[Internet physician's offices: main reasons for consultation and differences with Primary Care offices]. / Consultorios médicos por internet: principales motivos de consulta y diferencias con la Atención Primaria.

INTRODUCTION: Direct communication between patients and physicians through internet can represent an opportunity for medical consultation because of higher access that provides this medium. METHODS: A retrospective observational study was conducted in order to know the content and the characteristics of the consultations of a free medical physician's office by internet and its differences with the consultations in Primary Care. RESULTS: During a period of 45 days 221 consultations of which 188 corresponded to health problems were received. The average age of the consultants was very young (21.5 15.7 years; average SD), with predominance of men over women (1,4:1). In the consultations by internet, and in comparison with those of Primary Care, dermatological (relative risk: 6.1; CI 95%: 5.2-10.8), nervous system and sense organs (RR: 1.9; CI 95%: 1.3-2.8), genitourinary (RR: 2.0; CI 95%: 1.3-3.2), and digestive system (RR: 1.7; CI 95%: 1.1-2.6) consultations were carried out more frequently; less frequent consultations were those of respiratory tract (RR: 0.30; CI 95%: 0.16-0.56) and circulatory system (RR: 0.11; CI 95%: 0.03-0.33). CONCLUSIONS: The characteristics of this type of consultations and of the population group that ask for them are the reasons that their content and the grade of resolution of problems are very far from those of Primary Care.

Acute iridocyclitis in a patient with AIDS diagnosed as toxoplasmosis by PCR.

PURPOSE: To study the etiology of an acute iridocyclitis in a patient with AIDS using polymerase chain reaction (PCR) analysis of aqueous humor. METHODS: Case report describing a patient diagnosed with toxoplasmic retinochoroiditis in his left eye. He stopped his treatment after three weeks and subsequently developed an acute iridocyclitis without chorioretinitis in the fellow eye. Anterior chamber paracentesis was performed and aqueous humor was assayed by PCR. RESULTS: PCR of the aqueous humor showed positivity for Toxoplasma gondii. The iridocyclitis responded to topical dexamethasone and oral treatment with pyrimethamine and sulfadiazine. CONCLUSION: PCR is an effective method to diagnose toxoplasmic iridocyclitis in a patient with AIDS.

[Multidisciplinary study of cerebrovascular accidents: I. Definition, design, and general results]. / Estudio multidisciplinario del accidente vascular encefálico: I.- Definición, diseño y resultados generales.

Cerebrovascular accidents (CVA) constitute a major cause of adult cardiac cardiovascular mortality in Chile. From July 87 to August 89 we prospectively studied 300 patients with CVA utilizing a multidisciplinary approach. Besides clinical evaluation this included brain CT scan (48 hrs), glucidic and lipid profile. Occlusive CVA were additionally studied with 2D-Echocardiogram, 24 hr Holter, Cerebral Angiography and/or carotid Duplex Echotomograph, and a second brain CT scan was performed within the first week. We found a 62.3% incidence of cerebral infarcts, 28.3% of cerebral hemorrhages and 9.3% of transient ischemic attacks. Cerebral infarcts were found to be cardiac related in 33.5% of cases, whereas 13.2% were lacunar, 4.4% were atherothrombotic and 14% had no precise etiology. Hypertension was associated to cerebral hemorrhages in 76% of cases, 26% of which were intracranial. At 2 months of follow-up 16.3% of patients were severely handicapped and mortality was 19.3%. We have confirmed that cerebral infarcts constitute the most common cause of CVA and most of them are cardiac related. Hypertension appears to be the most important cause of cerebral hemorrhage. A multidisciplinary approach to cerebrovascular accidents allowed a more precise diagnosis and contributed to implement appropriate therapeutic and preventive strategies. Proper identification of high risk patients could contribute to decrease the high incidence and mortality of CVA in our community.

[Etomidate perfusion in neurosurgery]. / Perfusión de etomidato en neurocirugía.

In this prospective study, 20 patients undergoing mean duration (2-3 h) neurosurgical operations on fossa cranii posterior, and cervical and dorsolumbar rachis, were induced with 0.3 mg/kg etomidate bolus dose. To maintain anesthesia, etomidate perfusions at 10 micrograms/kg/min (group I) and 20 microg/kg/min (group II) were administered. Fentanyl at fractionated doses was used as analgesic without association to nitrous oxide and relaxation was achieved with pancuronium bromide. Quality of hypnosis, changes in serum concentration of cortisol as well as hemodynamic and electrolyte changes were evaluated. Serum concentrations of cortisol, glucose, sodium and potassium were measured in basal state, and during perioperative and postoperative period. Hemodynamic status was monitored and side effects were recorded. Patients of group I presented signs of deficient hypnosis consisting of marked sympathetic response. When etomidate perfusion ceased, both groups presented serum concentrations of cortisol under the lower normal limit. Six hours after operation, mean serum concentration of cortisol in group 2 patients was significantly lower than in group I patients; in their samples, a dose-dependent recovery was detected. Serum glucose concentration increased during anesthesia and operation and serum electrolyte concentration remained within normal range during perioperative and postoperative periods. Our results demonstrate that a 20 micrograms/kg/min etomidate infusion is adequate to achieve neuroanesthesia when nitrous oxide administration is contraindicated.