[Analysis of a clinical ethics committee activities at a general hospital]. / Experiencia del Comité de Ética Asistencial del Hospital Carlos van Buren entre los años 2007-2020.

BACKGROUND: Clinical Ethics Committees are deliberative groups whose main functions are to assess cases with ethical-clinical conflicts, to generate institutional protocols for preventive purposes, and to train health teams. AIM: To analyze the activity of a clinical ethics committee of a general hospital in the period 2007-2020. MATERIAL AND METHODS: A retrospective analysis of all session records, annual reports, case resolution and documents generated by the Clinical Ethics Committee of Carlos van Buren Hospital in Valparaíso, Chile, between 2007 and 2020, was carried out. RESULTS: On average, 12 cases are analyzed per year. Sixty percent correspond to requests from pediatric units and in 78% of these cases there was at least one neurological disease. In 62% of cases, the main ethical dilemma was adequacy of therapeutic effort, followed by dilemmas related to the exercise of autonomy in 18.2%. In education, two courses are identified aimed to doctors, residents, and other members of the health team. Regarding normative functions, several documents were generated at the request of the Hospital management or in different clinical situations. During COVID-19 pandemia, the active role of the committee was linked to the three main functions, namely evaluating cases, participating in morbidity and mortality meetings for preventive purposes, and issuing guidelines and recommendations for action. The active participation of Pediatric Neurology residents in the Committee, for educational and administrative purposes, stands out. CONCLUSIONS: The three main functions described for the ethics committees were exerted by this Committee during the evaluated period. The impact of our recommendations remain to be objectively evaluated.

Experiencia del Comité de Ética Asistencial del Hospital Carlos van Buren entre los años 2007-2020

Background: Clinical Ethics Committees are deliberative groups whose main functions are to assess cases with ethical-clinical conflicts, to generate institutional protocols for preventive purposes, and to train health teams. Aim: To analyze the activity of a clinical ethics committee of a general hospital in the period 2007-2020. Material and Methods: A retrospective analysis of all session records, annual reports, case resolution and documents generated by the Clinical Ethics Committee of Carlos van Buren Hospital in Valparaíso, Chile, between 2007 and 2020, was carried out. Results: On average, 12 cases are analyzed per year. Sixty percent correspond to requests from pediatric units and in 78% of these cases there was at least one neurological disease. In 62% of cases, the main ethical dilemma was adequacy of therapeutic effort, followed by dilemmas related to the exercise of autonomy in 18.2%. In education, two courses are identified aimed to doctors, residents, and other members of the health team. Regarding normative functions, several documents were generated at the request of the Hospital management or in different clinical situations. During COVID-19 pandemia, the active role of the committee was linked to the three main functions, namely evaluating cases, participating in morbidity and mortality meetings for preventive purposes, and issuing guidelines and recommendations for action. The active participation of Pediatric Neurology residents in the Committee, for educational and administrative purposes, stands out. Conclusions: The three main functions described for the ethics committees were exerted by this Committee during the evaluated period. The impact of our recommendations remain to be objectively evaluated.

[Renal angiomyolipoma rupture as a cause of lumbar pain: report of one case]. / Angiomiolipoma renal complicado como causa de dolor lumbar: Caso clínico.

Renal angiomyolipoma is a benign tumor formed by smooth muscle, adipose tissue and blood vessels. It is commonly found incidentally and its clinical manifestations are pain and abdominal mass or spontaneous tumor rupture with retroperitoneal bleeding. The clinical presentation of a hemorrhagic shock secondary to a retroperitoneal hematoma is uncommon. We report a 40 year-old male who presented to the emergency room with lumbar pain and deterioration of hemodynamic parameters. The CT scan showed a left renal injury associated to an expansive retroperitoneal process. The abdominal exploration, vascular control of the renal pedicle and nephrectomy allowed a successful outcome.

Angiomiolipoma renal complicado como causa de dolor lumbar: caso clínico / Renal angiomyolipoma rupture as a cause of lumbar pain: report of one case

Renal angiomyolipoma is a benign tumor formed by smooth muscle, adipose tissue and blood vessels. It is commonly found incidentally and its clinical manifestations are pain and abdominal mass or spontaneous tumor rupture with retroperitoneal bleeding. The clinical presentation of a hemorrhagic shock secondary to a retroperítoneal hematoma is uncommon. We report a 40 year-old male who presented to the emergency room with lumbar pain and deteríoration of hemodynamic parameters. The CT sean showed a left renal injury associated to an expansive retroperítoneal process. The abdominal exploration, vascular control of the renal pedicle and nephrectomy allowed a successful outcome.

Fulminant hepatic failure associated with propylthiouracil.

OBJECTIVE: To report 2 fatal cases of fulminant hepatic failure associated with propylthiouracil treatment against hyperthyroidism. CASE SUMMARY: Two women, 30 and 32 years old with no previous liver disease, were treated with propylthiouracil against Graves' disease. Both patients developed jaundice after a 4- and 5-month treatment period, respectively. The disease was similar to viral hepatitis, with a progressive course to severe liver dysfunction and death, along with multisystem organ failure despite extensive therapeutic measures. One of the patients was pregnant and subsequently miscarried. Neither patient had a history of alcoholism, drug abuse, blood transfusion, or exposure to hepatitis A, B, or C. Extrahepatic obstruction was ruled out with an abdominal ultrasonogram. Serologic studies and immunologic tests were negative. A submassive necrosis was shown in a postmortem histologic study. DISCUSSION: Naranjo probability scale criteria applied to both cases confirm the adverse reactions as probable. These cases fit the requirements of drug hepatotoxicity proposed by Hanson and the Council of the International Organization of Medical Sciences. Eight deaths associated to propylthiouracil were found in our review of the medical literature up to December 2000. CONCLUSIONS: Despite the widespread use of propylthiouracil, fulminant hepatitis with death is exceptionally rare; these 2 cases could be added to the fatal outcomes published to date.

Diagnóstico y tratamiento de los nódulos tiroideos / Diagnosis and treatment of thyroid nodules

La presente revisión corresponde a una actualización del diagnóstico y tratamiento de los nódulos tiroideos, orientada principalmente hacia el cáncer del tiroides. Se analizan los diferentes tipos de cáncer, su incidencia, factores pronósticos y procedimientos diagnósticos y terapéuticos

Zigomicosis orbitaria y cerebral: caso clínico / Orbitocerebral zygomycosis: a case report

Se presenta el caso de una paciente mujer de 54 años, diabética en quetoacidosis que es hospitalizada en el Servicio de Urgencia del Hospital Carlos van Buren de Valparaíso por un cuadro inflamatorio periocular derecho, cuyo manejo fue difícil, falleciendo a las 48 horas del ingreso. El diagnóstico de una zigomicosis es una infección micótica oportunista que afecta preferentemente a pacientes inmunodeprimidos y diabéticos en quetoacidosis, siendo su diagnóstico precoz de vital importancia y su manejo agresivo fundamental para la sobrevida del paciente. Dada la poca frecuencia de esta patología, pero que está en aumento en las últimas décadas, es necesario que el médico actual esté mejor preparado para enfrentarla. Los autores hacen una revisión de la literatura nacional y extranjera sobre el tema y actualizan los principales aspectos diagnósticos y terapéuticos

Evaluación del tratamiento quirúrgico del papiloma invertido de fosas nasales y cavidades paranasales / Evaluation of surgical treatment of the inverting papilloma of nasal and paranasal cavities

Los papilomas schneiderianos son tumores poco frecuentes que aparecen en las fosas nasales y cavidades paranasales. Ellos están clasificados en tres tipos histológicos: papilomas invertidos, fungiformes y de células cilíndricas. Son considerados como intermedios por su conducta agresiva. Invaden a través de extensión local y tiene una importante tendencia a recidivar. Pueden aparecer en osociación con malignidad. En su etiología se asume corrientemente un rol viral. Se confeccionó un protocolo prospectivo para el manejo del papiloma nasal en el Hospital Van Buren de Valparaíso. Trece pacientes fueron tratados en un período de 5 años: Cinco de ellos fueron operados por una rinotomía lateral y ocho por una técnica de Denker. Ambos abordajes permitieron una resección satisfactoria del tumor y tuvieron un control similar de la enfermedad. En esta serie hubo un caso de recurrencia y ninguno de malignidad. Se hace hincapié en los principios básicos del tratamiento como son: Biopsia previa a la cirugía, uso de tomografía axial computarizada (TAC), abordaje quirúrgico amplio, y la necesidad de someter cualquier tejido tomado de la fosa nasal a examen histopatológico a pesar de su aparente aspecto benigno