[Hospital medicine in Chile].

After 15 years of development of Hospital Medicine in Chile, there are several benefits of this discipline. Among others, a reduction in the length of hospital stay, readmissions, costs, and improved medical teaching of students, residents and fellows have been observed. However, in South América there are only isolated groups dedicated to Hospital Medicine in Chile, Argentina and Brazil, with a rather slow growth.

[Reducing the incidence of ventilator-associated pneumonia following heart surgery: 13-year experience of epidemiologic surveillance in a teaching hospital].

Objectives: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence.

Methods: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used.

Neoadjuvant chemoradiation therapy for borderline pancreatic adenocarcinoma: report of two cases.

Pancreatic cancer remains as one of the most aggressive human neoplasms, with overall poor survival rates. Radical surgery of the primary lesion is the best option for treatment. Borderline resectable pancreatic tumors (BRPT), defined as partial involvement of peripancreatic vasculature, may benefit from neoadjuvant therapy.

Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up.

Background: Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical technique with encouraging results. The objective of this study is to report surgical results after 1,000 consecutive LSG cases as a stand-alone procedure for morbid obesity during a 3-year follow-up.

Methods: Data were obtained by review of our prospectively maintained database, patients' clinical charts, and phone interview of all patients who underwent LSG in our institution from December 2005 to February 2010.

[Combined periampullary adenocarcinoma and neuroendocrine tumor in type 1 neurofibromatosis: report of one case].

Neurofibromatosis is a hereditary autosomal-dominant disease with high rates of de novo mutations, and carries a high risk of neoplasms. It affects both sexes and all races and ethnic groups. It is characterized by multiple cutaneous lesions and tumors, both benign and malignant, especially in the nervous system.

Endovascular treatment of complex cerebral aneurysms with onyx hd-500® in 38 patients.

Objective: To report our experience with Onyx HD-500(®) (Micro Therapeutics, Inc., Irvine, CA, USA) in the endovascular treatment of complex intracranial aneurysms as an alternative to treatment with platinum coils.

Patients And Methods: Between October 2003 and December 2007, 38 patients (20 female and 18 male) were selected for inclusion in the study based on aneurysm size and dome-to-neck ratio.

[Recombinant activated factor VII for perioperative bleeding].

Recombinant activated factor VII (rFVIIa) is a new haemostatic drug, originally used for the treatment of patients with hemophilia A and B. At the present time it is used for other bleeding conditions such as the perioperative period. When used prophylactically there is a reduction in the number of bleeding episodes but no changes in the need for blood transfusion or other blood products.

Safety, tolerability, pharmacokinetics, and immunogenicity of motavizumab, a humanized, enhanced-potency monoclonal antibody for the prevention of respiratory syncytial virus infection in at-risk children.

Background: : Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children. Motavizumab is an investigational humanized monoclonal antibody for RSV prophylaxis.

Methods: : A dose-escalation study was conducted followed by assessment of safety, tolerability, serum concentrations, and immunogenicity during a second consecutive RSV season.

[Enterocystoplasty for interstitial cystitis. Deferred results].

Introduction: Interstitial cystitis is clinically diagnosed entity, characterized by irritative bladder symptoms and suprapubic pain. It is reported that up to 10% of patients are refractory to conservative management. In these patients' supratrigonal cystectomy and bladder enlargement enterocystoplasty has been used.

[Ileorectal anastomosis in the surgical treatment of ulcerative colitis: long-term results].

Background: Total colectomy with ileorectal anastomosis (IRA) is an alternative to the ileoanal pouch for the surgical treatment of ulcerative colitis in a selected group of patients. This technique leaves rectal mucosa liable to develop persistent proctitis, dysplasia and cancer.

Aim: To describe short and long-term results of IRA and to assess the presence of dysplasia.

[Chemoembolization of hepatocarcinoma: report of two cases].

Chemoembolization is a therapeutic alternative for those patients with hepatocarcinoma that cannot be excised surgically or that are waiting a liver allograft. We report two patients with hepatocarcinoma who were subjected to chemoembolization. A 65 years old male with a chronic liver disease and right lobe hepatocarcinoma, waiting for a liver transplantation, was subjected to two sessions, of chemoembolization four weeks apart.

[Angina after a heart transplant with evidence of late sympathetic reinnervation. Report of one case].

We report a 56 years-old man presenting with chest pain with exercise, seven years after an orthotopic heart transplant. A coronary angiography showed an atherosclerotic lesion in the common left main coronary artery with more than 90% obstruction. The lesion was successfully treated with a transluminal angioplasty with stenting.

[Predictors of the level of patient satisfaction in a university hospital].

Background: Client satisfaction is an important indicator of the quality of services, and health care is not an exemption.

Aim: To explore and establish the predictors that exert the greater influence on the level of satisfaction with the service offered in a University Hospital.

Material And Method: The source of the study is a data base, obtained from a survery made to 355 patients of the Hospital Clínico de la Pontificia Universidad Católica de Chile prior to discharge.

[Human metapneumovirus as hospitalization cause in children under 3 years old with acute respiratory infections during 2004].

Human metapneumovirus was detected in 15 of 123 children (12%) younger than 3 years of age hospitalized for treatment of acute respiratory infection between July and November 2004. The virus was detected by RT-PCR directly from nasopharyngeal swabs and/or from supernatants after cell culture. Children infected with hMPV were mostly younger than one year of age (67%), all presenting with fever and cough.

[Flu vaccine in children: state of the art].

Influenza is an acute respiratory illness that year to year causes considerable morbidity and mortality. . All children, healthy or at high risk, are susceptible to this infection.

[Pulmonary thromboembolism treated with pharmacological thrombolysis and mechanical fragmentation. Report of one case].

Pulmonary Embolism (PE) has a wide clinical spectrum. It is imperative to detect patients with a high risk to develop right ventricular failure, because this is the main cause of death in patients with massive PE. In this group of patients, invasive therapies to relieve pulmonary obstruction and right ventricle overload should be used as soon as possible.

[Comparison of cardiac output measurement in critical patients using transesophageal Doppler or thermodilution: a preliminary report].

Background: Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery.

Aim: To compare both methods of cardiac output measurement.

[Prognostic value of hyperuricemia in chronic heart failure].

Background: Hyperuricemia has been proposed as a risk marker in chronic heart failure, but its value as an independent prognostic is not well established.

Aim: To determine the prognostic value of hyperuricemia, in patients with chronic stable heart failure.

Patients And Methods: Forty six male patients with chronic heart failure, aged 62 +/- 13 years, were studied.

[Catastrophic antiphospholipid syndrome and acute heart failure. Report of a case].

A 33 years old woman was admitted to the hospital after four days with cough, dyspnea, orthopnea and hemoptysis. Blood pressure was 170/90 mmHg, pulse was 112 and temperature was normal. She had cyanosis and a left ventricular gallop, without heart murmurs.

[Abdominal aortic aneurysms in patients over 80 years of age: conventional surgical treatment in 80 consecutive cases].

Background: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention.

Aim: To asses surgical complications and mortality in octogenarians treated for AAA.

[Mechanical ventilation to treat acute respiratory distress syndrome secondary to descending necrotizing mediastinitis. Role of dynamic axial computed tomography of the lung].

Lung computed tomography (CT) is being used increasingly to assess lung morphology in patients on mechanical ventilation. Lung CT under known levels of airway pressure (dynamic CT) can also assess the response of lung parenchyma to ventilatory therapy. We report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic CT oriented ventilatory management.

[Preliminary experience with dexmedetomidine treatment of confusional state and hyperadrenergic states at an intensive care unit].

Delirium (confusion) is an acute, reversible and fluctuating compromise of awareness and cognitive function, a state that can increase morbidity and mortality. We describe four patients with delirium associated with agitation and hyperadrenergic states refractory to haloperidol but responsive to dexmedetomidine.

[Persistence of oxidative stress after heart transplantation: a comparative study of patients with heart transplant versus chronic stable heart failure].

Introduction And Objective: Chronic heart failure (CHF) is associated with oxidative stress. Heart transplantation, an important therapeutic alternative in these patients, could reduce oxidative stress by improving cardiac function. Our aim was to evaluate post-heart transplantation oxidative stress.

[Treatment of severe respiratory failure with cardiopulmonary extracorporeal assistance. A clinical case].

Cardiopulmonary extracorporeal assistance is a high complexity procedure for patients with acute respiratory failure, who have failed conventional ventilatory support. A 30 years old female patient with bacterial endocarditis and congestive cardiac failure subjected to cardiac surgery presented severe hypoxemia, right heart failure and pulmonary hypertension, and failed conventional treatment. Cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) reverted the pathophysiologic alterations allowing a successful recovery.

[Suprahepatic vein catheterization in 4 cases of severe septic shock].

Splanchnic hypoperfusion, with pathogenic implications for multiple organ failure, can occur during septic shock. We report four patients with septic shock in whom regional hepatosplenic splanchnic perfusion was monitored through suprahepatic vein catheterization and gastric tonometry. Suprahepatic lactate and oxygen saturation showed splanchnic hypoperfusion in all patients.