[Predictive value of Ages & Stages Questionnaires for cognitive performance at early years of schooling]. / Validez del Ages & Stages questionnaires para predecir el desempeño cognitivo en los primeros años de educación escolar.

The Ages and Stages questionnaires (ASQ) has been recently validated in our country for developmental screening. The objective of this study is evaluate the validity of ASQ to predict low cognitive performance in the early years of schooling. PATIENTS AND METHOD: Diagnostic test studies conducted on a sample of children of medium-high socioeconomic level were evaluated using ASQ at least once at 8, 18 and/or 30 months old, and later, between 6 and 9 years old, reevaluated using the Wechsler Intelligence Scale for Children-third edition (WISC-III). Each ASQ evaluation was recorded independently. WISC-III was standardized, considering underperformance when the total score were under -1 standard deviation. RESULTS: 123 children, corresponding to 174 ASQ assessments (42 of them were 8 months old, 55 were 18 months and 77 were 30 months of age) were included. An area under the ROC curve of 80.7% was obtained, showing higher values at 8 months (98.0%) compared to 18 and 30 months old (78.1 and 79.3%, respectively). Considering different ASQ scoring criteria, a low sensitivity (27.8 to 50.0%), but a high specificity (78.8 to 96.2%) were obtained; the positive predictive value ranged between 21 and 46%, while the negative value was 92.0-93.2%. Conclusion ASQ has low sensitivity but excellent specificity to predict a low cognitive performance during the first years of schooling, being a good alternative to monitor psychomotor development in children who attend the private sector healthcare in our country.

Validez del Ages & Stages questionnaires para predecir el desempeño cognitivo en los primeros años de educación escolar / Predictive value of Ages & Stages Questionnaires for cognitive performance at early years of schooling

El Ages and Stages questionnaires (ASQ) fue validado en nuestro país para el tamizaje del desarrollo psicomotor. El objetivo es evaluar la validez del ASQ para predecir un menor rendimiento cognitivo en los primeros años de educación escolar. Pacientes y Método: Estudio de pruebas diagnósticas en una muestra de niños de nivel socioeconómico medio alto evaluados previamente con ASQ a los 8, 18 y/o 30 meses, y luego con la Escala de inteligencia para niños de Wechsler-tercera edición (WISC-III) entre los 6 y 9 años de edad. Cada evaluación con ASQ se contabilizó en forma independiente. La Escala de WISC-III fue estandarizada para la muestra, considerando rendimiento bajo cuando el puntaje total estaba bajo una desviación estándar de la media. Resultados: Se incluyeron 123 niños, correspondientes a 174 evaluaciones ASQ (42 de 8; 55 de 18; 77 de 30 meses de edad). El área bajo la curva ROC fue 80,7%, siendo superior a los 8 meses (98,0%) que a los 18 y 30 meses (78,1 y 79,3%, respectivamente). Considerando distintos criterios de corte con ASQ se obtuvo sensibilidad baja (27,8% a 50,0%), pero especificidad elevada (78,8% a 96,2%); el valor predictivo positivo varió entre 21,4% y 45,5%, mientras que el valor predictivo negativo fue 92,0-93,2%. Conclusión: El ASQ tiene baja sensibilidad pero excelente especificidad para predecir un menor rendimiento cognitivo durante los primeros años de educación escolar, siendo una buena alternativa para monitorizar el desarrollo psicomotor de niños que se atienden en el sector privado de salud de nuestro país.

The Ages and Stages questionnaires (ASQ) has been recently validated in our country for developmental screening. The objective of this study is evaluate the validity of ASQ to predict low cognitive performance in the early years of schooling. Patients and Method: Diagnostic test studies conducted on a sample of children of medium-high socioeconomic level were evaluated using ASQ at least once at 8, 18 and/or 30 months old, and later, between 6 and 9 years old, reevaluated using the Wechsler Intelligence Scale for Children-third edition (WISC-III). Each ASQ evaluation was recorded independently. WISC-III was standardized, considering underperformance when the total score were under -1 standard deviation. Results: 123 children, corresponding to 174 ASQ assessments (42 of them were 8 months old, 55 were 18 months and 77 were 30 months of age) were included. An area under the ROC curve of 80.7% was obtained, showing higher values at 8 months (98.0%) compared to 18 and 30 months old (78.1 and 79.3%, respectively). Considering different ASQ scoring criteria, a low sensitivity (27.8 to 50.0%), but a high specificity (78.8 to 96.2%) were obtained; the positive predictive value ranged between 21 and 46%, while the negative value was 92.0-93.2%. Conclusion ASQ has low sensitivity but excellent specificity to predict a low cognitive performance during the first years of schooling, being a good alternative to monitor psychomotor development in children who attend the private sector healthcare in our country.

[Applicability of the Ages & Stages Questionnaires (ASQ) as a developmental screening tool for psychomotor delay]. / Aplicabilidad del Ages & Stages Questionnaires para el tamizaje del desarrollo psicomotor.

The screening and timely intervention of developmental psychomotor delay (DSM) has proven benefits for the child, families and society. In order to improve the efficiency in the identification of these disorders, many scientific groups recommend performing clinical monitoring during health controls and the use of standard evaluations at specific patient age or when delays are suspected. In recent years, screening instruments have been developed based on the report of parents or primary caregivers, which have the advantage of being inexpensive, require little application and interpretation time and involve the adults who are responsible for the care and stimulation of the child. One of these tools is the Ages and Stages Questionnaires (ASQ), which has been widely used in the US and validated by several countries. This study describes the DSM assessment practices used in Chile and backs up the use of monitoring systems based on the report of parents/caregivers. ASQ validation experiences in other countries are discussed along with their psychometric characteristics for the Chilean population and consequent applicability.

Aplicabilidad del Ages & Stages Questionnaires para el tamizaje del desarrollo psicomotor / Applicability of the Ages & Stages Questionnaires (ASQ) as a developmental screening tool for psychomotor delay

The screening and timely intervention of developmental psychomotor delay (DSM) has proven benefits for the child, families and society. In order to improve the efficiency in the identification of these disorders, many scientific groups recommend performing clinical monitoring during health controls and the use of standard evaluations at specific patient age or when delays are suspected. In recent years, screening instruments have been developed based on the report of parents or primary caregivers, which have the advantage of being inexpensive, require little application and interpretation time and involve the adults who are responsible for the care and stimulation of the child. One of these tools is the Ages and Stages Questionnaires (ASQ), which has been widely used in the US and validated by several countries. This study describes the DSM assessment practices used in Chile and backs up the use of monitoring systems based on the report of parents/caregivers. ASQ validation experiences in other countries are discussed along with their psychometric characteristics for the Chilean population and consequent applicability.

La pesquisa e intervención oportunas de los trastornos del desarrollo psicomotor (DSM), tiene demostrados beneficios para el niño, su familia y la Sociedad. Con la finalidad de mejorar la eficacia en la identificación de las dificultades del DSM, distintas sociedades científicas recomiendan realizar una vigilancia clínica del desarrollo en los controles de salud y aplicar evaluaciones estandarizadas a edades específicas o frente a la sospecha de déficit. En los últimos años se han desarrollado instrumentos de tamizaje basados en el reporte de padres o cuidadores principales, los que cuentan con la ventaja de ser de bajo costo, demandan poco tiempo en su aplicación e interpretación e involucran a los adultos responsables del cuidado y estimulación del niño. Uno de estos instrumentos, el Ages and Stages Questionnaires (ASQ) ha sido ampliamente utilizado en USA y validado en varios países. En el presente manuscrito se describen las prácticas de evaluación del DSM que se utilizan en Chile y se fundamenta la implementación de un sistema de monitorización del desarrollo infantil basado en el reporte de padres/cuidadores a nivel nacional. Se revisan experiencias de validación del ASQ en otros países y sus características psicométricas para la población Chilena y las implicancias de su aplicabilidad clínica.

Prematuros moderados y tardíos, un grupo de riesgo de menor desarrollo cognitivo en los primeros años de vida / Moderately and late preterm newborns, a risk group for low cognitive development in the first years of life

Introduction: Recent studies show that moderately and late preterm infants (MLI) (Gestational age (GA) 32 to 36(6)), are in high risk for delayed psychomotor development (PMD) and learning disabilities. Objective: To compare PMD between MLI and full term infants (FTI) and to analyze associated perinatal risk factors. Methodology: 131 MLI and 119 FTI were recruited between May 2008 and April 2011 in a private health center in Santiago, Chile. Both groups were compared according to age, gender and socio-economic level. At the ages of 8, 18 and 30 months the children were evaluated by means of the Bayley III Scale for Infantile Development 3rd edition (BAYLEY-III). PMD was compared in both groups and multiple lineal regression analysis was performed. Results: MLI showed a significantly lower development coefficient, but it matched the FTI when corrected by GA, (99 +/- 10.4 versus 100.8 +/- 9.9). Even with corrected GA, the cognitive performance was lower (98 +/- 10.4 vs 103.1 +/- 11.4 p < 0.05). Multiple lineal regressions showed that GA and gender were associated with lower cognitive development. Conclusion: Cognitive performance of MLI was below that of FTI. This increases the need to have especial standards of care and stimulation for these children.

Introducción: Estudios recientes refieren que los prematuros moderados y tardíos (PMT) (Edad Gestacional (EG) 32 a 36(6)), presentan un elevado riesgo de retraso del desarrollo psicomotor (DSM) y dificultades de aprendizaje. Objetivo: Comparar el DSM entre niños nacidos PMT y recién nacidos de término (RNT) y analizar los factores de riesgo perinatal asociados. Metodología: En un centro de salud de Santiago de Chile, entre mayo 2008 y abril 2011, se reclutaron 131 PMT y 119 RNT, pareados por edad, género y nivel socioeconómico. A los 8, 18 o 30 meses se les aplicó la Escala de Bayley III de Desarrollo Infantil-3ª edición. Se comparó el DSM entre los dos grupos y se implementó una regresión lineal múltiple. Resultados: Los PMT presentaron un coeficiente de desarrollo significativamente inferior al no corregir EG, equiparándose con los RNT al corregirla (99 +/- 10,4 vs 100,8 +/- 9,9). Aún con EG corregida, el desempeño cognitivo fue inferior (98 +/- 10,4 vs 103,1 +/- 11,4 p < 0,05). En la regresión lineal múltiple el género y la EG se asociaron con menor desarrollo cognitivo. Conclusión: El desempeño cognitivo de los PMT fue inferior a los RNT. Se plantea la importancia de implementar un estándar de cuidado y estimulación para este grupo de niños.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of Traditional Psychomotor Development Evaluation versus a Self-Administered Test?

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79% en EEDP y 12,73% en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de los padres, madres y cuidadores en la observación del desarrollo de sus hijos.

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were conducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79% of patients through the use of EEDP and in 12.73% through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

The 2010 Mw 8.8 Maule megathrust earthquake of Central Chile, monitored by GPS.

Large earthquakes produce crustal deformation that can be quantified by geodetic measurements, allowing for the determination of the slip distribution on the fault. We used data from Global Positioning System (GPS) networks in Central Chile to infer the static deformation and the kinematics of the 2010 moment magnitude (M(w)) 8.8 Maule megathrust earthquake. From elastic modeling, we found a total rupture length of ~500 kilometers where slip (up to 15 meters) concentrated on two main asperities situated on both sides of the epicenter. We found that rupture reached shallow depths, probably extending up to the trench. Resolvable afterslip occurred in regions of low coseismic slip. The low-frequency hypocenter is relocated 40 kilometers southwest of initial estimates. Rupture propagated bilaterally at about 3.1 kilometers per second, with possible but not fully resolved velocity variations.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of traditional psychomotor development evaluation versus a self-administe-red test

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were con-ducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79 percent of patients through the use of EEDP and in 12.73 percent through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79 por ciento en EEDP y 12,73 por ciento en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de ...

Desarrollo psicomotor en niños de nivel socioeconómico medio-alto / Psychomotor development among children of upper-middle class in Chile

Objective: Describe the psychomotor development (PMD) in upper middle class children, utilizing Bayley's Scale of Intellectual Development (BSID), internationally standarized. Patients and Methods: A total of 119 children in groups of 8, 18 and 30 months were enrolled at the well-baby clinic in a Private Hospital in Santiago, Chile. BSID III was utilized in all cases. Children born preterm, or with neurological, genetic, or metabolic diseases were excluded. Results: BSID scores followed a normal distribution (100.3 +/- 10). Prevalence of déficit was found to be 30%) at 8 months, 7.7%> at 18 months, and 2.7%> at 30 months, without gender difference. Gross motor development and language predominated at 8 months. Ther threee subscales showed an upward trend, cognitive and motor scales most significantly. Gross motor scales, which had been deficient at 8 months became normal at 18 months. Conclusions: The high frequency of motor deficits found at 8 months of age was striking. While all scales improved, cognitive and motor scales were most significant. The effect of stimulation and upbringing patterns upon chil development is discussed, being important for future studies of causality.

Objetivo: Describir los puntajes de desarrollo psicomotor (DSM) en niños sanos de nivel socio económico medio alto mediante la Escala de Bayley de Desarrollo Infantil (BSID), estandarizada internacionalmente. Pacientes y Métodos: Estudio transversal descriptivo. Se enrolaron 119 niños 8, 18 y 30 meses, que acudieron a control sano en una Clínica privada de Santiago de Chile, para la aplicación de BSID III. Se excluyeron los nacidos de pre-término o con enfermedad neurológica, genética o metabólica conocida. Resultados: Los puntajes obtenidos en BSID siguieron una distribución normal (100,3 +/- 10). La prevalencia de déficit en el DSM fue 30% a los 8 meses, 7,7% a los 18 y 2,7% a los 30 meses, no hubo diferencia por sexo. A los 8 meses predominó el déficit motor grueso y posteriormente el lenguaje. Las tres subescalas mostraron una tendencia al alza, las áreas cognitiva y motriz siguieron una progresión significativa. La motricidad gruesa, que estaba en el rango inferior a los 8 meses, fue normal a los 18. Conclusiones: Destaca la alta frecuencia de déficit motor en la población evaluada, especialmente a la edad de 8 meses. Todas las subescalas mostraron una tendencia al alza, siendo ésta diferencia significativa en las áreas cognitiva y motora. Se discute el efecto de la estimulación y los patrones de crianza en el desempeño de los niños, siendo necesario planificar estudios prospectivos para conocer su relación de causalidad.

Validación de un cuestionario autoadministrado para la evaluación del desarrollo psicomotor / Validation of a parent completed developmenal screening questiommaire

Introduction: Psychomotor Development (PMD) is an essential component of health care. Several authors have attempted to facilitate this evaluation through quick and inexpensive tools that do not prolong the time of consult. The "Ages and Stages Questionnaire" (ASQ) is a well-known and validated parent-directed survey. Objective: To evaluate the psychometric validity of ASQ, through comparison with Bayley's Scale of Infant Development (BSID), a universally accepted tool which measures similar parameters, and is administered by an expert. Patients and Methods: Children seen at an upper-middle class Private Clinic in Santiago, Chile were admitted to this study, with the exception of pre-term newborns, or children with known neurological, genetic or metabolic disease. Groups were formed at 8, 18 and 30 months of age. A sample of nearly 40 children per age Group was formed. After parents responded to the ASQ, an expert, blind to the results of the ASQ, evaluated each patient within two weeks. Results: Total number of children enrolled was 119. PMD deficit was scored in 19.3 percent of children according to ASQ, 14.3 percent according to BSID (not significant). While the results obtained with both tests were found to be correlated (r = 0.52), scores obtained through BSID were lower among children with deficit, compared to those rated through ASQ (p < 0.001). The sensitivity of ASQ was 58.8 percent and the specificity was 87.2 percent. Conclusions: Both tests are correlated. ASQ was found to be highly specific, suggesting its use as a screening tool in outpatient clinics, at least in a similar a population. These results should be reevaluated after national validation, to determine cutting points and test potency in all populations.

Introducción: La evaluación del desarrollo psicomotor (DSM) es un componente esencial en la supervisión de salud. Distintos investigadores han buscado formas de facilitar esta evaluación en forma rápida y económica, sin prolongar el tiempo destinado a la consulta pediátrica. El Ages and Stages Questionnaires (ASQ) es un cuestionario de auto-reporte de los padres, validado ampliamente para este fin. Objetivo: Evaluar las propiedades psicométricas del ASQ. Para eso se compara con la Escala de Bayley III de Desarrollo Infantil (BSID), el cual es universalmente aceptado, mide parámetros similares, y es administrado por un experto. Pacientes y Métodos: Estudio transversal analítico. En forma secuencial se enrolaron niños de 8, 18 y 30 meses, de nivel socio económico medio alto, que acudieron a control sano en una Clínica privada de Santiago de Chile. Se excluyeron los nacidos de pretérmino o con enfermedad neurológica, genética o metabólica conocida. Se obtuvo una muestra cercana a 40 niños por grupo etáreo. Tras responder el ASQ, los niños fueron evaluados con la BSID III, por un experto, ciego a los resultados ASQ. La latencia entre ambas evaluaciones no superó las dos semanas. Resultados: Participaron 119 niños. La frecuencia global de déficit de DSM fue de 19,3 por ciento de acuerdo al ASQ y 14,3 por ciento según el BSID (no significativo). El rendimiento promedio del BSID fue inferior en el grupo de niños con déficit según el ASQ comparado con el grupo con ASQ normal (p < 0,001). Se demostró correlación entre ambos test (r 0,52). La sensibilidad del ASQ fue 58,8 por ciento y la especificidad fue 87,2 por ciento. Conclusiones: Se demostró una adecuada correlación entre el ASQ y el BSID. El ASQ resultó altamente específico, por lo que odría ser usado como método de screening del DSM en la consulta pediátrica. Estos resultados deberían ser reevaluados luego de completar la validación nacional, para establecer los puntos de corte y real potencia del teste.

Utilidad de la cintigrafía de vía biliar en el diagnóstico diferencial de colección intrahepática: l caso clínico / Usefulness of bile duct scintigraphy in the differential diagnosis of intrahepatic collection: a clinical case

Se presenta el caso clínico de un paciente de 48 años referido por cuadro clínico de dolor abdominal y omalgia derecha de 6 meses de evolución posterior a colecistectomía y resección hepatobiliar por Cancer vesicular. El TAC abdominal demostró una gran colección quística intrahepática. El AngioTAc no mostró comunicación vascular. Frente a la sospecha de un bilioma se efectuó cintigrafía de la vía biliar con Tc99m-DISIDA. Ésta demostró un gran defecto de captación intrahepático de límites netos que reemplazaba casi todo el lóbulo derecho, un lóbulo izquierdo de contraste normal y presencia de paso enlentecido del radiofármaco hacia intestino, hallazgos cintigráficos no sugerentes de un bilioma. Se efectuó una punción percutánea de la lesión bajo TAC la cual dió salida a contenido hemático oscuro. Inmediatamente después de efectuar una evacuación parcial se realizó un nuevo AngioTAC el cual confirmó sangramiento activo subcapsular en napa desde segmento VI del hígado como complicación tardía de colecistectomía.

An hepatobiliary scintigraphy with Tc-99m diisopropyl iminodiacetic acid (DISIDA) was done in a 48-year-old man who consulted for abdominal and right shoulder pain 6 months following hepatobiliary and gallbladder resection for a gallbladder cancer. The abdominal CT showed a huge intrahepatic cystic collection. The Angio-CT showed no vascular communication. Biliary scintigraphy with DISIDA showed a large cold intrahepatic defect in the right lobe not compatible with diagnosis of bilioma. The percutaneus punction revealed an haematic collection. After partial percutaneus evacuation done under CT, a new Angio-CT showed active subcapsular hepatic bledding from segment VI of the liver as a late complication of gallbladder surgery.

Cintigrafía de ventilación y perfusión en el manejo del tromboembolismo pulmonar / Ventilation and perfusion scintigraphy in patients with pulmonary thromboembolism

Background: The Progressive Investigation of Pulmonary Embolism Diagnosis (PIOPED) classifies the results of ventilation perfusion scintigraphy as having a high, intermediate and low diagnostic probability of pulmonary embolism or as normal. This classification can be confusing for the clinician. Aim: To retrospectively review the diagnoses of ventilation perfusion scintigraphies performed at a general hospital. Material and methods: All reports of ventilation perfusion scintigraphies done between 1997 and 2000 at the Nuclear Medicine Service of Valdivia Hospital were retrospectively reviewed. Results: During the study period, 85 patients with suspected pulmonary thromboembolism were referred for a ventilation perfusion scintigraphy and in 70, the procedure was done. Twenty-one (30 percent) patients were classified as having a high probability of pulmonary thromboembolism, 12 (17 percent) as having an intermediate probability, 31 (44 percent) as having a low probability and the scintigraphy was considered normal in 6 (9 percent) patients. Conclusions: The predictive value of ventilation perfusion scintigraphy must be interpreted using this diagnostic classification

Seismic hazard in the Marmara Sea region following the 17 August 1999 Izmit earthquake

On 17 August 1999, a destructive magnitude 7.4 earthquake occurred 100 km east of Istanbul, near the city of Izmit, on the North Anatolian fault. This 1,600-km-long plate boundary slips at an average rate of 2-3 cm yr(-1), and historically has been the site of many devastating earthquakes. This century alone it has ruptured over 900 km of its length. Models of earthquake-induced stress change combined with active fault maps had been used to forecast that the epicentral area of the 1999 Izmit event was indeed a likely location for the occurrence of a large earthquake. Here we show that the 1999 event itself significantly modifies the stress distribution resulting from previous fault interactions. Our new stress models take into account all events in the region with magnitudes greater than 6 having occurred since 1700 as well as secular interseismic stress change, constrained by GPS data. These models provide a consistent picture of the long term spatio-temporal behaviour of the North Anatolian fault and indicate that two events of magnitude equal to, or greater than, the Izmit earthquake are likely to occur within the next decades beneath the Marmara Sea, south of Istanbul.

Magnitude of late quaternary left-lateral displacements along the north edge of tibet.

Images taken by the earth observation satellite SPOT of the Quaternary morphology at 18 sites on the 2000-kilometer-long Altyn Tagh fault at the north edge of Tibet demonstrate that it is outstandingly active. Long-term, left-lateral strike-slip offsets of stream channels, alluvial terrace edges, and glacial moraines along the fault cluster between 100 and 400 meters. The high elevation of the sites, mostly above 4000 meters in the periglacial zone, suggests that most offsets resulted from slip on the fault since the beginning of the Holocene. These data imply that slip rates are 2 to 3 centimeters per year along much of the fault length and support the hypothesis that the continuing penetration of India into Asia forces Tibet rapidly toward the east.

Epidemiology of gastric cancer in Chile. III. Diagnostic practices in Santiago, 1976-8.

The purpose of this paper is to estimate the validity of current diagnostic procedures used in Santiago, Chile, in identifying gastric cancer (GC) patients among people with gastric complaints, many of whom suffer possible premalignant conditions. Review of diagnoses on 2296 patients seen at the University Hospital during 1976 and 1977 revealed 103 confirmed cases of adenocarcinoma. This review permitted us to estimate the validity of clinical/radiological and endoscopic methods versus diagnosis made from pathological specimens. A code of diagnostic categories was generated for application in eight hospitals participating in a subsequent case-control study of GC. A high prevalence of chronic atrophic gastritic (CAG) and chronic gastric ulcer (CGU) was found, both conditions together accounting for 50% of diagnoses on 845 clinic controls during the study period 1977-8. The value of gastroscopy and biopsy to separate out GC from other gastric conditions, the importance of studying the epidemiology of premalignant conditions in Chile, and differences between GC in Chile and the United States are discussed.

Descriptive epidemiology of cancer in Chile: 1973-78.

Review of detailed Chilean cancer mortality data for 1973-78 reveals that gastric cancer overshadows all other sites, with Chile second in the world in age-adjusted mortality rate. An excess of male deaths is seen for all cancer sites combined except in 2 age groups, i.e., 30-39 and 40-49 years, in which more female deaths occur. Stomach, lung, and esophageal cancers show a male:female ratio up to 4.7. Females experience higher mortality than males from gallbladder cancer; Chile has the highest death rate in the world from this cancer and also from other gallbladder diseases. In addition, Chile also has the highest death rate in the world for cancer of the cervix. An excess of female deaths is seen for colorectal cancer, whereas figures for cancer of the pancreas reveal only a slight excess of male deaths. This varied picture makes Chile an excellent setting in which one can study the epidemiology of cancer sites.

Ecology of stomach cancer in Chile.

The results of a case-control study and one on nitrate ecology are summarized. Patients attending gastroscopy clinics in 8 participating hospitals in Santiago were interviewed before their diagnoses were known. Of these patients, 360 with stomach cancer were matched to those with noncancerous diseases who were selected from the pool, and we found that 1) patients lived in high-risk areas for longer periods in early life than did controls; 2) controls lived in low-risk areas for longer terms than did the patients; and 3) an association existed between stomach cancer and occupation in agriculture. In a subgroup of 98 patients for whom histologic classification was available, the association with residence in early life in a high-risk area was seen only for patients with intestinal type stomach cancer. Nitrate levels in urine and nitrite levels in saliva were determined in school children 11-13 years of age in 2 areas of high-risk in central Chile and in 2 areas of low risk for stomach cancer located in the extreme northern and southern regions. Levels of both nitrates and nitrites were concurrently determined in selected vegetables. The results are apparently incompatible with the hypothesis of high nitrate intake in areas of high stomach cancer incidence. This paradoxical finding led us to suggest that cofactors are involved in the pathopoiesis of stomach cancer that promote or inhibit the formation of nitrosamines.

Epidemiology of gastric cancer in Chile: I - Case-control study.

The results of a case-control study of stomach cancer carried out with the collaboration of 7 participating hospitals in Santiago, Chile are reported. Patients attending gastroscopy clinics were interviewed before or after gastroscopy. The diagnosis was unknown to either the patient or the interviewer at the time of interview. 360 stomach cancer cases were subsequently matched to non-cancer patients selected from the pool interviewed at the same time as the cases. Study findings show: 1) longer-term residence in high-risk areas in early life by cases than controls; 2) an association between stomach cancer and a prior occupation in agriculture. In a subgroup of 98 cases for whom histologic classification was available, the association with residence in early life in a high-risk area was seen only for cases with intestinal-type stomach cancer.