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La instalación de un catéter de drenaje espinal es un procedimiento indicado principalmente en la reparación de aneurismas aórticos y en el escenario de neurocirugía. No siempre es un procedimiento fácil de realizar donde surgen dudas sobre indicación, técnica y eventuales complicaciones. En el siguiente artículo revisamos cada uno de estos temas.

El manejo de los pacientes que presentan un accidente vascular isquémico ha evolucionado en los últimos años. Varios estudios abrieron la posibilidad para el tratamiento endovascular de estos pacientes, mejorando sus resultados funcionales. El manejo anestésico basado en evidencia a cambiado gracias a nueva literatura relevante. En este artículo queremos describir brevemente los cambios en el estado del arte según la nueva evidencia clínica.

Resumen Introducción: La manifestación extramuscular de las miopatías inflamatorias idiopáticas (MII) es la enfermedad pulmonar intersticial (EPI) y el diagnóstico se basa en autoanticuerpos séricos. Los nuevos anticuerpos específicos y asociados a MII han ayudado a identificar nuevas entidades clínicas en el espectro de MII. El objetivo de este estudio es evaluar la contribución diagnóstica de un panel de anticuerpos de miositis (PM) en una cohorte de pacientes chilenos con EPI sin una enfermedad del tejido conectivo (ETC) definitiva. Materiales y Métodos: A partir de enero de 2017 se realizó un panel de miositis a 111 pacientes consecutivos con EPI y sospecha de ETC, pero sin un diagnóstico definitivo a través de otra herramienta diagnóstica, en el programa de Pulmón-Reumatológico del Instituto Nacional del Tórax, Santiago, Chile. Se compararon las características basales clínicas y serológicas de los pacientes que se asociaban más frecuentemente a la probabilidad de tener un panel positivo. Resultados: El PM fue positivo en 56 de 111 pacientes. El síndrome antisintetasa (SAS) fue el diagnóstico más frecuente. Los anticuerpos más frecuentes fueron Ro-52, PM / Scl-75 y Ku. Las variables más frecuentes en el grupo PM(+) fueron la presencia del Raynaud, miositis, manos de mecánico, los anticuerpos Ro y La positivos, la presencia de un patrón combinado de neumonía intersticial inespecífica y neumonía organizada en la tomografía computarizada de tórax. Conclusiones: la incorporación del PM nos ha ayudado a mejorar nuestra precisión diagnóstica en pacientes con EPI / ETC. Presentamos elementos clínicos y serológicos que perfeccionan el rendimiento de la prueba.

Resumen La historia natural de la fibrosis pulmonar idiopática (FPI) es heterogénea e impredecible. Aunque el curso de la enfermedad, sin tratamiento, es inevitablemente progresiva y de mal pronóstico. Los tratamientos históricos han variado desde corticosteroides e inmunosupresores (azatioprina, ciclofosfamida), hasta colchicina y N-acetilcisteína. En las últimas décadas se han realizado múltiples ensayos terapéuticos fallidos. Sin embargo, desde el año 2014 en los Estados Unidos, Europa y otros países, dos drogas, denominadas terapia antifibrótica o modificadoras de la enfermedad, están aprobadas para el tratamiento de la FPI: nintedanib y pirfenidona. La terapia antifibrótica, tiene como objetivo enlentecer en hasta 50% la declinación de la función pulmonar en pacientes con FPI. The natural history of idiopathic pulmonary fibrosis (IPF) is heterogeneous and unpredictable. The course of the disease without treatment, is inevitably progressive, with a poor prognosis. Historical treatments have varied from corticosteroids and immunosuppressants (azathioprine, cyclophosphamide), to colchicine and N-acetylcysteine. In the last decades, multiple failed therapeutic trials have been carried out. However, since 2014 in the United States, Europe and other countries, two drugs, called antifibrotic therapy or disease modifiers, are approved for the treatment of IPF: nintedanib and pirfenidone. The purpose of antifibrotic therapy is to slow down the decline in lung function in patients with IPF up to 50%.

Resumen La fibrosis pulmonar idiopática (FPI) es una forma específica de neumonía intersticial idiopática, de tipo fibrosante crónica y progresiva, con patrón radiológico y/o histológico de neumonía intersticial usual (NIU). Su patogenia es compleja, el modelo más aceptado actualmente es basado en las células epiteliales alveolares, aberrantemente activadas que conducen a la proliferación de fibroblastos y su diferenciación a miofibroblastos que depositan matriz extracelular y destruyen irreversiblemente la arquitectura pulmonar. No existe un claro factor inicial que explique la activación y posterior mantención del mecanismo de la fibrosis. El factor de crecimiento transformante beta (TGF-β) liberado por las células epiteliales alveolares se ha implicado como unos de los principales conductores de la inducción y proliferación de fibroblastos alterados que persiste mucho tiempo después de la estimulación inicial, lo que explicaría en gran parte el comportamiento clínico progresivo y crónico. Idiopathic pulmonary fibrosis (IPF) is a specific form of idiopathic interstitial pneumonia, of chronic and progressive fibrosing type, with radiological and / or histological pattern of usual interstitial pneumonia (UIP). Its pathogenesis is complex, the most accepted model currently is based on the fact that the alveolar epithelial cells, aberrantly activated, lead to the proliferation of fibroblasts and their differentiation to myofibroblasts that deposit extracellular matrix and irreversibly destroy the pulmonary architecture. There is no clear initial trigger that explains the activation and subsequent maintenance of the fibrosis mechanism. The transforming growth factor beta (TGF-β), released by the alveolar epithelial cells, has been implicated as one of the main drivers of the induction and proliferation of altered fibroblasts that persists long after the initial stimulation, which would largely explain progressive and chronic clinical behavior.

Resumen Antes de la publicación de la clasificación ATS/ERS 2002 de las neumonías intersticiales idiopáticas (NII), la evaluación histopatológica se consideraba la referencia de oro para el diagnóstico de las enfermedades pulmonares intersticiales (EPI). Sin embargo, varios estudios posteriores mostraron que las concordancias interobservador entre anatomopatólogos expertos torácicos eran sorprendentemente pobres ya que las apariencias histopatológicas pueden superponerse entre entidades distintas. Por lo anterior, se hace necesario un nuevo sistema diagnóstico que sirva de patrón de oro en pacientes con EPI. Es así como nace el concepto de discusión multidisciplinaria, para referirse a una reunión que permita la integración de todos los datos clínicos, radiológicos y patológicos disponibles para un paciente individual y así poder determinar un diagnóstico de trabajo.

Resumen Antes de la publicación de la clasificación ATS/ERS 2002 de las neumonías intersticiales idiopáticas (NII), la evaluación histopatológica se consideraba la referencia de oro para el diagnóstico de las enfermedades pulmonares intersticiales (EPI). Sin embargo, varios estudios posteriores mostraron que las concordancias interobservador entre anatomopatólogos expertos torácicos eran sorprendentemente pobres ya que las apariencias histopatológicas pueden superponerse entre entidades distintas. Por lo anterior, se hace necesario un nuevo sistema diagnóstico que sirva de patrón de oro en pacientes con EPI. Es así como nace el concepto de discusión multidisciplinaria, para referirse a una reunión que permita la integración de todos los datos clínicos, radiológicos y patológicos disponibles para un paciente individual y así poder determinar un diagnóstico de trabajo. Prior to the publication of the 2002 ATS / ERS classification of idiopathic interstitial pneumonias (IIP), the histopathological evaluation was considered the gold standard for the diagnosis of interstitial lung diseases (ILD). However, several subsequent studies showed that interobserver concordances between expert lung pathologists were surprisingly poor, since histopathological appearances may overlap between different entities. Therefore, a new diagnostic system that serves as a gold standard in patients with ILD became necessary. This is how the concept of multidisciplinary discussion was born, to refer to a meeting that allows the integration of all the clinical, radiological and pathological data available for an individual patient and thus be able to determine a working diagnosis.

Resumen Introducción: La actinomicosis, es una infección crónica rara producida por bacterias del género Actinomyces sp. La afectación pélvica es una de sus formas más infrecuentes y en gran parte de los casos se relaciona al uso de un dispositivo intrauterino de larga data o a una cirugía previa. Como otras enfermedades raras, la infección es conocida como “la gran imitadora” por su variada forma de presentación y particular comportamiento pudiendo simular una neoplasia. El tratamiento es fundamentalmente médico y de buenos resultados. Caso Clínico: Damos a conocer el caso de una paciente que se presentó con un cuadro compatible con un tumor de recto, pero que resultó ser actinomicosis. El diagnóstico se realizó en base a la tinción de Gram, el cuadro clínico y el antecedente de un dispositivo intrauterino abandonado por más de 25 años. Fue corroborado posteriormente mediante anatomía patológica y tratada en forma exitosa con antibióticos por un periodo extendido. Conclusión: Si bien la actinomicosis es una patología infrecuente, debe ser considerada en el diagnóstico diferencial de los pacientes que se presentan con tumores de la pelvis. Un alto índice de sospecha y una actitud diagnóstica activa son fundamentales para un tratamiento oportuno, seguro y eficaz de esta enfermedad. Introduction: Actinomycosis is a rare chronic infection caused by bacterias of the genus Actinomyces sp. Pelvic involvement is one of its most infrequent forms and in many cases it is related to the use of a longstanding intrauterine device or a previous surgery. Like other rare diseases, the infection is known as “the great imitator” because of its varied form of presentation and its particular behavior, which can simulate a neoplasm. The treatment is fundamentally medical with good results. Case Report: We present the case of a patient who presented with a rectal tumor but that turned out to be Actinomycosis. The diagnosis was made based on the Gram stain, the clinical presentation and the history of an intrauterine device left for more than 25 years. It was subsequently corroborated by pathological anatomy and successfully treated with antibiotics for an extended period. Conclusion: Although actinomycosis is an infrequent pathology, it should be considered in the differential diagnosis of patients who present with tumors of the pelvis. An active diagnostic attitude and a high index of suspicion are fundamental for the timely, safe and effective treatment of this disease.

Julio Escámez Contreras was a highly creative, skilled and versatile Chilean painter who painted in Chile from 1940 to 1974 when he went into exile to Costa Rica and died there in 2015. In 1953-54, Escámez painted a large mural in a private pharmacy in the city of Concepcion, Chile, The History of Medicine and Pharmacy in Chile. This mural describes the origins and development of medicine and pharmacy in Chile, placing that origin in the medicinal activities of the mapuche indigenous population. The mural consists of three sections, each painted on the upper segment of three adjacent walls in the pharmacy, with each section focused on one period in the evolution of medicine and pharmacy in Chile. The first section is devoted to indigenous medical practices including its pharmacopeia and religious practices, the second describes medical approaches during colonial times, still with strong indigenous components but also with indigenous and Catholic hybrid religious elements, while the third depicts modern medicine, including chemistry, anatomical, physical and pharmacological activities complemented with public health components such as nursing, vaccination and health education. Read from left to right, the mural provides a highly lively, accurate and valid depiction of the evolution of medicine and pharmacy in Chile. Escámez' artistry and skill in the use of perspective, color, landscape, architecture and Chilean subjects, including real life individuals, produces a typical Chilean mural. However, his originality and consummate use of a non-verbal visual language delivers a more universal message, one that helps to explain the repeated efforts, of the government responsible for his exile, to destroy some of the works produced by him.

The author in this short text remembers the passing of a beloved pet cat. Cats are beautiful animals and wonderful companions. They evolved together with humans in Africa, subsequently spread over the five continents with them, and became the subject of many human cultural activities, including art, poetry and religion. Abandoned and roaming free, cats readily return to the wild, potentially acquiring many zoonotic infections. Surprisingly, feline company is increasingly used for therapy of mental and other illnesses such as cardiovascular disorders. Responsible ownership and good veterinary care of these marvelous animals under the One Health paradigm are essential to their well-being as well as to that of humans. They are an ethical and small price to pay for the affectively rewarding relationships humans have with these endearing and evocative animals.

RESUMEN Introducción: La glándula parótida es el sitio más común de tumores de glándulas salivales, correspondiendo al 75%-85% de éstos y al 3% de todos los tumores de cabeza y cuello. Ochenta por ciento de ellos corresponden a tumores benignos. Objetivos: Analizar la experiencia quirúrgica en tumores parotídeos operados en el Hospital Guillermo Grant Benavente. Material y método: Revisión de todos los pacientes con tumores parotídeos operados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, del Hospital Guillermo Grant Benavente entre enero del año 2011 y abril del año 2016. Las cirugías fueron realizadas por el mismo equipo quirúrgico. Se registraron datos demográficos, clínicos, quirúrgicos, histológicos y resultados posoperatorios. Resultados: En el periodo descrito se operó un total de 94 pacientes. 84,3% correspondieron a tumores benignos y 15,7% a tumores malignos. El 62,9% corresponde a pacientes de sexo femenino y 37,1% de sexo masculino, representando una relación de 1,69:1. La incidencia de parálisis facial transitoria fue de 16,1%, y de ellos solo un paciente mantuvo una parálisis permanente. Conclusión: Los tumores malignos representaron el 15,7%, siendo menor a lo reportado en la literatura. Se presenta una gran serie de tumores parotídeos tratados quirúrgicamente a nivel nacional, con una baja tasa de complicaciones. Abstract Introduction: Parotid gland is the most common site of salivary gland tumors, corresponding to 75-85% of these and 3% of all head and neck tumors. 80% of them correspond to benign tumors. Aim: To analyze the surgical experience in parotid tumors operated in the Guillermo Grant Benavente Hospital. Material and Method: Review of all patients with parotid tumors operated in the Otorhinolaryngology and Head and Neck Surgery Unit of Hospital Guillermo Grant Benavente between January 2011 and April 2016. All surgeries were performed by the same surgical team. Demographic, clinical, surgical, histological and postoperative results were recorded. Results: In the period described, a total of 94 patients were operated on. 84.3% corresponded to benign tumors and 15.7% to malignant tumors. 62.9% corresponds to female patients and 37.1% male, representing a ratio of 1.69:1. The incidence of transient facial paralysis was 16.1%, and of these, only one patient maintained permanent paralysis. Conclusions: Malignant tumors represented 15.7% of cases, being less than reported in the literature. This article presents a large series of parotid tumors treated surgically in our country, with a low associated complication rate.

RESUMEN Introducción: Los tumores de la glándula submandibular son poco frecuentes. Representan menos del 1% de todos los tumores de cabeza y cuello. Corresponden al 10% de los tumores de las glándulas salivales. Aproximadamente el 50% son malignos. Objetivos: Analizar la experiencia clínica con las submandibulectomias realizadas en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital Guillermo Grant Benavente. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes intervenidos de submandibulectomía entre el 01 de enero de 2011 y el 31 de diciembre de 2016 en nuestro servicio. Resultados: Se realizaron 28 submandibulectomías por patología tumoral. La edad promedio fue de 54 años, siendo el 71% de sexo femenino. 21 tumores fueron benignos (75%), siendo el más frecuente el adenoma pleomorfo (14 casos), y 7 tumores malignos (25%), siendo el más frecuente el carcinoma adenoidequístico. Se reportaron dos complicaciones transitorias (7%), una paresia de la rama marginal del nervio facial y una paresia del nervio hipogloso. El 42% de los tumores malignos presentó recurrencia. Conclusión: Nuestra serie presenta resultados acordes a la literatura en cuanto a edad de presentación, distribución por sexo, tipos histológicos, tasa de complicaciones y recurrencia; sin embargo, difiere en la menor frecuencia de tumores malignos, siendo en nuestra serie de 25%. Patología poco frecuente. La presencia de una masa indolora submandibular debe ser derivada a los centros de referencia para estudio y eventual resolución quirúrgica por el riesgo de malignidad. ABSTRACT Introduction: Submandibular gland tumors are rare. They represent less than 1% of all head and neck tumors. They correspond to 10% of the tumors of the salivary glands. Approximately 50% are malignant. Aim: To analyze the clinical experience with the submandibulectomies performed in the Otorhinolaryngology and Head and Neck Surgery Service of the Guillermo Grant Benavente Hospital. Material and Method: Retrospective descriptive study. Review of clinical records of patients treated with a submandibulectomy between January 1,2011 and December 31, 2016 in our service. Results: 28 submandibulectomies were performed due to tumor pathology. The average age was 54 years, being 71% female. 21 tumors were benign (75%), being the most frequent the pleomorphic adenoma (14 cases), and 7 malignant tumors (25%), being the most frequent the adenoidequistic carcinoma. Two transient complications (7%) were reported, a paresis of the marginal branch of the facial nerve and a paresis of the hypoglossal nerve. 42% of malignant tumors presented recurrence. Conclusion: Our series presents results according to the literature regarding age of presentation, distribution by sex, histological types, complication rate and recurrence; however, it differs in the lower frequency of malignant tumors, being in our series of 25%. Uncommon pathology. The presence of a submandibular painless mass must be referred to the reference centers for study and possible surgical resolution due to the risk of malignancy.

RESUMEN La disfunción olfatoria es una patología frecuente que trae consigo una disminución importante en la calidad de vida de los pacientes y que incluso conlleva una mortalidad aumentada respecto a la población general. Sin embargo, es una condición subdiagnosticada, ya sea por desconocimiento de los profesionales o por falta de un método diagnóstico adecuado. A la fecha no existe un tratamiento efectivo para estos pacientes y generalmente se les deja sin tratar. Una alternativa para este gran problema es el entrenamiento olfatorio, tratamiento propuesto recientemente con resultados promisorios. ABSTRACT Olfactory dysfunction is a frequent pathology associated with an important decrease in the quality of life of patients and an increased mortality respect to the general population. However, it is an underdiagnosed condition, either due to lack of knowledge of the professionals or due to the lack of an adequate diagnostic method. To date there is no effective treatment for these patients and they are usually left untreated. An alternative to this problem is olfactory training, a treatment recently proposed with promising results.

RESUMEN El angiofibroma nasofaríngeo es el tumor benigno más frecuente de la nasofaringe, representando el 0,05% del total de las neoplasias de cabeza y cuello. Los angiofibromas en localizaciones distintas a la nasofaringe son entidades raras. Ellos son descritos esporádicamente en la literatura, ubicándose principalmente en el seno maxilar. En este artículo presentamos un caso de fibroangioma extranasofaríngeo localizado en fosa temporal derecha seguido de una revisión de literatura. ABSTRACT Nasopharyngeal angiofibroma is the most common benign tumor of the nasopharynx, representing 0.05% of total neoplasms of the head and neck. Extranasopharyngeal angiofibromas are rare entities described sporadically in the literature, being located mainly in the maxillary sinus. We present a case of an extra-nasopharyngeal fibroangioma located in the right temporal fossa followed by a literature review.

RESUMEN Las hendiduras laríngeas posteriores son anomalías congénitas de la laringe de baja incidencia que comprometen la región interaritenoidea o la lámina cricoidea. En caso de extenderse hasta la tráquea son denominados clefts laringo-tráqueo-esofágicos. Su clínica es inespecífica y debe sospecharse en todo niño con trastorno de deglución y neumonía aspirativa a repetición. A continuación, presentamos un caso de un cleft laríngeo tipo 2 tratado endoscópicamente. ABSTRACT The posterior laryngeal clefts are congenital anomalies of the larynx of low incidence that comprise the interaritenoid region or the cricoid lamina. In case of extending to the trachea they are called laryngo-tracheo-esophagic clefts. Its clinic is non-specific and should be suspected in any child with swallowing disorder and aspiration pneumonia. We present a case of an endoscopically treated laryngeal cleft type 2.

RESUMEN Introducción: El sinus tympani (ST) es una de las áreas que más presenta colesteatoma residual. Recientemente se ha clasificado en 3 tipos de acuerdo a su morfología. Objetivos: Determinar el tipo de ST en los pacientes sometidos a cirugía de colesteatoma y analizar su impacto como factor de recidiva. Material y método: Revisión de fichas clínicas de pacientes sometidos a cirugía de colesteatoma entre los años 2004 y 2015 en el Hospital Regional de Concepción. Análisis de la tomografía axial computarizada (TAC) preoperatoria y posterior evaluación clínica de los pacientes operados mediante mastoidectomía canal wall down (CWD). Resultados: En el periodo descrito se operaron 271 oídos. El 60% de los casos analizados presentó ST tipo A y 40% ST tipo B. Se identificaron 12 casos de recidiva, 3 ST tipo B y 9 ST tipo A, sin diferencia estadísticamente significativa entre ambos. Discusión: Distinto a lo reportado en la literatura el tipo de ST más frecuente en nuestro estudio fue el tipo A, lo que podría corresponder a una variable étnica. Conclusión: El estudio preoperatorio con TAC es una herramienta útil para evaluar el tipo y compromiso del ST. Las diferencias anatómicas entre ST tipo A y B parece no ser un factor determinante de recidiva en mastoidectomías CWD. ABSTRACT Introduction: Sinus tympani (ST) is one of the areas with the most residual cholesteatoma. Recently it has been classified in 3 types according to its morphology. Aim: To determine the type of ST in patients undergoing cholesteatoma surgery and to analyze its impact as a relapse factor. Material and method: Review of clinical files of patients submitted to cholesteatoma surgery between 2004 and 2015 at the Regional Hospital of Concepción. Preoperative computed axial tomography (CT) analysis and subsequent clinical evaluation of patients operated by canal wall down mastoidectomy (CWD). Results: In the described period 271 ears were operated. 60% of the cases analyzed had ST type A and 40% ST type B. Twelve cases of relapse were identified, 3 ST type B and 9 ST type A, with no statistically significant difference between the two. Discussion: Unlike to what is reported in the literature, the most common ST type in our study was type A, which could correspond to an ethnic variable. Conclusion: The preoperative study with CT is a useful tool to evaluate the type and commitment of ST. The anatomical differences between ST type A and B seems not to be a determinant factor of relapse in CWD mastoidectomies.

Maturity-Onset Diabetes of the Young (MODY) refers to a heterogeneous group of monogenic diabetes. Unlike other types of MODY characterized by genetic defects in transcription factors, MODY 2 is triggered by metabolic alterations caused by mutations of glucokinase (GCK), the first enzyme of the glycolytic pathway. We report a three-generation Chilean family with multiple cases affected with this disease. The index case is a patient who presented severe neonatal hyperglycemia (831 mg/dl, without ketosis) requiring continuous infusion of insulin, which was suspended after 48 hours with normalization of blood glucose. Subsequently, continuous glucose monitoring at 4 months of age revealed 47% of tissue glucose levels above 140 mg/dl, with fasting glucose levels between 120 and 166 mg/dl. The genetic analysis revealed a previously reported mutation in heterozygous state of the GCK gene (c.148C>T; p.His50Tyr). This mutation was also identified in more than one affected relative in the last two generations, with a transmission pattern suggestive of dominant inheritance. GCK gene sequencing led to a correct molecular diagnosis of MODY 2 while bioinformatic analysis indicated the possible molecular causes of the enzyme dysfunction. The knowledge of the molecular diagnosis allowed an adequate medical treatment for this disease.

RESUMEN: Este trabajo pretende contribuir al incipiente desarrollo de la teoría contemporánea del derecho de contratos en Chile. El derecho de contratos requiere ser justificado políticamente, y la teoría del derecho de contratos cumple un rol fundamental en dicha justificación. El artículo analiza la necesidad de una teoría del derecho contractual, explora su metodología y formula la distinción entre el rol de la dogmática y el de la teoría. Finalmente, se analiza la relación entre ambas. ABSTRACT: The object of this paper is to contribute to the growing development of contemporary contract theory in Chile. Contract law requires political justification, and contract theory plays a crucial role in such justification. The paper analyzes the need for a theory of contract law, explores its methodology and draws a distinction between the role of contract doctrine and contract theory. Finally, the paper analyzes their relationship.

Introducción: El uso de expansor mamario, previo a la reconstrucción definitiva con prótesis, no está exento de complicaciones. Las mismas no solo tienen relación con la presencia de radioterapia perioperatoria, o factores propios de las pacientes, sino que también guardan relación con la cobertura muscular íntegra del expansor mamario. Material y métodos: Revisión retrospectiva de pacientes sometidas a reconstrucción mamaria diferida utilizando una modificación de la técnica del cierre de bolsillo submuscular con celulosa oxidada regenerada NU-KNIT® de expansor mamario. Entre el 1 de enero de 2014 y el 31 de diciembre de 2015 un solo cirujano plástico (J.V.) de la Unidad de Patología Mamaria de la Clínica Alemana de Santiago realizó reconstrucción con dicha técnica en 31 pacientes. Se describe la modificación de la técnica, así como los datos demográficos, histológicos y complicaciones de la fase de expansión de las mismas. Resultados: Se realizaron 40 reconstrucciones mamarias en 31 pacientes. Se presentaron 11 seromas (27,5% del total de los expansores), 2 sufrimientos de colgajo cutáneo con dehiscencia de la herida (5% de los expansores) y una infección de la herida operatoria (2,5% de los expansores). Dos pacientes requirieron aseo quirúrgico por dehiscencia e infección. Una paciente requirió explantación del expansor (2,5% del total de los expansores). Discusión: La modificación de la técnica quirúrgica representa una alternativa segura y reproducible para lograr un cierre total del bolsillo muscular y con ello la cobertura completa del expansor, evitando así algunas de las complicaciones descritas secundarias a una cobertura insuficiente del mismo. Introduction: The use of breast expander, prior to the final prosthetic reconstruction, is not exempt from complications. They not only relate to the presence of peri-operative radiation therapy, or patient-related issues; but also related to the muscle integrate coverage of the breast expander. Material and methods: Retrospective review of patients undergoing deferred breast reconstruction using a modification of the technique of sub muscular pocket closing with oxidized regenerated cellulose NU-KNIT TM for the breast expander. Between January 1, 2014 and December 31, 2015 one plastic surgeon (J.V.), from the Breast Pathology Unit at Clínica Alemana de Santiago, performed reconstruction surgeries with this technique in 31 patients. In the present article, the technique modification, demographic data, histological data and the complications which arose during the expansion phase of the same, will be described. Results: 40 breast reconstructions were performed in 31 patients. 11 seromas (27.5% of total expanders), 2 sufferings of skin flap wound dehiscence (5% expanders) and 1 wound infection (2.5% of expanders) were presented. Two patients required surgical debridement due to surgical dehiscence and infection. One patient required explantation of the expander (2.5% of total expanders). Discussion: The modification of the surgical technique represents a safe and reproducible alternative to achieve a complete closure of the muscular pocket and thus a complete coverage of the expander, consequently; avoiding some of the secondary complications drawn from an insufficient coverage of the expander.

Introducción: Se estima que del total de los cánceres, el 5-10% tendría una base genética. Actualmente es posible identificar a los individuos con predisposición genética en algunos cánceres como manera de intervenir precozmente en el desarrollo de esta enfermedad. Objetivos: Evaluar la utilidad de la cirugía profiláctica en el cáncer medular de tiroides hereditario. Material y métodos: Este trabajo es una revisión de literatura de diferentes estudios extraídos de bibliotecas electrónicas como Scientific Electronic Library Online (SciELO), MedLine-PubMed y UpToDate, mediante la construcción de preguntas clínicas y términos MeSH enfocados principalmente en la búsqueda específica de información sobre el cáncer medular de tiroides hereditario. Resultados: Los estudios revisados demuestran que la tiroidectomía profiláctica con resección linfática cervical representa el único tratamiento eficaz en el caso del cáncer medular de tiroides hereditario. Conclusiones: La cirugía profiláctica ha demostrado una importante disminución del riesgo de cáncer de tiroides y se considera una conducta de rigor en portadores del gen RET en el cáncer medular de tiroides. Introduction: Approximately 5-10% of global cancer has a genetic base. Nowadays it is possible to identify those who have a genetic predisposition for some cancers, so they can be treated in short term. Objectives: Evaluate how useful is prophylactic surgery on hereditary Medullary Thyroid Cancer. Materials and methods: This investigation is a literature review of different research papers from electronic databases such as Scientific Electronic Library Online (SciELO), MedLine-PubMed and UpToDate. The research was made with clinical queries and MeSH terms, specially focused on hereditary Medullary Thyroid Cancer. Results: This research shows that prophylactic Thyroidectomy with cervical lymph node resection is the only effective and curative treatment for hereditary Medullary Thyroid Cancer. Conclusions: Prophylactic surgery has proof an important role decreasing the risk on Hereditary Thyroid cancer Syndrome and in RET carriers surgery is considered a must.

Las fracturas laríngeas se producen principalmente en el contexto de traumas cervicales, ahorcamiento o estrangulamiento. Las fracturas laríngeas no traumáticas son excepcionales, existiendo escasos reportes en la literatura. A continuación, presentamos dos casos de fracturas laríngeas no traumáticas evaluadas en nuestro servicio. Laryngeal fractures occur mainly in the context of cervical trauma, hanging or strangulation. Nontraumatic laryngeal fractures are rare and there are fewreports in the literature. We present two cases of nontraumatic laryngeal fractures evaluated in our service.

En los humanos las infecciones más frecuentes son las respiratorias, siendo la principal indicación de antibióticos en niños. El uso indiscriminado de antibióticos lleva a la aparición de gérmenes multirresistentes. Uno de los objetivos actuales en salud es la prevención de las enfermedades infecciosas para disminuir el uso de antibióticos. Una estrategia postulada recientemente para prevenir infecciones respiratorias es el uso de probióticos. In humans, the most frequent infections are respiratory, being the main indication of antibiotics in children. The indiscriminate use of antibiotics leads to the emergence of multi-resistant germs. One of the current health objectives is the prevention of infectious diseases so we can reduce the use of antibiotics. A potential strategy for preventing respiratory infections is the use of probiotics.

Los trastornos respiratorios obstructivos del sueño corresponden a un amplio espectro de patologías que incluyen a los roncadores primarios, el síndrome de resistencia de vía aérea superior y al síndrome de apnea obstructiva del sueño (SAOS). Dentro de sus manifestaciones clínicas se encuentra la roncopatía y la respiración bucal, las cuales generan alteraciones en el crecimiento craneofacial del niño pudiendo ser la causa de un SAOS residual. El objetivo de esta revisión es analizar las alteraciones del crecimiento craneofacial en niños generadas por la roncopatía y respiración bucal. Obstructive sleep breathing disorders correspond to a broad spectrum of diseases that include primary snorers, upper airway resistance syndrome and obstructive sleep apnea syndrome (OSAS). Its clinical manifestations include snoring and mouth breathing, which generates alterations in the craniofacial growth of the child that may be the cause of a residual OSAS. The objective of this review is to analyze the alterations of craniofacial growth generated by snoring and mouth breathing in children.

Introducción: La tiroidectomía es una de las cirugías más frecuentes realizadas en cabeza y cuello. Existen escasos reportes de experiencia en tiroidectomías en servicios de otorrinolaringología en Chile. Objetivo: Analizar la experiencia clínica con las tiroidectomías totales realizadas en el Servicio de ORL y Cirugía de Cabeza y Cuello de nuestro hospital. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes sometidos a tiroidectomías totales (TT) entre los años 2010 y 2014 en nuestro servicio. Resultados: Se realizaron 271 tiroidectomías totales. La indicación más frecuente fue por tamaño (51%). Los diagnósticos más frecuentes fueron carcinomas papilares (46%) e hiperplasia folicularcoloidea (37%). Se presentaron lesiones transitorias del nervio laríngeo recurrente en 2,9%, y lesiones persistentes en 2,5%. Hipocalcemia transitoria se presentó en el 25% de los pacientes. Discusión: Nuestra serie presenta resultados concordantes con la literatura, presenta una baja tasa de complicaciones, las cuales se observan principalmente en pacientes con vaciamiento cervical y/o en que se observaron 2 o menos paratiroides. Conclusiones: La tiroidectomía total es una técnica quirúrgica segura y nuestra experiencia presenta resultados concordantes a los publicados en la literatura internacional. Introduction: Thyroidectomy is one of the most common surgeries performed in head and neck. There are few reports of experience in thyroidectomy in otolaryngology services in Chile. Aim: To analyze the clinical experience with total thyroidectomy performed in the service of ENT and Head and Neck Surgery of our hospital. Material and method: Retrospective descriptive study. Review of medical records of patients undergoing total thyroidectomy (TT) between 2010 and 2014 in our service records. Results: A total of 271 thyroidectomy were performed. The most frequent indication was size (51%). The most frequent diagnoses were papillary carcinomas (46%) and follicular colloid hyperplasia (37%). We found 2.5% of transient recurrent laryngeal nerve injury and 2.9% had persistent lesions. Transient hypocalcemia occurred in 25% of patients. Discussion: Our series shows good agreement with literature, it has a low rate of complications, which are mainly seen in patients with neck dissection and/or observed 2 or less parathyroid during surgery. Conclusions: Total thyroidectomy is a safe surgical technique, and our experience shows consistent results to those reported in international literature.

Introducción: Se estima que del total de los cánceres, el 5-10% tendría una base genética. Actualmente es posible identificar a los individuos con predisposición genética a desarrollar cáncer de mama, una manera de intervenir precozmente en el desarrollo de esta enfermedad. Objetivos: Evaluar la utilidad de la cirugía profiláctica en el síndrome de cáncer hereditario de mama. Material y métodos: Este trabajo es una revisión de literatura de diferentes estudios extraídos de bibliotecas electrónicas como Scientific Electronic Library Online (SciELO), MedLine-PubMed y UpToDate, mediante la construcción de preguntas clínicas y términos MeSH enfocados principalmente en la búsqueda específica de información del síndrome de cáncer hereditario de mama. Resultados: Los estudios revisados demuestran que la mastectomía bilateral profiláctica (MBP) disminuye en un 90% el riesgo de desarrollar cáncer de mama en las mujeres portadoras de BRCA1 o BRCA2. En cuanto a la salpingooferectomía (SO), reduciría entre un 50-56% el riesgo de cáncer de mama dependiendo de la mutación a la que se asocie. Conclusiones: La cirugía profiláctica ha demostrado importante disminución del riesgo de cáncer de mama, por lo que su uso es recomendado al hallazgo de las mutaciones BRCA1 y BRCA2. Introduction: Approximately 5-10% of global cancer has a genetic base. Nowadays it is possible to identify those who have a genetic predisposition for breast cancer, so they can be treated in short term. Objectives: Evaluate how useful is prophylactic surgery on Hereditary Breast cancer Syndrome. Materials and methods: This investigation is a literature review of different research papers from electronic databases such as Scientific Electronic Library Online (SciELO), MedLine-PubMed and UpToDate. The research was made with clinical queries and MeSH terms, specially focused on Hereditary Breast cancer Syndrome. Results: This research shows that prophylactic bilateral mastectomy (PBM) decreases 90% risk of developing breast cancer in BRCA1 and BRCA2 carriers. On the other hand, Salpyngo-oophoferectomy (SO) technique decreases around 53% chances of breast cancer, depending on the associated mutation. Conclusion: Prophylactic surgery has shown an important role decreasing the risk on Hereditary Breast cancer Syndrome. So on, in cases of BRCA1 and BRCA2 carriers we suggest to perform prophylactic surgery.

Introducción: La laringomalacia es la causa más frecuente de estridor en lactantes, representando el 60%-70% de los defectos congénitos laríngeos. Entre 10%-20% de estos pacientes puede requerir tratamiento quirúrgico. Objetivo: Revisar las manifestaciones clínicas y los resultados de las supragloto-plastías en laringomalacia severa en nuestro hospital durante 2015. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes sometidos a supraglotoplastía en el Hospital Guillermo Grant Benavente de Concepción en 2015. Resultados: Se intervinieron 11 pacientes siendo el promedio de edad, al momento de la cirugía, de 7,3 meses. Todos los pacientes tenían dificultad para alimentarse y el 45% además cianosis con la alimentación y el llanto, desaturaciones y pausas respiratorias. Cuatro casos portaban anomalías congénitas asociadas y el 73% presentó lesiones concomitantes de vía aérea, principalmente estenosis subglótica (64%). Los tipos morfológicos observados de laringomalacia fueron los tipos I y II con 27% y 73%, respectivamente. La tasa de éxito quirúrgico fue de 91%, sin necesidad de revisiones y no se presentaron complicaciones relacionadas al procedimiento. Conclusiones: La supraglotoplastía con láser es una técnica segura y efectiva para el tratamiento de laringomalacia severa. Los pacientes con laringomalacia severa debiesen ser sometidos a una revisión completa de vía aérea para evaluar otras comorbilidades. Introduction: Laryngomalacia is the most common cause of stridor in infants, accounting for 60%-70% of laryngeal congenital defects. Between 10% to 20% of these patients may require surgical treatment. Aim: To review the clinical manifestations and outcomes of supraglottoplasties in severe laryngomalacia at our hospital during 2015. Material and method: Retrospective medical record review of children that underwent CO2 laser supraglottoplasty at Hospital Guillermo Grant Benavente in Concepcion during 2015. Results: Eleven patients were included in this study, the average age at the time of surgery was 7.3 months. All the patients had stridor associated with feeding difficulty and 45% of them also had cyanosis with feeding and crying, desaturations and respiratory pauses. Four cases had associated congenital anomalies and 73% of the patients had airway comorbidity, mostly subglottic stenosis (64%). All of ourpatients had types I and II laryngomalacia with 27% and 73%, respectively. The success rate of surgery was 91%, no patients required a revision supraglottoplasty and there were no complications related to the procedure. Conclusions: CO2 laser supraglottoplasty proved to be a safe and effective treatment for severe laryngomalacia. Patients with severe laryngomalacia should undergo a full airway revision under general anesthesia to assess airway comorbidity.

La xerostomía es la sensación de boca seca producto de una alteración del funcionamiento de las glándulas salivales. No es una enfermedad propiamente tal, pero sí una manifestación común a una serie de patologías alterando considerablemente la calidad de vida de los pacientes. Es una complicación frecuente de los pacientes oncológicos de cabeza y cuello que han sido irradiados, por lo que el otorrinolaringólogo juega un rol importante en su manejo. El objetivo de esta revisión es actualizar el manejo de la xerostomía, haciendo énfasis en la prevención de ésta en el paciente oncológico. Xerostomia is the sensation of dry mouth and is usully caused by an altered functioning of the salivary glands. It is not a disease itself, but it is a common manifestation of a number of pathologies altering the quality of life of patients. It is a common complication of head and neck cancer patients that have been irradiated, so the otolaryngologist plays an important role in its management. The objective ofthis review is to update the management of xerostomia, with emphasis on preventing this in cancer patients.

Introducción: El papiloma invertido es uno de los tumores benignos más frecuentes de la región nasosinusal. Los principales problemas en su manejo son la recurrencia y transformación maligna. Su tratamiento es la extirpación quirúrgica. Objetivos: Describir y analizar las caracterfsticas cínicas y epidemiológicas, así como el resultado del tratamiento endoscópico practicado en el Hospital Clínico Regional de Concepción. Material y método: Se realizó un estudio retrospectivo, descriptivo, de todos los pacientes con diagnóstico de papiloma invertido nasosinusal operados vfa abordaje endoscópico entre los años 1997 y 2012. Se analizaron variables epidemiológicas y clínicas, incluyendo análisis de las recurrencias y transformación/asociación a cáncer. Resultados: Se encontraron 57 casos de papiloma invertido nasosinusal, 55 de los cuales se abordaron endoscópicamente, 65,5% hombres, 54,7 años en promedio de edad. La obstrucción nasal fue el principal síntoma. La mayor cantidad se concentró en estadio 2 (47,3%) y 3 (32,7%) de Krouse. Complicaciones relevantes 7,8%, las cuales fueron resueltas sin secuelas. Seguimiento promedio de 4,1 años, con una recurrencia de 5 (9,1%) casos, una persistencia (1,8%). Asociación con carcinoma escamoso en el 5,5% de los casos. Conclusión: La experiencia con la resección endoscópica en el papiloma invertido nasosinusal ha demostrado ser efectiva en nuestro medio, con baja tasa de complicaciones y recurrencias. Introduction: The inverted papilloma is one of the most common benign tumors of the sinonasal region. The main problems in their management are the recurrence and malignant transformation. Their treatment is surgical removal. Aim: To describe and analyze the clinical and epidemiological characteristics, as well as the results of endoscopic treatment in a tertiary hospital. Materials and methods: A retrospective, descriptive study of all patients with diagnosis ofsinonasal inverted papilloma operated by endoscopic approach between 1997 and 2012 was carried out. Epidemiological and clinical variables were analyzed, including analysis of recurrences and transformation to / association with cancer. Results: 57 cases of sinonasal inverted papilloma were found, 55 of which were endoscopically resected, 65.5% male, 54.7 years old on average. Nasal obstruction was the main symptom. Most of them were in Krouse stage 2 (47.3%) and 3 (32.7%); 7.8% of major complications, which were resolved without sequels. The follow up average was 4.11 years, with a recurrence of 5 (9.1%) cases, and (1.8%) persistence. Association with squamous-cell carcinoma was found in 5.5% of cases. Conclusion: The clinical and epidemiological characteristics do not differ greatly from those reported in the literature. Experience with endoscopic resection in sinonasal inverted papilloma has proven effective in our clinical practice, with a low rate of complications and recurrences, this approach currently being the first choice in most cases.

Realism is a painting style that began with Millet and Courbet in politically convulsed France in the middle of the nineteenth century. In the second half of that century, the pragmatic and democratic tradition of the United States fostered the careers of many realist painters, including that of Thomas Eakins. Eakins, trained in France, developed his career completely associated with Philadelphia at a time when this city was in the vanguard of American emerging industry, culture and medicine. Eakins "The clinic of Dr. Gross" and the "The clinic of Dr. Agnew" are icons of these developments and symbolize a perfect union of art and medicine. Both paintings permit the viewer to appreciate the artist's mastery, originality and Americanism while simultaneously tracking the progress of surgery as evidenced by the introduction of asepsis, anesthesia and nursing. Eakins mastery is revealed by its use of some European Old Masters approaches to portray medical professionals undertaking their daily duties in their work environments with critical and unadorned vision. This combination of vision and skills led Eakins to create a highly original yet analytical art. Unfortunately, his representations were far ahead of his time and resulted in under appreciation of his paintings and a censorious reaction to their content. His contemporaries rejection of Eakins work negatively affected his career as a painter, as a teacher and even his private life. This judgment was overturned in subsequent years and by the twentieth century Eakins was recognized as an American master without parallel.

Diego Rivera is one of the artistic giants of the 20th century. His many original creations included landscapes, portraits and large murals created in both Mexico and the United States. Rivera ventured into many styles-cubism, naturalism and narrative realism-with great success. Rivera’s murals build on those of the Renaissance, pre-historic and colonial civilizations of Mexico. Biological and medical topics and their history form an important concern in Rivera’s work, present in many of his murals in a highly informative and creative manner. His two History of Cardiology murals present an original and comprehensive account of the developments of this medical specialty from pre-historic to modern times. His History of Medicine in Mexico (The people demands health) mural is a creatively and vigorously fashioned and highly dynamic and synthetic vision of the relationships between pre-historic and modern medicine in Mexico and its social foundations. Medical topics such as vaccines and vaccination, embryology and surgery are inventively and accurately presented in the large mural, Detroit Industry. The trigger and impetus for the concern of Rivera for these topics of life and death, and the exceedingly ground-breaking way he presents them, appear to stem from his rational materialism, his concern for collective wellbeing, his belief in progress through scientific developments and political action and his commitment to understand Mexican and American history.

From its basis in the writings of the philosopher Peter Singer and the bioethical shortcomings of animal experimentation and animal husbandry, the animal rights movement has evolved into an important societal movement critical of animal experimentation in biomedical research. A lack of dialogue and transparency, an absence of understanding and an unreasonable radicalization of different positions regarding animal experimentation has frequently resulted in an adversarial relationship between some members of the scientific community and societal groups aggressively protecting animal rights. In response to this problem, both the bioethical regulations pertaining to biomedical experimentation with animals and the powers of animal care committees (IACUCs) have been strengthened. Careful analysis of the relevance of animal models to human conditions, replacement of these models with non-animal models when possible, adequate re-examination of existing knowledge before undertaking new experimental projects involving animals, and the improvement of methods to avoid animal stress and pain have further strengthened the bioethical basis of animal experimentation. To improve the ethical integrity of research conducted with animals, it is also necessary to increase the editorial scrutiny of the bioethical standards of potentially publishable research utilizing animals. Of note is also the recent use of animals in alternative animal associated therapies (AAT) to ameliorate several medical conditions. Education of the biomedical community, including students and professionals, and of societal groups concerned about this issue as well as directness and continuous dialogue among all the stakeholders are essential to insure the wellbeing of animals and the ethical integrity of biomedical research.

From its basis in the writings of the philosopher Peter Singer and the bioethical shortcomings of animal experimentation and animal husbandry, the animal rights movement has evolved into an important societal movement critical of animal experimentation in biomedical research. A lack of dialogue and transparency, an absence of understanding and an unreasonable radicalization of different positions regarding animal experimentation has frequently resulted in an adversarial relationship between some members of the scientific community and societal groups aggressively protecting animal rights. In response to this problem, both the bioethical regulations pertaining to biomedical experimentation with animals and the powers of animal care committees (IACUCs) have been strengthened. Careful analysis of the relevance of animal models to human conditions, replacement of these models with non-animal models when possible, adequate re-examination of existing knowledge before undertaking new experimental projects involving animals, and the improvement of methods to avoid animal stress and pain have further strengthened the bioethical basis of animal experimentation. To improve the ethical integrity of research conducted with animals, it is also necessary to increase the editorial scrutiny of the bioethical standards of potentially publishable research utilizing animals. Of note is also the recent use of animals in alternative animal associated therapies (AAT) to ameliorate several medical conditions. Education of the biomedical community, including students and professionals, and of societal groups concerned about this issue as well as directness and continuous dialogue among all the stakeholders are essential to insure the wellbeing of animals and the ethical integrity of biomedical research.

Georg Friedrich Nicolai (1874-1964) was a German physician and physiologist whose pacifism during the First World War led him in 1914 to cosign with W. J. Foerster, A. Einstein and O. Bueck a "Manifesto to the Europeans" against the entry of Germany into the war and the invasion of Belgium. As a result of this appeal and his strong pacifism, Nicolai lost his positions as cardiologist to the German royal family, professor at the University of Berlin and chief of laboratory at the Charite hospital also in Berlin, and was sent as a garrison physician in Graundenz, in today's Poland. There he began to write his book, The Biology of War. It managed to avoid censorship and was published in Leipzig in 1916. He was court-martialed in Danzig in 1916 but escaped to Denmark. Nicolai was reinstated to his faculty positions by the Weimar Republic after the war but was subsequently forced to emigrate from Germany to South America by the pressure of right wing student groups who accused him of being a deserter and a traitor. From 1922 to 1932 Nicolai lived in Argentina, and from 1932 until his death in 1964, in Chile. In this later country Nicolai was professor in the University of Chile and interacted with members of the Chilean intelligentsia, including the poets Vicente Huidobro, Gonzalo Rojas and Pablo Neruda. Through his friendship with Chilean psychiatrist Agustin Tellez, Nicolai influenced the development of phenomenological psychiatric school in Chile. The Chilean novelist Fernando Alegria compared him favorably with Robert J. Oppenheimer and Linus Pauling.

Este estudio presenta, por un lado, una serie de problemáticas ecológicas y socioeconómicas que afectan directamente a las familias campesinas que habitan la zona denominada “Secano Interior” de la Región del Biobío, Chile. Estas problemáticas son diversas tanto en su procedencia como en su naturaleza, es por esta misma razón es que para este estudio se propone una metodología y enfoque interdisciplinario. Por otro lado, este estudio aborda estas problemáticas a través de las estrategias adoptadas y gestadas por las familias campesinas para afrontar esta dinámica y progresiva crisis socio-ambiental. Estrategias que deben ser observadas con atención, ya que consisten de conocimiento materializado y puesto a prueba, y que responden también a una propuesta más agroecológica para el futuro del campo chileno. ABSTRACT: This study describes a number of ecological and socioeconomic problems that directly affects the peasant families that inhabit the called area of “Secano Interior” (Interior dry-land) present in the Biobío region in Chile. These problematic are diverse not only in their origin, but also, in their nature, for reason is that this study proposes an interdisciplinary methodology to approach such multitude of factors. The study also focuses on the strategies adopted and engendered by the peasant families in order to face this dynamic and progressive socio-environmental crisis. These strategies must be observed with care, as they are rooted in time tested materialized knowledge, and that also respond to a more agroecological proposal for the Chilean countryside.

The aim of this project is to realize a qualitative investigation, on the practice and the novice teacher of history PUCV in his initial teacher's formation, and in I make concrete on his professional performance executing the collaborative model. More than, beyond presenting the theoretical postulates of the collaborative model, takes root in opening an investigation of the practice and the novice teacher in and on the action relating to the concept of autoperception. &nbsp, El objetivo de este proyecto es realizar una investigación cualitativa, sobre la práctica y los practicantes de historia PUCV en su formación docente inicial y, en concreto, sobre su desempeño profesional ejecutando el modelo colaborativo. La centralidad de este trabajo, más allá de presentar los postulados teóricos del modelo colaborativo, radica en desplegar una investigación de la práctica y los practicantes en y sobre la acción referente al concepto de autopercepción. &nbsp, O objetivo deste projeto é realizar uma investigalo qualitativa, sobre a prática e os praticantes de história PUCV em sua formacáo docente inicial, em concreto sobre seu desempenho professional executando o modelo colaborativo. A centralidade deste trabalho, mais que, presentear os postulados teóricos do modelo colaborativo, radica em despregar uma investigacáo da prática e os praticantes em é sobre a acáo referente ao conceito de autopercepcáo. &nbsp

El objetivo de este proyecto es realizar una investigación cualitativa, sobre la práctica y los practicantes de historia PUCV en su formación docente inicial y, en concreto, sobre su desempeño profesional ejecutando el modelo colaborativo. La centralidad de este trabajo, más allá de presentar los postulados teóricos del modelo colaborativo, radica en desplegar una investigación de la práctica y los practicantes en y sobre la acción referente al concepto de autopercepción. The aim of this project is to realize a qualitative investigation, on the practice and the novice teacher of history PUCV in his initial teacher's formation, and in I make concrete on his professional performance executing the collaborative model. More than, beyond presenting the theoretical postulates of the collaborative model, takes root in opening an investigation of the practice and the novice teacher in and on the action relating to the concept of autoperception. O objetivo deste projeto é realizar uma investigalo qualitativa, sobre a prática e os praticantes de história PUCV em sua formação docente inicial, em concreto sobre seu desempenho professional executando o modelo colaborativo. A centralidade deste trabalho, mais que, presentear os postulados teóricos do modelo colaborativo, radica em despregar uma investigação da prática e os praticantes em é sobre a ação referente ao conceito de autopercepção.

Backgroud: Latent Autoimmune Diabetes in Adults (LADA) is the term used to describe adults who have a slowly progressive form of diabetes mellitus (DM) of autoimmune etiology, but that may be treated initially without insulin. Although it shares some immunological and genetic aspects with type 1 DM, it affects an age group that is typically affected by type 2 DM. Therefore, it could be considered an intermediate type. Diagnosis is based on clinical and laboratory criteria: age of onset, initial response to oral hypoglycemic agents and the presence of specific antibodies for diabetes. Although the definitive treatment is insulin, glitazones may be useful in early stages of the disease. Currently, its management represents a challenge for the physician, including specialists, and it is a form of DM to keep in mind.

En estudios realizados se ha identificado que en las minas emplean un personal aproximado de (50-300) trabajadores y por lo tanto los riesgos asociados con la minería tienen efecto considerable, ya que efectúan todas las labores subterráneas exponiéndose a accidentes de trabajo como explosión de grisú, inundaciones, incendios, polvo de carbono y difusiones instantáneas de gases (CO2 y CH4) y a principales enfermedades laborales como artrosis, sordera, neumoconiosis, bronconeumopatias, asma profesional, alveolitis, dermatitis crónica, bronquitis crónica, conjuntivitis, rinitis. “Debido a estas partículas, todas las minas subterráneas de carbón son potencialmente explosivas, concluyó un estudio de la Universidad Nacional de Colombia en Medellín. El análisis de muestras de la sustancia tomadas en 40 de los más importantes socavones del país revela que las minas de Norte de Santander son las de mayor riesgo”.*, Introducción, Justificación, Planteamiento del Problema, Pregrado, Profesional en Seguridad y Salud en el Trabajo

The National Library of Medicine (NLM) of the United States of America, celebrates in 2011 its 175th anniversary. This Library, the largest biomedical library in the world, has a proud and rich history serving the health community and the public, especially since its transfer to the National Institutes of Health in Bethesda, Maryland, in 1968. It holds 17 million publications in 150 languages, and has an important collection of ancient and modern historical books as well as original publications of Vesalius and other founders of biomedicine. Its modern document collections illustrate the progress of medical sciences. These collections include laboratory notes from many scientists whose work forms the foundations of contemporary life sciences. The Library also provides several services for health research and for the public, including databases and services such as MedLine and BLAST. The NLM constantly strives to fulfill the information needs of its customers, whether scientists or the public at large. For example, as the Hispanic population of the Unites States has increased in recent years, the NLM has made larger and larger amounts of data available in Spanish to fulfill the health information needs of this population. NLM programs train professionals in library science and biomedical informatics and link biomedical libraries of 18 academic centers throughout the United States. The NLM funds competitive grants for training at the Library, organizing short instruction courses about library science and informatics, and writing books on health related matters including the history of medicine and public health. The NLM is managed and maintained by an outstanding and farsighted group of professionals and dedicated support staff. Their focus on serving and reaching both the biomedical community and the public at large has been crucial to its development into a world icon of biomedical sciences, information technology and the humanities.

Progress in understanding the biological processes that allow Mycobacterium tuberculosis to be a successful parasite have accelerated in the last twenty years. This progress has been stimulated by the return of tuberculosis (TB) as an important disease in industrialized countries, by its increase in emergent nations in the tail of population increases and poverty and by the spread of multiple drug resistant (MDR) and extensively drug resistant (XDR) M. tuberculosis as a result of treatment failures. Progress on M. tuberculosis biology has also been fueled by advances in microbiology and molecular biology, including molecular genetics, genomics, proteomics and in vitro and in vivo models of infection. The study of latency or dormancy, a phenomenon central to understanding the persistence of M. tuberculosis and the development of TB in individuals, its spread in human populations and the emergence of antibiotic-resistant/tolerant organisms, has been preferred targets for investigators in this area. In this manner, factors that trigger M. tuberculosis latency (e. g, hypoxia, nutrient starvation, NO exposure) have been characterized and the metabolic shifts to host lipid utilization, tolerance to antimicrobials and resistance to host immune mechanisms involved in latency have been determined. Similarly, genetic changes and the resulting antimicrobial mechanisms mediating the MDR and XDR states have been characterized and potential new vaccines that avoid reactivation from latency and infection are being developed. Despite this progress, and given the fact that effective anti tuberculosis therapy was developed and first introduced clinically at the end of the 1940s, there are now more cases of latent and active TB worldwide than ever before. This reinforces the concept of TB as a bacterial disease with strong social and economical! determinants which are presently stimulating increased transmission in many human groups, undermining diagnostics, treatment and prevention. It suggests that in a scenario of global economical crisis the struggle against TB will be weakened, unless efforts are included to alleviate poverty, decrease economic inequality, improve public health and allow democracy and political organization.

Tesis (Licenciado en Periodismo) La falta de cobertura a temas que realmente merecían ser tocados es un claro ejemplo del déficit de la diversidad de los medios de comunicación en nuestro país. Al referirse a diversidad nos referiremos al hecho de que en Chile las diferentes secciones noticiosas (nacional, internacional, deportes y espectáculos) no tienen un espacio equivalente para cada una, en especial al ámbito internacional. Es por esto último que el Consejo Nacional de Televisión (CNTV), organismo autónomo y con personalidad jurídica, encargado de velar por el correcto funcionamiento de este medio de comunicación, fue el principal blanco de críticas durante el 2010 por no aplicar sanciones a las estaciones televisivas que carecen de un importante factor a la hora de emitir hechos de contingencia, la cobertura heterogénea, el dar un espacio determinado a los diferentes ámbitos de la noticia, nacional, internacional, deportes, espectáculos. Los noticieros de televisión abierta en la actualidad parecen estar dedicados a tratar sólo 3 temáticas: deporte (sección dedicada sólo al fútbol), social (que incluye todo lo relacionado con denuncias, demandas y abusos) y policial (robos, asaltos y estafas). Dejando de lado casi por completo los otros ámbitos noticiosos. Si tomásemos una persona que nutre sus conocimientos de actualidad netamente de los actuales noticiarios televisivos probablemente pensará que el mundo es un lugar donde sólo existen criminales, abusos y el único deporte que existe es el fútbol.

Tesis (Ingeniero en Administración de Empresas) Este seminario se enfocará en desarrollar un Plan de Marketing para el año 201 1 que permita generar principalmente aumento en la venta del Terminal de Punto de Venta Hiopos de la empresa Tecno Link Ltda.

Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease, of unknown etiology, affecting almost exclusively women. Microscopically LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). It presents with progressive breathlessness or with recurrent pneumothorax or chylothorax. We report a 33 year-old woman with a history of recurrent pneumothorax. Computed tomography (CT) scans showed numerous thin-walled cysts throughout the lungs, a characteristic finding in LAM. A pulmonary biopsy was compatible with the diagnosis and HMB-45 monoclonal antibodies were positive. Treatment with Sirolimus was started).