatment modality and survival rate. Results: A total of 23 cases (56 percent) were unilateral and 18 cases (44 percent) were bilateral. The mean age at diagnosis was 21.6 months (range 2 - 84) and 27 children (65.9 percent) were male. The most common presenting signs were leucokoria (51.2 percent), strabismus (24.4 percent) and proptosis (4.9 percent). Enucleation was performed in 48 eyes (81.3 percent), being the only required treatment in 17 children (41.5 percent). The remaining 24 patients received systemic and/or local therapy with chemotherapy, focal therapy and external beam radiation. 5 children died during the follow - up study period, due to extraocular extension to the orbit, central nervous system and bone marrow. Conclusion: In spite of high enucleation rate as initial therapy for retinoblastoma, the survival rate with this current treatment protocol is similar to those from developed countries.

Se presenta un estudio retrospectivo de las fichas clínicas de 41 niños (59 ojos) con diagnóstico de retinoblastoma tratados por un equipo multidisciplinario en el Hospital Luis Calvo Mackenna, Santiago, Chile, entre los a±os 1999-2007. Se recolectó información respecto al género, edad al diagnóstico, signos de presentación, lateralidad, diseminación del tumor, tipos de tratamiento y sobrevida. Veintitrés casos (56 por ciento) fueron unilaterales y 18 (44 por ciento) bilaterales. La edad promedio al momento del diagnóstico fue de 21,6 meses (rango 2-84) y 27 niños (65,9 por ciento) fueron hombres. Los signos de presentación más frecuentes fueron leucocoria (51,2 por ciento), estrabismo (24,4 por ciento) y proptosis (4,9 por ciento). Se realizó enucleación en 48 ojos afectados (81,3 por ciento), siendo el único tratamiento necesario en 17 niños (41,5 por ciento). Los 24 pacientes restantes recibieron tratamientos complementarios locales y/o sistémicos en la modalidad de quimioterapia, terapia focal y radioterapia externa. Durante el período de seguimiento del estudio fallecieron 5 niños, todos ellos con extensión extraocular de la enfermedad hacia la órbita, sistema nervioso central o médula ósea. Conclusiones: No obstante el alto porcentaje de pacientes con retinoblastoma que requieren enucleación como terapia inicial, la tasa de sobrevida con el protocolo actual de tratamiento es comparable a la de países desarrollados.

[Vertebral fractures, osteoporosis and vitamin D levels in Chilean postmenopausal women]. / Fracturas vertebrales, osteoporosis y vitamina D en la posmenopausia: Estudio en 555 mujeres en Chile.

BACKGROUND: Approximately one-third of vertebral fractures can be clinically diagnosed. AIM: To study the frequency of vertebral fractures in postmenopausal women. PATIENTS AND METHODS: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. RESULTS: Overall, 142 of 478 patients with a complete study (29.7%) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32% and 14% of women, respectively. The proportion of women with spinal osteoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3% at age 80-85. However, 56% of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8+/-6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5% of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. CONCLUSIONS: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.

Fracturas vertebrales, osteoporosis y vitamina D en la posmenopausia: Estudio en 555 mujeres en Chile / Vertebral fractures, osteoporosis and vitamin D levels in Chilean postmenopausal women

Background: Approximately one-third of vertebral fractures can be clinically diagnosed. Aim: To study the frequency of vertebral fractures in postmenopausal women. Patients and methods: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. Results: Overall, 142 of 478 patients with a complete study (29.7 percent) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32 percent and 14 percent of women, respectively. The proportion of women with spinal opeoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3 percent at age 80-85. However, 56 percent of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8±6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5 percent of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. Conclusions: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.

Gastric pouch carcinoma after gastric bypass for morbid obesity.

The relationship between bariatric surgery and gastric cancer is conjectural. We present a 52-year-old woman with BMI 45 operated initially by a Lap-Band procedure complicated by gastric wall erosion of the band 9 months later. She was re-operated and the band was removed. She subsequently underwent a Roux-en-Y gastric bypass. 5 years after, gastric carcinoma was discovered in the gastric pouch. Because of varied symptoms following bariatric surgery, patients may not present promptly with symptoms related to a gastric carcinoma.

Eventraciones y hernias ventrales: experiencia con 200 casos por abordaje laparoscópico. Técnica quirúrgica / Laparoscopic approach in abdominal wall and incisional hernias: experience in 200 cases and surgical technique

Objetivo. El tratamiento laparoscópico de eventraciones y hernias ventrales ha sido poco usado, aunque estas hernias se pueden tratar muy bien por vía laparoscópica. El objetivo de este estudio ha sido revisar nuestra experiencia en el abordaje laparoscópico para el tratamiento de las hernias ventrales e incisionales. Material y métodos. Entre enero de 1994 y noviembre de 1999 una serie de 200 pacientes fueron intervenidos por hernias ventrales e incisionales por medio de cirugía laparoscópica con una media de 36 meses de seguimiento postoperatorio. La media del número de defectos de pared fue de 4,3 por paciente y la superficie media a corregir de 138 cm2. Un total de 15 hernias fueron menores de 5 cm, 105 de tamaño medio (5 a 10 cm) y 80 fueron hernias grandes (> 10 cm). El origen de los defectos de pared fue primario en 33 casos y posquirúrgico en 167. Se usaron tres puertas de entrada en todas ellas describiendo el resto de la técnica quirúrgica. Los defectos herniarios fueron cubiertos con malla de PTFE Dual Mesh de 26 × 18 cm en 10 pacientes, 19 × 15 en 187 y 10 × 15 en 65 casos. En 65 pacientes se usó una malla adicional. En los últimos 130 casos fue empleada una malla PTFE Dual Mesh Plus multiperforada. Resultados. El tiempo medio quirúrgico fue de 64 min. Sólo una intervención fue reconvertida a cirugía abierta (0,5 por ciento) y únicamente un paciente requirió una segunda intervención en el postoperatorio inmediato. Las complicaciones menores incluyeron 2 pacientes con enfisema subcutáneo, 4 casos con hematomas subcutáneos, 28 pacientes con pequeños seromas no complicados y 16 casos que refirieron dolor postoperatorio. No hubo infecciones en los orificios de los trocares ni tampoco infecciones de ninguna malla. Cuatro pacientes desarrollaron hernia recidivada (2 por ciento) en el primer mes postoperatorio y fueron reintervenidos con una técnica laparoscópica similar. La ingesta oral y la movilización se realizó a las pocas horas de la cirugía con una estancia media hospitalaria de 28 h. Conclusiones. La técnica laparoscópica permite evitar grandes incisiones, así como la no utilización de drenajes con un bajo número de complicaciones, infecciones y recidivas. El abordaje laparoscópico acorta considerablemente el tiempo quirúrgico y la estancia hospitalaria postoperatoria (AU)

Diverticulitis aguda y enfermedad diverticular del colon: una satisfactoria indicación de cirugía laparoscópica / Acute diverticulitis and diverticular disease of the colon: a safe indication for laparoscopic surgery

INTRODUCCIÓN: analizar y estudiar la experiencia obtenida con el tratamiento quirúrgico de la diverticulitis y enfermedad diverticular del colon sintomática utilizando la vía de abordaje laparoscópica. MÉTODOS: entre enero de 1994 y octubre de 1999 un grupo de 52 pacientes con criterios de enfermedad diverticular sintomática en el colon sigmoide y descendente fueron operados por vía laparoscópica con un porcentaje de media de 40 cm de resección de colon enfermo. La anastomosis colorrectal se realizó intrabdominalmente con sutura mecánica transanal. La utilización de tijeras armónicas ha simplificado y mejorado la técnica laparoscópica y los tiempos quirúrgicos. RESULTADOS: la morbilidad operatoria total fue del 15 por ciento. Dos casos con diverticulitis aguda y sepsis difusa fueron reconvertidos a cirugía abierta. Cuatro enfermos presentaron rectorragia postoperatoria que cedió espontáneamente y tres pacientes tuvieron infección en la minilaparotomía de extracción de la pieza. No hubo complicaciones a distancia salvo una hernia incisional en orificio de trócar. La hospitalización postoperatoria fue de 3-8 días (media: 5,5) y el tiempo operatorio medio de 130 minutos (rango: 70-240), comenzando la alimentación oral entre el segundo y el tercer día del postoperatorio. DISCUSIÓN: a pesar de haber tenido que superar la curva de aprendizaje para esta compleja cirugía, las muy aceptables cifras de morbimortalidad con el abordaje laparoscópico, especialmente para estos pacientes de alto riesgo quirúrgico (edad > 65 años, HTA, EPOC, etc.), indican la necesidad de poder ofrecer esta opción quirúrgica con criterios de efectividad y seguridad, mejorando los resultados de la cirugía convencional. Sin embargo, aquellos pacientes con enfermedad diverticular complicada precisan cirujanos con amplia experiencia en cirugía laparoscópica del colon (AU)

Tumor carcinoide gástrico esporádico (tipo III) asociado a hipergastrinemia / No disponible

No disponible

Acute diverticulitis and diverticular disease of the colon: a safe indication for laparoscopic surgery.

AIM: We analyzed our experience with a laparoscopic method for the treatment of acute diverticular disease. METHODS: Between January 1994 and October 1999 a group of 52 patients who fulfilled the criteria for symptomatic diverticular disease in the descending and sigmoid colon underwent laparoscopy with resection of an average of 40 cm of the bowel. Intraabdominal mechanical anastomosis completed the procedure. RESULTS: The use of ultrasonic scissors made the laparoscopic technique easier and shortened operative time. Operative morbidity was 15%. Two patients with acute diverticulitis and associated sepsis were reconverted to open surgery, and 4 patients presented postoperative rectal bleeding which ceased spontaneously. No long-term complications were found except in 1 patient who developed an incisional hernia through an entry port. Oral intake began between the second and third day. Postoperative hospitalization was 3-8 days (mean: 5.5 days) and mean operative time was 130 min (range: 70-240 min). CONCLUSIONS: Despite the steep learning curve for this type of surgery, the good morbidity and mortality rates with the laparoscopic method, especially with high-risk groups of patients (age > 65 years, high blood pressure, etc.) suggest that this surgical option can be used efficiently and safely, and that it achieves better results than with open surgery. However, we feel that the treatment of patients with acute complications of diverticular colon disease requires extensive experience with laparoscopic colorectal surgery.

Prevalencia de la deleción 185AG del gen BRCA1 en mujeres chilenas con cáncer de mama / Prevalence of BRCA1 gene 185AG deletion in Chilean women with breast cancer

Background: The most important identified pathogenic factor for breast cancer is the presence of mutations in BRCA1 gene. These are associated with familial breast cancer in up to 80 percent of cases. The most frequent mutation of BRCA1 gene in Caucasian populations is the exon 2 185AG deletion. Aim: To study the presence of 185AG deletion in Chilean women with sporadic or familial breast cancer. Patients and methods: We studied 15 women with familial breast cancer, in whom at least one close relative was affected, and 40 women with sporadic breast cancer. In genomic DNA obtained from a blood sample, an allele specific polymerase chain reaction was done. This reaction allows the identification of 185AG deletion and uses two pairs of primers. One for the native form that renders a 118 base pairs product and one for the deletion that renders a 170 base pairs product, both with a respective 280 base pairs internal control. Results: The diagnosis of breast cancer was done at 40ñ5 and 65ñ10 years old in women with familial and sporadic breast cancer, respectively. In none of the samples, the amplification of the 170 base pairs band that corresponds to 185AG deletion, was obtained. In both groups, the product of the amplification was the 118 base pairs band, that corresponds to the native form of BRCA1 gene. The polymerase chain reaction was optimized for a duration of 90 minutes. Conclusions: 185AG deletion of BRCA1 gene was not detected in this group of Chilean women with sporadic or familial breast cancer

Vertical ring gastroplasty (VRG) in the treatment of the serious clinical obesity. Results and complications.

OBJECTIVE: The morbid obesity is a serious polysystematic disease to which it is necessary to offer a surgical solution when the conservative alternatives fail. METHODS: In a period of five years, 50 patients with vertical ring gastroplasty (VRG) have been evaluated and protocolized in the program of surgery of the morbid obesity, with an average weight of 134.3 kg corresponding to an overweight and body mass index (BMI) average respectively, of 69.7 kg and 49.8 kg/m2. RESULTS: The early morbidity has been scarce and the postoperative average stay of 7 days. The decrease of the percentage of weight, overweight and BMI was maximum 2 years later, with losses of 52 kg, with a percentage of loss of average overweight of 76.8% and a fall of 21 points in the BMI; however there was a partial recovery of the indexes in the following years. The accompanying pathology was solved in the period of studied time, although 84% of the patients referred vomits and practically 100% dietary limitations. CONCLUSIONS: The gastroplasty is a quick, simple technique and of scare morbimortality, although it is being subjected to criticism for the restrictions in the diet, quality of life and disruptions of the line of clamped. However, nowadays there is not a consensus on the ideal bariatric solution, and as a surgical alternative, the vertical gastroplasty can represent one of the techniques of choice for certain selected types of serious obesity.

Carcinoma papilar esclerosante difuso del tiroides: comunicación de dos casos / Diffuse sclerosing papillary thyroid carcinoma: report of two cases

Unlike classical papillary carcinoma, diffuse sclerosing papillary thyroid carcinoma presents as a diffuse goiter with a discretely irregular surface, associated to hypo or hyperthyroidism, specially in young women. We report two women aged 41 and 23 years old with this disease, one with normal thyroid function and the other with hyperthyroidism. It is concluded that diffuse sclerosing papillary thyroid carcinoma must be suspected in patients with rapidly growing goiter with irregular surface or diffuse minute calcifications, specially in the presence of hypo or hyperthyroidism. Fine needle aspiration is a good diagnostic procedure

Cáncer tiroídeo tipo intermedio folicular-medular; una forma inhabitual, particular y agresiva: comunicación de tres casos / Mixed medullary and follicular carcinoma of the thyroid: report of three cases

Mixed medullary and follicular carcinomas of the thyroid shares secretory and immunohistochemical features of both follicular and parafollicular thyroidal cells. We report three women, aged 34, 63 and 61 old with this type of tumor. Its diagnosis must be bore in mind in patients with thyroidal tumors and a histological appearance of a medullary or undifferentiated carcinomas. An early diagnosis of a mixed medullary and follicular carcinomas of the thyroid is important, considering its special treatment and negative prognosis