Eruptive skin tags and keratoacanthomas in a patient with prolactinoma and colonic polyposis.
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Adenomatous Polyposis Coli↗
Biomedical subjects
E Medina
Publications and source records attributed to E Medina.
[Attitudes and behaviour concerning tobacco use among physicians from Santiago].
The aim of this work was to study the prevalence, behavior and opinions towards smoking in a sample of 288 physicians from Santiago, stratified according to sex and specialty. The WHO Europe questionnaire was applied and smoker was defined as the person that consumed one or more cigarettes per day. Thirty six percent of the sample (40.2% of men and 23.8% of women) smoked an average of 9 cigarettes per day, compared to the figure of 28.3% obtained in a similar study in 1983. Fifty percent of smokers felt that they will not quit. No differences in knowledge about problems associated to smoking or forbidding smoking in hospitals, were observed between smokers and non-smokers. A majority of smokers did not smoke in front of their patients and did not allow smoking in their private clinics. It is concluded that, although a high proportion of physicians continue to smoke, their opinions and behavior will support smoking cessation efforts.
Adult↗
[Characteristics and management of morbidity in Santiago 1993].
Results of morbidity and medical care surveys of the Santiago's population are presented in this paper. A random sample of 1,000 dwellings with 4,700 people was selected and studied 3 times, in 1993 and 1994. All health events (acute and chronic morbidity, health examinations, dental care) and main features of medical care were registered in the interviews which covered a 2-week period each time. The population sample had similar characteristics than the results of the last Population and Dwellings Chilean Census. Health events were registered with high frequency: 56% of the families had one or more members with chronic disease; 51% with acute diseases; 46% with emotional troubles; 24% had dental care; 17% health examination and 6% different types of injuries. Frequency of medical care during the fortnight period was 5.6% out of total population of acute diseases; 1.0% of injuries; 4.9% for chronic diseases, 3.9% of health examinations and 5.6% of dental care. Frequency of diseases was significantly higher among women (50%) than in men (33%) and in poor people than in higher socioeconomic levels. Most of the acute disease were respiratory illnesses followed by communicable diseases, skin troubles and rheumatologic disorders. The most important detected chronic diseases were blood hypertension, diabetes mellitus, bronchial asthma and alcoholic addiction.(ABSTRACT TRUNCATED AT 250 WORDS)
Accidents↗
[Celebration of the 50th anniversary of the School of Public Health of the University of Chile].
The joined initiative of the University of Chile, the Health institutions, the Bacteriological Institute and the Rockefeller Foundation support allowed the creation of the School of Public Health. A group of skilled and talented young specialists gave rise to the School, as an expression of the need to refurbish the medical care of the forties. The aim of the School was to communicate the scientific basis of sanitary practice, to study national problems and to group people that can contribute to improve the health status of the country. During fifty years, the number of Chilean and foreign students expanded considerably. During these five decades the School has trained 1588 specialists (459 foreigners) in Public Health. The School was awarded by WHO in 1988 in recognition of its outstanding contributions to Public Health. It is difficult to make adequate decisions at the present time, due to the complexity of Chilean health situation, that is going through an epidemiological and demographic transition. A systematic effort to investigate and to train people in public health and health administration is mandatory. These are the principal tasks of the School, that maintains its fifty years tradition left by its founders.
Chile↗
[Active epidemiologic surveillance of tuberculosis].
With 5,000 new active cases each year, tuberculosis in Chile remains as the most important communicable disease in the country. Since the type of control programs are linked to the epidemiologic situation as far as infection, morbidity and mortality are concerned, an effective surveillance system is needed, with analysis of the general data and an active search for other evidences which show the advantages and problems of the control programs. The number of active cases shows a downward trend with 66 new cases per 100,000 population in 1982 and 37 in 1992. nevertheless, in Santiago, comparing years 1991 and 1991, an increase of 4% in morbidity, 37% of mortality and 33% in the case fatality rate are observed. Morbidity rates are variable with highest numbers in the I Region of Tarapacá probably linked to the prevalent ethnic type of the population. One quarter out of total tuberculosis deaths depends on the late effects of the disease and three quarter are the consequences of recent active disease. People over 55 years of age represents 25% out of total new cases. Besides classical indicators it is important to consider the frequency and results of the practice of diagnostic laboratory tests; the antibiotic therapy resistance; the results of the treatment, analyzing cohorts of treated people; the importance of different infection factors; the evaluation of BCG immunization; the meaning of animal tuberculosis infection; the slowness in the beginning of treatment in new cases; the results of the screening of high risk population and the systematic analysis of each death due to tuberculosis.
Adolescent↗
Arthroscopic lysis in knee arthrofibrosis.
Arthrofibrosis continues to be a difficult complication in articular surgery on the knee. We present our experience in 21 cases of arthroscopic lysis as an alternative to mobilization under anesthesia. The technique begins with the liberation of the adhesions of the suprapatellar pouch, continues down both gutters, and ends with a cleaning of the notch where necessary. When a restriction of patellar mobility persists, we make a retinacular release. The results obtained are very satisfactory, with an average increase in the arc of mobility of 68 degrees. The average gain in mobility at 6 months is significantly greater than that achieved in the immediate postoperative period. Longer follow-up showed no improvement in range of motion after 6 months.
Adult↗
Lymphocyte activation in HIV-1 infection. I. Predominant proliferative defects among CD45R0+ cells of the CD4 and CD8 lineages.
OBJECTIVES AND DESIGN: The proliferative defects of CD4 and CD8 cells taken from 474 HIV-1-seropositive individuals during various stages of disease were quantitated. Phytohaemagglutinin (PHA) and soluble anti-CD3 were used in optimal mitogenic concentrations in the presence of recombinant interleukin-2 (rIL-2) and conditioned medium, and the proliferation of cells from HIV-1-seropositive donors was assessed in co-culture with HIV-1-seronegative cells in order to exclude effects of cytokine deficiency. Defects within the CD45RA+ ('unprimed') and CD45R0+ ('primed') T-cell populations were also investigated. METHODS: Quantitative immunofluorescence and double and triple labelling in flow cytometry were performed for (1) CD25 (IL-2 receptor alpha chain) expression, (2) lymphocyte and T-cell survival, and (3) blast transformation and proliferation--in relation to the original input of cells for each subpopulation. RESULTS: T cells from normal and HIV-1-seropositive donors were CD25+ at day 1. In HIV-1-seropositive patients a variable number of CD4 and CD8 lymphocytes failed to further increase CD25, and died as a sign of activation-associated lymphocyte death (AALD). Forty-two per cent of asymptomatic subjects, including 32% of those with CD4 cell counts > 400 x 10(6)/l, showed a poor blast transformation (< 30% blasts). Cells from HIV-1-seropositive donors showed poor blast responses when co-cultured with HIV-1-seronegative cells; both CD4 and CD8 cells were handicapped. In asymptomatic HIV-1-seropositive people T cells with the CD45R0+ RA- ('primed') phenotype were three to five times more vulnerable to AALD than the CD45RA+ RO- ('unprimed') cells. In patients in Centers for Disease Control and Prevention (CDC) disease stage IV both CD45R0+ and -RA+ populations were severely affected. CONCLUSIONS: This is the first quantitative analysis to demonstrate that in HIV-1 infection mitogen-stimulated CD45R0+ ('primed') T cells preferentially die upon activation. Both the CD4 and CD8 lineages are affected, as seen in animal models of graft versus host disease. AALD may explain defects of immunological memory. The analysis of AALD may be a suitable assay for studying whether antiviral drugs influence the proliferative responses of lymphocytes.
CD3 Complex↗
Multihormonal response to CRH in a patient with Cushing syndrome and a pituitary adenoma producing ACTH and GH.
Preoperative bilateral and simultaneous catheterization of the inferior petrosal sinuses was performed in a patient with Cushing's syndrome. This procedure revealed parallel intersinus gradients for ACTH, PRL, GH and a response of all these hormones to CRH. The patient had transphenoidal surgery and a soft white-yellowish mass occupying the whole sella conditioned a total hypophysectomy. Morphologic studies and immunostaining techniques revealed a rare mixed pituitary adenoma of ACTH and GH containing cells and failed to demonstrate PRL immunoreactivity in the tumor cells. These results are of clinical and speculative interest. Whether GH and PRL secretion in response to CRH stems from the tumor or reflect hormone release by non-tumor cells via a paracrine effect remains to be defined.
Adenoma↗
[Long-term survival of patients with stomach cancer treated with subtotal gastrectomy].
The aim of this work was to determine the 5 and 12 years survival of 233 patients with gastric cancer subjected to subtotal gastrectomy. Patients with early gastric cancer (n = 51) had a 95% survival and those with intermediate cancer (n = 19) a 87% survival. Patients with advanced gastric cancer (n = 163) subjected to curative surgery had a 60% survival, whereas none subjected to palliative surgery survived. Those patients that survive more than 24 months after the surgical procedure, have an excellent long term prognosis.
Adult↗
[Liver cirrhosis in Chile: epidemiologic considerations].
Liver cirrhosis is an important public health problem in Chile, accounting for 5% of all deaths, proportion that has increased 24 fold in the last 60 years. Chile has the highest death rate for cirrhosis in America and the second highest in the world, after Hungary. The risk of death and hospitalization for cirrhosis has increased significantly between 1950 and 1970, stabilizing thereafter in values near to 50 hospitalizations and 30 deaths/year per 100,000 inhabitants. The risk for cirrhosis is higher among men and increases with age. Among people between 35 and 60 years of age, cirrhosis is the first or second cause of death and the third among those aged 60 to 69 years. The age of patients hospitalized for cirrhosis has increased from 42.7 years in 1950 to 55.5 in 1990. Among women, cirrhosis appears at older ages than in men. Mortality rates vary in the different regions of the country and range from 55 in Concepcion and Talcahuano to 8 per 100,000 inhabitants in Coquimbo. The certainty of Chilean information on cirrhosis and the evidences associating cirrhosis to alcohol consumption are discussed, being prominent the significant association between annual death rates for cirrhosis and wine production.
Adolescent↗
[Diagnostic value of aspiration cytology with ERCP].
ERCP is of great value in diagnosing malignant pathology of the biliopancreatic duct system. However, the ERCP endoscopic characteristics in malignant stenosis often lack specificity and are difficult to differentiate from those of chronic pancreatitis. In these cases histological confirmation is essential to diagnosis. With the aim of increasing the diagnostic possibilities of ERCP in pancreatic cancer--particularly when associated with chronic pancreatitis--we performed aspiration cytology of pancreatic juice obtained via endoscopic cannulation of the main pancreatic duct using ERCP in 102 patients with suspected periampullar pathology, chronic pancreatitis and/or pancreatic cancer. The diagnostic sensitivity of cytology for pancreatic malignancy was 33.3%, versus 60% for cancer of Vater's papilla. Specificity was 100% in both cancers. We observed no false positive results or complications. On combining both techniques, i.e., ERCP and cytology of the pancreatic juice, sensitivity increased to 100% for pancreatic malignancy, 77.7% for chronic pancreatitis (characteristic ERCP radiographic images and absence of neoplastic cells) and 100% in the case of ampullomas. Difficulties in the differential diagnosis between advanced chronic pancreatitis and pancreatic cancer persist with ERCP alone. In such cases aspiration cytology may secure a definitive diagnosis--particularly when neoplastic cells are demonstrated (Class IV).
Adult↗
[Treatment of mild hypertension with captopril and captopril with hydrochlorothiazide. Impact on blood pressure values and quality of life].
The effects of captopril alone or associated to hydrochlorothiazide on blood pressure and quality of life was studied in 244 hypertensive subjects. After a medication wash out period of 30 days (and 7 additional days when diuretics were used) patients were treated initially with captopril 25 mg b.i.d. (scheme A); if blood pressure was not normalized, hydrochlorothiazide 25 mg o.d. was added (scheme B) and the dose of captopril was increased to 50 mg bid (scheme C) in a stepwise fashion. Sixteen patients (6.6%) were lost from follow up; in the rest a significant reduction of blood pressure was obtained at the end of the treatment period (from 163/98.9 +/- 19.7/3.1 to 143/85 +/- 12.7/6.7 p < 0.05), without changes in cardiac frequency. Using captopril alone, blood pressure was normalized at 15 and 75 days in 62.9 and 70.6% of patients respectively. With captopril plus hydrochlorothiazide blood pressure was normalized in 80.9% of patients. Quality of life improved significantly from of 42.8 +/- 1.7 to 50.7 +/- 15 score points (p < 0.05) secondary effects were observed in 7.4% of patients. It is concluded that captopril alone or associated to hydrochlorothiazide is effective in the treatment of mild hypertension, produces few secondary effects and improves the quality of life.
Adult↗
[Biliary surgery mortality in Chile in 1990. Cooperative study in 17 hospitals].
A survey about surgical procedures performed in 1990 was answered by 17 surgical services. With these data the operative mortality of biliary surgery was analyzed. During 1990, 39,643 patients were subjected to major surgery of which 9,654 (24.3%) corresponded to benign biliary tract diseases. Forty nine percent of patients had chronic cholecystitis, 36% acute cholecystitis and 16% choledocholithiasis. Global mortality of these procedures was 0.58% and mortalities for chronic cholecystitis, acute cholecystitis and choledocholithiasis were 0.06, 0.6 and 2% respectively. These numbers increased significantly in patients over 60 years old, are lower than those reported 10 years ago and could be useful as "gold standards" for laparoscopic cholecystectomy.
Biliary Tract Diseases↗
[Long-term results of endoscopic sphincterotomy].
A review is made of the results of long-term endoscopic sphincterotomy. We studied 81 endoscopic sphincterotomies performed between 1980 and 1985. The technique performed, its indications and immediate complications were evaluated, along with the follow-up carried out in these patients (minimum 6 years). In view of the results obtained, the patients were classified as asymptomatic or symptomatic. Thus, immediate complications (21.9%) were all minor, with the exception of one case (1.2%) of severe complication due to acute pancreatitis. One death was recorded three days after sphincterotomy, corresponding to an elderly patient with in situ gallbladder as a consequence of biliary sepsis. In turn, 91.4% of the patients followed-up at long term remained asymptomatic. The overall results show the method to be effective, with few either immediate or long-term complications.
Adult↗
Quantum interference effects for strongly localized electrons.
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Journal Article↗
Chronic anemia due to gastric ectopia within the duodenum.
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Aged↗
[Clinical course characteristics of gastric cancer 1958-1990].
The clinical, surgical and histopathologic characteristics of patients with gastric cancer were compared among 3 consecutive periods from 1958 to 1990. A significant increase in the frequency of location at the upper third of the stomach, a greater proportion of resectable lesions, an increasing tendency towards extended total gastrectomy and a significant increase in the frequency of undifferentiated or diffuse carcinoma were observed. A change in pathogenetic factors along the years may be involved in the differences described.
Adult↗
[A cooperative study on early and intermediate gastric cancer: clinical, diagnostic and therapeutic aspects].
A cooperative study involving 13 hospitals in Chile allowed the analysis of 353 patients with gastric cancer in early stages. 82 cancers were located at the mucosal level, 151 at the submucosa and 120 reached the muscular layer. There were no differences in age and sex among these groups. Compared to early stage, patients with intermediate stage had a greater incidence of bleeding, anemia and undernutrition and exhibited lower body weight. Endoscopy had a higher diagnostic yield compared to radiological study. The diagnosis was confirmed by biopsy in 95% of patients. Total or subtotal gastrectomy was performed according to the location of the lesion, with a low operative mortality rate. Early gastric cancer accounts for 8 to 10% of all patients with gastric cancer undergoing surgical treatment.
Adult↗