Alvaro Huete G

Tratamiento endovascular de aneurisma aórtico abdominal: resultados en 80 pacientes consecutivos

1.0 cm in diameter, were treated. The surgical risk of 38% of patients wasgrade III according to the American Society of Anesthesiologists classification. Each procedure wasperformed in the operating room, under local or regional anesthesia, with the aid of digitalsubstraction angiography. The endograft was deployed through the femoral artery (83.7% bifurcated,16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-up included aspiral CT scan at 1, 6 and 12 months postoperatively, and then annually.

Tratamiento endovascular del trauma de aorta descendente

Mortality of traumatic aortic lesions is over 80%. Agroup of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that isdetected during imaging studies. Since conventional surgical treatment of traumatic aorticlesions has a great mortality, endovascular treatment has been used as an alternative treatmentin the last decade.

Neumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana: Caso clínico y revisión

Escuela de Medicina. Pontificia Universidad Catolica de Chile:Departamento de Medicina Interna (RRB).Estudiante de Medicina (AMS).Residente Medicina Interna (RBB).Departamento de Respiratorio (JJA).Departamento de Inmunologia Clinica y Reumatologia (MCM).Departamento de Anatomia Patologica (DOB).Departamento de Radiologia (AHG).UDA Laboratorios Clinicos (PGC).Instituto de Salud Publica de Chile:Laboratorio de Referencia de Bacterias Fastidiosas, Seccion Bacteriologia Clinica (MCCP).Recibido: 22 de octubre 2004Aceptado: 28 de marzo 2005Rev Chil Infect 2005; 22 (2): 155-160

Desarrollo y validación del instrumento MEDUC-RX32, para la evaluación de docentes de programas de la especialidad de postítulo en radiología

Abstract: The objective of this study is to develop and validate a guideline for the evaluation of the clinical teaching process in radiology; Catholic University Medical School, Radiology 32 items (MEDUC-RX32). A mixed methodology was used for the development of the questionnaire; two interview groups (residents and faculty) and one individual to a radiology program head. Using a modified Delphi technique to reach an agreement, a national validity panel assessed the importance of each item. The Delphi panel refined the questionnaire from 88 to 32 items after two rounds. The final guideline was perfomed in 55 residents of the program. The final instrument shows high reliability (Cronbach’s alpha coefficient of 0.957). The average performance evaluations of teachers was 6.23 ± 0.8 (Likert scale 0 to 7) becoming a valid and reliable guideline for teacher evaluation of programs in the specialty of radiology, in Spanish speaking countries. Keywords: Assessment guidelines, Medical education, Postgraduate, Radiology teacher evaluation.

Quiste hidatídico retro-peritoneal: Una enfermedad frecuente en una ubicación inusual

La hidatidosis sigue siendo un problema prevalente en areas endemicas. Presentamos el caso de un quiste hidatidico primario ubicado en el espacio retro-peritoneal. Mujer de 54 anos, procedente de area rural del sur de Chile, hospitalizada por cuadro de coxalgia derecha y aumento de volumen gluteo, con tres meses de evolucion. Se realizo el diagnostico de hidatidosis complicada por medio de examenes de imagenes, tests serologicos y anatomia patologica. No se demostraron quistes hidatidicos en otras ubicaciones. Se realizo un drenaje percutaneo del quiste infectado y se administraron antihelminticos durante 12 semanas y actualmente permanece en seguimiento cercano con buena respuesta al tratamiento. El quiste hidatidico debe ser considerado en el diagnostico diferencial de masas quisticas retro-peritoneales, especialmente en areas endemicas.

ISQUEMIA MESENTERICA AGUDA: EVALUACION CON TOMOGRAFIA COMPUTADA MULTIDETECTOR

Las distintas variantes de isquemia mesenterica aguda constituyen un grupo de patologias con alta morbimortalidad. Suelen ser de dificil diagnostico clinico, lo que frecuentemente deriva en un retraso en el tratamiento quirurgico. La tomografia computada mutidetector ha surgido como una herramienta de gran utilidad en la deteccion de la isquemia intestinal y de la patologia vascular causal. Se discute la fisiopatologia del dano isquemico mesenterico, el espectro de alteraciones posibles del intestino delgado, peritoneo y vasculatura abdominal segun la etiologia, y se revisaran los parametros para optimizar el estudio tomografico en la evaluacion de esta patologia

Tratamiento endovascular de la disección aórtica tipo B mediante endoprótesis

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was connrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusion: Endovascular treatment of type B aortic dissection has good immediate andlong term results

MASAS SUPRARRENALES: EVALUACION POR TOMOGRAFIA COMPUTADA Y RESONANCIA MAGNETICA

Abstract: Despite being small, suprarenal glands constitute a frequent milieu for diseases, since some type of gland anomaly can be present in 9% of the population. Because of the increasing massive use of computed tomography and magnetic resonance imaging, damage detection at this level has been incremented. The usefulness of these techniques lies not only in their ability in timely and accurate detection of lesions but also in the characterization of them, distinguishing benign from malignant masses. Nevertheless, some-times it is not possible to determine their nature and therefore complementary imaging techniques such as possitron emission tomography or even a biopsy must be performed to reach a conclusive diagnosis. At the end of our revision we propose an action algorithm for assessing suprarenal damages.Keywords: Computed Tomography, Magnetic reso-nance imaging, Masses, Suprarenal glands. Resumen: Las glandulas suprarrenales, a pesar de ser pequenas, son sitio frecuente de enfermedad, presentando algun tipo de alteracion en el 9% de la poblacion. Con el uso cada vez mas masivo de la tomografia computada y de la resonancia magne-tica, ha aumentado la deteccion de lesiones a este nivel. El rol de estas modalidades no solo radica en la deteccion de las lesiones sino que tambien en la caracterizacion de estas, diferenciandolas en benignas o malignas. Sin embargo, en ocasiones no es posible determinar su naturaleza, por lo que debe recurrirse a examenes complementarios como la tomografia de emision de positrones, o incluso la biopsia, para llegar a un diagnostico definitivo. Al final de la revision, proponemos un algoritmo de accion para la evaluacion de las lesiones suprarrenales. Palabras clave: Glandulas suprarrenales, masas, tomografia computada, resonancia magnetica.

COLITIS ISQUÉMICA NO OCLUSIVA GANGRENOSA: CRITERIOS DIAGNÓSTICOS CON TOMOGRAFIA COMPUTADA MULTIDETECTOR

Introduccion: La isquemia constituye la principal causa de colitis en pacientes mayores de 50 anos. La mayor parte de los casos cursa un cuadro autolimitado, de buen pronostico. Existe un subgrupo de pacientes que presentan isquemia transmural con necrosis parietal y mortalidad determinada por peritonitis y sepsis secundaria. Objetivo: Documentar los hallazgos lu minales, parietales y peritoneales en pacientes con necrosis colonica de etiologia isquemica, que permitan un diagnostico oportuno. Material y Metodos: Revision retrospectiva de fichas clinicas y estudios tomograficos de doce pacientes (7 hombres, 5 mujeres) cuyas edades varian entre los 46-91 anos (promedio: 70.3 anos) con necrosis secundaria a colitis isquemica (Cl) no oclusiva, documentando el status del paciente (ambulatorio, hospitalizado), factores de riesgo y sintomas al ingreso. Los doce pacientes fueron sometidos a tomografia computada multidetector (TCMD). Resultados: Seis pacientes consultaron al servicio de urgencia por dolor abdominal y 6 debutaron durante hospitalizacion por otra causa. La evaluacion parietal demostro ausencia de impregnacion en 11/12 casos (91.6%) y neumatosis mural o vascular en 5/12 casos (41.6%). Engrosa-miento parietal fue visible en 4/12 casos (33%) y gas pericolonico en 3/12 casos (25%). Considerando el ileo y la alteracion de la densidad del tejido adiposo pericolonico como hallazgos inespecificos, en 3/12 pacientes (25%) la ausencia de impregnacion mural del colon era el unico marcador de lesion parietal severa. Conclusion: Signos clasicos de Cl como engrosamiento parietal son infrecuentes de encontrar en casos avanzados con gangrena mural. La falta de impregnacion parietal post contraste se correlaciona con la presencia de necrosis y puede ser el unico marcador tomografico de lesion isquemica transmural irreversible del colon, en ausencia de neumatosis o evidencias de perforacion intestinal

Herramientas útiles y métodos de búsqueda bibliográfica en PubMed: guía paso a paso para médicos

Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors.