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La presión inspiratoria máxima (PIM) ha sido utilizada como indicador de fuerza de la musculatura inspiratoria. No obstante sus valores presentan gran variabilidad (~20%). El objetivo del estudio fue determinar la PIM, según tres protocolos en sujetos jóvenes. Se realizó un estudio observacional de corte transversal en una muestra por conveniencia de 60 estudiantes, 30 hombres (19,2 ± 0,81 años) y 30 mujeres (19,17 ± 0,91 años). Se evaluó la PIM según el protocolo definido para cada grupo compuesto por 20 participantes de ambos géneros: Grupo 1: American Thoracic Society/European Respiratory Society (ATS/ERS); Grupo 2: Aprendizaje; Grupo 3: Calentamiento. Para el análisis se utilizó estadística descriptiva, e inferencial considerándose significativo un valor de p < 0,05. No se encontraron diferencias de PIM de los tres mejores promedios entre grupos (p = 0,078). Al comparar el desempeño total de las repeticiones de PIMG3 fue más alto que G1 y G2 (p < 0,0001). El coeficiente de variación fue más alto en G2. Se concluye que el protocolo calentamiento (G3) podría atenuar el efecto de aprendizaje.

Ehlers Danlos Syndrome comprises a heterogeneous group of genetic disorders of the connective tissue, due to defects in collagen or its modifying enzymes. We report a 21 years old male presenting with translucent skin revealing the subcutaneous venous pattern. He had a thin face, large-appearing eyes, thin lips, thin nose, joint hypermotility and history of hip dysplasia. A vascular Ehlers Danlos Syndrome was suspected. However, the genetic study to confirm the diagnosis was not done.

Endurance exercise competitions have shown a transient negative effect on global right ventricular (RV) performance. Most published studies are based on terrestrial sports. The aim of our study was to evaluate the cardiac effects after an open water swimming race. We evaluated 33 healthy swimmers (mean age 40.9 ± 7.2) participating in a 9.5 km open water swimming race. All subjects underwent a standard transthoracic echocardiography including an evaluation of dimensions and myocardial ventricular deformation. Echocardiography was performed 24 h before and within the first hour of arrival at the finish line. Cardiac troponin I (cTn I), NT-ProBNP and leukocytes were also evaluated. No changes in left ventricle (LV) ejection fraction or LV global longitudinal strain were observed. A significant increase in RV end-diastolic area (RVEDA) was noted after the race (RVEDA at baseline 15.12 ± 1.86; RVEDA after race 16.06 ± 2.27, p

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EFFECT OF COPPER SULPHATE ON THE LUNG DAMAGE INDUCED BY CHRONIC INTERMITTENT EXPOSURE TO OZONE Background: Ozone exposure could increase lung damage induced by airborne particulate matter. Particulate matter lung toxicity has been attributed to its metallic content. Aim: To evaluate the acute effect of intratracheal administration of copper sulfate (CuSO4) on rat lungs previously damaged by a chronic intermittent ozone exposure. Material and Methods: Two months-old male Sprague-Dawley rats were exposed to 0.5 ppm ozone four h per day, five days a week, during two months. CuSO4 was intratracheally instilled 20 h after ozone exposure. Controls breathed filtered air or were instilled with 0.9% NaCl or with CuSO4 or were only exposed to ozone. We evaluated lung histopathology. F2 isoprostanes were determined in plasma. Cell count, total proteins, ? glutamyl-transpeptidase (GGT) and alkaline phosphatases (AP) were determined in bronchoalveolar lavage fluid (BALF). Results: Ozone increased total cell count, macrophages, proteins and AP in BALF (p

Background: Human T-lymphotropic virus-1 (HTLV-1) infection has been associated with the pathogenesis of cutaneous T cell lymphomas (CTCL). Aim: To search for HTLV-1 DNA in skin biopsies of patients with CTCL. Material and Methods: A retrospective study was conducted using 25 biopsies of patients with CTCL. DNA was extracted from lymphoid tissue by microdissection. A nested PCR was conducted to detect HTLV-1 genome using primers for the tax region. As negative controls, four cases of superficial perivascular dermatitis were chosen. As positive controls, five cases of T-cell leukemia/lymphoma (ATCL) were studied. Results: A positive reaction was found in 3 of 25 cases. These biopsies corresponded to a case of Mycosis Fungoides, a case of CD30 (-) T-cell lymphoma and a case of lymphomatoid papulosis. Search was negative in the four cases of superficial perivascular dermatitis and positive in four cases of adult T-cell leukemia/lymphoma (ATCL). Conclusions: HTLV-1 DNA search in tissues is a useful tool recommended to study T-cell lymphomas. HTLV-1 infection only occurs in sporadic cases but may contribute to tumor aggressiveness and prognosis.

La inflamacion es un fenomeno habitualmente presente en mucosa gastrica de pacientes infectados por H. pylori y sus efectos protumorales son ampliamente conocidos. Un importante proceso de vinculacion entre inflamacion y neoplasia es la activacion del eje multiligando/RAGE. RAGE es un receptor de membrana, de la familia de inmunoglobulinas cuya sobreexpresion ha sido demostrada en numerosas neoplasias. En cancer gastrico, la sobreexpresion de RAGE ha sido asociada a mayor invasion y generacion de metastasis, ademas de mayor susceptibilidad al desarrollo y agresividad en algunos polimorfismos. El presente trabajo tuvo por objetivo evaluar la expresion de RAGE y otras moleculas vinculadas con el proceso de transformacion maligna gastrica (MUC-1, ? Catenina libre y fosforilada, Ciclina D1 y GSK3?) en pacientes de la Region del Maule, zona de alta prevalencia y mortalidad por esta neoplasia . Se evaluo, mediante tecnica de inmunohistoquimica, biopsias gastricas de 138 pacientes: 47 sin lesiones endoscopicas (gastritis leve a moderada), 50 con lesiones erosivas (gastritis intensa) y 41 con lesiones displasicas o neoplasia incipiente (in situ). En general, los resultados obtenidos fueron concordantes con lo descrito por la literatura para la expresion molecular en la transformacion maligna de la mucosa gastrica. En el caso particular de RAGE, la mayor expresion o en lesiones displasicas/neoplasicas incipientes avala la participacion del eje multiligando/RAGE en carcinogenia gastrica. Su reconocimiento a nivel nuclear es un hecho infrecuente que requiere ser corroborado con otros estudios que permitan su confirmacion y evaluen el significado funcional de dicho hallazgo

Background: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.

Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, is characterized by fever, neutrophilia, erythematous and tender skin lesions that typically show a diffuse infiltrate of neutrophils in the upper dermis. This disorder has been associated with myeloproliferative syndromes. We report the case of a 53-year-old woman with an acute myeloid leukemia, presenting a Sweet's syndrome. A worsening of cutaneous lesions injuries was observed when granulocyte colony stimulating factor was added to treatment.

Bronchiolar disorders are generally difficult to diagnose. A detailed clinical history may point toward a specific diagnosis. Pertinent clinical questions include history of smoking, collagen vascular disease, inhalation injury, medication use and organ transplantation. It is important also to evaluate possible systemic and pulmonary signs of infection, evidence of air trapping, and high-pitched expiratory wheezing, which may suggest small airways involvement. Pulmonary function tests and plain chest radiography may demonstrate abnormalities; however, they rarely prove sufficiently specific to obviate bronchoscopic or surgical biopsy. High-resolution CT (HRCT) scanning of the chest is often an important diagnostic tool to guide diagnosis in these difficult cases, because different subtypes of bronchiolar disorders may present with characteristic image findings. Some histopathologic patterns of bronchiolar disease may be relatively unique to a specific clinical context but others are nonspecific with respect to either etiology or pathogenesis. Primary bronchiolar disorders include acute bronchiolitis, respiratory bronchiolitis, follicular bronchiolitis, mineral dust airway disease, constrictive bronchiolitis, diffuse panbronchiolitis, and other rare variants. Prominent bronchiolar involvement may be seen in several interstitial lung diseases, including hypersensitivity pneumonitis, collagen vascular disease, respiratory bronchiolitis-associated interstitial lung disease, cryptogenic organizing pneumonia, and pulmonary Langerhans’ cell histiocytosis. Large airway diseases that commonly involve bronchioles include bronchiectasis, asthma, and chronic obstructive pulmonary disease. The clinical and prognostic significance of a bronchiolar lesion is best determined by identifying the etiology, underlying histopathologic pattern and assessing the correlative clinic-physiologic-radiologic context.

Neurofibromatosis is a hereditary autosomal-dominant disease with high rates of de novo mutations, and carries a high risk of neoplasms. It affects both sexes and all races and ethnic groups. It is characterized by multiple cutaneous lesions and tumors, both benign and malignant, especially in the nervous system. We report a 52-year-old woman with a type 1 neurofibromatosis, presenting with fever, jaundice and weight loss. On physical examination, the patient was jaundiced and had "cafe au lait" spots in the skin. A magnetic resonance imaging showed bile duct dilation and a possible ampullar carcinoma. The patient was operated, during the exploration she presented a periampullary tumor and multiple small nodular lesions in the stomach, the tumor was resected with a pancreaticoduodenectomy and the nodular gastric lesions were biopsied. The pathological study revealed a combined adenocarcinoma and neuroendocrine duodenal tumor. The study of the stomach lesions revealed a gastrointestinal stromal tumor. Four months after surgery, the patient is in good condition.

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Skin necrosis must be considered as a syndrome, because it is a clinical manifestation of different diseases. An early diagnosis is very important to choose the appropriate treatment. Therefore, its causes should be suspected and confirmed quickly. We report eleven patients with skin necrosis seen at our Department, caused by different etiologies: Warfarin-induced skin necrosis, loxoscelism, diabetic microangiopathy, ecthyma gangrenosum, disseminated intravascular coagulation, necrotizing vasculitis, paraneoplastic extensive necrotizing vasculitis, livedoid vasculopathy, necrotizing fasciitis, necrosis secondary to the use of vasoactive drugs and necrosis secondary to the use of cocaine. We also report the results of our literature review on the subject.

Herpes folliculitis is a rare manifestation of herpes virus infection. It usually represents a diagnostic challenge, due to the absence of characteristic skin manifestations such as vesicles or pustules. The reported cases are mainly associated with varicella zoster virus (VZV) and less commonly with herpes simplex viruses (HSV-1 y HSV-2). We report a 51-year-old male with a relapsing non-Hodgkin Lymphoma under chemotherapy, with history of extensive follicular lesions lasting one month. The pathologic study of the lesions was consistent with necrotizing herpes folliculitis. The patient was treated with Valacyclovir, achieving remission of the lesions. The appearance of folliculitis, especially in an immunocompromised patient, should raise the suspicion of herpes virus infection. Polymerase chain reaction may help to elucidate the diagnosis when pathologic findings are non-specific.

La exposicion intermitente de ratas centinela a la contaminacion del trafico vehicular de Santiago se ha asociado a disminucion del crecimiento corporal despues de cien dias de exposicion (rango: 101-111) y a dano histopatologico del pulmon a los 90 dias y mas, especialmente a los 180 dias de exposicion. Nuestro objetivo fue evaluar si la exposicion al aire de una avenida con elevado trafico vehicular durante 90 dias era capaz de inducir en la rata una respuesta inflamatoria sistemica. Ratas Sprague-Dawley de 30 dias de edad (n = 7) fueron directamente expuestas a respirar el aire de una avenida con elevado flujo vehicular (8 h, 5 dias por semana, desde el 27 de abril hasta el 29 de julio de 2009). Las ratas control (n = 7) respiraron aire del bioterio. Las ratas se pesaron dos veces por semana y despues de completar 90 dias de observacion, los pulmones se destinaron a estudio histopatologico. Se realizo microhematocrito y se determino proteina C reactiva, viscosidad y F2-isoprostano plasmaticos en muestras de sangre. La exposicion a PM10, PM2,5, ozono, NO2 y CO se calculo de los registros de cuatro estaciones de monitoreo de Santiago. Despues de 90 dias de exposicion se observo un aumento significativo (p < 0,05) de la proteina C reactiva y de la viscosidad plasmatica y tambien del microhematocrito, en relacion a la serie control. No se observaron cambios significativos en F2-isoprostano plasmatico, ni en la histopatologia pulmonar, ni en la curva de peso corporal versus tiempo al comparar la serie expuesta con la serie control. El promedio horario de PM2,5 en las 8 horas de exposicion fue alto: 38,9 µg/m3. Concluimos que 90 dias de exposicion intermitente a la contaminacion aerea de Santiago en el modelo experimental promueve una reaccion inflamatoria sistemica. Esta respuesta a la contaminacion aerea podria preceder a la disminucion del crecimiento corporal y al dano histologico pulmonar encontrado en otro de nuestros estudios en esta misma especie despues de la exposicion intermitente a la contaminacion aerea de Santiago.

Background: Impact of Event Scale Revised (IES-R), that evaluates the subjective perception of stress, is used to assess post traumatic stress disorder simptoms. Aim : To adapt and validate IES-R to the Chilean population. Material and Methods : Two hundred seventy eight subjects exposed to stressful life events of varying magnitude were assessed using the IES-R, the Beck Depression Inventory, the anxiety and so- matoform subscales of the Depressive, Anxiety and Somatoform Disorders Scale and the AUDIT Questionnaire. Results : IES-R had adequate psychometric properties in terms of internal consistency, test-retest reliability, convergent and discriminating validity. It identifi ed a principal factor, explaining 67% of the variance. Conclusions : The IES-R can be used in the Chilean population to assess the degree of suffering produced by a traumatic event

La disquinesia ciliar primaria (DCP) corresponde a una enfermedad genetica heterogenea, que se produce por una alteracion estructural o funcional de los cilios. Es de dificil diagnostico tanto por su variada sintomatologia como por la existencia de metodos de screening y diagnostico complejos. El metodo que hasta ahora ha sido considerado como gold standard es el analisis de la estructura ciliar por medio de la microscopia electronica de transmision (MET). Esta tecnica tiene limitaciones porque permite analizar un numero limitado de axonemas ciliares y puede excluir del diagnostico a pacientes con axonema normal pero con alteracion funcional y clinica clasicas. En los ultimos anos se han desarrollado metodos diagnosticos sobre la base de un mejor conocimiento de la estructura proteica de los cilios, de los genes que codifican estas proteinas y de las mutaciones asociadas a DCP. Estos nuevos metodos consisten en un analisis genetico y un estudio de la expresion de proteinas ciliares en los pacientes afectados. Esta publicacion tiene como objetivo realizar una revision de la fisiopatologia de la DCP, los metodos diagnosticos actuales y resumir el desarrollo del diagnostico genetico en la literatura internacional y su posible aplicacion en nuestro medio.

Acquired reactive perforating collagenosis is a perforating dermatosis characterized by transepidermal elimination of collagen. It is frequently associated to diabetes mellitus and chronic renal insufficiency, but it is also related to other systemic diseases. The lesions tend to resolve once the underlying condition is treated. We report two patients with the condition. A 65 year-old diabetic female on hemodialysis consulted for multiple itching cutaneous ulcers lasting one year. On physical examination, hyperpigmented papules and nodules were observed. A 65 year-old female with chronic renal failure in hemodialysis consulted for itching lesions in hands, forearms and arms. On physical examination, hyperpigmented lesions with ulcers, erosions and crusts were observed. In both cases, the pathological study of the lesions disclosed a reactive perforating collagenosis.

We report a 66 year-old woman with a history of pulmonary sarcoidosis, diagnosed with a lung biopsy in 1993 and treated with prednisone for 2 years. She presented at our institution in 1999 with a stage IV disease and important functional and clinical impairment. A bronchial biopsy disclosed non caseating granulomas. Tuberculosis was intensively studied and persistently negative. Due to frequent nausea and vomiting an endoscopic gastric biopsy was performed which revealed non caseating granulomas involving the gastric mucosa. There was no evidence of Helicobacter pylori and stains for fungi and acid-fast bacilli were negative. Treatment with prednisone relieved digestive symptoms, although a control biopsy of the gastric mucosa revealed persistence of non caseating granulomas. Both lung stage IV and gastric sarcoidosis are uncommon forms of the disease.

The present article commemorates the fifth anniversary of thedeath of Professor Benedicto Chuaqui Jahiatt, a prominent Chilean pathologist at the School ofMedicine of the Pontificia Universidad Catolica de Chile. Professor Chuaqui was well known forhis teaching skills, his scientific work with international projections and his humanistic visionof medicine. His publications reflect, his wide spectrum and integrative vision of differentdisciplines of both natural sciences and linguistics (Rev Med Chile 2008; 136: 1343-7).(

Skin biopsy is a powerful diagnostic tool in dermatology. Its use has been extended to other medical specialties, allowing the diagnosis of several diseases that previously required complex and high risk diagnostic procedures. Skin contains numerous cell types, including blood vessels and peripheral nerves and represents a window to the systemic circulation and nervous system. In this review we discuss the use of skin biopsy to diagnose nervous system diseases in which patients do not exhibit any clinical cutaneous manifestations. We review the usefulness of skin biopsy in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), some lysosomal storage diseases, Lafora disease and in peripheral neuropathies.

We report a 7 year-old girl with mapuche ancestors, diagnosed as a cerebral palsy since infancy and on active rehabilitation. She acquired motor and cognitive skills at 3 years of age. At 5 years of age, a slow neurological deterioration started, associated to visual impairment. Optic atrophy was added to the typical neurological exam ofataxic cerebral palsy and the diagnosis was re-considered. Neuroimaging showed a slow and progressive atrophy of intracerebral structures and ultramicroscopy revealed intracytoplasmatic inclusions in conjunctiva and skin, compatible with mucolipidoses type IV (ML-IV). ML-IVmust be included in the differencial diagnosis of cerebral palsy associated with loss of acquired skills and progressive visual impairment. Electrón microscopy of skin or conjunctiva is a useful diagnostic test. Suspicion of ML-IV must not be restricted to Ashkenazi Jewish population

la enfermedad pulmonar difusa asociada al consumo de tabaco no ha sido claramente definida, la bronquiolitis respiratoria (RB) es un hallazgo morfologico frecuente en fumadores asintomaticos, se caracteriza por la acumulacion de macrofagos pigmentados en los bronquiolos respiratorios. Solo una pequena proporcion de los sujetos fumadores presenta una respuesta inflamatoria exagerada que compromete el intersticio y espacio alveolar, lo cual corresponde a la bronquiolitis respiratoria asociada a enfermedad pulmonar difusa (RBIID), que se manifiesta por disnea de esfuerzos y tos. la neumonia intersticial descamativa (DIP) se caracteriza por compromiso panlobular, fibrosis intersticial discreta e infiltracion masiva del espacio aereo por macrofagos. El patron histopatologico de RBIID y DIP se pueden sobreponer, siendo los principales elementos diferenciadores entre ambas entidades, la distribucion y extension de las lesiones: compromiso bronquiolo-centrico en RBIID y difuso en DIP. Se ha planteado que la RB, RBIID y DIP pueden constituir diferentes fases de una misma enfermedad asociada al consumo de tabaco, lo cual aun es motivo de controversia. Con el proposito de ilustrar este problema, se presenta el caso clinico de un paciente fumador que consulto por disnea progresiva, tos e infiltrados pulmonares bilaterales sugerentes de enfermedad pulmonar difusa asociada al tabaquismo.

Background: Ciliary dyskinesia (CD) is a low incidence genetic illness, that presents with a wide clinical spectrum. Also, there are transitory conditions that present with ciliary anomalies, secondary to infectious diseases of the airways. Aim: To describe clinical and ultrastructural findings and clinical and therapeutic evolution of these patients. Patients and Methods: Retrospective review of medical records and electron microscopy findings of 33 patients (aged 1 to 21 years, 14 females) with ultrastructural diagnosis of CD. To obtain follow up information, a telephone survey was done. Results: In 30 patients (90%) the inner dynein arm (IDA) was absent in 50 or more percent of the cilia. Twenty two (66%) had absence of the outer dynein arm. Before diagnosis of CD, 19 patients (57%) presented recurrent otitis media, 25 patients (77%), three or more episodes of rhinosinusitis and 18 patients (56%) had recurrent pneumonia. Middle ear ventilation tubes were placed in 19 patients (57%), and during its use, 12 (68%) remained without othorrea. Sixteen patients (48%) with recurrent episodes of rhinosinusitis required adenoidectomy. Seven (21%) required a functional endoscopic sinus surgery (FESS), and 6 (86%) improved after FESS. Conclusions: Our patients with CD presented recurrent infections in different airway locations. In those with a diagnosis of CD and recurrent otological and rhinosinusal infections, IDA was absent in a high percentage of cilia. FESS and the use of ventilation tubes may have a beneficial role in a subgroup of patients with CD (Rev Med Chile 2007; 135: 1147-52). (Key words: Ciliary motility disorders; Otitis; Rhinitis; Sinusitis)

En el presente trabajo de revision se describe la clasificacion actual de las lesiones linfoproliferativas del pulmon propuesta por la OMS el ano 2004 con enfasis en el cuadro clinico y los aspectos histopatologicos. La definicion de estas entidades incluye cuadro clinico, histopatologia, inmunohistoquimica y caracteristicas moleculares. Se discute brevemente el diagnostico diferencial de las formas mas importantes

Interstitial lung diseases are uncommon in children, and can be idiopathic or secondary to known causes, sharing common pathological findings. We report a girl with progressive respiratory insufficiency secondary to interstitial pneumonia and pulmonary fibrosis, with risk factors such as bronchopulmonary dysplasia and respiratory infections (respiratory syncytial virus and suspected Mycoplasma pneumoniae), that may have had an additive effect. Nasal bi-level Positive Airway Pressure was used in the last period of her disease. She died due to global respiratory failure at the age of 14 years (Rev Méd Chile 2005; 133; 82-88)

We report a female newborn with a dystrophic epidermolysis bullosa. The diagnosis was made by electron microscopy of a bullous skin lesion. The importance of reaching a specific diagnosis is underscored. Close relatives can therefore be informed and educated about prognosis, etiology and the possibility of having new affected offspring. An accurate diagnosis can be reached through electronic microscopy or modern immunohistochemical techniques. Further complementary information given by conventional histology is required. A complete study is recommended to minimize errors in the intepretation of morphology (Rev Méd Chile 2004; 132: 614-8).

Un paciente de 45 anos bajo tratamiento corticoidal por una probable sarcoidosis y una pancitopenia moderada ingresa por una neumonia que no responde a antibioticos ni a tratamiento antimicotico indicado a raiz del aislamiento de Aspergillus fumigatus en expectoracion. Desarrolla una insuficiencia respiratoria progresiva e hipotension y una inmunofluorescencia para virus parainfluenza 3 resulta positiva. Fallece al septimo dia y la necropsia muestra una neumonia necrotizante, dano alveolar difuso y abundantes particulas virales

A 50 years old male with a diagnosis of ulcerative colitis treated with mesalazine, developed after 2 months of treatment, cough, fever and progressive dyspnea. Chest X ray examination and CT scan showed pulmonary infiltrates in the right upper lobe that subsequently involved both lower lobes. A biopsy, made through videothoracoscopy, showed an eosinophilic pneumonia. After the discontinuation of mesalazine and the use of glucocorticoids, the respiratory involvement resolved, and pulmonary infiltrates regressed. Mesalazine is widely used in the treatment of inflammatory bowel diseases. Pulmonary toxicity is an uncommon complication of mesalazine treatment. Nevertheless, this complication should be considered in patients that use it and develop respiratory symptoms (Rev Méd Chile 2003; 131: 81-84)

We report a previously healthy 51 years old woman with a one year history of pain in the left hip associated with a mass without fever or local inflammatory changes. Magnetic resonance imaging located the mass in the medial gluteal muscle. The pathological examination of the mass disclosed unspecific inflammatory changes. Due to worsening of pain, a left throchanteric bursitis was diagnosed two weeks later and a throchanteric bursectomy was performed, obtaining a second biopsy. Aerobic, anaerobic and fungal cultures were negative. Lowenstein-Jensen culture showed development of mycobacteria and a genetic probe confirmed the presence of Mycobacterium tuberculosis. The second biopsy also identified several granulomas with areas of caseation and the Ziehl-Nielsen stain was positive for acid fast bacilli. Osteoarticular tuberculosis, specially bursitis, shoulds be suspected in the presence of chronic pain associated with swelling (Rev Med Chile 2002; 130: 319-21)

The uncommon bronchiolitis obliterans organizing pneumonia can be idiopathic or caused by infection or medications. We report a 5 year old boy with pericardial sarcoma that was treated with chemotherapy (vincristine, doxorubicin, etoposide, cyclophosphamide) and radiotherapy. During the third cycle of chemotherapy, he developed progressive cough and dyspnea, needing oxygen therapy. Chest X-ray examination showed bilteral infiltrates. After discarding infectious etiologies, an open lung biopsy was performed, and the pathological examination showed a bronchiolitis obliterans organizing pneumonia. He was treated with prednisolone for 7 days, followed by prednisone for additional 45 days. He continued with fluticasone propionate as maintenance and remains in good condition with a ches X ray showing mild interstitial images, after seven months of follow up. (Rev Méd Chile 2000; 128: 633-40).

The present article reviews the most relevant aspects of the practice of Anatomic Pathology in Chile. The importance of biopsy and autopsy are analysed, in particular the consequences of the fall in the number of autopsies performed in our hospitals, in the recent decades. The modern pathologist is confronted with two situations: the renovation of the value of the autopsy and the acquisition of new diagnostic technologies, both not usually considered in the classical morphologic approach of Pathology. The ways to solve these problems in a discipline that is still a fundamental specialty in modern medicine are analyzed. (Rev Méd Chile "000; 1"8: 533-8)

Hemoptysis is an infrequent symptom in childhood and potentially life threatening. The most common causes in this age group are bronchiectasis secondary to cystic fibrosis, cardiovascular and pulmonary congenital anomalies and a miscellaneous group of causes including retained intrabronchial aspirated foreign bodies. We report a previously healthy 5-year-old girl with recurrent pneumonias associated with episodes of hemoptysis. She was admitted in our institution to investigate the persistence of hemoptysis. Based on clinical history, aspiration of a vegetal foreign body was postulated as the etiology and it was confirmed in the pathological examination after surgical exploration, with pulmonary lobe resection. The importance of a good history taking in pediatric hemoptysis is emphasized.

Bicuspid aortic valve; Glycoprotein; Lipoprotein metabolism Vàlvula aòrtica bicúspide; Glicoproteïna; Metabolisme de les lipoproteïnes Válvula aórtica bicúspide; Glicoproteína; Metabolismo de las lipoproteínas Introduction: The bicuspid aortic valve (BAV) confers a high risk of ascending aorta dilatation (AAoD), although its progression seems highly variable. Furthermore, the implication of lipoprotein metabolism and inflammation in the mechanisms that underlie AAoD is not fully established. The aim of this study consisted of evaluating the impact of the lipoprotein and glycoprotein profiles in AAOD as well as its progression in BAV aortopathy. Methods: Using 1H-nuclear magnetic resonance (1H-NMR), we analyzed and compared the lipoprotein and glycoprotein profiles of plasma samples from 152 BAV patients with dilated and nondilated ascending aorta. Additionally, these profiles were also compared for 119 of these patients who were prospectively followed-up clinically and by echocardiography in the long-term (5 years). Ascending aorta dilation velocity (mm/year) was calculated for this analysis. Results: Several parameters related to the lipoprotein profile including remnant cholesterol, small LDL and IDL-cholesterol were found to be significantly increased in the dilated group compared to those in the nondilated group. The glycoprotein A-nuclear magnetic resonance (NMR) signal, a novel inflammation biomarker, was also observed to be increased in the dilated group. After performing multivariate analysis, remnant cholesterol remained an independent variable related to AAoD. In the long-term follow-up, proatherogenic lipoprotein parameters were related to ascending aorta dilatation velocity ascending. After a lineal regression analysis, non-HDL particles remained as an independent predictor of ascending aorta dilation velocity. Conclusions: Patients with BAV and AAoD presented a more pro-atherogenic profile assessed by 1H-NMR, especially related to triglyceride-rich lipoproteins. This pro-atherogenic profile seems to contribute to the higher growth rate of ascending aorta diameter. This research was funded by “Proyectos de Investigación Clínica” from the Spanish Society of Cardiology, grant Bayer 2019. BA-G received a research scholarship within the Martí-Franquès Research Fellowship Program from the University of Rovira i Virgili.

The influence of quasispecies dynamics on long-term virus diversification in nature is a largely unexplored question. Specifically, whether intra-host nucleotide and amino acid variation in quasispecies fit the variation observed in consensus sequences or data bank alignments is unknown. Genome conservation and dynamics simulations are used for the computational design of universal vaccines, therapeutic antibodies and pan-genomic antiviral agents. The expectation is that selection of escape mutants will be limited when mutations at conserved residues are required. This strategy assumes long-term (epidemiologically relevant) conservation but, critically, does not consider short-term (quasispecies-dictated) residue conservation. We calculated mutant frequencies of individual loci from mutant spectra of hepatitis C virus (HCV) populations passaged in cell culture and from infected patients. Nucleotide or amino acid conservation in consensus sequences of the same populations, or in the Los Alamos HCV data bank did not match residue conservation in mutant spectra. The results relativize the concept of sequence conservation in viral genetics and suggest that residue invariance in data banks is an insufficient basis for the design of universal viral ligands for clinical purposes. Our calculations suggest relaxed mutational restrictions during quasispecies dynamics, which may contribute to higher calculated short-term than long-term viral evolutionary rates. The research at Centro de Biologia Molecular Severo Ochoa (CSIC-UAM) (CBMSO) was funded by Ministerio de Economia y Competitividad (MINECO), grant numbers SAF2014-52400-R and SAF2017-87846-R, and by Ministerio de Ciencia, Innovacion y Universidades (MCIU), grant number BFU2017-91384-EXP, and by Instituto de Salud Carlos III, grant number PI18/00210, and by PLATESA from Comunidad de Madrid/FEDER, grant numbers S2013/ABI-2906 and S2018/BAA-4370. C.P. is supported by the Miguel Servet program of the Instituto de Salud Carlos III (CP14/00121 and CPII19/00001) cofinanced by the European Regional Development Fund (ERDF). CIBERehd (Centro de Investigacion en Red de Enfermedades Hepaticas y Digestivas) is funded by Instituto de Salud Carlos III. Institutional grants from the Fundacion Ramon Areces and Banco Santander to the CBMSO are also acknowledged. The research at Vall d'Hebron Institut de Recerca (VHIR) was funded by Instituto de Salud Carlos III, cofinanced by the European Regional Development Fund (ERDF), grant number PI19/00301 and by the Centro para el Desarrollo Tecnologico Industrial (CDTI) from the MCIU, grant number IDI-20151125. The research at Centro de Astrobiologia (CAB) was supported by MINECO, grant numbers BIO2016-79618R and PID2019-104903RB-I00 (funded by EU under the FEDER program) and by the Spanish State research agency (AEI), grant number MDM-2017-0737 (Unidad de Excelencia "Maria de Maeztu"-Centro de Astrobiologia (CSIC-INTA). C.G.-C. is supported by predoctoral contract PRE2018-083422 from MCIU. B.M.-G. is supported by predoctoral contract PFIS FI19/00119 from Instituto de Salud Carlos III (Ministerio de Sanidad y Consumo) cofinanced by Fondo Social Europeo (FSE); With funding from the Spanish government through the "María de Maeztu Unit of Excellence" accreditation (MDM-2017-0737) Peer review