Revista Medica Herediana

Disease and aching

Applicants and entering to the school of Medicine of the Universidad Peruana Cayetano Heredia, 1962-1994

Se analiza la evolución de las características socioeconómicas y los antecedentes educacionales de postulante e ingresantes a la Facultad de Medicina en la Universidad Peruana Cayetano Heredia (UPCH) entre 1962 y 1994. También se establecen comparaciones con información similar de otras universidades del país, encontrando similitudes en la evolución del número de postulantes. En la UPCH las vacantes de medicina se ha mantenido cerca de 70 desde 1962 hasta 1991, período en el cual las necesidades de médicos se incrementaron y la competencia por una vacante de medicina llegó a ser 60:1, muy superior al promedio de las otras universidades. La mayoría de los postulantes a la UPCH solicitan admisión a medicina y provienen de Lima y Callao. El estudio muestra que entre los postulantes a medicina se han incrementado los jóvenes de 15 a 16 años, las mujeres, los egresados de colegios particulares y los hijos de padres con educación superior. Los ingresantes muestran características similares, excepto que la edad es mayor de 18 años y que el intervalo secundaria universidad y el número de postulaciones hasta lograr el ingreso se ha incrementado. Se proponen razones que explican los cambios observados. (Rev Med Hered 1995; 6: 59-71).

A study is made on the socio-economic characteristic and educational background of the applicants and students entering the School of Medicine of the Universidad Peruana Cayetano Heredia (UPCH); the study covered the period from 1962 to 1994, and it also compared related information from other universities in our country, showing similar variations in the numbers of applicants. In the UPCH the openings for medicine remained nearly 70 since 1962 until 1991, period in which the need for physicians increased, and the competition for entering reached a 60:1 proportion, stiffer than in any other university of the country. Most of the applicants to UPCH seek admittance to medical school and come from the metropolitan area of Lima. The study also shows an increasing number of younger applicants (15-16 years), of women, and of private schools graduates, whose parents have higher education. Entering students show similar characteristics, except that their age is higher than 18 years and that the interval between the end of school and the admittance to the university is increasing. A discussion is made of the observed findings. (Rev Med Hered 1995; 6: 59-71).

Effects of fast intravenous expansion with Hartmann's solution and sodium chloride at 0.9% on the internal milieo, in patients with cholera like diarrhea

Objetivo: comparar el efecto de la expansión endovenosa rápida con ClNa al 0.9% y solución Hartmann, sobre la acidosis metabólica y los niveles de electrolitos plasmáticos en pacientes con deshidratación severa por diarrea coleriforme. Material y métodos: se evaluaron prospectivamente 13 pacientes con deshidratación severa por enfermedad diarreica aguda compatible con cólera, que acudieron al Hospital Nacional Cayetano Heredia en febrero de 1994. Los pacientes fueron adultos entre 14 y 60 años, 7 pacientes fueron expandidos con ClNa al 0.9% con solución Hartmann a un flujo de 50 cc/Kg/hora endovenoso hasta recuperar diuresis. Resultados: las condiciones basales de ambos grupos fueron iguales, los resultados postmicción, cuando eran expandidos con ClNa fueron: el Na+: 148± 1.60 mEq/L, el Cl-: 118± 2.99 mEq/L, la osmolalidad: 299± 3.97, el pH: 7.23 ± 0.07, el HCO3-: 13.3 ± 3.10mEq/L; y cuando eran expandidos con solución Hartmann fueron: el Na+: 142 ± 2.29 mEq/L, el Cl- 109 ± 2.74 mEq/L, la osmolalidad: 290 ± 4.33, el pH: 7.37 ± 0.07 y el HCO3-: 16.1± 1.36 mEq/L. Se muestra las diferencias y los beneficios de usar la solución Hartmann en la fase de expansión rápida. (Rev Med Hered 1995; 6: 72-75).

We compare the effect of rapid volume expansion with sodium chloride and Hartmann solution in metabolic acidosis and serum electrolytes of severely dehydrated patients due to choleriform diarrhea. Thirteen patients with severe dehydration due to choleriform diarrhea were attended at Hospital Nacional Cayetano Heredia, Lima - Perú, in February 1994. The patients were adults (14-60 years), 7 patients were expanded with ClNa 0.9% and 6 with Hartmann solution 50 cc/Kg/hour IV, until diuresis was recovered. The basal conditions were simile in both groups, the results at time of diuresis recovery with ClNa 0.9% expansion were: Na+ 148± 1.6 mEq/L, Cl-: 118± 2.99 mEq/L, osmolality: 299± 3.97, pH: 7.23 ± 0.07, HCO3-: 13.3 ± 3.10 mEq/L, with Hartmann solution expansion were: Na+: 142± 2.29 mEq/L, Cl-:109 ± 2.74 mEq/L, osmolality: 290± 4.33, pH: 7.37 ± 0.07 and HCO3-: 16.1 ± 1.36 mEq/L.We show the differences and the benefits of Hartmann solution when it is used in rapid volume expansion (Rev Med Hered 1995; 6: 72-75)

Peak expiratory flow rate in asthmatic children: Case/control study

Con el fin de determinar las variaciones del Flujo Espiratorio Máximo (PEF), se estudiaron a 38 niños asmáticos (CASOS) en período intercrítico de la enfermedad y a 38 niños sanos (CONTROLES), de ambos sexos comprendidos entre los 5 y 15 años de edad. Los niños asmáticos fueron clasificados por parámetros clínicos en determinado grado de severidad de asma bronquial, determinando el PEF de cada niño objeto de estudio conel mini-Wright Peak Flow Meter, en 2 registros diarios a los 06 y 18 horas, durante 7 días consecutivos, obteniendo la variabilidad del mismo. Se encuentra diferencia en la variabilidad global de niños asmáticos de todos los grados de severidad de la enfermedad comprada con la de los niños normales, con diferencia estadística altamente significativa (p<0.000001). Las variaciones diurnas del PEF ayuda en el diagnóstico del asma bronquial y también son útiles para realizar la catalogación de severidad de la enfermedad. El PEF correlaciona bien con los síntomas presentados por los pacientes y por lo tanto guarda correspondencia con la Hiperreactividad bronquial (HRB) del niño asmático. Postulamos que un niño con historia clínica sugestiva, una variabilidad global mayor del 8% indica que el diagnóstico de asma es altamente probable (Rev Med Hered 1995; 6: 76-82)

To determine variations in the Peak Expiratory Flow Rate (PEFR), we studied 38 asthmatic children during intercritical period and 38 healthy children, between 5 and 15 years old. Asthmatic children were classified according to clinic parameters in different levels of severity; using the PEFR measured with the mini-Wright Peak Flow Meter at 6 and 18 hours during 7 consecutive days with its corresponding variability. Difference was found in the global variability of asthmatic children in all severity levels, in contrast with healthy children, with statistic difference (p<0.000001). Diurnal variations on PEFR helps in the diagnosis of asthma and its corresponding degree of severity disease. PEFR correlates good with symptoms and airway responsiveness in asthmatic children. We postulate that children with sugestive history and a global variability greater than 8% have a very probable diagnosis of asthma. (Rev Med Hered 1995; 6: 76-82)

Non melanoma skin cancer: clinic-pathological aspects

El presente retrospectivo evaluó a 120 pacientes con 130 lesiones de cáncer primario de la piel: 78 lesiones de carcinoma basocelular (CBC) y 52 de carcinoma epidermoide (CE) diagnosticados en el Hospital Belén, Trujillo, Perú, desde 1980 a 1990 con la finalidad de identificar sus características clínicas e histopatológicas. El CE fue más frecuente en pacientes mayores de 80 años (p=0.044), del sexo masculino (p=0.025), se localizó con mayor frecuencia en trono y extremidades (p<0.001), las lesiones fueron multricéntricas o múltiples (p=.006), fijas (p=0.0049), de tamaño mayor o igual a 2 cm. (p<0.001) y se presentaron estadíos clínicos más avanzados (p=.0003) con respecto al CBC. En ambos carcinomas predominaron las formas ulceradas (47%) y el CE bien diferenciado fue el más frecuente (62%). Se concluye que el cáncer de la piel, es más frecuente en áreas expuestas a la radiación solar y que el aspecto macroscópico ayuda para guiar hacia un diagnóstico, pero el examen histológico es absolutamente necesario para tipificar el caso. (Rev Med Hered 1995; 6: 83-92).

This retrospective analysis evaluate to 120 patients with 130 cancers of the skin with histologically proved diagnosis of basal cell carcinoma (n=78) or squamous cell carcinoma (n=52) seen at Belen Hospital Trujillo, Peru, between 1980 and 1990 with the aim to identify their clinicopathologic features. Squamous cell carcinomas was more frequent in patients older than 80 years of age (p=0.044), in men than in women (p=0.025), predominantly occurred on the trunk or extremities (p<0.001), presented multicentric or as multiple growths (p=.006), fixation to deep structures (p=0.0049), was more than 2 cm in diameter (p<0.001) or developed as a more advanced disease (p=0.0003) as compared with basal cell carcinoma. Both cancers were mostly ulcerated (47%) and squamous cell carcinoma was more often well differentiated (62%). We concluded that the carcinoma of the skin is most often observed in areas of the body exposed to the sun and its diagnosis can be suspected with a high percentage of accuracy on the basis of the gross appearance and its location, but a biopsy should always be taken for confirmation. (Rev Med Hered 1995; 6: 83-92).

Brucellosis in children: A report of two inusual cases

Even though brucellosis in our country is an endemic disease, it is more commonly seen over the age of ten years. We here present two cases of children whose ages eighteen months and two years respectively. It is interesting the way both patients began their disease, with acute pharingitis and exudative amigdalitis, signs that are poorly emphasized in the literature, and that accounts for the fact that many of them are treated initially for a respiratory infection.

Aneurysm of the Valsalva sinus with double rupture to the pulmonary artery and to the right ventricle: Report of one case and review of the literature

We report a case of a 21 year old female who presented with congestive cardiac failure. In initial investigations an aneurysm of sinus of Valsalva was found ruptured to the pulmonary artery. It was surgically repaired uneventfully. The patient was discharged home after 10 days. During the follow-up appointments she was found to have reappearing symptoms of congestive cardiac failure. This lead to her readmission and a repeated cardiac catheterization found her to have an aneurysm of sinus of Valsalva reuptured to the right ventricule, which in a second operation was succesfully repaired. We review the bibliography over the last 20 year finding the unusual presentation of the rupture to the pulmonary artery. We point out the importance of a sharp clinical examination and the preference of cardiac catheterization to make the diagnosis.

Cytomegalovirus hepatitis: Report of two cases

Two cases of hepatitis by cytomegalovirus are described, one in a child and the other in a young adult, presenting with a history of fever, general malaise, hepatomegaly and no jaundice. Their blood test showed atypical lymphocytes, normal bilirubin, elevated liver enzymes, and IgG antibodies against cytomegalovirus. Their course was un was unremarkable except for asthenia which persisted in spite of clinical and laboratory improvement. This course was unremarkable except for asthenia which persisted in spite of clinical and laboratory improvement. This presentation is done because of the low prevalence or infrequent diagnosis of anicteric hepatitis due to cytomegalovirus in normal individuals. Most of the literature refers to congenital cases, premature babies, or patients with debilitating or immunocompromising diseases.