Aurelio Carvallo

Enfermedad de Still del adulto: Una gran simuladora. Experiencia clínica basada en 20 casos

Background: Adult Still’s disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute. Aim: To report our experience with Adult Still’s disease. Material and methods: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still’s disease, followed in two public hospitals of Metropolitan Santiago. Results: Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed leukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and leflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode. Conclusions: Adult Still’s disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis (Rev Med Chile 2009; 137: 1010-6).

Consideraciones éticas sobre el error en medicina

It is usually inevitable to save the physician-patient relationship from the effects of medical errors. It is so because either the professional responsibility, the patients trust and the principles that govern the medical action are compromised by such events. The possibility to learn from it, prevent its appearance, improve the procedures and curtail its consequences, is linked to developing ethical attitudes to overcome these circumstances without further legal accountability (Rev Med Chile 2001: 129: 1463-5)

Dermatomiositis juvenil: manifestaciones clínicas y de laboratorio

more additional skin signs. Ninety percent of patients had risen se^um activity of muscle associateden^imes, lactic dehydrogenase (LDH) being the most constantly elevated: 7/7 studied cases. All patients showedabnormal electromyographic and hystologic findings in muscle biopsy. Treatment was based upon rehabilitation,prednisone (average daily dose: 1.5mg • kg of body weight) associated o

Reflexiones en torno a la ley N° 20.584 y sus implicancias para la investigación biomédica en Chile

After years of discussion by the Chilean legislature, the Law No 20.584, which regulates health care related rights and duties of people, entered into force in Chile in October 2012. This bill represents an important step in the recognition and protection of health care related rights, welfare, dignity and duties of persons. It also intends to protect potential participants in clinical research. However such protective measures include explicit prohibitions such as the review of clinical records or the inclusion of people with mental or psychological handicaps as research participants. We herein discuss the implications of this law in medical research.