Morbilidad dermatológica en interconsultas de pacientes hospitalizados en el Complejo Asistencial Barros Luco / Dermatologic morbidity in consultations of patients at the Complejo Asistencial Barros Luco

Las patologías dermatológicas comunes y los signos cutáneos de enfermedades sistémicas están habitualmente presentes en los pacientes hospitalizados. El objetivo de este estudio fue analizar las interconsultas derivadas al Servicio de Dermatología y evaluar el perfil del paciente, el patrón de referencia y la precisión diagnóstica de los médicos no dermatólogos. Se realizó un estudio retrospectivo, se revisaron todas las interconsultas de pacientes hospitalizados durante el período comprendido entre abril del 2006 y diciembre del 2009 en el Complejo Asistencial Barros Luco. En 1.009 interconsultas se analizaron las variables de edad, género, fecha de derivación, Servicios Clínicos y la concordancia diagnóstica. La edad media de los pacientes derivados fue de 53,73 años (+/- -19.24 SD) con un 45,39 por ciento de mujeres y 56,61 por ciento de hombres. Los Servicios Clínicos con mayor frecuencia de solicitudes de interconsultas fueros: Hospital Infecccioso (37,80 por ciento), Medicina Interna (27,50 por ciento), Neurología (6,90 por ciento) y UCI (6,30 por ciento). La concordancia diagnóstica general fue de 48,75 por ciento y varía por cada grupo de enfermedades dermatológicas (inflamatorias: 54,90 por ciento, infecciosas: 22,25 por ciento; neoplasias benignas y malignas: 13,8 por ciento y otros diagnósticos: 9,07 por ciento). El perfil de interconsultas es diferente al de los pacientes ambulatorios, el diagnóstico específico que presentó el mayor porcentaje de derivaciones fueron las reacciones adversas medicamentosas, lo que se explica por la gran cantidad de fármacos usados a nivel hospitalario a diferencia del nivel ambulatorio donde éstas no son un diagnóstico significante. La concordancia diagnóstica respecto al diagnóstico dermatológico no supera el 50 por ciento en forma global y la tumoral solo presenta un 42,99 por ciento de asertividad, por lo que sería importante mejorar la educación dermatológica de pregrado especialmente en patologías de mayor...

Common dermatologic conditions and skin signs of systemic diseases are routinely present in hospitalized patients. The objective of this study was to analize the patient profile and the referral pattern of the in - patient dermatology consultation and evaluate the diagnostic accuracy of non dermatologist. This was retrospective study reviewing all inpatient referrals during a period (April 2006. December 2009) at the Barros Luco Hospital. 1009 dermatological consultations were analized by age, sex, date, clinical service and diagnostic correlation. The average age of the patients was 53.73 years old (+/-19.24DS) with a 45.39 percent of female and 56.61 percent of males. The Clinical services that most require consultations were infetious diseases (37.80 percent), internal medicine (27.50 percent), Neurology (6.90 percent) and ICU (6.30 percent). The total correlation diagnosis was 48.75 percent and this percentage was analized per dermatological disease (inflammatory 54.90 percent, infectious diseases 22.25 percent, benign and malignant neoplasias 13.8 percent and other diagnosis 9.07 percent). The inpatients consultation profile is different from the outpatient, the specific diagnosis that had the highest percentage of referrals were "adverse drug reactions" which can be explained by the large number of drugs used the hospital level opposed to an outpatient setting where adverse drug reactions do not represent a significant diagnosis. The diagnostic correlation was less than 50 percent globally compared with the dermatologic diagnosis; in tumors a 42.99 percent of concordance was found. It would be important to improve undergraduate education, especially in the most important dermatological diseases.

[Medullary cancer of the thyroid. Experience at the Hospital de Valdivia]. / Cáncer medular de tiroides. Experiencia del Hospital de Valdivia.

BACKGROUND: Medullary carcinoma of the thyroid is an infrequent type of thyroid tumor. AIM: To retrospectively study all cases of medullary carcinoma of the thyroid diagnosed at a regional hospital. PATIENTS AND METHODS: The charts and pathological studies of eight patients with medullary carcinoma of the thyroid, among 75 with thyroidal cancer, were reviewed. RESULTS: Solitary nodules were the presenting sign in seven patients and cachexia in one. Five patients were subjected to total thyroidectomy, five to cervical lymph node dissection and four to complementary radiotherapy. Pathological diagnosis was made with the surgical piece in seven patients and by aspiration cytology in one. Five of the eight patients are alive after 50 months of follow up as a mean, one patient with bone metastasis. CONCLUSIONS: The small sample size precludes conclusions on the prognosis and treatment of the disease.

[Breast cancer in males. Report of 4 cases]. / Cáncer mamario en el hombre. Comunicación de cuatro casos.

Breast cancer is infrequent in men. We report four men with breast cancer seen at a surgical service in Valdivia. Their presentation form, histological diagnosis and evolution are described. An updated revision of the literature is also presented.

[Intestinal obstruction caused by peritoneal carcinomatosis due to signet ring cell carcinoma of the breast]. / Obstrucción intestinal por carcinomatosis peritoneal debida a carcinoma mamario de células en anillo de sello.

The signet ring variant of lobular mammary carcinoma is aggressive and metastasis to serosal surfaces. We report a 46 years old woman presenting with an intestinal obstruction due to a peritoneal carcinomatosis secondary to a signet ring cell carcinoma of the breast. After surgery, the patient received chemotherapy (5-fluorouracil, adriamycin, cyclophosphamide and tamoxifen). A satisfactory response, with regression of peritoneal carcinomatosis and a good quality of life, was achieved. The patient is alive after 2 years of diagnosis.

[Bilateral signet ring cell carcinoma of the breast: case report]. / Carcinoma mamario bilateral de células en anillo de sello caso clínico.

Signet ring cell carcinoma of the breast is a rare type of tumor characterized by the presence of numerous cells containing large intracellular and little extracellular amounts of mucin. These tumors show an unusual metastatic pattern, involving serosal surfaces and have a poor prognosis with a mean survival time of 50 months. This paper reports the case of a 39 year old woman with a bilateral signet ring cell carcinoma who developed metastases in bone, lung and peritoneum. Combined surgery, radiotherapy and chemotherapy was used but the patient died 2 years and 3 months after diagnosis.

[Hodgkin's disease in children. Modified COPP combined treatment and radiotherapy in advanced stages]. / Enfermedad de Hodgkin en el niño. Tratamiento combinado COPP modificado y radioterapia en estadios avanzados.

Twenty two children, under 15 years of age, from southern Chile's Tenth Region, with advanced stages of Hodgkin's disease (8 III-A, 6 III-B and 8 IV-B) were treated with chemotherapy (modified COPP protocol) and radiotherapy between 1976 and 1985 at Valdivia's Regional Hospital. Overall survival rate was 77.3% and disease-free survival rate was 64.5% after a follow-up period from 3 to 13 years (median 70 months). Five patients died during the first two years. One relapsed 10 years after beginning of therapy, but achieved a second complete remission. The survival rate in patients with lymphocytic depletion type (5 cases) was 20.0%, whereas that of the mixed cellularity type (14 cases) was 92.9% (p less than 0.01). No cases of second neoplasms related to chemotherapy and radiotherapy were seen in this series.

Plasmocitoma extramedular de ubicación inhabitual: cabeza y riñon / Extramedullar plasmacytoma of unussual location; head and kidney

Un hombre de 39 años consultó por tumoraciones de la cabeza cuya biopsia demostró un plasmocitoma maligno. El estudio radiológico del esqueleto fue normal y se descartaron otros sitios de infiltración plasmocitaria, particularmente de la médula ósea. Fue tratado con esquema convencional de alkeránprednisona y radioterapia de 30 gy al mayor de los tumores con regresión total. En ese período presentó hematuria total macroscópica y dolor en fosa lumbar derecha. Los estudio radiológicos sugirieron un tumor renal derecho y se practicó una nefrectomía radical derecha encontrándose un tumor de 4 cms., con estudio histopatológico de plasmocitoma renal. Por reaparición de algunas tumoraciones dolorosas en la cabeza se empleó el esquema VAD de quimioterapia, con regresión temporal, presentando poco después progresión de los tumores, pero sin compromiso de la médula ósea y falleciendo 18 meses después del comienzo de los síntomas. Este caso constituiría el décimo descrito en la literatura occidental y el segundo con asociación de plasmocitoma renal y cefálico

T gamma cell levels in mammary and cervical uterine cancer patients before and after local irradiation treatment.

Total T and T gamma cell populations were studied in patients suffering from mammary of cervical uterine cancer. The results show that for both groups of patients there were no changes in the total T cell counts when compared with controls: but T gamma subpopulation values were greatly increased in the cancer patient groups, irrespective of in the mammary cancer group, whether the tumor mass was present at the moment of evaluation or surgically removed. The percentage of T mu cells returned to normal level after local irradiation treatment in all cases studied. We speculate about the possible changes in lymphocyte migration as a consequence of irradiation which may affect cells in the blood stream.