[Congenital adrenal hyperplasia causing male infertility. Report of one case]. / Alteración de la fertilidad masculina por hiperplasia suprarrenal congénita. Azoospermia reversible con terapia de glucocorticoide.

In males, congenital adrenal hyperplasia due to 21 hydroxylase deficiency is associated to normal fertility or infertility caused by a hypogonadotrophic hypogonadism (HH) or gonadal damage caused by intratesticular adrenal remnants. We report a 29-year-old male with azoospermia, without any important personal or family background. Physical examination was normal, his height was 150 cm and his testicular volume was 10 ml (normal 15 to 25 ml). Laboratory showed a normal testosterone and FSH and LH in the low normal limit. These results discarded a HH, whose diagnostic requirements are a low testosterone and inadequately normal or low gonadotrophins. A testicular biopsy was informed as compatible with HH. A 21 hydroxylase deficiency was suspected and confirmed with extremely high levels of 17 hydroxyprogesterone at baseline and after stimulation with fast acting ACTH. Clomiphene citrate did not increase testosterone or gonatrophin levels. Testicular ultrasound discarded the presence of adrenal nodules. Betametasone therapy resulted in a normal testicular development, normalization of sperm count, reduction of 17 hydroxyprogesterone and testosterone levels with an ulterior rise of the latter. Spontaneous paternity was achieved twice. It must be remembered that in cases of azoospermia due to congenital adrenal hyperplasia, testosterone produced by adrenal glands hinders the laboratory diagnosis of HH.

Clinical behavior of solitary fibrous tumor: a retrospective review of 30 patients.

BACKGROUND: Solitary fibrous tumors (SFTs) are a rare type of soft tissue sarcoma of unpredictable clinical behavior. Some clinicopathologic characteristics have also been related to patient outcome. METHODS: This study is a retrospective review of 30 patients. We analyzed the clinical course and pathological factors to predict recurrence. RESULTS: The mean age was 55.9 years. Forty-five percent were located in the thoracic region. The mean tumor size was 10 cm (max24). Thirty-three percent had a relapse and 20 % have died. Median time to relapse was 7.18 (1-13) years. Median overall survival (OS) was 15.5 years (0-32). On histopathologic analysis, 6 % percent had >4 mitoses, 23 % had necroses, and 36 % had atypia/pleomorphism. Forty-three percent had tumor size >10 cm. Forty-six percent had at least one characteristic of malignancy. None of this data could predict clinical behavior by itself. CONCLUSIONS: SFT can be an aggressive disease and relapses can occur several years from diagnosis. We did not find any clinicopathologic factors that could predict the tumor behavior accurately. Nevertheless, it should be consider that we included different tumor locations and the sample size is small.

Muertes por suicidio en la Región de Tarapacá, años 1990-2013 / Suicides death in the Region of Tarapacá, years 1990-2013

Introduction: It presents the update of an epidemiologic descriptive study of deaths by suicide that took place in the Tarapacá region, Chile. The study encompasses almost a quarter of a century, between the years 1990 and 2013, and brings interesting information with respect to the tendencies of the phenomenon along an extensive period of time. Method: A retrospective epidemiologic descriptive study of type transvensal of deaths classified as violent in the autopsy protocols of the Servicio Médico Legal of the city of Iquique and the medical death certificate. Results: In a total of 565 cases, a general rate of suicide for this period of 9,18 for 100.000 hab has been noted, with variations of the annual rates between 4, 95 in the year 1995 and 13, 97 in the year 1999. It was observed that suicide was more frequent between the ages 20 and 44 years, with a relation men-women of 5,3:1. Conclusions: The previous study (2010) confirmes a tendency to the stabilization of the increasing rates observed in the past decade. In figures this rate was somehow inferior to the general rate of suicide of the country in the year 2011 (13,3 for 100.00 hab.), but it doubled the registered rates in the 90’s.

Introducción: Se presenta la actualización de un estudio epidemiológico descriptivo de las muertes por suicidio ocurridas en la región de Tarapacá, Chile, abarcando casi un cuarto de siglo, entre los años 1990 y 2013, lo que aporta una interesante información respecto del movimiento tendencial del fenómeno a lo largo de un período extenso de tiempo. Método: Estudio epidemiológico descriptivo de tipo retrospectivo transversal a partir de las muertes clasificadas como violentas en los protocolos de autopsias del Servicio Médico Legal de Iquique y del certificado médico de defunción. Resultados: En un total de 565 casos, constatamos una tasa general de suicidio para el período de 9,18 por 100.000 hab., con variaciones de tasas anuales que van entre 4,95 el año 1995 y 13,97 el año 1999; se observó que el suicidio fue más frecuente entre los 20 y los 44 años, con una relación hombre-mujer de 5,3:1. Conclusiones: Respecto del estudio anterior (2010) se confirma una tendencia a la estabilización del alza de tasas observada en la década anterior, en cifras algo inferiores a la tasa general de suicidio del país en el año 2011 (13,3 por 100.000 hab.), pero el doble respecto a las tasas registradas en los años noventa.

[Etiological study of gynecomastia: results of a prospective study and recommendations]. / Etiología de la ginecomastía: Importancia de no subdiagnosticar una ginecomastia patológica.

BACKGROUND: Gynecomastia can be physiological or pathological. A limited study of gynecomastia is recommended during puberty and in the elderly, ages in which gynecomastia is usually considered physiological. Other authors suggest that this condition should be studied when it is painful, rapidly growing, of recent onset, when its diameter is more than 4 cm and when is associated to testicular masses. AIM: To investigate the causes of gynecomastia and to evaluate the above mentioned criteria to exclude pathological conditions. MATERIAL AND METHODS: Prospective study of 117 patients aged 10 to 83 years, consulting for gynecomastia. All were subjected to a standardized study including a clinical examination and measurement of plasma estradiol and testosterone levels. RESULTS: Forty one percent of gynecomastias were considered pathological and the rest, physiological. Among pathological conditions, 18 patients had an endocrine etiology (hypogonadism in ten patients, estrogen secreting tumors in three, hyperestrogenism of unknown etiology in four and peripheral resistance to androgens in one), in 17 it was secondary to medications and in 13 it was secondary to other causes (idiopathic, pesticide exposure, alcoholism, diabetes or re feeding). In 79% of 86 patients of less than 20 years, the condition was physiological and in four of five elderly subjects, it was pathological. Thirty nine percent of pathological gynecomastias lacked the signs and symptoms that according to authors, should prompt a thorough study. CONCLUSIONS: All patients with gynecomastia should be studied with a complete medical history and the measurement of estradiol and testosterone levels. The criteria proposed to conduct minimal studies in gynecomastia, would miss a large volume of pathological conditions.

[Influence of size and duration of gynecomastia on its response to treatment with tamoxifen]. / Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico.

BACKGROUND: Gynecomastia is treated when it is painful, there are psychosocial repercussions or it does not revert in less than two years. It is treated with the antiestrogenic drug tamoxifen, but there are doubts about its effectiveness in high volume gynecomastias or in those lasting more than two years. AIM: To assess the effectiveness and safety of tamoxifen for gynecomastia and the influence of its volume and duration on the response to treatment. PATIENTS AND METHODS: Forty three patients with gynecomastia, aged 12 to 62 years, were studied. Twenty seven patients had a pubertal physiological gynecomastia, in eight it was caused by medications, in four it was secondary to hypogonadism, in three it was idiopathic and in one it was due to toxic exposure. Twenty patients had mastodynia and in 33, gynecomastia had a diameter over 4 cm. It lasted less than two years in 30 patients, more than two years in nine and four did not recall its duration. All were treated with tamoxifen 20 mg/day for 6 months. A follow up evaluation was performed at three and six months of treatment. RESULTS: Mastodynia disappeared in all patients at three months. At six months gynecomastia disappeared in 26 patients (62%), but relapsed in 27%. All gynecomastias caused by drugs with antiandrogen activity disappeared. Fifty two percent of gynecomastias over 4 cm and 90% of those of less than 4 cm in diameter disappeared (p<0.05). Fifty six percent of gynecomastias lasting more than two years and 70% of those of a shorter duration disappeared (p=NS). Two patients had diarrhea or flushes associated to the therapy. CONCLUSIONS: Tamoxifen is safe and effective for the treatment of gynecomastia. Larger lesions have a lower response to treatment.

Alteración de la fertilidad masculina por hiperplasia suprarrenal congénita: Azoospermia reversible con terapia de glucocorticoide / Congenital adrenal hyperplasia causing male infertility: Report of one case

In males, congenital adrenal hyperplasia due to 21 hydroxylase deficiency is associated to normal fertility or infertility caused by a hypogonadotrophic hypogonadism (HH) or gonadal damage caused by intratesticular adrenal remnants. We report a 29-year-old male with azoospermia, without any important personal or family background. Physical examination was normal, his height was 150 cm and his testicular volume was 10 ml (normal 15 to 25 ml). Laboratory showed a normal testosterone and FSH and LH in the low normal limit. These results discarded a HH, whose diagnostic requirements are a low testosterone and inadequately normal or low gonadotrophins. A testicular biopsy was informed as compatible with HH. A 21 hydroxylase deficiency was suspected and confirmed with extremely high levels of 17 hydroxyprogesterone at baseline and after stimulation with fast acting ACTH. Clomiphene citrate did not increase testosterone or gonatrophin levels. Testicular ultrasound discarded the presence of adrenal nodules. Betametasone therapy resulted in a normal testicular development, normalization of sperm count, reduction of 17 hydroxyprogesterone and testosterone levels with an ulterior rise of the latter. Spontaneous paternity was achieved twice. It must be remembered that in cases of azoospermia due to congenital adrenal hyperplasia, testosterone produced by adrenal glands hinders the laboratory diagnosis of HH.

Prevalencia del suicidio en la Región de Tarapacá, años 1990-2008 / Prevalence of suicide in the Region of Tarapacá, years 1990-2008

Hemos llevado a cabo un estudio epidemiológico descriptivo de las muertes de tipo suicida en Tarapacá, Chile, entre los años 1990 y 2008, obteniéndose interesantes datos acerca del comportamiento de este fenómeno en una zona extrema, con indicios de una compleja adaptación social y dificultades en la integración individual. En un total de 432 casos, por ejemplo, la tasa de suicidio varió de un 6,11 por 100.000 hab. en 1990 a 13,32 por 100.000 hab. en 2008; se observó que el suicidio fue más frecuente entre los 20 a 44 años, especialmente en hombres, con una proporción cercana a 6:1, siendo el mecanismo más utilizado el ahorcamiento, tanto entre hombres como mujeres. Otro punto interesante lo constituye el hecho de que la tasa de suicidio a partir de 1996 se duplica respecto a los años precedentes, excediendo las tasas de otras regiones del país, la tasa nacional de suicidio y la de muchos países de la región y de Europa, constituyéndose en la segunda causa de muerte violenta en la provincia, lo cual nos retrotrae al complejo fenómeno biopsicosocial involucrado en la génesis del suicidio.

We carried out an epidemiological descriptive study of suicidal type deaths in Tarapacá, Chile, between 1990 and 2008, collecting interesting information about the behavior of this phenomenon in an extreme zone, with indicators of a complex social adjustment and difficulties in individual integration. In a whole of 432 cases, for example, the rate of suicide changed from 6.11 for 100.000 hab. in 1990 to 13.32 for 100.000 hab. in 2008; we observe that the suicide was more frequent in ages between 20 to 44 years, especially in men with a nearby proportion of 6:1, being the mechanism most used in both sexes, the hanging. Another interesting point constitutes the fact that the rate of suicide from 1996 doubled in relation to previous years, exceeding the rates of other regions of the country, the national rate and the rate of many American countries and even some European countries, being constituted in the second cause of violent death in our province, which makes us think about the complex phenomenon biopsicosocial involved in the genesis of the suicide.

Morphology and electrophysiological properties of reticularis thalami neurons in cat: in vivo study of a thalamic pacemaker.

Reticularis thalami neurons (RE neurons) were identified morphologically, and their electrophysiological properties were studied in cat under barbiturate anesthesia. Intracellular HRP injections showed that RE neurons possessed very long dendrites bearing numerous filopodia-like appendages and that their axons were directed toward main thalamic nuclei. As a rule, small axonal branches were also emitted within the RE nucleus itself. At rest, the membrane potential of RE neurons displayed 2 types of oscillations: a slow 0.1-0.2 Hz oscillation and fast 7-12 Hz oscillations occurring on the positive phase of the former. Episodes of spindle (7-12 Hz) waves lasted for 2-3 sec and were characterized by rhythmic depolarizations and burst discharges. Intracellular injections of QX314 and current pulse analyses revealed the presence in RE cells of 2 distinct inward currents: a persistent current that promoted tonic firing and a low-threshold current deinactivated by hyperpolarization that generated burst discharges. The low-threshold current deinactivated with large somatic hyperpolarizations (up to 30 mV) and produced depolarizing responses that lasted for about 70 msec. In addition, low-threshold responses appeared rhythmically at intervals of about 150 msec after recovery of the membrane potential from hyperpolarization. Because of their duration, voltage dependence, and persistence after intracellular injections of QX314, it is suggested that these responses resulted from activation of a low-threshold Ca2+ current at the dendritic level. In QX314-injected cells, selective components of spontaneous oscillations were abolished, among them the positive phase of the slow oscillation and late depolarizing humps that followed burst discharges within spindle sequences. However, the rhythmic occurrence of spindle episodes at 0.1-0.2 Hz was never affected by DC currents or by QX314 or Cl- injections, suggesting that oscillations within a particular RE neuron partly reflected the oscillatory behavior of a network of cells. On the basis of these electrophysiological results and the known morphological and neurochemical features, a new hypothesis is proposed to account for the rhythmicity of RE neurons.

[Frequency of Trichomonas vaginalis infection in apparently healthy women in western Santiago]. / Frecuencia de infeccion por Trichomonas vaginalis en mujeres aparentemente sanas del area occidente de Santiago.

PIP: The incidence of infection by Trichomonas vaginalis in apparently healthy women was surveyed in the western area of Santiago, Chile, which comprised both urban and rural areas with medium- or low-income people. A retrospective review of the data of the cytopathology laboratory of San Juan de Dios Hospital was conducted. The data contained all annual Pap smears and epidemiological information about the presenting patients. During 1983, a total of 29,501 women had Pap smears taken to detect signs of early cervical and uterine cancer. 10,491 of these women came from rural areas of the western health district and sought medical care in hospitals located there. The rest of the women (19,010) were urban inhabitants who attended consultation rooms and polyclinics in the peripheries. It was found that, among 29,501 smears of cervical secretions examined, 3365 contained Trichomonas vaginalis (11.4% of the studied group). The age range of those affected was 20-49 years. There was no difference in infection rate between rural and urban inhabitants. The presence of T. vaginalis was 9.1% in the 10-19 age group; 12.3% in the 20-29 age group; 11.5% in the 30-39 age group; and 11.6% in the 40-49 age group. The 20-49 age group had the highest incidence, because their sexual activity also was the highest. A previous (1975) investigation in Santiago indicated a 7.9% rate of infection by T. vaginalis; therefore, it can be concluded that infection maintains a fairly stable incidence in this female population.^ieng

Locomotor and feeding activity rhythms in a light-entrained diurnal rodent, Octodon degus.

The wheel running (WR) and feeding activity (FA) of Octodon degus, a new laboratory rodent characterized by its diurnal habits, were recorded under different lighting conditions. Under 12:12-h light-dark (LD 12:12) cycles, WR activity exhibited a crepuscular pattern with two peaks, M and E, associated with "dawn" and "dusk," respectively. In both cases, an anticipatory activity was patent, suggesting that, beside the masking effect of LD transitions, both peaks have an endogenous origin. This pattern, which was also observed under a skeleton photoperiod (LD 0.5:11.5), became unimodal after LD 0.5:23.5 and constant darkness (DD) exposure. Simultaneously, FA showed an arrhythmic pattern in most animals, especially under DD, when none of the animals exhibited a significant circadian rhythm. The existence of two groups of oscillators, or two oscillators, would explain most properties of the WR rhythms noted in this species. Our results show that the degu's temporal feeding strategy seems mainly arrhythmic, whereas its WR pattern is driven by a strongly circadian bimodal rhythm.

A cost-analysis of suspected adverse drug reactions in a hospital emergency ward.

The main objective of this study was to analyse the minimum direct cost to the Public Health System (PHS) of diagnosing and treating those patients attended to in the emergency ward (EW) for suspected adverse drug reaction (ADR). The cases were collected during March 1995 in the emergency ward of a 900-bed tertiary teaching hospital that covers 900,000 inhabitants. ADR was considered according to the WHO definition. The following EW costs were used: EW physician visit 78.5 ecus (1 ecu=156 pesetas), thorax or abdomen radiograph 21.5 ecus, computerized tomography 112.7 ecus, endoscopy 48 ecus, specialist physician visit 62 ecus. Three types of laboratory costs were considered: block of biochemical tests 16 ecus, biochemical tests with blood count 22.5 ecus, and biochemical tests with blood count and coagulation study 41.6 ecus. Pharmacotherapy of the ADR and changes in patient's usual drug therapy due to ADR were estimated. For patients admitted in the hospital, a per day cost of 391 ecus was considered. A mean ADR cost per organ or system affected (cutaneous, metabolic, gastrointestinal, nervous) was computed. The main conclusion of this study is that ADR, apart from inflicting damage on the patients, also incur PHS costs. The quantity of 42,732 ecus during the month of March, in a single hospital, can seem small when compared with the cost of some diseases such as AIDS or ischemic heart disease. But remembering that about 40% of all ADR attended to in hospitals is avoidable, a decrease of 40% could produce an annual saving of 205,216 ecus to the hospital, which is twice the annual budget of the Pharmacovigilance Centre of the Basque Country. Pharmacovigilance centres should include cost analysis of ADR among their objectives, to provide health systems managers with enough information to implement those measures that will result in a better utilization of the scarce resources of the Public Health System.

Terapia médica de la ginecomastia con tamoxifeno. Influencia del volumen y duración de la ginecomastia en el resultado terapéutico / Influence of size and duration of gynecomastia on its response to treatment with tamoxifen

Background. Gynecomastia is treated when it is painful, there are psychosocial repercussions or it does not revert in less tan two years. It is treated with the antiestrogenic drug tamoxifen, but there are doubts about its effectiveness in high volume gynecomastias or in those lasting more than two years. Aim. To assess the effectiveness and safety of tamoxifen for gynecomastia and the influence of its volume and duration on the response to treatment. Patients and methods. Forty three patients with gynecomastia, aged 12 to 62 years, were studied. Twenty seven patients had a pubertal physiological gynecomastia, in eight it was caused by medications, in four it was secondary to hypogonadism, in three it was idiopathic and in one it was due to toxic exposure. Twenty patients had mastodynia and in 33, gynecomastia had a diameter over 4 cm. It lasted less than two years in 30 patients, more than two years in nine and four did not recall its duration. All were treated with tamoxifen 20 mg/dayfor 6 months. A follow up evaluation was performed at three and six months of treatment. Results. Mastodynia disappeared in all patients at three months. At six months gynecomastia disappeared in 26 patients (62 percent), but relapsed in 27 percent. All gynecomastias caused by drugs with antiandrogen activity disappeared. Fifty two percent of gynecomastias over 4 cm and 90 percent of those of less than 4 cm in diameter disappeared (p<0.05). Fifty six percent of gynecomastias lasting more than two years and 70 percent of those of a shorter duration disappeared (p=NS). Two patients had diarrhea or flushes associated to the therapy. Conclusions: Tamoxifen is safe and effective for the treatment of gynecomastia. Larger lesions have a lower response to treatment.

Etiología de la ginecomastía: Importancia de no subdiagnosticar una ginecomastia patológica / Etiological study of gynecomastia: Results of a prospective study and recommendations

Background : Gynecomastia can be physiological or pathological. A limited study of gynecomastia is recommended during puberty and in the elderly, ages in which gynecomastia is usually considered physiological. Other authors suggest that this condition should be studied when it is painful, rapidly growing, of recent onset, when its diameter is more than 4 cm and when is associated to testicular masses. Aim: To investigate the causes of gynecomastia and to evaluate the above mentioned criteria to exclude pathological conditions. Material and methods: Prospective study of 117 patients aged 10 to 83 years, consulting for gynecomastia. All were subjected to a standardized study including a clinical examination and measurement of plasma estradiol and testosterone levels. Results: Forty one percent of gynecomastias were considered pathological and the rest, physiological. Among pathological conditions, 18 patients had an endocrine etiology (hypogonadism in ten patients, estrogen secreting tumors in three, hyperestrogenism of unknown etiology in four and peripheral resistance to androgens in one), in 17 it was secondary to medications and in 13 it was secondary to other causes (idiopathic, pesticide exposure, alcoholism, diabetes or re feeding). In 79 percent of 86 patients of less than 20 years, the condition was physiological and in four of five elderly subjects, it was pathological. Thirty nine percent of pathological gynecomastias lacked the signs and symptoms that according to authors, should prompt a thorough study. Conclusions: All patients with gynecomastia should be studied with a complete medical history and the measurement of estradiol and testosterone levels. The criteria proposed to conduct minimal studies in gynecomastia, would miss a large volume of pathological conditions.

Aumento del daño en el ADN y estrés oxidativo en espermatozoides de pacientes con oligozoospermia idiopática y antecedentes de criptorquidismo / Extent of sperm DNA damage in spermatozoa from men examined for infertility. Relationship with oxidative stress

Background: Cryptorchidism and oligozoospermia are clinical conditions closely associated with impaired fertility. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility. Aim: To determine the extent of sperm nuclear DNA damage in patients affected with idiopathic oligozoospermia or undescended testes and to examine its relationship with oxidative stress. Patients and methods: We studied 20 patients with idiopathic oligozoospermia and 18 with undescended testes (who previously underwent orchiopexy) and 25 normozoospermic healthy controls. All subjects underwent semen analysis. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry (SCSA-FCM) and by the dUTP-biotin nick end labeling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity (TAC) were assessed by a chemiluminescence assay. Results: DFI (percentage of sperm with denatured DNA) values and percentage of TUNEL positive cells were significantly greater in patients with oligozoospermia (DFI: 28.8±5.6; TUNEL+: 26.9±3.0) or cryptorchidism (DFI: 26.4±10.1; TUNEL+: 29.1±3.9), compared with controls (DFI: 7.1±0.9; TUNEL+: 14.2±1.2). Similarly, both groups of patients had significantly higher (p <0.01) levels of ROS. TAC levels did not differ between control and patient groups, suggesting that the DNA damage occurs before spermiation. Conclusions: Sperm DNA damage is significantly increased in men with idiopathic oligozoospermia and in cryptorchid subjects. The finding of increased ROS levels may indicate that seminal oxidative stress may be involved in the pathogenesis of sperm DNA damage in these patients.

Factores causales de infertilidad masculina: contribución del factor endocrino / Causes of male infertility: the contribution of endocrine factors

Background: Male infertility is responsible for 35 percent of infertile couples. Aim: To investigate the causes of male infertility and the relative importance of endocrine factors. Patients and methods: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testitular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. Results: Two hundred fifty seven males were studied. In 3.5 percent of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9 percent it was classified as testicular, in 15.6 percent as posttesticular and in 14 percent, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9 percent were associated to varicocele, 12.8 percent were associated to cryptorchidism, 8.9 percent to Klinefelter syndrome and 6.6 percent to exposure to toxic substances. In 50 percent of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. Conclusions: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy

La depresión mayor como nuevo factor de riesgo en la cardiopatía coronaria en Chile / Major depression as a risk factor for coronary disease

Background: Major depression, a frequent psychiatric disease, is associated with ischemic heart disease. It is usually subdiagnosed and subtreated. Aim: To study the prevalence of major depression among survivors of an acute myocardial infarction. Patients and methods: Retrospective study of 42 survivors of an acute myocardial infarction treated at a regional Chilean Hospital. The presence of major depression in the 6 months previous to the acute myocardial infarction, was investigated using the diagnostic instruments CIDI (Composite International Diagnostic Interview) and DIS (Diagnostic Interview Schedule), psychiatric diagnoses were based on DSMIII-R. The prevalence of depression was compared with that observed in a group of 156 healthy subjects participating in a psychiatric epidemiological study. Results: Major depression was diagnosed in 12 male subjects with an acute myocardial infarction. The prevalence in the control group was significantly lower (15 percent, p <0.049). Patients with depression were older and required longer hospital stay than patients without depression. Conclusions: Patients with acute myocardial infarction, had a significantly greater prevalence of major depression in the previous 6 months, than the general population. Thus, major depression could be an independent and modifiable coronary risk factor

La prevención de la tortura como problema de salud pública / Torture prevention as a problem of public health

Se analiza la tortura, expresión particular y específica de las violaciones al derecho a la vida, desde una perspectiva de la salud pública. Se problematiza su caracterización como materia objeto de las ciencias médicas y se plantean diversas áreas de acción posibles de identificar en los marcos de la prevención, tanto específica como inespecífica. Se enfatiza en la necesidad de soslayar los riesgos de reduccionismo en el tratamiento del tema

Una experiencia de psiquiatría social / An experience of social psychiatry

Se describe la experiencia de cinco años de trabajo de un Servicio de Psiquiatría inserto en un hospital general de provincia, orientada a su transformación de una entidad clínica tradicional en una institución de psiquiatría clínica y social. Se analizan las condicionantes socioeconómicas y epidemiológicas que caracterizan la provincia de Iquique, se presenta una visión crítica de los modelos dominantes en el ámbito de la rehabilitación psiquiátrica y se exponen los fundamentos teóricos y metodológicos de nuestro trabajo. Finalmente, se presenta un diseño estratégico en el que se basan los programas y las actividades tanto clínicas como comunitarias del Servicio y se hace una breve descripción de ellas

Tercero ausente: un enfoque sistémico del duelo en familias con un miembro desaparecido / Third absent: a systemic approach to mourning in families with a missing member

Con apoyo en el concepto de "tercero ausente", propuesto por Edith Goldbetter, se analiza el proceso de duelo en familias afectadas por la desaparición forzada de uno de sus miembros. Se enfatiza en los patrones relacionales observados en el nivel intrafamiliar y la incidencia que en ellos tiene el proceso histórico chileno derivado del golpe militar de 1973, en tanto contexto macrosistémico de la situación en crisis. A partir de nustra experiencia de terapia con familias de detenidos desaparecidos, ilustramos las características que adquiere este tercero ausente en las diferentes etapas del conflicto familiar y las influencias que sobre él ejercen los cambios socio-políticos. También se hacen algunas reflexiones teóricas acerca de las dificultades técnicas que se le presentan al terapeuta para encarar la psicoterapia con fines resolutivos del duelo