Calculous biliary disease is a common condition in Chile. Over 60.000 cholecystectomies are performed annually, making gallstone disease one of the most common digestive health problems. The treatment of calculous biliary disease has evolved over the last 2 decades. With the development of laparoscopic technology in the late 1980s, new techniques for cholecystectomy were introduced. By the early 1990s, laparoscopic cholecystectomy had replaced open cholecystectomy in the operative management of gallbladder stone disease. Unfortunately, the widespread application of laparoscopic cholecystectomy has led to a concurrent rise in the incidence of major bile duct injuries. Reports have estimated the incidence has risen from 0.1-0.2 to 0.5-0.7%. Although, exponential training of surgeons in minimally invasive surgery has led to decrease this numbers again, bile duct injuries still constitute one of the most serious complications in surgery, generating a great impact on the patient’s quality of life, and even health costs that can be devastating. The management of patients following major bile duct injurie is a surgical challenge, often requiring the skills of experienced hepatobiliary surgeons at tertiary referral centers. In this setting, the most important action is to routinely maximize prevention measures. However, once injury has occurred, patient’s future depends directly on the correct judgment of the surgeon, both to make an early diagnosis and to choose the best therapeutic confrontation. The objective of this article is to present the different preventive and therapeutic options available when this complication occurs.

Resumen La colecistolitiasis es una condición común en Chile. La complicación más frecuente de esta condición es la colecistitis aguda. Aproximadamente 60.000 colecistectomías son realizadas anualmente en nuestro país, convirtiéndola en una de las patologías digestivas más frecuentes. El tratamiento de la colelitiasis ha evolucionado las últimas dos décadas. Con el desarrollo de la laparoscopía a final de 1980, la colecistectomía abierta fue definitivamente sustituida en los 90 por la vía laparoscópica. Desafortunadamente, la generalización de este procedimiento produjo un aumento en la incidencia de lesiones de vía biliar, aumentando desde una 0,1-0,2% hasta un 0,5-0,7%. Si bien, con el progresivo entrenamiento de los cirujanos en la cirugía mínimamente invasiva esta cifra ha disminuido nuevamente, la LVB aún constituye una de las complicaciones más graves en cirugía, generando gran impacto en la calidad de vida del paciente, e incluso costos en salud que pueden llegar a ser devastadores. El manejo de una lesión de vía biliar es, para muchos cirujanos, un desafío quirúrgico, que para su resolución requiere de las habilidades y experiencia de un cirujano hepatobiliar y derivación a centros de salud especializados. Sin duda, la acción más importante es extremar de manera rutinaria las medidas de prevención. Sin embargo, una vez que la lesión se ha producido, el futuro del paciente depende, directamente, del buen criterio del cirujano, tanto para realizar un diagnóstico temprano, como del enfrentamiento terapéutico que realice. El objetivo de este trabajo es dar a conocer diferentes conductas preventivas y terapéuticas cuando esta complicación se presenta.

Objective: To Present the implementation of the first porcine model of liver transplant in Chile and its results. Materials and Methods: In the context of an investigation based on normothermic perfusion that was subsidized by the National Fund for Scientific and Technological Development, surgical and anesthetic protocols were implemented. Two pigs were selected by weight (35-40 kg), in which one was a donor and the other a receptor; submitted to procure and as a transplant recipient, respectively. The analysis was executed with descriptive statistics. Results: 26 experiments (June 2018-October 2019) were performed. The protocol includes 7 stages: Preparation, Instrumentalization, Procure or Hepatectomy, Anhepatic Time, Phase of Ischemia-Reperfusion, Monitoring and Euthanasia. The first three stages are similar in both pigs; meanwhile the last four are exclusive to the receptor. 92.3% (24/26) survived the surgery and 76.9% (20/26) survived the follow up, including the pilots. Average surgical time was 170 minutes, and the anhepatic time was 33 minutes. The mean arterial pressure decreased after the reperfusion and it improved towards the end of the monitorization (67,4 mmHg average) In the follow up, pigs presented acidosis (7.21 average). Vasoactive drugs were necessary in 12 experiments. Discussion: We managed to implement a simple and reproducible model of porcine liver transplant without extracorporeal circulation or veno-venous by-pass. This was possible due to the standardization of surgical technique and perioperative cares. Conclusions: The consolidation of porcine liver transplant model is the first step in pre-clinical research for the development of new technologies in liver transplant in Chile.

Resumen Objetivo: Presentar la implementación del primer modelo porcino de trasplante hepático (TH) en Chile y sus resultados. Material y Método: Se implementó un protocolo quirúrgico y anestésico en el contexto de una investigación en perfusión normotérmica hepática financiada por un Fondo Nacional de Desarrollo Científico y Tecnológico. Los cerdos fueron seleccionados por peso (35-40 kilos), en cada experimento se utilizó dos, donante y receptor, sometidos a procura y trasplante respectivamente. El análisis se realizó con estadística descriptiva. Resultados: Se realizaron 26 experimentos (marzo de 2018-octubre de 2019). El protocolo consta de 7 etapas: Preparación, Instrumentalización, Procura o Hepatectomía, Tiempo Anhepático, Etapa de Isquemia-Reperfusión, Monitorización y Eutanasia. Las primeras tres son similares en ambos cerdos, y desde la cuarta en adelante corresponde sólo al receptor. La supervivencia a la cirugía fue de 92,3% (24/26) y al seguimiento de 76,9% (20/26). La mortalidad se produjo por inestabilidad cardiovascular postreperfusión portal. El tiempo quirúrgico promedio fue de 170 min, y el tiempo anhepático de 33 min. La PAM cursó una baja postreperfusión con recuperación al final de la monitorización (67,4 mmHg media) y la tendencia en ph fue a acidosis al final del seguimiento (7,21 media). Se requirió drogas vasoactivas en 12 casos. Discusión: Logramos implementar un modelo experimental simplificado y reproducible de TH sin necesidad de circulación extracorpórea ni puente veno-venoso gracias a la estandarización de la técnica quirúrgica y de los cuidados perioperatorios. Conclusiones: La consolidación de un modelo experimental significa el primer paso en investigación preclínica de nuevas tecnologías asociadas al TH en Chile.

Aim: To determine readmission rates and its associated factors in patients undergoing pancreatic and hepatic resections at our center. Matherial and Methods: Perioperative variables of patients undergoing pancreatic and hepatic resections between 2012-2014 were reviewed. Demographic and perioepartive data, as well as up —to postoperative day 30— readmisson rates were analyzed. Emergency cases, postoperative mortality and/or patients undergoing less extensive surgery (less than 2 Couinaud's segments, non-anatomical resections and non resective cases such as bilioenteric anastomoses) were excluded. Readmission associated factors were identified using both univariate (χ2 for categorical and t-student's/Mann-Whitney for continuous variables) and multivariate (logistic regression) analysis. Results: 116 cases were included, 50.9 % female. Mean postoperative stay was 14 days. Pancreatic adenocarcinoma was the most frequent diagnosis (25.9%), and the 40.5% of surgical procedures were pancreaticoduodenectomy. Overall 30-day readmission rate was 18.1%, with a 23.7% for pancreatic resections and 12.2% for hepatic resections. According to univariate analysis; readmission associated factors were: pancreatic resection, preoperative White cell count, the development of postoperative complications and postoperative length of stay. On Multivariate analysis only postoperative stay was the only significant associate factor [OR 1,2 CI 95% 1.1- 1.5 (p = 0.001)]. Conclussion: Readmission rates after pancreatic and hepatic resections are elevated, even in high-volume centers. Postoperative length of stay is a consistent risk factor for readmission after these type of surgeries. We highly recommend including this parameter as a quality marker of our surgical results in our country.

Resumen Objetivo: Determinar la frecuencia de reingreso hospitalario y sus factores asociados en pacientes sometidos a resecciones hepáticas o pancreáticas en nuestro centro. Metodología: Se revisaron registros de pacientes sometidos a resecciones hepáticas o pancreáticas entre 2012 y 2014. Se registraron variables biodemográficas, quirúrgicas y reingresos hasta 30 días posalta. Se excluyó la cirugía de urgencia, pacientes fallecidos durante la hospitalización, pacientes sometidos a resecciones hepáticas menores a dos segmentos, cirugías no anatómicas o cirugía no resectiva. El análisis estadístico univariable se realizó con prueba χ2 para variables categóricas y T Student/Mann Whitney para variables continuas. El análisis multivariable se realizó con regresión logística. Resultados: Se incluyeron 116 pacientes, 50,9% mujeres. La estadía promedio fue de 14 días. El adenocarcinoma pancreático fue el diagnóstico más frecuente (25,9%) y 40,5% de los procedimientos quirúrgicos fueron pancreatoduodenectomías. La tasa de reingreso global fue 18,1%, mayor en pancreatectomías respecto a hepatectomías (23,7 vs 12,2% respectivamente p < 0,05). Los factores asociados a reingreso fueron: resección de páncreas, leucocitos preoperatorios, complicaciones posoperatorias y tiempo de estadía hospitalaria. Tras el análisis multivariable, sólo el tiempo hospitalario se asocia de forma independiente al reingreso precoz [OR 1,2 IC 95% 1,1-1,5 (p = 0,001)]. Conclusión: La estadía hospitalaria prolongada es un factor de riesgo consistente en la literatura para la rehospitalización posterior a resecciones hepáticas o pancreáticas. La tasa de reingreso posterior a resecciones hepáticas o pancreáticas es elevada, incluso en centros de alto volumen. Recomendamos el uso de este parámetro como un nuevo instrumento de medición de calidad en los resultados quirúrgicos en nuestro país.

Objetivo: Adaptar culturalmente el cuestionario LINQ (Lung Information Needs Questionnaire) en pacientes con enfermedad pulmonar crónica. Métodos: Estudio descriptivo, después de la traducción del cuestionario por traductor certificado y de la adaptación cultural, se aplicó en ocho pacientes para identificar las dificultades y dudas relacionadas con el entendimiento de las preguntas, la terminología y para evaluar no solo la calidad de la traducción, sino también para verificar aspectos prácticos de su aplicación. Posteriormente, se realizó una segunda traducción al idioma inglés la cual fue enviada a los autores para asegurar el contenido original del cuestionario y conseguir el aval para su uso. Resultados: La muestra en la fase de adaptación cultural fue constituida por 6 hombres y 2 mujeres con una edad promedio de 61 años. La versión en español del LINQ y la adaptación cultural fue comprensible y fácil de usar y no presentó discrepancias con la versión original durante el proceso de retratraducción. Conclusiones: La traducción al español y la adaptación del LINQ fue adecuada pues los pacientes no manifestaron dificultades para entender y responder las preguntas. Esto podrá facilitar la realización de futuros estudios que evalúen el componente educativo en los programas de rehabiltación pulmonar.

Objective: To perform a cultural adaptation of the LINQ (Lung Information Needs Questionnaire) for patients with chronic pulmonary disease. Method: Descriptive study. After the translation of the questionnaire by a certified translator, and after its cultural adaptation, it was applied in eight patients in order to identify the difficulties and doubts related to an understanding of the questions and of its terminology, not only to evaluate the quality of the translation, but to verify practical aspects of its application, as well. Afterward, a second translation was done from Spanish to English, and sent back to the authors to ensure the original content of the questionnaire was maintained, and to obtain endorsement for its use. Results: During the cultural adaptation phase, the sample was constituted by 6 men and 2 women, with an average age of 61 years. The Spanish version of the LINQ, as well as the cultural adaptation, was easy to use and did not show any discrepancies with the original version during the re-translation process. Conclusions: The LINQ's translation to Spanish and the cultural adaptation proved to be adequate, because the patients did not express any difficulties in understanding and answering the questions. This will facilitate future studies that evaluate the educational component in the pulmonary rehabilitation program.

Objetivo: adaptar culturalmente o questionário LINQ (Lung Information Needs Questionnaire) em pacientes com doença pulmonar crônica. Métodos: Estudo descritivo, depois da tradução do questionário por tradutor certificado e da adaptação cultural, aplicou-se a oito pacientes para identificar as dificuldades e dúvidas relacionadas com o entendimento das perguntas, a terminologia e para avaliar não só a qualidade da tradução, más também para verificar aspectos práticos de sua aplicação. Posteriormente, realizou-se uma segunda tradução ao idioma inglês a qual foi enviada aos autores para assegurar o conteúdo original do questionário e conseguir o aval para seu uso. Resultados: a amostra na fase de adaptação cultural foi constituída por 6 homens e 2 mulheres com uma idade média de 61 anos. A versão em espanhol de LINQ e a adaptação cultural foram compreensíveis e fáceis de usar e não apresentaram discrepâncias com a versão original durante o processo de retradução. Conclusões: a tradução ao espanhol e a adaptação do LINQ foi adequada pois os pacientes não manifestaram dificuldades para entender e responder as perguntas. Isto poderá facilitar a realização de futuros estudos que avaliem o componente educativo nos programas de reabilitação pulmonar.

Introduction: Sacrococcygeal pilonidal cyst or sinus is a common condition in young people. There is still discussion about which of the many existing techniques is best suited to resolve this condition. Objective: To analyze the short-and long-term use of Karydaki's technique in our Hospital. Material and Methods: We analyzed prospective protocols from patients with pilonidal cyst with Karydaki's technique from June 2005 to August 2010. Clinical and telephonic follow-up was done to all patients and a satisfaction survey done to a random sample of the series. Results: We analyzed 62 patients with mean age of 24.5 years (15-45), being 33 men (53%). Cysts were previously relapsed in 20.9% of cases. The average hospital stay was 2.5 days (1-3). Early complications occurred in 14.3% of patients being the most common seroma in 8% and dehiscence in 6.4%. At a mean follow up of 38 months (12-62), relapse occurred in two patients (3.2%), one at 6 months and the other at 3 years, being resolved one by a new Karydaki's technique and the other with marsupialization. Among the group surveyed for satisfaction, 75% found the technique satisfactory or very satisfactory in terms of aesthetics and 95% would recommend this technique. Conclusions: Karydaki's operation achieves with a simple and aesthetic technic a low recurrence and morbidity and a complete recovery after 15 days in most patients.

Introducción: El quiste o seno pilonidal sacrocoxígeo es una patología frecuente en gente joven. Aún hay discusión sobre cual de las múltiples técnicas existentes es la más adecuada para resolver esta patología. Objetivo: Analizar los resultados a corto y largo plazo con la utilización de la técnica de Karydakis en nuestro medio. Material y Método: Se analizan los protocolos prospectivos de pacientes intervenidos por quiste pilonidal con la técnica de Karydakis desde junio de 2005 hasta agosto de 2010. Se realizó seguimiento clínico y telefónico de los pacientes y una encuesta de satisfacción a una muestra aleatoria de la serie. Resultados: Se analizan 62 pacientes con promedio de edad de 24,5 años (15-45), siendo de ellos 33 hombres (53%). En un 20,9% de los casos eran quistes recidivados. La hospitalización promedio fue de 2,5 días (1-3). Un 14,3% presentó complicaciones precoces siendo las más frecuentes el seroma (8%) y dehiscencia de sutura (6,4%). El seguimiento promedio fue de 38 meses (i: 12-62). Dos pacientes tuvieron recidivas (3,2%), a los 6 meses y a los 3 años, resolviéndose una con nueva técnica de Karydakis y la otra con marsupialización. Del grupo encuestado, el 75% consideró que la técnica fue satisfactoria o muy satisfactoria (estética) y el 95% de los pacientes la recomendaría. Conclusiones: La operación de Karydakis logra con una técnica simple y estética una baja recidiva y morbilidad y una recuperación definitiva a los 15 días en la mayoría de los pacientes.

Se presentan dos pacientes posparto, con antecedente de preeclampsia, que consultaron por cefalea y síntomas neurológicos, en quienes se diagnosticó trombosis de los senos venosos cerebrales, con una posible asociación a presencia de anticuerpos antinucleares. Se hace una revisión de la literatura de la trombosis de los senos venosos durante el posparto con énfasis en el diagnóstico y las recomendaciones del tratamiento con anticoagulantes. Se recomienda la terapia anticoagulante por tres a seis meses. En ambas pacientes descritas se presentó un aumento de los títulos de anticuerpos antinucleares, por lo que surge la hipótesis de una posible asociación causal.

Two postpartum patients, having a history of preeclampsia, were presented. They had consulted because of cephalalgia and neurological symptoms being presented; the diagnosis was thrombosis of the cerebral venous sinuses, possibly associated with the presence of antinuclear antibodies. The literature regarding thrombosis concerning venous sinuses during the postpartum period was reviewed, placing special emphasis on diagnosis and instructions for treatment with anticoagulants. Three to six months’ anticoagulant treatment is recommended. Both patients presented increased antinuclear antibody titres, suggesting posible causal association.

El objetivo del estudio fue comparar los cambios en la ingesta y estado nutricional de algunos minerales, durante tres meses de tratamiento para reducción de peso, utilizando dietas con distinto aporte energético. 62 mujeres obesas (edad 33,2 ± 8,3 años; IMC 34,6 ± 3,4 kg/m2) fueron asignadas a dos tratamientos dietéticos: uno con 1000 kcal/día (Dieta 1) y otro con 1300 kcal/día (Dieta 2). Al inicio y después de tres meses se evaluó ingesta de hierro (Fe), cinc (Zn), cobre (Cu) y calcio (Ca) con encuestas alimentarias de registro de tres días. Se analizaron parámetros de laboratorio respecto al estado nutricional de Fe, Zn y Cu: hemoglobina, ferritina sérica, cinc-protoporfirina, saturación de transferrina, cinc plasmático, cinc en pelo y cobre plasmático. La reducción de peso fue 10,8% en la Dieta 1 y 8,5% en la Dieta 2 (p= 0,29). La ingesta de Fe, Zn, Cu y Ca se redujo en promedio en 50, 30, 40 y 9%, respectivamente. El cambio de ferritina sérica fue significativo en el grupo con la dieta 1 (p= 0,040), en pacientes con pérdida de peso ≥10% (p=0,006), y aquellas con menor ingesta proteica (p=0,033). En los otros parámetros de laboratorio, aunque se observaron tendencias a mayores alteraciones en el grupo con 1000 kcal/día, estas no alcanzaron significación estadística. La indicación de dietas con 1000 y 1300 kcal/día, no produjo alteraciones significativas en el estado nutricional de minerales durante los tres primeros meses de tratamiento, a excepción de un mayor deterioro de los depósitos de hierro

Effect of moderate energy-restricted diets on the nutritional status of selected minerals in obese women. The aim of this study was to compare changes of nutrient intakes and nutritional status of selected minerals, during a three-month weightloss program using diets with distinct energy contents. 62 obese women (age 33.2 ± 8.3 years; BMI 34.6 ± 3.4 kg/m2) were allocated to two diets, one supplying 1000 kcal/d (Diet 1), and the other 1300 kcal/d (Diet 2). Before and after 3 months, intakes of iron (Fe), zinc (Zn), copper (Cu), and calcium (Ca) were evaluated through selfreported three-day dietary records. Selected laboratory parameters related to the nutritional status of iron, zinc and copper were analyzed: hemoglobin, serum ferritin, zinc-protoporfirin, transferrin saturation, plasma zinc, hair zinc, and plasma copper. Mean weight loss was 10.8% on Diet 1 and 8.5% on Diet 2 (p= 0.29). Intakes of Fe, Zn, Cu and Ca decresed by 50%, 30%, 40%, and 9%, respectively. The change of serum ferritin was significantly greater in the group on Diet 1 (p= 0.04), in ≥10% of weight loss subjects (p= 0.006) and in patients with lower protein intake (p= 0.033). Others parameters studied, although tended consistently to present greater disturbances in subjects receiving the 1000 kcal/d diet, they did not reach statistical significance. The prescription of weight-reducing diets with 1000 y 1300 kcal/d did not produce major effects on the nutritional status of minerals during the first three months of treatment, except by the significant detriment of body iron stores in subjects receiving the 1000 kcal diet, as indicated by the changes of serum ferritin

Objective: To compare measured resting energy expenditure (REE) with that predicted by formulas derived from populations with normal weight or obesity and from women with severe and morbid obesity. Material and methods: 66 women (aged 35.6 ± 10.3 y and BMI of 44.7 ± 4.9 kg/m²) were evaluated by indirect calorimetry with a metabolic monitor Deltatrac (Datex Inst., Finland), before undergoing gastric bypass. REE was calculated with the following equations: Harris-Benedict's with both actual and adjusted weight, Ireton-Jones', Mifflin's, and Carrasco's Fast Estimation, which corresponds to 16.2 kcal × kg actual weight. Results: (mean ± sd). Measured REE was 1797 ± 239 kcal/day. All formulas, except Harris-Benedict's with adjusted weight, overestimated REE. The Ireton-Jones' equation presented the greater overestimation (689 ± 329 kcal/day), whereas Mifflin's equation overestimated REE only by 6 ± 202 kcal/day. No significant differences were detected between measured and calculated REE by Mifflin's and Carrasco's Fast Estimation. Accuracy (defined as difference between calculated and measured REE within ± 10%) was greater with Mifflin's equation (68%), followed by Harris-Benedict's with actual weight (64%) and Carrasco's Fast Estimation (61%). By using the Bland-Altman analysis, significant correlations were observed between calculated-measured REE and mean REE (calculated + measured/2) with all equations except Carrasco's Fast Estimation. This means that all but one formula underestimate or overestimate REE depending on the level of measured REE. Conclusion: In severe and morbid obese women, Mifflin's and Carrasco's Fast Estimation equations provided the best performance to estimate REE. Before recommending an equation in an a subset of individuals it is necessary to make previous validation studies to determine that equation with the best predictive power for this particular group of patients.

Objetivo: Comparar el gasto energético de reposo medido con el gasto energético de reposo estimado (GER) por fórmulas predictivas diseñadas a partir de población con peso normal u obesidad, en mujeres con obesidad severa y mórbida. Material y métodos: a 66 mujeres (índice de masa corporal 44,7 ± 4,9 kg/m²; edad 35,6 ± 10,3 años) se les realizó calorimetría indirecta con monitor metabólico Deltatrac (Datex Inst., Finlandia), antes de someterse a cirugía bariátrica. Se estimó el GER con las siguientes ecuaciones: Harris-Benedict con peso real y peso ajustado, Ireton-Jones, Estimación Rápida de Carrasco (16,2 kcal × kg peso real) y Mifflin. Resultados: (x ± de). El GER medido fue 1.797 ± 239 kcal/día. Todas las fórmulas, excepto Harris-Benedict con peso ajustado, sobreestimaron el gasto energético; la ecuación de Ireton-Jones fue la que sobreestimó en mayor cuantía el GER (689 ± 329 kcal/día), mientras que la ecuación de Mifflin sobreestimó el GER sólo en 6 ± 202 kcal/día. No se encontraron diferencias significativas entre el GER medido y el GER estimado por Mifflin y Estimación Rápida. La ecuación de Mifflin fue la más exacta: en 68% de los casos la diferencia entre el GER estimado y medido estuvo dentro de ± 10%, seguida por Harris-Benedict con peso real (64%) y la Estimación Rápida (61%). Según el análisis de Bland-Altman, hubo una correlación significativa entre la diferencia GER estimado-medido y el promedio de GER estimado y medido con todas las ecuaciones, excepto con la Estimación Rápida de Carrasco. Esto implica que, con la excepción de esta última, las fórmulas estudiadas subestiman o sobrestiman el GER dependiendo de la magnitud del GER medido. Conclusión: En la serie pacientes con obesidad severa y mórbida evaluadas, la ecuación de Mifflin y la Estimación Rápida otorgan el menor error de estimación del gasto energético de reposo en mujeres. Antes de recomendar una ecuación en particular es necesario realizar estudios de validación para determinar cuál es la ecuación de predicción más exacta para este grupo de pacientes.

The purpose of this study was to provide new data on the quality and adequacy of the diet of Chilean women. Body mass index (BMI) and the quality of the diet in terms of adequacy of nutrient intakes, food portions as suggested to the Chilean nutrient pyramid, and an adaptation of the healthy food index (HFI) were evaluated in a group of 54 women. Fifty-five percent of subjects had excess body weight. Adequate intakes of vitamin C and folic acid but not energy, iron, calcium, fiber were observed. Mean intakes of vegetables, fruits and dairy products were less than 50% of the recommended portions. F % was 32.6%. Saturated fat was less than 10% and cholesterol intake less than maximum suggested. Appropriate values of HFI were obtained in 20.4% of individuals. No associations were found among BMI and energy intake and HFI. It is concluded that a high proportion of women presents less-than-adequate diets

El propósito de este estudio fue aportar nuevos antecedentes acerca de la suficiencia y calidad de la alimentación de mujeres adultas chilenas. Se determinó en 54 mujeres el Índice de Masa Corporal (IMC) y la calidad de la alimentación mediante su adecuación a las recomendaciones de energía y nutrientes, porciones de alimentos recomendadas por las Guías de Alimentación Chilenas y al Índice de Alimentación Saludable (ISA) adaptado. Se observó un 55% de exceso de peso, una buena adecuación del consumo de vitamina C y ácido Fólico y baja de energía, hierro, calcio, fibra. Para verduras, frutas y lácteos el consumo promedio fue menos del 50% de las porciones recomendadas. El G % fue de 32.6 % con un aporte de grasas saturadas menor del 10% y de colesterol menor al máximo sugerido. Sólo el 20.4% consumía una alimentación saludable. No se encontró una asociación entre IMC y consumo de energía e ISA. Se concluye que una importante proporción del grupo de mujeres estudiadas presenta una alimentación poco saludable, con un inadecuado consumo de alimentos y desequilibrios en el aporte de nutrientes

Background: The prevalence of obesity is growing in Chile. The personal perception about the own nutritional status is associated to the risk of obesity. Aim: To analyze the personal perception about their nutritional status among adults living in Santiago and to compare it to the objective diagnosis obtained according to Chilean Health Ministry norms. Material and methods: The body image was explored in 735 people between the ages of 20 and 90. The weight and height were obtained under standard conditions, and the body mass index (BMI) was calculated (kg/m²) and classified according to the criteria of the Health Ministry. The concordance and Kappa index between both criteria in function of age, gender, nutritional status and height were analyzed. The model that best explained the weight subestimation was determined with multivariate logistic regressions. Results: Fifty two percent of subjects classified correctly their nutritional status, 30% subestimated, and 18% overstimated the nutritional status (Kappa 0.27). The multivariate analysis showed greater subestimation in obese (OR 5.8 95% IC 4.2-7.9), in men (OR 4.5 95% IC 2.7-7.3), people younger than 60 years old (OR 2.0 95% IC 1.3-3.1) and people of small stature (OR 3.1 95% IC 1.9-4.9). Conclusions: Half of the studied subjects had an inadequate perception of the body image. Educative campaigns are needed to reinforce the concept of adequate weight. This may contribute to promote health and reduce the risk of obesity

Hemodynamic care during postoperative management of myocardial revascularization should include vasorelaxing drugs to insure adequate graft and coronary flow, and stimulation of stroke volume to maintain vascular perfusion pressure. We tested the cardiac (inotropic and lusitropic) and vascular (relaxant) effects of diltiazem (0.1 nM to 0.1 mM), dobutamine (10 µM to 10 mM) and amrinone (10 µM to 1 mM) on isolated rat atria and thoracic aorta, and also on isolated human saphenous vein (HSV) and human mammary artery (HMA). Dobutamine produced a maximal positive inotropic effect (+dF/dt max = 29 ± 7%) at its ED50 for aortic relaxation (88 ± 7 µM). Conversely, at their ED50 for aortic relaxation diltiazem depressed myocardial contractility and amrinone did not exhibit myocardial effects. In HSV and HMA contracted with 80 mM potassium, diltiazem and dobutamine (but not amrinone) had a vasorelaxant activity similar to that in rat aorta. Norepinephrine-contracted human vessels were significantly more sensitive than potassium-contracted vessels to the relaxant effect of amrinone (ED50 HMA = 15 ± 5 µM, ED50 HSV = 72 ± 31 µM, P < 0.05). We conclude that at concentrations still devoid of myocardial effects dobutamine and amrinone are effective dilators in graft segment vessels and rat aorta contracted by membrane depolarization. If the difference between aortic and myocardial tissue still holds in human tissues, at the appropriate concentrations these drugs should be expected to improve cardiac performance while still contributing to the maintenance of graft patency.

Background: Epidemiological studies have suggested that smoking, nutrition and sexual patterns are major risk factors for cervical cancer. Aim: To study the association between food consumption patterns, smoking and sexual behavior and the risk of cervical cancer. Material and methods: A matched case control study of 170 cases and 340 controls. Food and nutrient intakes were assessed by a food frequency questionnaire considering 58 antioxidant rich food items. Median daily intake of vegetables, fruits, antioxidant vitamins and fiber was calculated. A conditional logistic regression model was used to determine odds ratios associated with variations in nutritional intake and no nutritional factors (age at first delivery, parity, body mass index, family history of cancer and smoking). Results: High intakes of vegetables, fruits, beta carotene, vitamin C, E and fiber were associated with a lower risk of cervical cancer (Odds ratios ranging from 0.56 to 0.78). The risk for cancer was inversely associated with the age at first delivery and directly associated with the total number of pregnancies and smoking. Multivariate analysis model showed a protective effect for vegetable and vitamin E consumption (odds ratio of 0.6 with confidence intervals of 0.5 to 0.8 p<0.001) and a higher risk associated to smoking (odds ratio 2.8, confidence intervals 1.5-5.5 p<0.002) and a younger age at the first delivery (odds ratio 3.37 confidence intervals 2-5.3 p<0.001). Conclusions: Cervical cancer is associated with reproductive and food consumption behaviors. A higher intake of vegetables and foods rich in vitamin E can reduce its risk (Rev Méd Chile 2001; 129: 597-603)

Background: Epidemiological studies suggest a relation between breast cancer, diet and life styles. Aim: To analyze the association between food patterns, obesity, smoking, alcohol consumption and breast cancer risk in women of Santiago. Patients and methods: A case-control study design (170 cases and 340 controls), matched by age and sex, was used. Through a food frequency questionnaire the average daily intake of vegetables, fruits, ß-carotene, vitamin A, C, E and fiber was analyzed. Other exposures to non-nutritional risks (parity, smoking, cancer history) were also studied. Conditional logistic regression was calculated to determine the odds ratio associated with variations in food and nutrient intake and nonnutritional factors. Results: Cases had a greater BMI and a higher prevalence of obesity than controls (p< 0.02). No differences were observed in either group food patterns. The ORs for breast cancer associated with obesity and alcohol consumption were 1.65 (95% CI 1.06-2.64) and 1.61 (95% CI 1.06-2.54) respectively (p< 0.05). Multiparity had a protective effect with 0.66 less risk (95% CI 0.44-0.99). No protective effect associated to a greater intake of vegetables, fruits or natural antioxidants was observed. Multivariate analysis model disclosed obesity as a risk factor (OR 1.79, p< 0.02) and parity ³ 4 as protective (OR 0.62, p<0.02). Conclusions: This study does not support a protective role for natural antioxidants against breast cancer but indicate a weakassociation with obesity.

Objective: to assess food consumption and physical activity patterns of school children from the Aysen Region in order to develop an obesity prevention program. Patients and methods: the group studied was a representative sample from the school children from playground to fourth grade (n = 340). Sociodemographic, as well as food and physical activity patterns were obtained from interviews conducted at each participant’s house. Frequency and intake level of selected foods were studied and compared with Ministry of Health recommendations. An index of overall diet quality was developed based on Chilean food pyramid and food consumption guidelines. Results: average age was 7.7± 1.6 years. Vegetables, fruits, and dairy products were among foods with low frequency of consumption. On contrast, high consumption frequency of mayonnaise, lard, and soft drinks were observed. High-fat meats and lacteous products were commonly consumed. Adequacy by food groups showed low figures regarding vegetables, fruits and dairy products, and high values on fats (oils), sugar and meats, mainly in women. Median for quality index was 3 (p 25 = 2, p 75 = 4), over a maximum of 7, without significant differences neither by age, sex nor nutritional status. Median of physical activity was considered as low: 6 walked blocks/day (95% CI 4.5-6.0), sports and active games 4 hours/week (95% CI 4-4). Conclusion: the food and physical activity patterns of school children from Aysen are inadequate. It is necessary to elaborate plans to promote healthy life stiles as preventing measures for obesity