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Presentamos el caso de un paciente, fumador de dos paquetes/día, que acudió a un servicio médico de urgencias refiriendo un cuadro de tres días de evolución de disnea y edema facial y palpebral. Con el diagnóstico de edema angioneurótico es remitido a nuestro servicio para estudio. A la exploración física el paciente presentaba un edema cérvico-facial y palpebral, así como una ingurgitación de las venas yugulares. En la parte superior del tórax se evidenciaron dilataciones varicosas de las venas superficiales. Con el diagnóstico de sospecha de síndrome de la vena cava superior (SVCS), se realizó una radiografía de tórax, en la que se objetivaron una masa pulmonar y un ensanchamiento mediastínico. Tras realizar una biopsia transbronquial mediante fibrobroncoscopía, se establece el diagnóstico de carcinoma broncogénico de células pequeñas (oat-cell). Se comentan la etiología, diagnóstico diferencial y tratamiento del SVCS (AU)

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Presentamos el caso de un paciente, fumador de dos paquetes/día, que acudió a un servicio médico de urgencias refiriendo un cuadro de tres días de evolución de disnea y edema facial y palpebral. Con el diagnóstico de edema angioneurótico es remitido a nuestro servicio para estudio. A la exploración física el paciente presentaba un edema cérvico-facial y palpebral, así como una ingurgitación de las venas yugulares. En la parte superior del tórax se evidenciaron dilataciones varicosas de las venas superficiales. Con el diagnóstico de sospecha de síndrome de la vena cava superior (SVCS), se realizó una radiografía de tórax, en la que se objetivaron una masa pulmonar y un ensanchamiento mediastínico. Tras realizar una biopsia transbronquial mediante fibrobroncoscopía, se establece el diagnóstico de carcinoma broncogénico de células pequeñas (oat-cell). Se comentan la etiología, diagnóstico diferencial y tratamiento del SVCS

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Background: Oral isotretinoin (Roaccutane) revolutionized the treatment of acne when it was introduced in 1982. Methods: Twelve dermatologists from several countries with a special interest in acne treatment met to formally review the survey of their last 100 acne patients treated with oral isotretinoin. The primary purpose of the survey was to identify the types of acne patients who were prescribed oral isotretinoin and low the patients were managed. Results: Of the 1,000 patients reviewed, 55% of those who received oral isotretinoin had those indications treated historically, i.e. severe nodular cystic acne or severe inflammatory acne, not responding to conventional treatment. Forty-five percent pd patients who were prescribed oral isotretinoin however and either moderate or mild acne. Most patients in this group had moderate acne (85%). Hovewer, 7.3% had mild acne on physial examination. The criteria for prescribing oral isotretinoin in this less severe group of patients included acne that improves <50% after 6 months of conventional oral antibiotic and topical combination therapy, acne that scars, acne that induces psychological distress and acne that siginificantly relapses during or quickly after conventional therapy. Treatment is usually initiated at daily doses of 0.5 mg/kg (but may be higher) and is increased to 1.0 mg/kg. Mucocutaneous side-effects occur frequently but are manageable while severe systemic side-effects are rarely problematic (2%). The teratogenicity of oral isotretinoin demands responsible consideration by both female patients and their physicians. Significant cost savings when treating acne patients with oral isotretinoin as compared to other treatment modalities were further proven in this study. Conclusions: Our recommendation is that oral isotretinoin should be prescribed not only to patients with severe disease but also to patients with less severe acne, especially if there is scarring and significant psychological stress associ...

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Las histiocitosis constituyen un grupo heterogéneo de enfermedades de causa desconocida y caracterizada por la presencia de histiocitos reactivos neoplásicos en varios tejidos y órganos. En su clasificación existe un grupo poco frecuente y conocido como histiocitocitosis de células de Langerhans cutánea pura autoinvolutiva. Se han descrito casos en todo el mundo y esta enfermedad se caracteriza por la proliferación de células de Langerhans con afección cutánea exclusiva y su tendencia a la curación espontánea. Presentamos dos casos clínicos

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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.

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We performed a survey concerning the use of psychotropic drugs among 223 patients admitted to a university hospital in November 1986. 39% of patients were receiving some psychotropic drug, and 73% of these corresponded to benzodiazepines. Insomnia and anxiety were reported as the main causes for drug use. Patients above age 50 were most affected. 61% of drugs had been in use for more than 6 months. These results confirm previous findings regarding psychotropic drug use in adults.

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It has been suggested that manifestations of mental illnesses have been changing during the last decades. Thus, the catatonic form of schizophrenia is scarcely observed nowadays and should be about to disappear. Changes in both catatonic schizophrenia prevalence, and catatonic symptoms are analyzed according to revisions dated 1964, and 1984, of the clinical records to be found at the Psychiatric Clinic, University of Chile. A diminution of schizophrenia catatonic forms in 1984 records was found out when comparing with 1964 records. A diminution of catatonic symptons--usually associated to severe forms of schizophrenia--was also noticeable. In both groups, however, such variations have no relation whatever with the extent of the evolutive period prior to institutionalization.

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Os autores apresentam um caso de embolia cutânea por cristais de colesterol. Após revisäo da literatura discutem sua paratogênese, clínica, histopatologia e prognóstico; sugerem que em caso de aparecimento súbito de livedo reticular, o diagnóstico da embolia cutânea por cristais de colesterol deve ser cogitado

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It has been suggested that manifestations of mental illnesses have been changing during the last decades. Thus, the catatonic form of schizophrenia is scarcely observed nowadays and should be about to disappear. Changes in both catatonic schizophrenia prevalence, and catatonic symptoms are analyzed according to revisions dated 1964, and 1984, of the clinical records to be found at the Psychiatric Clinic, University of Chile. A diminution of schizophrenia catatonic forms in 1984 records was found out when comparing with 1964 records. A diminution of catatonic symptons--usually associated to severe forms of schizophrenia--was also noticeable. In both groups, however, such variations have no relation whatever with the extent of the evolutive period prior to institutionalization.

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É apresentado o primeiro caso espanhol publicado de reticuloendoteliose com eosinofilia (doença de Omenn). Este quadro é considerado, atualmente, como uma imunodeficiência mista, grave e mortal, que dá lugar a uma proliferaçäo histiocitária reativa generalizada. No plano clínico, caracteriza-se por apresentar-se em lactentes, em forma de infecçöes diversas, diarréias, eritrodermia, alopécia, deterioraçäo do estado geral, hepatoesplenomegalia, adenopatias generalizadas e eosinofilia persistente. Em alguns casos, tem-se observado um déficit de 5-nucleotidase linfocitária e um aumento de IgE. O diagnóstico diferencial deve ser feito, fundamentalmente, com as histiocitoses malígnas (histiocitose X e histiocitoses que cursam com autocitofagia) e com outras histiocitoses reativas secundárias a déficits imunitários congênitos

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Se estudia una población chilena de 567 pacientes (1.134 ojos) de consulta por morbilidad oftalmológica general, en busca de la Arteria Cilioretinal. Se determina una frecuencia de 26,2% en el grupo de pacientes y de 15,9% en el total de ojos, siendo más frecuente en hombres. Fue bilateral en 5,6% del grupo y en 21,5% de todas las ACR encontradas. La ubicación más frecuente es temporal (97%) y la longitud en 76,4% mayor de 1 diámetro discal (1,5 mm). Se determina alta correlación (93,3%) entre el diagnóstico oftalmoscópico y la confirmación angliográfica

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