Diseño de un modelo de asistencia personal breve para personas con discapacidad intelectual en Chile / Design of a short personal assistance model for people with intellectual disabilities in Chile

La asistencia personal para personas con discapacidad intelectual puede contribuir a la aplicación de los nuevos paradigmas de autodeterminación e inclusión social y a una mejora de la calidad de vida. Mediante revisión de la literatura y un análisis con expertos profesionales, expertos por experiencia y potenciales usuarios, se elaboró un modelo breve de asistencia personal para ser ejecutado por agentes comunitarios con supervisión profesional. El modelo considera actividades en los espacios habituales de las personas y sus familias, con apoyo para el uso de recursos formales e informales de la comunidad y el refuerzo de redes de apoyo que continúen operando una vez que termine la intervención. Con una duración de 9 meses, el modelo se desarrolla mediante un proceso de 3 etapas: 1) establecimiento de vínculo y elaboración de un plan individualizado, 2) implementación del plan y 3) refuerzo de los aprendizajes de los participantes y traspaso a redes de apoyo. Se discute la factibilidad de la aplicación del modelo en países latinoamericanos y la necesidad de realizar estudios que evalúen su implementación

Personal assistance for people with intellectual disabilities can contribute to the application of the new paradigms of self-determination and social inclusion and to an improvement in the quality of life. Through a literature review and analysis with professional experts, experts from experience and potential users, a brief model of personal assistance was developed to be executed by community agents with professional supervision. The model considers activities in the usual spaces of people and their families, with support for the use of community formal and informal resources and the reinforcement of social support networks that continue operating once the intervention ends. With duration of 9 months, the model is developed through a 3-stage process: 1) engagement and formulation of an individualized plan, 2) implementation of the plan, and 3) participants' learning reinforcement and transfer to support networks. The feasibility of the model in Latin American countries and the need for studies to evaluate its implementation are discussed

Cell-surface properties of Vibrio ordalii strains isolated from Atlantic salmon Salmo salar in Chilean farms.

Vibrio ordalii is the causative agent of atypical vibriosis and has the potential to cause severe losses in salmonid aquaculture, but the factors determining its virulence have not yet been elucidated. In this work, cell-surface-related properties of the isolates responsible for outbreaks in Atlantic salmon were investigated. We also briefly examined whether pathogenicity against fish varied for V. ordalii strains with differing cell-surface properties. Hydrocarbon adhesions indicated the hydrophobic character of V. ordalii, although only 4 of 18 isolates induced haemagglutination in Atlantic salmon erythrocytes. A minority of the studied isolates (6 of 18) and the type strain ATCC 33509T produced low-grade biofilm formation on polyethylene surface after 2 h post-inoculation (hpi), but no strains were slime producers. Interestingly, V. ordalii isolates showed wide differences in hydrophobicity. Therefore, we chose 3 V. ordalii isolates (Vo-LM-03, Vo-LM-18 and Vo-LM-16) as representative of each hydrophobicity group (strongly hydrophobic, relatively hydrophobic and quasi-hydrophilic, respectively) and ATCC 33509T was used in the pathogenicity studies. All tested V. ordalii strains except the type strain resisted the killing activity of Atlantic salmon mucus and serum, and could proliferate in these components. Moreover, all V. ordalii isolates adhered to SHK-1 cells, causing damage to fish cell membrane permeability after 16 hpi. Virulence testing using rainbow trout revealed that isolate Vo-LM-18 was more virulent than isolates Vo-LM-03 and Vo-LM-16, indicating some relationship between haemagglutination and virulence, but not with hydrophobicity.

UTP controls cell surface distribution and vasomotor activity of the human P2Y2 receptor through an epidermal growth factor receptor-transregulated mechanism.

Extracellular nucleotides transmit signals into the cells through the P2 family of cell surface receptors. These receptors are amply expressed in human blood vessels and participate in vascular tone control; however, their signaling mechanisms remain unknown. Here we show that in smooth muscle cells of isolated human chorionic arteries, the activation of the P2Y(2) receptor (P2Y(2)R) induces not only its partition into membrane rafts but also its rapid internalization. Cholesterol depletion with methyl-beta-cyclodextrin reduced the association of the agonist-activated receptor into membrane rafts but did not affect either the UTP-mediated vasoconstrictions or the vasomotor responses elicited by both serotonin and KCl. Ex vivo perfusion of human chorionic artery segments with 1-10 mum UTP, a selective P2Y(2)R agonist, displaced the P2Y(2)R localization into membrane rafts within 1 min, a process preceded by the activation of both RhoA and Rac1 GTPases. AG1478, a selective and potent inhibitor of the epidermal growth factor receptor tyrosine kinase activity, not only blocked the UTP-induced vasomotor activity but also abrogated both RhoA and Rac1 activation, the P2Y(2)R association with membrane rafts, and its internalization. Altogether, these results show for the first time that the plasma membrane distribution of the P2Y(2)R is transregulated by the epidermal growth factor receptor, revealing an unsuspected functional interplay that controls both the membrane distribution and the vasomotor activity of the P2Y(2)R in intact human blood vessels.

P2Y1 receptor activation elicits its partition out of membrane rafts and its rapid internalization from human blood vessels: implications for receptor signaling.

The nucleotide P2Y(1) receptor (P2Y(1)R) is expressed in both the endothelial and vascular smooth muscle cells; however, its plasma membrane microregionalization and internalization in human tissues remain unknown. We report on the role of membrane rafts in P2Y(1)R signaling by using sodium carbonate or OptiPrep sucrose density gradients, Western blot analysis, reduction of tissue cholesterol content, and vasomotor assays of endothelium-denuded human chorionic arteries. In tissue extracts prepared either in sodium carbonate or OptiPrep, approximately 20 to 30% of the total P2Y(1)R mass consistently partitioned into raft fractions and correlated with vasomotor activity. Vessel treatment with methyl beta-cyclodextrin reduced the raft partitioning of the P2Y(1)R and obliterated the P2Y(1)R-mediated contractions but not the vasomotor responses elicited by either serotonin or KCl. Perfusion of chorionic artery segments with 100 nM 2-methylthio ADP or 10 nM [[(1R,2R,3S,4R,5S)-4-[6-amino-2-(methylthio)-9H-purin-9-yl] 2,3dihydroxybicyclo[3.1.0]hex-1-yl]methyl] diphosphoric acid mono ester trisodium salt (MRS 2365), a selective P2Y(1)R agonist, not only displaced within 4 min the P2Y(1)R localization out of membrane rafts but also induced its subsequent internalization. 2'-Deoxy-N(6)-methyladenosine 3',5'-bisphosphate tetrasodium salt (MRS 2179), a specific P2Y(1)R antagonist, did not cause a similar displacement but blocked the agonist-induced exit from rafts. Neither adenosine nor uridine triphosphate displaced the P2Y(1)R from the membrane raft, further evidencing the pharmacodynamics of the receptor-ligand interaction. Vascular reactivity assays showed fading of the ligand-induced vasoconstrictions, a finding that correlated with the P2Y(1)R exit from raft domains and internalization. These results demonstrate in intact human vascular smooth muscle the association of the P2Y(1)R to membrane rafts, highlighting the role of this microdomain in P2Y(1)R signaling.

P2Y1 and P2Y2 receptor distribution varies along the human placental vascular tree: role of nucleotides in vascular tone regulation.

The expression of purinergic P2Y receptors (P2YRs) along the cord, superficial chorionic vessels and cotyledons of the human placenta was analysed and functional assays were performed to determine their vasomotor activity. Immunoblots for the P2Y(1)R and P2Y(2)R revealed a 6- to 8-fold increase in receptor expression from the cord to the chorionic or cotyledon vessels. In the cord and chorionic vessels the receptor distribution was mainly in the smooth muscle, whereas in the cotyledon vessels these receptors were equally distributed between the endothelium and smooth muscle cells. An exception was the P2Y(2)R at the umbilical artery, which was distributed as in the cotyledon. mRNA coding for the P2Y(1)R and P2Y(2)R were detected by RT-PCR and the mRNA coding for the P2Y(4)R, P2Y(6)R and P2Y(11)R was also identified. Application of 2-MeSADP and uridine triphosphate (UTP), preferential P2Y(1)R and P2Y(2)R ligands, respectively, resulted in contraction of isolated rings from umbilical and chorionic vessels. The vasoconstriction was blocked in a concentration-dependent manner by 10-100 nm indomethacin or 10 nm GR32191, suggesting the involvement of thromboxane receptors. MRS 2179, a selective P2Y(1)R antagonist, reduced the 2-MeSADP- but not the UTP-evoked contractions. Perfusion of cotyledons with 2-MeSADP or UTP evoked concentration-dependent reductions in perfusion pressure mediated by the NO-cGMP pathway. Blockade of NO synthase abolished the vasodilatation and the rise in luminal NO elicited by either agonist. MRS 2179 antagonized the dilatation and rise in luminal NO evoked by 2-MeSADP but not by UTP. In summary, P2Y(1)R and P2Y(2)R are unevenly distributed along the human placental vascular tree; both receptors are coupled to different signalling pathways in the cord/chorionic vessels versus the cotyledon leading to opposing vasomotor responses.

Do the pelvic lymph nodes predict the parametrial status in cervical cancer stages IB-IIA?

The aim of this study was to determine whether the pelvic lymph nodes would predict the parametrial status in patients with cervical cancer stages IB1-IIA submitted to radical surgery and pelvic lymphadenectomy. To this end, we evaluated the relationship between positive and negative pelvic lymph nodes and their parametria. Our final purpose was to use this information to recommend the tailoring of the parametrial resection according to the status of pelvic lymph nodes to decrease the morbidity related with radical paratrectomy. From January 1996 to December 2001, 107 consecutive patients with cervical cancer stages IB1 and IIA were primarily treated by radical hysterectomy type III with systematic pelvic lymphadenectomy in a prospective study. Parametria were studied in two sections: the first included the tissue adjacent to the cervix, and the second the distal 2/3. Lymph nodes were routinary processed. Twenty-two patients (20.6%) had positive pelvic nodes and 16 patients (14.9%) had parametrial involvement, mostly by direct extension. Eight patients with positive pelvic nodes (36.4%) had parametrial involvement, whereas among 85 patients with negative pelvic nodes only eight patients (9.4%) had parametrial involvement (P < 0.001), most in internal parametria (62.5%). The sensitivity of pelvic lymph nodes for parametrial involvement was 50% and the positive predictive value was 36.4%, whereas the specificity was 84.6%; and the negative predictive value 90.6%. In the group of negative pelvic lymph nodes, only two patients (2.3%) had parametrial involvement beyond internal parametria. The univariated and multivariated analysis of prognostic factors was always significant but without a significant independent factor for positive parametria. Pelvic lymph nodes appear as good predictors of parametrial status, especially in node-negative patients, and could be used to decrease the paratrectomy in radical surgery.

Auditoria médica: herramienta de gestión moderna subvalorada / Medical audit: an undervalued management tool

Medical audit is defined as the critical and periodical assessment of the quality of medical care, through the revision on medical records and hospital statistics. This review defines the work of the medical auditor and shows the fields of action of medical audit, emphasizing its importance and usefulness as a management tool. The authors propose that every hospital should create an audit system, should provide the necessary tools to carry out medical audits and should form an audit committee

Clonidine-induced nitric oxide-dependent vasorelaxation mediated by endothelial alpha(2)-adrenoceptor activation.

1. To assess the involvement of endothelial alpha(2)-adrenoceptors in the clonidine-induced vasodilatation, the mesenteric artery of Sprague Dawley rats was cannulated and perfused with Tyrode solution (2 ml min(-1)). We measured perfusion pressure, nitric oxide (NO) in the perfusate using chemiluminescence, and tissue cyclic GMP by RIA. 2. In phenylephrine-precontracted mesenteries, clonidine elicited concentration-dependent vasodilatations associated to a rise in luminal NO. One hundred nM rauwolscine or 100 microM L(omega)-nitro-L-arginine antagonized the clonidine-induced vasodilatation. Guanabenz, guanfacine, and oxymetazoline mimicked the clonidine-induced vasorelaxation. 3. In non-contracted mesenteries, 100 nM clonidine elicited a maximal rise of NO (123+/-13 pmol); associated to a peak in tissue cyclic GMP. Endothelium removal, L(omega)-nitro-L-arginine, or rauwolscine ablated the rise in NO. One hundred nM aminoclonidine, guanfacine, guanabenz, UK14,304 and oxymetazoline mimicked the clonidine-induced surge of NO. Ten microM ODQ obliterated the clonidine-induced vasorelaxation and the associated tissue cyclic GMP accumulation; 10 - 100 nM sildenafil increased tissue cyclic GMP accumulation without altering the clonidine-induced NO release. 4. alpha(2)-Adrenergic blockers antagonized the clonidine-induced rise in NO. Consistent with a preferential alpha(2D)-adrenoceptor activation, the K(B)s for yohimbine, rauwolscine, phentolamine, WB-4101, and prazosin were: 6.8, 24, 19, 165, and 1489 nM, respectively. 5. Rat pretreatment with 100 mg kg(-1) 6-hydroxydopamine reduced 95% tissue noradrenaline and 60% neuropeptide Y. In these preparations, 100 nM clonidine elicited a rise of 91.9+/-15.5 pmol NO. Perfusion with 1 microM guanethidine or 1 microM guanethidine plus 1 microM atropine did not modify the NO surge evoked by 100 nM clonidine. 6. Clonidine and congeners activate endothelial alpha(2D)-adrenoceptors coupled to the L-arginine pathway, suggesting that the antihypertensive action of clonidine involves an endothelial vasorelaxation mediated by NO release, in addition to presynaptic mechanisms.

Laryngeal mask for difficult intubation in children.

We present a new intubation technique using an oral preformed tracheal tube passed through a laryngeal mask. Six patients (neonate to six months old) with craniofacial malformations of head and neck and scheduled for reconstructive plastic surgery are the basis of this report. An inhalation induction with increasing doses of halothane in oxygen while maintaining spontaneous ventilation was performed. Once an adequate anaesthetic depth was achieved, a direct laryngoscopy was performed. The epiglottis could not be seen in any of the patients. Anaesthesia was deepened in order to insert the laryngeal mask, size 1 or 2, with an oral preformed 3.5 or 4.0 tracheal tube inside it. Correct position of the mask was confirmed by capnography. The preformed tracheal tube was then advanced 1-2 cm. and its position in the trachea verified. The 15 mm connector was then removed, and an adult intubating stylet was attached to the end of the tracheal tube. The laryngeal mask was removed, holding the stylet and tube in place. Once the mask was removed, the stylet was disconnected, and the 15 mm connector reattached. Our experience was that this takes about 20 to 30 s. We recommended this technique in paediatric patients in which a difficult intubation is foreseen.

[Merkel cell carcinoma. Report of 4 cases]. / Carcinoma de células de Merkel. Comunicación de cuatro casos.

We report four cases of Merkel cell carcinoma, a rare cutaneous neuroendocrine neoplasm with a high malignant potential. The first patient is a 90 years old male presenting with a tumor in the left superior eyelid. Surgical excision was the only treatment and seven months later, a local and regional tumoral relapse caused the death of this patient. The second patient is a 83 years old female with a tumor in her left ear. She was treated surgically and with radiotherapy, being free of disease after five years of follow up. The third patient is a 45 years old male with a tumor in the left forearm. Treatment was surgical excision of the primary tumor and axillary lymph nodes. He received post operative radiotherapy and is free of disease after three years of follow up. The last case is a 76 years old male, who was subjected only to an excisional biopsy of a lesion located in the left knee. He had a tumor relapse with inguinal and crural lymph node involvement that caused his death 12 months later.

Alpha 1-antitrypsin expression in human thyroid papillary carcinoma.

Alpha 1-antitrypsin is a plasma serine protease inhibitor originally used as a marker for tumors of histiocytic origin. Our casual finding of immunoreactive alpha 1-antitrypsin in one case of thyroid papillary carcinoma led us to investigate its presence in 10 thyroid papillary carcinomas by applying immunocytochemical and immunochemical techniques to tissue sections and Western blots of tissue homogenates prepared from neoplastic tissue and from uninvolved normal areas in the vicinity of each tumor. The immunocytochemical study was performed in both thyroid tissue and metastatic regional lymph nodes. This analysis revealed immunoreactivity for alpha 1-antitrypsin in nine of the 10 cases studied. Immunoreactivity was intense in some of the cells forming the papillar and follicular structures. These cells were intermingled with completely unstained tumoral cells. In contrast to neoplastic tissue, the normal thyroid tissue present in the vicinity of each tumor showed no staining for alpha 1-antitrypsin. The electrophoretic analysis performed on homogenates prepared from both tumoral and normal thyroid tissue revealed a drastic reduction in the band corresponding to thyroglobulin in the tumoral tissue compared with normal thyroid extracts, where it represented the major protein. Western blotting and immunoprinting with a polyclonal alpha 1-antitrypsin antibody confirmed the results obtained with immunocytochemistry about the presence of this protease inhibitor in neoplastic thyroid tissue. Immunoprinting with the anti-alpha 1-antitrypsin antibody revealed an intense immunoreactive band of 53 kDa in the extracts prepared from tumoral tissue. This band had exactly the same apparent molecular mass previously described by others for alpha 1-antitrypsin purified from plasma and was identical to the molecular mass of the purified commercial standard employed.

[Medullary cancer of the thyroid. Experience at the Hospital de Valdivia]. / Cáncer medular de tiroides. Experiencia del Hospital de Valdivia.

BACKGROUND: Medullary carcinoma of the thyroid is an infrequent type of thyroid tumor. AIM: To retrospectively study all cases of medullary carcinoma of the thyroid diagnosed at a regional hospital. PATIENTS AND METHODS: The charts and pathological studies of eight patients with medullary carcinoma of the thyroid, among 75 with thyroidal cancer, were reviewed. RESULTS: Solitary nodules were the presenting sign in seven patients and cachexia in one. Five patients were subjected to total thyroidectomy, five to cervical lymph node dissection and four to complementary radiotherapy. Pathological diagnosis was made with the surgical piece in seven patients and by aspiration cytology in one. Five of the eight patients are alive after 50 months of follow up as a mean, one patient with bone metastasis. CONCLUSIONS: The small sample size precludes conclusions on the prognosis and treatment of the disease.

[Mammary phyllodes tumor. A clinico-pathological review of 14 cases]. / Tumor filodes mamario. Una revisión clinicopatológica de 14 casos.

We report a retrospective analysis of 14 female patients, aged 20 to 62 years old, with phyllodes tumors of the breast. The tumors were located in the right breast in nine patients and their diameter ranged from 2.5 to 28 cm. Six mammographies and six needle cytological examinations were performed and aided very little to the diagnosis. The preoperative diagnosis was correct in five patients and the principal differential diagnosis was fibroadenoma. Eight patients were subjected to tumorectomy, three to simple mastectomy, one to a cleaning mastectomy, one to a modified radical mastectomy and one to a subcutaneous mastectomy. The anatomopathologic study disclosed an increased stromal growth in two patients and increased stromal cellularity in six cases. Only one case had more than five mitoses per microscopic field. Phyllodes tumors are infrequent, their diagnosis requires a high degree of clinical suspicion and they have a benign biologic behaviour.

[Breast cancer in males. Report of 4 cases]. / Cáncer mamario en el hombre. Comunicación de cuatro casos.

Breast cancer is infrequent in men. We report four men with breast cancer seen at a surgical service in Valdivia. Their presentation form, histological diagnosis and evolution are described. An updated revision of the literature is also presented.

[Contemporary biopsy for diagnosis of abortion residues: preliminary experience]. / Biopsia contemporánea para el diagnóstico de restos de aborto: experiencia preliminar.

The differential diagnosis between abortion and ectopic pregnancy has important clinical implications. In this report we have tested the accuracy of frozen sections in uterine curettings to identify intrauterine pregnancy. Uterine curettings with a diagnosis of products of gestation, from 104 patients were studied. In all of them plasmatic levels of B Gonadotrophin were measured. The curetting material was fixed and studied on frozen sections and on paraffin embedded tissue. A high positive relationship between frozen and embedded material was observed. The sensibility, specificity, positive and negative predictive value of the frozen section to detect chorionic villi were 90.6; 100; 100 and 74% for each of them.