[Spinal dural arteriovenous fistula with peri-medullary venous drainage: analysis of a series from a single centre and review of the literature]. / Les fistules artério-veineuses durales rachidiennes à drainage veineux péri-médullaire: analyse d'une série monocentrique et revue de la littérature.

INTRODUCTION: The optimal diagnosis and therapeutic managements of spinal dural arteriovenous fistulae, a rare disease, is discussed. MATERIAL AND METHODS: We report a series of 10 patients seen in a 7-year period, treated by embolization. RESULTS: There were 6 males and 4 females, with an average age of 58.4 years (range: 31 to 74 years). Diagnosis was made 2 days to 5 years (mean 15.3 months) after symptom onset with a high rate of incomplete or atypical clinical patterns (prolonged isolated sensory disorder, lumbo-sciatalgia, claudication, monoplegia), or sudden-onset deficit. In all cases, spinal MRI showed an intramedullary high-intensity signal on T2-weighted images but enlarged intradural vessels in only 70p.cent of cases. Angiography showed in all cases an arteriovenous fistula at the upper dorsal level (T1 to T7, 5 cases), lower dorsal (T8-T12, in 3 cases) and lumbar levels (2 cases). The fistula was successfully obliterated after initial embolization in 3 cases, but two (2 cases) or 3 procedures (2 cases) were sometimes required. The endovascular therapy failed in 3 cases. CONCLUSION: In this series, the fistula was successfully obliterated in 70p.cent of patients. In the literature, fistula of 96.8p.cent to 97.9p.cent of patients were obliterated by surgery, which is a more invasive treatment. Embolization could be used as the first-line therapy, but incomplete obliteration requires rapid surgery. While the success of embolization is demonstrated, MRI and angiography must still be performed 6 months later.

[Populational research of gastric cancer in digestive symptomatic patients, from 1996 to 2000]. / Pesquisa poblacional de cáncer gástrico en pacientes sintomáticos digestivos, período 1996-2000.

BACKGROUND: Gastric cancer is the first cause of death due to malignant tumors in Chile. Its mortality rates have stabilized in the last two decades and its prognosis is closely associated to the degree of tumor invasion at the moment of surgery. AIM: To study the frequency of gastric cancer among symptomatic patients subjected to an upper gastrointestinal endoscopy at a secondary care health center. PATIENTS AND METHODS: All upper gastrointestinal endoscopies performed to patients derived from public primary care clinics were recorded. RESULTS: In the study period, 4,145 endoscopies were done to 818 men and 2,128 women. Seventy one percent of patients were aged over 40 years of age. Fifty one carcinomas and one lymphoma were detected. Of these, 10 tumors were incipient. Thirty one patients were operated on and in 22 a total gastrectomy was performed. One patient, that required an esophageal resection, died. CONCLUSIONS: Gastric cancer was detected in 1.2% of symptomatic adult patients subjected to an upper gastrointestinal endoscopy.

El coordinador de trasplantes: su importancia en el procuramiento de órganos en Chile / Transplant coordinator: it importance in the organ procurement in Chile

El coordinador de transplante ha sido definido como: la persona que facilita el transplanta, desde la pesquisa del donante hasta el implante del órgano. Desde la década del 70 que su perfíl profesional se ha ido definiendo progresivamente para haberse constituido en una subespecialidad dentro de los profesionales de la salud. Es una persona que conoce todas las estapas del procuramiento de órganos, sirve de nexo entre los diversos profesionales involucrados y desarrolla importantes actividades de promoción y educación sobre la donación y el transplante de órganos. El objetivo de esta revisión fue conocer cuál ha sido la importancia a nivel nacional. Desde 1992 en adelante la red de coordinadores se ha incrementado de 1 a 18 profesionales. El número de donantes potenciales y efectivos se ha casi cuadruplicado (32 donantes efectivos en 1992; 132 donantes efectivos en 1999). En aquellos centros, en los cuales estos coordinadores son más activos (9 centros nacionales) se obtiene el mayor número de procuramiento y, en conjunto, suman más de 2/3 del total nacional. La proporción de donantes potenciales versus donantes efectivos se ha mantenido estable en este período. El número de transplantes de órganos sólidos en Chile también se ha cuadruplicado (de 75 en 1992 a 300 en 1999). A futuro esta red debe incrementarse a todos los hospitales clase A del país

[Gutiérrez Bueno (1745-1822), textbooks and a new public for chemistry in the last third of the 18th century]. / Pedro Gutiérrez Bueno (1745-1822), los libros de texto y los nuevos pùblicos de la química en el último tercio del siglo XVIII.

This paper is a part of a general research project on the role that chemistry played in the transition of materia medica to experimental pharmacology during 19th century Spain. Within this general framework, the paper deals with the main characteristics of Spanish textbooks aimed at pharmaceutical and medical students. In a former study, published in this journal, we outlined the institutional context in which these books were read, written and published. Some of these issues are developed in the present paper through analysis of the "Curso de química" written by Pedro Gutiérrez Bueno. New light is shed on the public for chemistry during the late XVIII century Spain and their role in shaping the contents and organisation of chemistry textbooks.

[Chemistry textbooks for Spanish students of medicine and surgery (1788-1845]. / Los libros de texto de quimica destinados a estudiantes de medicina y cirugia en Espana (1788-1845).

This paper is a part of a general research project on Spanish pharmacology during the 19th century. Among other issues, this project addressed the role that chemistry played in transforming materia medica into experimental pharmacology. Within this general framework, this paper deals with chemistry textbooks aimed at students of medicine and surgery during the late 18th century and the first half of the 19th century. Our purpose is to shed light on the institutional context in which these books were read, written and published during this period. The study begins in 1788, the year in which several important chemistry textbooks were published, including various French translations and the textbooks of Pedro Gutierrez Bueno. After highlighting Fourcroy's influence on Spanish chemistry, we study the debate on the medical applications of chemistry by analyzing a substantial text written by Juan M. de Arejula. In addition, some of the most important characteristics of medicine and surgery teaching institutions are outlined by paying special attention to the syllabus and textbooks employed in their classrooms. Our study ends in 1845 with Jose Pidal's so-called educational reforms.

Evaluación de un programa de procuramiento de riñón cadáver: realidad y futuro en el trasplante de órganos vascularizados / Evaluation of a cadaver kidney retrieval program: reality and future in the vascularized organ transplant

La donación de órganos para trasplantes vascularizados continúa insuficiente de acuerdo a las necesidades existentes en nuestro país. Diversos estudios han estimado el número potencial de donantes en alrededor de 25-40 individuos por millón de habitantes por año. Existe un gran número potencial de donantes que se pierden por negativa familiar o por falta de interés del cuerpo médico. El objetivo de este trabajo fue analizarcúal fue la realidad en lo que se refiere a pesquisa de donantes y obtención de órganos para trasplante, especifícamente en lo que se refiere a riñones y cuales son las posibilidadesfuturas. Se estudió el período del 1 de enero de 1992 al 30 de abril de 1993. se pesquisó 94 potenciales donantes (63 hombres y 31 mujeres), con 80 por ciento de ellos menores de 44 años. Un 30 por ciento de los donantes no alcanzaron a ser donantes efectivos por negativa familiar. Más del 66 por ciento de los individuos con muerte encefálica fueron por trauma. El 71,2 por ciento presentó muerte cerebral a las 48 horas de ingreso a un servicio de Urgencia. Existen 4 Centros Nacionales que aportan más del 50 por ciento de todos los riñones para trasplante de donante de cadáver. Existe un 15 por ciento de los riñónes obtenidos que van derivados a Centros no procuradores. El porcentaje de recuperación de donantes efectivos se mantiene en alrededor del 25 por ciento en los últimos 6 años. Para mejorar estos resultados, en lo que se refiere a trasplante renal y de otros órganos, en nuestro país debe fomentarse campañas públicas periódicas, sensibilizar a la comunidad médica, concentrar los recursos disponibles en unos pocos lugares y efectuar evaluaciones periódicas de los resultados