Revista médica de Chile
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Revista médica de Chile · Jan 1999
Comparative Study Clinical Trial[Long nasojejunal feeding tube: endoscopic method for placing and its use for enteral nutrition in acute pancreatitis].
Enteral nutrition can be useful for the feeding of patients with acute pancreatitis, specially in the later phases of the disease. ⋯ Long nasojejunal tubes can be easily placed beyond the ligament of Treitz with endoscopic aid and can be used for enteral feeding in patients with acute pancreatitis.
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There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. ⋯ A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.
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Revista médica de Chile · Nov 1998
[Prognostic factors in acute bacterial meningitis in children. A case control study].
The prognosis of acute bacterial meningitis continues to be poor in our country. Previous studies suggest that the delay in diagnosis has an important prognostic value. ⋯ Early diagnosis of acute bacterial meningitis is protective for death or gross sequelae at discharge. Age, coma and S Pneumoniae etiology are the main factors associated with a poor prognosis.
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Revista médica de Chile · Oct 1998
Case Reports[Decompensated diabetes mellitus and hyperchloremic metabolic acidosis: a case with both pathologies].
Diabetic ketoacidosis is manifested by elevated blood glucose levels, ketosis and metabolic acidosis with increased anion gap. A transitory hyperchloremic acidosis, with normal anion gap, can appear. We report a 21 years old female with a type 2 diabetes mellitus, admitted to the emergency room of a general hospital with hyperglycemia, absence of ketonemia, severe hypokalemia and hyperchloremic metabolic acidosis. ⋯ Normal blood glucose levels were rapidly achieved but electrolyte and acid base alterations persisted, leading to the suspicion that another associated condition was causing the acidosis and hypokalemia. Urinary pH and anion gap measurement, the study of renal acidification and a bicarbonate overload test lead to the diagnosis of a distal renal tubular acidosis, secondary to a Sjögren syndrome, that was confirmed with a Schirmer test and positive anti Ro antibodies. In this diabetic patient, the acute hyperglycemia intensified the hypokalemia of her distal renal tubular acidosis and unchained the acute metabolic condition.
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The impact of Hippocratic Oath on medical practice is universally recognized. However, some physicians raise questions about its validity and few medical schools use it in graduation ceremonies. It is postulated that this oath does not harmonize with present bioethical concepts and that the principles of beneficence, lack of harm, autonomy and justice, elaborated by Anglo-Saxon philosophers, would do so. ⋯ Modified versions of the oath or original texts presumptuously pretend to replace a document that has lasted 2500 years and that meant a revolution, not only to medicine, but for all mankind. Students should have the opportunity to analyze its content and the way its values are related to concrete situations of present medical practice. Medical schools should shelter it without objections, as the expression of a reflexive compromise acquired by physicians during their studies and to be applied in medical practice.