Reflexiones de un otorrino clínico / Clinical consideration of an ent

El autor hace un análisis de la forma cómo ve él la relación médico paciente y cuáles serían los elementos fundamentales para obtener un puente de comunicación. Reflexiona sobre su experiencia en la consulta con niños y adultos. Resalta elementos puntuales para llegar a un diagnóstico más preciso. Destaca el valor incalculable de haber trabajado en Clínica Las Condes desde sus inicios y lo complementario que ha sido el desarrollo tanto de la Clínica misma como del Departamento de Otorrinolaringología.

The author analyzes his relationship with the patients and which would be the key elements for establishing a good communication. He elaborates about his experience in the office with children and adults and the ways to get to a better diagnosis. He enhances the value of having worked at Clinica Las Condes since its opening which has enabled him to participate in a growing and leader Othorhinolaryngology Department and appreciate how gratifying this has been.

Short report epidemiologic studies on cutaneous leishmaniasis in eastern Panama.

The Panamanian Ministry of Health, through the Interamerican Development Bank, contracted the Gorgas Memorial Laboratory to conduct epidemiologic studies on leishmaniasis and malaria in eastern Panama from July 1984 through June 1985. Preliminary results of the biomedical and entomologic teams investigating the epidemiology of cutaneous leishmaniasis in the eastern part of the country are presented in this short report. The principal findings of the study revealed 1) a large disparity in the incidence and prevalence of the disease among the five communities investigated; 2) the appearance of self-cures without the benefit of effective treatment; 3) a relatively high percentage of subclinical cases; and 4) determination of the sandfly vector species for each community. Also reported here is a case of a double infection with two distinct species of Leishmania, L. mexicana and L. amazonensis, in a single individual.

[Prevalence of cardial or fundic mucosa and Helicobacter pylori in the squamous-columnar mucosa in patients with chronic patological gastroesophageal reflux without intestinal metaplasia comparated with controls]. / Prevalencia de mucosa cardial o fúndica y presencia de Helicobacter pylori en la unión de mucosas escamoso-columnar en pacientes con reflujo gastroesofágico crónico patológico sin metaplasia intestinal comparados con controles.

BACKGROUND: The mucosa distal to the endoscopic mucosal change zone can have easily diagnosed early alterations, in patients with chronic gastroesophageal reflux. AIM: To determine the type of mucosa existent in the zone distal to the squamous-columnar junction in patients with chronic gastroesophageal reflux without intestinal metaplasia. PATIENTS AND METHODS: One hundred thirty four controls and 208 patients with chronic gastroesophageal reflux lasting two years were studied. Forty three of these patients had a normal endoscopy, 54 had an erosive esophagitis and 111 had a short columnar epithelium covering the distal esophagus, without intestinal metaplasia. In all subjects, four biopsies were obtained from a zone distal to the squamous-columnar junction and two from the distal gastric antrum. RESULTS: In 59% of control subjects, fundic mucosa was present in the zone distal to the squamous-columnar junction. Cardial mucosa was present in the rest. In patient with chronic gastroesophageal reflux, cardial mucosa was predominant. Helicobacter pylorii infection decreased along with increasing extension of cardial mucosa covering the distal esophagus. CONCLUSIONS: In patients with chronic gastroesophageal reflux there is a metaplasia of fundic mucosa towards cardial mucosa. On the other hand, Helicobacter pylorii infection decreases gradually.

Host-feeding patterns of mosquitoes (Diptera: Culicidae) from central Panama.

A 10-year study of blood meal identification in mosquitoes collected at numerous sites over several ecosystems in central Panama was conducted from 1977 to 1987. The hosts for 4,391 mosquito blood meals, representing 30 species, were identified to the family level of specificity in most instances. The degree that individual mosquitoes had fed on animals of different classes and families within these classes was determined. Multiple feeding among several mosquito species was documented. The relationship between reservoir hosts of endemic arboviruses and a number of known and potential mosquito vectors was demonstrated as a result of the blood meal identifications.

Granulomatosis de Wegener / Wegener's granulomatosis

Se presenta un caso de granulomatosis de Wegener (GW) en una paciente de 56 años cuya sintomatología inicial y única fue a nivel de oídos. Las manifestaciones otológicas incluían otitis serosa refractaria que progresó a una mastoiditis subaguda unilateral y parálisis facial progresiva. La radiografía de tórax mostró infiltrados nodulares. Se le practicó un vaciamiento mastoídeo bilateral simultáneo y una descompresión del nervio facial derecho. El diagnóstico de GW se hizo basado en los hallazgos histológicos del tejido granulatorio obtenido de ambas mastoides y confirmado por los anticuerpos anticitoplasma de neutrófilos (ANCA). El tratamiento se basó en el uso prolongado de ciclofosfamida oral asociado a esteroides. Se realiza una revisión bibliográfica del tema, enfatizando que el veinte por ciento de los pacientes con GW tendrán alguna manifestación otológica durante su enfermedad. En algunos casos los síntomas de oído serán los síntomas iniciales de la enfermedad. La no respuesta al tratamiento convencional será lo que nos deba llevar a la sospecha diagnóstica. La confirmación diagnóstica se hace por medio de los ANCA, los cuales también son útiles en el seguimiento de la enfermedad, tanto para evaluar el resultado del tratamiento como para ver la actividad a largo plazo de la enfermedad

Leishmania mexicana complex: human infections in the Republic of Panama.

Parasites of the genus Leishmania responsible for human cutaneous leishmaniasis in the New World form 2 major taxonomic divisions: the Leishmania braziliensis and the L. mexicana complexes. We report the isolation and characterization of the L. mexicana complex among humans in the Republic of Panama. Characterization was based on parasite morphology, pathogenesis in infected golden hamsters, cellulose acetate isoenzyme electrophoretic mobilities, and membrane-specific monoclonal antibodies using the radioimmune binding assay technique.

Host feeding profiles of Triatoma dimidiata in peridomestic habitats of western Panama.

Bloodmeal analysis of Triatoma dimidiata collected in peridomestic habitats of western Panama showed that avian feedings comprised 25% of this species' host selections; opossums, the principal reservoir of Chagas' disease in the republic, were not among mammalian feedings. These findings may account for the low infestation rates of Trypanosoma cruzi in the bugs and the hypoendemicity of Chagas' disease in western Panama.

Comparison of Plasmodium falciparum infections in Panamanian and Colombian owl monkeys.

Parameters of blood-induced infections of the Vietnam Oak Knoll, Vietnam Smith, and Uganda Palo Alto strains of Plasmodium falciparum studied in 395 Panamanian owl monkeys in this laboratory between 1976-1984 were compared with those reported from another laboratory for 665 Colombian owl monkeys, studied between 1968-1975, and, at the time, designated Aotus trivirgatus griseimembra. The virulence of these strains was less in Panamanian than in Colombian owl monkeys, as indicated by lower mortality rates of the Panamanian monkeys during the first 30 days of patency. Maximum parasitemias of the Vietnam Smith and Uganda Palo Alto strain, in Panamanian owl monkeys dying during the first 15 days of patent infection, were significantly higher than in Colombian owl monkeys. Panamanian owl monkeys that survived the primary attack had significantly higher maximum parasitemias than the surviving Colombian owl monkeys. Peak parasitemias were attained significantly earlier after patency in Panamanian than in Colombian owl monkeys, irrespective of the strain of P. falciparum. More Panamanian than Colombian owl monkeys evidenced self-limited infection after the primary attack of either the Vietnam Smith or Uganda Palo Alto strain. The duration of the primary attacks and recrudescences were significantly shorter in Panamanian than in Colombian owl monkeys. Mean peak parasitemias during recrudescence were usually higher in Panamanian owl monkeys than in Colombian monkeys. Differences of infection parameters were probably attributable, in part, to geographical origin of the two monkey hosts and parasite strains.

Arbovirus investigations in Argentina, 1977-1980. II. Arthropod collections and virus isolations from Argentine mosquitoes.

Prospective surveys for arboviruses were carried out in Santa Fe, Corrientes, and Chaco provinces, Argentina, aperiodically during 1977-1980. A total of 313,233 mosquitoes and 598 biting flies other than mosquitoes were collected and tested for virus in 5,197 and 45 pools, respectively. Forty virus strains were isolated, all from mosquitoes, as follows: Santa Fe Province: 4 Gamboa group viruses from Aedeomyia squamipennis, 1 strain each of St. Louis encephalitis virus from Culex pipiens quinquefasciatus and Culex (Culex) spp.; Corrientes Province: a single strain of a newly discovered Anopheles A serogroup virus, Las Maloyas, from Anopheles albitarsis; and Chaco Province: 4 Gamboa group viruses from Ad. squamipennis, 6 strains of new Bunyaviridae (1 Antequera, 1 Barranqueras, and 4 Resistencia) from Culex (Melanoconion) delpontei, 3 strains of a new subtype of western equine encephalitis virus and 1 strain of Para virus from the Cx. (Mel.) ocossa group, 12 strains of a newly discovered subtype (VI) of the Venezuelan equine encephalitis complex from Cx. (Mel.) delpontei, and 1 strain each from Ad. squamipennis, Aedes scapularis, Ae. spp., Cx. (Cux.) spp., Cx. (Mel.) ocossa group, Mansonia spp., and Psorophora spp. Bloodmeals from 265 engorged mosquitoes were identified by precipitin test. These data, coupled with data on engorgement rates for 25,995 mosquitoes from bait collections, provide information on the host feeding patterns of several mosquito species. This information is discussed, along with data on relative abundance of mosquito species, within the context of the vector relationships of the species from which viruses were isolated. The association of Cx. (Mel.) delpontei with 18 strains of 4 different viruses in Chaco Province, plus its catholic feeding habits, clearly indicate for the first time the importance of this species as an arbovirus vector.

Isoenzyme patterns of Leishmania isolates from Colombia.

Promastigotes from four cutaneous leishmaniasis cases from Colombia were tested by cellulose acetate electrophoresis using nine enzyme systems. The isoenzyme profiles of the Colombian isolates were indistinguishable from each other and from Panamanian Leishmania braziliensis panamensis controls, but were distinct from an isolate of Leishmania braziliensis guyanensis from Brazil and three isolates from the Leishmania mexicana complex for the enzyme phosphogluconate dehydrogenase.

Host availability limits population density of Panstrongylus megistus.

In order to determine whether host availability limits triatomine population growth, 5th-stage Panstrongylus megistus were maintained in feeding chambers containing 0, 1, 2, or 3 mice. During the 5-day feeding period, triatomines exposed to two or three mice gained significantly more weight than did bugs exposed to one mouse. In addition, half of the bugs exposed to two or three mice molted, as compared to one-fifth of the P. megistus exposed to one mouse. Thus, weight gain and molting were related to host density. In contrast, bug mortality was related to the triatomine-mouse ratio, being greatest among bugs exposed to one mouse. Twenty-nine nonplastered mud-stick houses in a Chagas' disease endemic area were censused and examined for triatomines. About 70% of houses with greater than or equal to 4 persons contained dense bug populations, while only 20% of houses with 1-3 persons were densely infested. Moreover, blood-meal identifications demonstrated that two-thirds of the P. megistus collected from these houses fed on man. The density of triatomines present in infested houses is related to the number of persons available as hosts.

Hosts of sandfly vectors of Leishmania braziliensis guyanensis in the central Amazon of Brazil.

The blood meals of 2,569 phlebotomine sandflies from areas endemic for cutaneous leishmaniasis in the central Amazon of Brazil were tested by the microcapillary precipitin method to determine their vertebrate hosts. The two-toed sloth, Choloepus didactylus, was the predominant host of two incriminated vectors of Leishmania braziliensis guyanensis in the region, Lutzomyia umbratilis and Lu. anduzei (64.0% and 63.6%, respectively). The Lu. "shannoni" group, a complex of several species in which females are indistinguishable, also fed predominantly on sloths (73.0%). Species comprising the Lu. "shannoni" group have not been implicated as vectors of leishmaniasis; however, their feeding patterns in the study area illustrate their potential involvement in the transmission of the parasites to two-toed sloths, which are the principal reservoir hosts of L. braziliensis in Panama. Rodents, and particularly porcupines, were the second most frequently fed-on mammal by Lu. umbratilis (11.6%) and the Lu. "shannoni" group (8.5%).

The tree-buttress biotope: a pathobiocenose of Leishmania braziliensis.

A total of 52,033 sandflies, comprising 33 species, was collected in tree buttresses in Panama. Of the 18,025 females collected, 1,592 (8.8%) engorged phlebotomines of 18 species contained sufficient blood for identification of their vertebrate hosts by the microcapillary precipitin method. Lutzomyia ylephiletor and Lu. trapidoi, vectors of Leishmania braziliensis, had fed predominantly on sloths (47.0% and 65.1%, respectively). Lutzomyia shannoni, a common non-anthropophilic sandfly in tree buttresses also fed most frequently on sloths (28.0%) and probably also contributes to the Leishmania transmission cycle among the edentates. Two-toed sloths (Choloepus hoffmanni), the principal reservoir of L. braziliensis in Panama, cohabit the same arboreal bioptope with these sandfly species. Leishmania braziliensis was isolated in culture from 14 of 68 (20.6%) C. hoffmanni captured in the study sites during the period of this investigation. The data illustrate that the butrresses of large trees in Panama represent potential pathobiocenose bioptopes of L. braziliensis. Other sandfly species tested for host-feeding sources included: Lu. trinidadensis, which fed preferentially on reptiles; Lu. triramula, Lu. ovallesi, and Lu. camposi fed most frequently on armadillos. The hosts of 11 additional sandfly species were identified; however, the numbers recorded were too small to discern distinct feeding patterns among the phlebotomines.