S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300001 Genoma humano: perspectivas y realidades Céspedes Montealegre Carlos de ,Hospital Nacional de Niños Dr. Carlos Sáenz Herrera 09 2000 2000 42 01 01
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300002 La enfermedad coronaria, la epidemia del Siglo XXI: ¿Podemos enfrentarla? Tortós Guzmán Jaime E ,CCSS 09 2000 2000 42 100 100
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300003 Síndromes coronarios agudos: evaluación y manejo Póveda-Fernández Jonathan Sáenz-Madrigal Manuel Eduardo ,CCSS ,CCSS 09 2000 2000 42 101 108 Síndrome coronario Angina inestable Cardiopatia isquémica Graves EJ National Hospital discharge survey: Annual survey 1996 National Hospital discharge survey: Annual survey 1996 1998 Series 13 Washington D.C National Center for Health Statistics Detailed diagnoses, and procedures, National Hospital Discharge Survey Vital Health Stat. 1998 13 Cairns J Theroux P Armstrong P Bogarty P Wells C Thompson C Warnica W Report from a Canadian expert round table Can J Card 1996 12 Theroux P Fuster V Unstable angina and Non Q wave MI.: Cardiology new frontiers Circulation 1998 97 Califf RM Acute ischemic syndromes Med Clin of NA 1995 79 ^s5 Klootwjik P Hamm C Acute coronary syndromes:: diagnosis Lancent 1999 ^sII Theroux P Fuster V Acute coronary syndromes Circulation 1998 97 Yeghiazarians Y Unstable angina pectoris N Engl J Med 2000342 ^s2 Libby P Molecular basis of the acute coronary syndromes Circulation 1995 91 Ambrose JA Winters SL Arora RR Riccio A Gorlin R Angiographic evolution of coronary artery morphology in unstable angina J Am Coll Cardiol 1986 7 Falk E Unstable angina with fatal outcome:: dynamic coronary thrombosis leading to infarction or sudden death Circulation 1985 71 Fuster V Fayad Z Badimon J Acute coronary syndromes:: Biology Lancet 1999 353 ^sII Cannon CP Mccabe CM Stone DM ECG predicts one year outcome of patients with unstable angina and non Q wave myocardial infarction:: Results of TIMI IIIB Registry ECG ancillary studies J Am Coll Cardiol 1997 30 Seronnito S Ardissino D Granger CB Prognostic value of the admission electrocardiogram in acute coronary syndromes JAMA 1999 281 Roberts R Parker CW Sobel BE Detection of acute myocardial infarction by radioinmunoassay for CKMB Lancet 1977 2 Puleo PR Gradagno PA Roberts R Early diagnosis of acute myocardial infarction based on assay subforms of CK-MB Cirulation 1990 82 Hamm CW Raukilde J Gerhart W The prognostic value of troponin T in unstable angina N Engl J Med 1992 377 Antman EM Tanasijevic MI Thompson B Cardiac specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes N Engl J Med 1996 335 Morron PA Rifar N Antarnem EM C reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes J Am Coll Cardiol 1998 31 Stratmann HG Younis LT Wittry MD Amato M Miller DD Exercise Technetium 99m myocardial tomography for risk stratification of man with medially treated unstable angina pectoris Am J Cardiol 1995 76 Fayed ZA Taumena N Badimon J MRI of human atherosclerotic aorta in vivo Circulation 1998 98 Roth GS Majerus DW The mechanism of the effect of aspirin in human platelets:: acetylation of a particular fraction proteins J Clin Invest 1975 56 Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17187 cases of suspected acute myocardial infarction:: ISIS-2 Lancet 1988 2 Lewis HD Davis JW Archibald DG Steinke WE Smitherman AZ Doherty AE Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina N Engl J Med 1983 309 Cairns JA Grant M Singer J Finnie KJ Froggart GM Holder DA Aspirin, sulfinpirazone or both in unstable angina: Results of a Canadian multicenter trial N Engl J Med 1985 313 Theroux P Ouitment H McCans J Latour JG Levy G Aspirin, heparin or both to treat acute unstable angina N Engl J Med 1988 319 Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease Lancet 1990 336 Patrono C Collar B Dalen J Fuster V Gent M Harker L Platelet active drugs:: the relationship among dose, effectiveness and side effects Chest 1988 114 Antry EH Loscalzo J Aspirin Circulation 2000 101 A randomized blinded trial of clopidrogel vs. aspirin in patients at risk of ischemic events Lancet 1996 348 Balsano F Rizzon P Violi F Antiplatelet treatment with ticlopidine in unstable angina a controlled multicenter clinical trial Circulation 1990 82 Benett CL Connors JM Carwail JM Thrombotic thrombocytopenic purpura associated with clopidrogel N Engl J Med 2000 342 Mousar I Oetgens M Roubin G Effectiveness of Clopidrogel and aspirin vs. Ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation Circulation 1999 99 And international, randomized controlled trial of lamifiban, a platelet glycoprotein IIb/IIIa inhibitor, heparin, or both in unstable angina Circulation 1988 97 Inhibition of the platelet glycoprotein IIb/IIIa receptor with Tirofiban in Unstable angina and Non - Q wave myocardial infarction N Engl J Med 1998 338 Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes N Engl J Med 1998 339 Topol EJ Toward a new frontier in myocardial reperfusion therapy:: emerging platelet pre-eminence Circulation 1998 97 Effects of platelet glycoprotein IIb/IIIa blockade with Tirofiban, on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty Circulation 1997 96 Cannon CP McCabe Cm Borzak S Randomized trial of and oral antiplatelet glycoprotein IIb/IIIa antagonist, sibrofiban in patients after acute coronary syndromes: Results of TIMI 12 trial Circulation 1998 97 Kereiakes DJ Kleinhman NS Ferguson J Pharmacodynamic efficacy, clinical safety and outcomes after prolonged platelet glycoprotein IIb/IIIa receptor blockade with oral xemlofiban:: results of a multicenter, placebo, controlled randomized trial Circulation 1998 98 Ferguson JJ Deedwania DC Kereiakes DJ Sustained platelet glycoprotein IIb/IIIa blockade with oral orbofiban:: interin pharmacodynamic results of the SOAR study J Am Coll Cardiol 1998 31 ^sA Oler A Whooley MA Oler J Grady D Adding heparin to aspirin reduces the incidence of myocardial infarction in patients with unstable angina: a meta-analysis JAMA 1996 276 Warkentin TE Levine MN Hirsh J Heparin induced thrombocitopenia in patients treated with LMWH or unfractioned heparin N Engl J Med 1995 332 Ryan TJ Anderson JL Antman EM Braniff BA Brooks NH Califf RM ACC/AHA Guidelines for the management of patients with AMI: A report of ACC/AHA Task Force on practice guidelines: Comitee on management of acute myocardial infarction J Am Coll Cardiol 1996 19 99 28 Hirsh J Levine M Low molecular weigth heparins Blood 1993 79 Weitz JL Low molecular weigth heparins N Engl J Med 1997 337 Leizorovicz A Fraxis study Fraxis study Congress of the European Society of Cardiology Aug. 1998 Vienna Klein W Buchwald D Hills SE Monrad S Sanz G Turpie AGG Comparison of low molecular weigth heparins with unfractioned heparin and with placebo for six weeks in the management of unstable coronary disease: Fragmin in unstable coronary disease study (FRISC) Circulation 1997 96 Cohen M Remers C Gurfinkel R Turpie AGG Goodman S A comparison of low molecular weigth heparins with unfractioned heparin for unstable coronary disease N Engl J Med 1997 337 Cohen M Bigonzi I Lelover V One year follow up of the ESSENCE trial (Enoxaparin vs heparin in unstable angina and non-Q wave myocardial infarction J Am Coll Cardiol 1998 31 ^sA Mark DB Optimizing outcomes:: socioeconomic perspective Heart 1999 82 ^sA Antman HM McCabe CH Premmereur J Enoxaparin prevents death and cardiac ischemic in unstable angina / non Q wave myocardial infarction:: results of TIMI 11B Circulation 1999 100 Effects of recombinant hirudin (lepirudin) compared with heparin on death, myocardial infarction, recurrent angina and revascularization procedures in patients with acute myocardial infarction without ST elevation: A randomized trial Lancet 1999 353 A low molecular weight selective thrombin inhibitor, inogatran vs heparin in unstable coronary disease in 1209 patients a double blind randomized dose finding study Eur Heart J 1997 181 Cairns JA Lewis HD Meade TN Sutton BC Theroux P Antithrombotic agents in coronary artery disease Chest 1995 108 ^s1 Randomized double blind trial of fixed low dose warfarin with aspirin after myocardial infarction Lancet 1997 350 Effects of TPA and a comparison of early invasive and conservative strategies in unstable angina and non-Q wave myocardial infarction: Results of the TIMI IIIB trial Circulation 1994 89 GISSI-3: effect of lisinopril and transdermal gliceriltrinitrate alone and together on 6 week mortality and ventricular function after AMI Lancet 1994 343 ISIS-4 Randomized factorial assessing early oral captopril, oral mononitrate and intravenous magnesium sulfate in 58050 patients with suspected acute myocardial infarction Lancet 1995 345 A randomized trial of propanolol in patients with acute myocardial infarction mortality results JAMA 1982 247 Randomized trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction Lancet 1986 2 Yusuf S Wittes J Friedinan L Overview of results of randomized clin¡cal triais in heart disease: Unstable angina, heart failure, primary prevention with aspirin and risk factor modification JAMA 1988 260 Packer M Briston MR Cohn JN Colucci WS Fowler MB Gilgert EM The effect of carvedilol on morbidity and mortality in patients with cronic heart failure N Engl J Med 1996 334 Wilcox RG Hampton JR Banes DC Birkhead JS Browser IA Bumstox CJ Trial of early nifedipine in acute myocardial infarction:: The Trent study BMJ 1986 293 Gibson RS Boden WE Theroux P Strauss HD Pratt CM Gheorgidde M Diltiazem and reinfarction in patients with non Q - wave myocardial infarction . Results of a double blind, randomized trial N Engl J Med 1986 315 Pfeffer MA Braunwald E Moye LA Barta C Byon ES Cuddy TE Effect of ramipril on mortality and morbidity patients with left ventricular disfunction after myocardial infarction Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence heart failure Lancet 1993 342 Effects of and angiotensin converting enzyme inhibition, ramipril, on cardiovascular events in high risk patients N Engl J Med 2000 342 Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus:: results of the HOPE study and micro-HOPE substudy Lancet 355 Boden NE O´rourke RA Crawford MH Blenstein AJ Deedwania DL Zoble RG Outcomes in patients with acute myocardial infaretion ramdomly assigned to an invasive as compared with conservative strategy N Engl J Med 1998 378 Hillis LD Rutherford JD Coronary angiopiasty compared with bypass grafting N Engl J Med 1994 331 Versaci F Gaspardore A Tomai F Crea F Chigriello L Gioffre PA A comparison of coronary artery stenting with angioplasty for isolated stenosis of proximal left anterior descending coronary artery N Engl J Med 1997 336 Savage MP Dougals AS Fischman DL Pepine CJ Kiny SB Werner JA Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts N Engl J Med 1997 337 Cannon AD Roubin GS Macunder PS Agrawal SK lntracoronary stent as and adjunet to angioplasty in acute myocardial infarction J lnv Cardiol 1991 3 Seffuys PW de Joegne P Kiemeneij F Macaya L Rutsem W Heydrickx G A comparison of balloon expandable stent iinplantation with balloon angioplasty in patients with coronary artery disease N Engl J Med 1994 331 Fischman DL Leon MB Baim PS Schatz DA Savage MD Deon I A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease N Engi J Med 1994 331 Use of a monoclonal antibody directed against the platelet glycoprotein Ilb/IIIa receptor in high risk coronary angioplasty N Engl J Med 1994 330
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300004 Expansores tisulares: Conceptos generales Centeno-Rodríguez Madelein Centeno-Ramírez Carlos Alberto ,Clínica de Cirugía Plástica Universal San José ,CCSS 09 2000 2000 42 109 114

In this article, we present a review of general concepts regarding tissue expansion, history, operative technique, clinical applications, principal complications as well as advantages and disadvantages presented with the use of this alternative in reconstructive surgery.

 Expansión tisular expansores tisulares tissue expansion tissue expanders Austad ED Rose GL A self-inflating tissue expander Plast Reconstr Surg 1982 70 ^s5 Argenta L Vanderkolk C Tissue expansion in craniofacial surgery Clin Plast Surg 1987 14 Chretien-Marquet B Rapid intraoperative distension using isotonic saline solution Plast Reconstr Surg 1995 96 ^s1 Austad E The origin of expanded tissue Clin Plast Surg 1987 14 ^s3 Radovan C Tissue expansion in soft-tissue reconstruction Plast Reconstr Surg 1984 74 ^s4 Marks MW Argenta LC Thornton JW Burn management: the role of tissue expansion Clin Plast Surg 1987 14 Chun JT Rohrich RJ Versatility of tissue expansion in head and neck burn reconstruction Ann Plast Surg 1998 41 ^s1 Vanderkolk CA McCann JJ Knight KR O' Brien BMcC Some further characteristics of expanded tissue Clin Plast Surg 1987 14 ^s3 Kawashima T Yamada A Veda K Asato H Harii K Tissue expansion in facial reconstruction Plast Reconstr Surg 1994 94 ^s7 Neumann CG The expansion of an area of skin by progressive distention of a subcutaneous balloon Plast Reconstr Surg 1957 19 Raposio E Santi P Computer-aided preoperative planning of tissue expansion Ann Plast Surg 1997 39 Cohen IK Turner D Immediate breast reconstruction with tissue expanders Clin Plast Surg 1987 14 ^s3 Duits EHA Molenaar J van Rappard JHA The modeling of skin expanders Plast Reconstr Surg 1989 83 ^s2 Austad ED Complications in tissue expansion Clin Plast Surg 1987 14 ^s3 Argenta LC Marks MW Pasyk KA Advances in tissue expansion Clin Plast Surg 1985 12 ^s2 Radovan C Breast reconstruction after mastectomy using the temporary expander Plast Reconstr Surg 1982 69 ^s2 Hallock GG Rice DC Objective monitoring for safe tissue expansion Plast Reconstr Surg 1986 77 ^s3 Van Beek AL Adson MH Tissue expansion in the upper extremity Clin Plast Surg 1987 14 ^s3 Austad ED Thomas SB Pasyk K Tissue expansion:: dividend or loan? Plast Reconstr Surg 1986 78 ^s1 Pasyk KA Argenta LC Austad ED Histopathology of human expanded tissue Clin Plast Surg 1987 14 ^s3 Manders EK Schenden MJ Furrey JA Hetzler PT Davis TS Graham WP Soft-tissue expansion:: concepts and complications Plast Reconstr Surg 1984 74 ^s4 Hong C Stark GB Futrell JW Elongation of axial blood vessels with a tissue expander Clin Plast Surg 1987 14 ^s3 Marks MW Argenta LC Thornton JW Rapid expansion:: experimental and clinical experience Clin Plast Surg 1987 14 ^s3 Thornton JW Marks MW Izenberg PH Argenta LC Expanded myocutaneous flaps:: their clinical use Clin Plast Surg 1987 14 ^s3 Cherry GW Phil D Austad E Pasyk KK McClatchey K Rohrich RJ Increased survival and vascularity of random-pattern skin flaps elevated in controlled, expanded skin Plast Reconstr Surg 1983 72 ^s5 Becker H The permanent tissue expander Clin Plast Surg 1987 14 ^s3 Anderson RD Expansion-assisted treatment of male pattern baldness Clin Plast Surg 1987 14 ^s3 Manders EK Au VK Wong RKM Scalp expansion for male pattern baldness Clin Plast Surg 1987 14 ^s3 Edington HDJ Mooney MP Losken A Hurwitz DJ Siegel MI The effects of soft-tissue expansion on lip repair and midfacial growth in a rabbit cleft lip model Ann Plast Surg 1998 41 ^s2 Antonyshyn O Gruss J Zuker R Mackinnon S Tissue expansion in head and neck reconstruction Plast Reconstr Surg 1988 82 ^s1 Perlyn C Meara JG Smith JD Breving KH Bartlett R Secondary reconstruction of a giant congenital lentiginous dermal nevus with a serial, large volume tissue expansion Ann Plast Surg 1999 43 ^s5 Pisarski GP Mertens D Warden GD Neale HW Tissue expander complications in the pediatric burn patient Plast Reconstr Surg 1998 102 ^s4 Paletta CE Huang DB Dehghan K Kelly C The use of tissue expanders in staged abdominal wall reconstruction Ann Plast Surg 1999 42 ^s3 Still J Craft-Coffman B Law E Use of pedicled flaps and tissue expanders to reconstruct burn scars of the anterior abdomen and chest wall Ann Plast Surg 1998 40 ^s3 Youm T Margiotta M Kasabian A Karp N Complications of tissue expansion in a public hospital Ann Plast Surg 1999 42 ^s4 Brown MD Johnson TM Complications of tissue expansion J Dermatol Surg Oncol 1993 19
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300005 Análisis de la condición funcional de los adultos mayores para el manejo dómestico de los medicamentos Rojas-Mora Laura Sáenz-Campos Desirée ,Universidad de Costa Rica ,CCSS San José Costa Rica 09 2000 2000 42 115 120

Justificación y Objetivo: Muchas personas mayores tienen dificultades para el manejo individual de sus medicamentos, lo cual pone en riesgo de incumplimiento terapéutico y de errores con la medicación al paciente mayor y conlleva significativas consecuencias médicas y económicas. El estudio pretende evaluar la condición funcional del adulto mayor ambulatorio, por medio de las habilidades psicomotoras aplicables al manejo individual de medicamentos, y relacionarla con la autoadministración (o administración asistida) de estos productos. Métodos: Estudio descriptivo y transversal. Se entrevistó a n= 52, 30 mujeres (M) y 22 varones (V) mayores de 65 años que viven en zona urbana, edad = 76 + 6 años (V= 78 + 7 años, M= 75 + 6 años) y se aplicó una escala para evaluación de habilidades para el manejo de medicamentos (5 ítems): habilidad para leer etiquetas, abrir un frasco de seguridad, extraer dos tabletas del frasco, comprender instrucciones y diferenciar colores; y puntaje global. Para análisis estadístico de la comparación por sexo, se aplicó X² y se consideró significativo cualquier valor p menor de 0.05. Resultados: Un 73% (V= 69%, M= 75%) pudo leer las etiquetas con instrucción (tipo Seguro Social), un 56% (V= 44%, M= 61%, p<0.05) abrió el frasco con tapa de seguridad, un 87% (V= 75%, M= 92%, p<0.05) extrajo las 2 tabletas de un frasco lleno de comprimidos, un 96% (V= 87%, M= 100%, p<0.05) interpretó bien las instrucciones para su ingesta, un 90% (V= 87%, M= 92%) discriminó bien los 5 colores diferentes, y solo un 44% (V= 37%, M= 47%, p<0.05) registró habilidad global óptima (5 puntos); todas las tareas fueron mejor resueltas por las mujeres. Un 85% (n= 44) consumían medicamentos, el 82% los toman ellos mismos (n= 36) y la mayoría (83%, n= 30) resolvieron entre 5 y 4 tareas; una significativa mayor proporción de mujeres (+44.5%, p<0.05) está a cargo de los medicamentos en casa. Dos varones no resolvieron prueba alguna y 2 mujeres que deben manejar sus medicamentos y los de sus cónyuges solo realizaron 2 tareas bien. Conclusiones: En adultos mayores evaluados, especialmente las mujeres, la capacidad funcional es variable pero suficiente para hacer permisible el manejo doméstico de medicamentos. La autoadministración de medicamentos y su administración a otros obedece a la necesidad doméstica y es independiente del grado de conservación de las habilidades psicomotoras (no resuelven bien las pruebas y aún así se ven obligados a autoadministrarse los medicamentos), aunque la mayoría de pacientes que manejan sus medicamentos tienen las habilidades psicomotoras conservadas y se los toman bien.

Background-aim: Many elderly people have difficulties using their medications, with a higher risk of dosing errors which might have significant medical and economic consequences. The purpose of this study was to assess the functional condition of ambulatory elderly adults (ability to manage their medication) by evaluating their psychomotor abilities in relationship with self-administration (or assisted administration) of these products. Methods: Descriptive and transversal study. A total of 52 elderly adults (older than 65 years and residents of the urban area) were interviewed at home (30 females (F) and 22 males (M)). Age= 76 + 6 years (M= 78 + 7 y., F= 75 + 6 y.). We applied a scale to evaluate the abilities for the use of medications in which we included five points: ability to read a prescription label, to open a safety-capped prescription vial, to remove two tablets from a prescription vial, to understand instructions and to recognize tablet colors, for a total score (5 points) assigned. (chi-square statistics were used to find differences in sexes p<0.05). Results: 73% (M= 69%, F= 75%) could read (social security labels) prescription labels, 56% (M= 44%, F= 61%, p<0.05) opened the safety-capped vials, 87% (M= 75%, F= 92%, p<0.05) removed tablets from full medication vials, 96% (M= 87%, F= 100%, p<0.05) interpreted medication instructions correctly, and 90% (M= 87%, F= 92%) recognized the five different tablet colors; 44% (M= 37%, F= 47%, p<0.05) showed a optimal ability for medication management (all tasks evaluated), women showed better results. 85% used medications (n= 44), 82% (n= 36) by self-administration and most of them (83% n=30) resolved between 4 and 5 items. A significant higher number of women (+44.5%, p<0.05) are in charge of the medication at home. Two males didn't resolve any task, and 2 women that manage their medicines and the medication of their spouses resolved only two tasks. Conclusions: In the individuals tested, the functional capacity is variable, but enough for the domestic management of medicines. The administration of medicines for themselves or others is dependent on need and has no relation with the level of conservation of their psychomotor abilities. Self-administration of drugs and administration to relatives is caused by domestic necessity and is independent of degree of psychomotor abilities status. Nonetheless most patients that self-administere their medications have good psychomotor performance and drug intake was correct.

 ancianos autoadministración condición funcional habilidades psicomotoras farmacoterapia geriátrica medicamentos Yee-Young L Koda-Kimble MA Guglielmo BJ Kradjan WA Special age groups:: Geriatric therapy Handobook of Applied Therapeutics Handobook of Applied Therapeutics 1996 97 Vancouver Applied Therapeutics Inc Ennis KJ Reichard RA Maximizing drug compliance in the elderly Postgraduate Medicine 1997 102 ^s3 Sáenz-Campos D Estudio comparativo de la prescripción de fármacos a pacientes mayores y menores de 60 años en consulta externa de medicina general Fármacos 1990 6 ^s1 Sáenz-Campos D Laclé-Murray A Comparación por zona rural-urbana del uso de medicamentos en mayores de 55 años (trabajo libre) Comparación por zona rural-urbana del uso de medicamentos en mayores de 55 años (trabajo libre) Congreso Médico Nacional noviembre 30 a diciembre 03, 1998 San José Sáenz-Campos D Laclé-Murray A Análisis comparativo del consumo domiciliar de medicamentos por adultos mayores en zonas rural y urbana Acta Med Costarric 1999 41 ^s2 Rojas-Mora L Sáenz-Campos D Análisis de la disposición y uso de medicamentos por adultos mayores a nivel domiciliar Fármacos 1999 12 ^s1 Ruscin JM Semla TP Assessment of medication management skills in older outpatients Annals Pharmacotherapy 1996 30 ^s10 Roquier-Charles D Le viellessement Actualites Pharmaceutiques 1996 346 Timiras PS Greger R Windhorst U Physiology of Aging:: Standarts for age-related functional competence Comprehensive Human Physiology Comprehensive Human Physiology 1996 2 Berlin Heidelberg Springer-Verlag Beers M Ouslander J Risk factors in geriatric drug prescribing Drugs 1989 37 Sáenz-Campos D Martín S Farmacoterapia Geriátrica:: Cumplimiento Terapéutico Fármacos 1991 7 ^s1 Fernández-Ballesteros R Izal M Montorio I González J Díaz P Actividades de la vida diaria en la vejez Evaluación e intervención psicológica en la vejez Evaluación e intervención psicológica en la vejez 1992 Barcelona Edit. Martínez-Roca Morera-Sigler M Evaluación de la información sobre su enfermedad y tratamiento farmacológico que tienen los pacientes ambulatorios en una clínica de la seguridad social Fármacos 1997 10 ^s1
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300006 Caracterización de algunos hábitos y enfermedades de los médicos costarricenses Jiménez-Navarrete Manuel Fco González-Blandón Ronaldo Sell-Salazar Virginia ,CCSS Nicoya Costa Rica ,Unión Médica Nacional San José Costa Rica ,Centro Nacional de Rehabilitación San José Costa Rica 09 2000 2000 42 121 130

Justificación y objetivo: Analizar la morbilidad entre los médicos costarricenses. Métodos y materiales: Investigación descriptiva, retrospectiva y de correlación, de corte transversal. Para recoger la información se utilizo una encuesta, bajo el sistema modificado de entrevista. Se aplicó el muestreo no probabilístico como técnica y el método primario accidental. Resultados: Se trabajó con 724 encuestas representativas del Cuerpo Médico Nacional (CMN). La muestra evidenció una proporción hombres y mujeres de 2,5: 1, la mayoría de los encuestados eran casados (75%), la mitad trabajando en la provincia de San José, siendo más los especialistas que los generalistas (48,5% vs 40,6%). La mayoría solamente trabajaban en labores clínicas (78,6%). El 50% de la población en estudio eran abstemios y entre los que consumían licor el 29,6% eran de consumo moderado a alcohólicos; la mayoría de los encuestados que consumían licor en exceso eran especialistas y trabajaban en hospitales. Dos tercios de toda la muestra no fumaban, pero el tercio restante en su mayoría consumía por lo menos diez cigarrillos diarios. Un 4,8% reportó consumir algún psicotrópico o estupefaciente, con un consumo promedio de 7,6 años. Dos tercios de la muestra practicaba algún tipo de ejercicio, pero en general este era de poca intensidad y generalmente solo los fines de semana. El 45,6% de los hombres y el 44,3% de las mujeres reportaron padecer algún tipo importante de enfermedad; entre los hombres se reportaron 92 entidades y entre las mujeres 68 distintas. Los médicos especialistas se reportaron más enfermos (60,9%). Entre las enfermedades más frecuentes en ambos sexos destacaron diversas alergopatías y la hipertensión arterial. Los hombres más que las mujeres asociaban dos o más enfermedades, sobre todo crónicas. Un número significativamente alto de galenos jóvenes reportaron ser portadores de trastornos del metabolismo (hiperuricemia, displipdemia, intolerancia a carbohidratos). El 8% de los colegas reportó alguna discapacidad. Conclusión: El consumo de licor y de tabaco y las enfermedades crónicas afectan un número significativo de médicos costarricenses, ello puede comprometer su desempeño laboral, y obstaculizar una eficiente y eficaz utilización de los recursos del sistema de salud, pero primordialmente dificulta la mejor calidad de vida en este grupo de profesionales tan expuesto a múltiples situaciones que comprometen su estabilidad física, mental y espiritual.

Background: To determine the morbidity and habits among Costa Rican medical doctors. Methods: Descriptive and retrospectiva study based on a survey which was applied by the modified interview system and the non-probabilistic sampling. Results: 724 surveys were obtained. These documents showed a 2,5:1 proportion between men and women, the majority married (75%), half of them working in San José, more specialists than general practitioners (48.5% vrs. 40.6%) and the majority working only in clinical practice (78.6%). Fifty per cent were non-drinkers and between the drinkers 29,6% admitted lo drink only moderate amounts. Two thirds of the interviewed did not smoke, but the third that did smoked ten or more cigarettes per day. Nearly 5% of the interviewed reported lo be consumers of psychotropic or narcotic drugs, the majority for an average of 7.6 years. Two thirds of the doctors practiced some type of exercise, but most of them in low intensities and only during the weekends. Regarding diseases 46.5% of men and 44,3% of women reported some type of illness. The specialists were more unhealthy (60.9%). The main pathologies reported were allergic problems and hipertension. An important number of young doctors reported lo have metabolic derrangements. Eight per cent reported some disability, the majority were specialists and were hospital employees. Conclusion: An important amount of liquor and tobacco consumption and chronic ilinesses were observed among costa rican physicians. This could interfere with their c professional performance, in the quality of the use of resources of the health system and mainly, in their own quality of life.

 morbilidad médicos costarricenses Jiménez M El Médico es un Ser Humano Opinión Médica 1990 8 Valverde C La mortalidad en los médicos Opinión médica 1992 10 Seedhouse D Cribb A Changing Ideas in Health Care: Capítulo II Changing Ideas in Health Care: Capítulo II 1989 Chichester John Wiley & Sons Chantler C Reinventing doctors BMJ 1998 317 McKeown Th Lowe C Introducción a la Medicina Social Introducción a la Medicina Social 1986 III edición México DF Siglo Veintiuno Editores Lask B Forget the stiff upper lip BMJ 1987 295 Dudley H Stress in Junior Doctors:: stress and support BMJ 1990 301 Swafford S Young doctors feel isolated BMJ 1997 314 Lowry S Dr. Kildare let me down BMJ 1988 296 González J Suberviola JF Prevalencia del síndrome de burnout o desgaste profesional en los médicos de atención primaria Atención Primaria 1998 22 Martí Ibáñez E Origen del Caduceo y la Vara de Escolapio MD en español octu br e Rosemberg N Rosemberg L Historia de la Medicina Moderna Historia de la Medicina Moderna 1969 11 edición México, DF Editorial Diana, S.A Polit D Hungler B Investigación Científica en Ciencias de la Salud Investigación Científica en Ciencias de la Salud 1985 11 edición México D F Editorial Nueva Interamericana, S.A. Manejo Integral de la Fármacodependencia en Costa Rica Manejo Integral de la Fármacodependencia en Costa Rica Ener o de San José Unidad de Publicaciones, IAFA Jiménez M La Autoridad Moral en el Médico (y su repercusión enlos pacientes) Opinión Médica 1989 7 Scally G Phycisians can't heal themselves The Lancet 1996 347 Petersdorf R Defining the Good Doctor JAMA 1993 269 Deliyore J Acreditación, certificación y recertificación médica Diagnóstico, Vida & Salud 1999 36 Ingenieros J Hacia una moral sin dogmas Hacia una moral sin dogmas 1990 VIII edición Buenos Aires Editorial Losada, S.A Jiménez M Cuerpo Médico Nacional 1991 Opinión Médica 1992 10 Bankowski Z Una nueva ética Una nueva ética 1990 ; en Graharne-Smith Arenson Oxford Textbook of Clinical Pharmacology and Drug Therapy Oxford Textbook of Clinical Pharmacology and Drug Therapy 1992 Second edition Oxford University Press Regueyra G Alfaro M Martínez P Capítulo 1:: Epidemiología Manejo Integral de la Fármacodependencia en Costa Rica Manejo Integral de la Fármacodependencia en Costa Rica 1990 San José Unidad de Publicaciones. Instituto de Alcoholismo y Fármacodependencia Sandí L Frank C Amador G Zúñiga H Artavia P Capítulo 11:: Factores asociados al consumo de sustancias Manejo Integral de la Fármacodependencia en Costa Rica Manejo Integral de la Fármacodependencia en Costa Rica 1990 San José Unidad de Publicaciones. Instituto de Alcoholismo y Fármacodependencia Smith R All doctors are problem doctors BMJ 1997 314
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300007 Melioidosis en Costa Rica: Reporte del primer caso Messino Julio Alfredo Villegas Villareal lrene ,Hospital Monseñor Sanabria Puntarenas Costa Rica ,Hospital Monseñor Sanabria Puntarenas Costa Rica 09 2000 2000 42 131 133

Melioidosis es una enfennedad infecciosa causada por la Burkholderia pseudomallef. Esta enfermedad es endémica en áreas tropicales de Asia y Australia y ha habido reportes aislados en Centro y Sur América. Aquí nosotros informamos del primer caso probado de melioidosis en Costa Rica, correspondiendo a un paciente sin historia de viajes a lugares endémicos. El paciente consultó por una bronconeumonía de adquisición comunitaria y sepsis. El hecho que el aislamiento bacteriano sea tan inusual en nuestro país implicó un retraso subsecuente en el inicio del tratamiento antibiótico específico en este caso, lo cual pudo influir en la evolución tan tórpida del paciente. Esto nos plantea el interrogante de si esta enfermedad debe ser incluida en el diagnóstico diferencial de sepsis de adquisición comunitaria en nuestro país.

Melioidosis in an infectious disease caused by Burkholderia pseudomallei. This disease is endemie in areas of tropical Asia and Australia; there have been isolated reports of the disease in Central and South America. Here we report the first documented case of Melioidosis in Costa Rica in a patient without a history of traveling lo endemic areas. The patient was seen at the hospital because of sepsis and a community acquired bronchopneumonia. Due lo the rareness of this bacterial isolation in our country the corroboration of the diagnosis was delayed and subsequently the specific antibiotics were started 5 days later after the admission, this could have influenced the torpid evolution the patient had. This case should alert us and points lo the need of including this rare disease in the differential diagnosis of community acquired sepsis in our country.

 Mandel D Bennett's Principies and practice of infections diseases Principies and practice of infections diseases 1995 fourth editions Woods A Jones A Hill P Interaction of insulin with Psedomonas Pseudomallei Infection and Inmunity 1993 61 ^s10 Egan A Gordon D Burholderia pseudomallei activases complement and is ingested but not killed by polimorphonuclear leukocytes lnfection and Inmunity 1996 64 ^s12 Chowagul W Suputtamongkol Y Dance DA Rajchanuvong A White NJ Relapse in Melioidosis:: Incidence and risk Factor The journal of infections Diseases 1993 168 Chowagul W White N Dance D Yupapom W Pimjai N Davis T Pitakwatchara N Melioidosis a mayor cause of conmunity-acquired septicemia in northeaster Thailand The journal of Infections disease 1989 159 Leclarasamee AB Melioidosis Reviews of infections diseases 1989 11 ^s3 Lieberman A Grossman M Bloomgarden D Sporotrichoid lymphangitis due to Staphylococus aureus in a diabetic patient Clinical infectious diseases 1995 21 Koch FW Zoller M Pankow W Kohnl FV Kuchier R An cute septic Course of Melioidosis after a stay in Thailand Disch.Med.Wochenschr 1997 122 Koth KB Melioidosis presenting as epididymo orchtis Singapore Med Journal 1995 36 Wong PK Melioidosis presenting with orbital cellulitis Singapure Med Journal 1996 37 Jones A Beveridge T Woods D Intracellular survival of Burkholderia pseudomallei Infection and Inmunity 1996 64 ^s3 Egan AM Gordon DL Burholderia pseudomallie activases complement and is ingested but not killed by polymorphonuclear leukocytes infect inmun 1996 64 Seott lA Bell AM Staines DR Fatal human melioidosis in south eastem Queenstand Med Joumal Aust 1997 166 Walsh AL Wuthickanun Y The laboratory diagnosis of Melioidosis Br. Joumal Biomed Sci 1996 53 White NJ Chowagul W Dance D Wattanagoon Y Wuthiekanum V Pitakwatchara N Haliving of mortality of severe Melioidosis by ceftazidime The Lancet 1989 Chaowagul W Melioidosis, a treatment challenge Scand J Infections disease 1996 101 ^sl Wong KT Vadiveln J Puthucheary SD Tan KL An immunihistochemical method for the diagnosis of Melioidosis Pathology 1996 28 Dharakull T Songsivilat S Anuntagool N Chaowagul W Wongbunnate S Sirisinha S Diagnsotic value of an antibody enzyme-Iinked inmunosorbent assay using affinity-purified antigen in an arca endemie for Melioidosis Aiu J Trop Med Hyg 1997 56 Rattamathongkom A Serinswan RW Wongratanacheewin S Detection of Burholderia pseudomallei in blood samples using polymerase chain reaction Mol-Cell-Probes 1997 11 Dhrakull T Songsivilal S Viriyachiltra S Luangwedcharkam V Tassaneetritap B Chaowagul W Detection of Burkholderia pseudomadei DNA in patients with septise"c Melioidosis Joumal Clin Microbiol 1996 34 Wuthiekanun V Smith MD Dance DA Walh AL Piti TL White NJ Biochemical Characteristics of elinical and environmental isolates of Burholderia pseudomallei Joumal Med Microbiol 1996 45 Phung LV Han Y Oka S Hotta H Smith MD Theeparakum P Yabuuchi E Yano L Enzyme linked inmunosorbent assay (ELISA) using a glicolipid antigen for the serodiagnosis of Melioidosis Fems inmunol Med Micribiol 1995 12
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300008 Linfangioleiomiomatosis pulmonar Salazar-Vargas Carlos Monterroso-Azofeifa Victoria Arauz-Pacheco Gloria Robelo-Pentzke Bayardo ,Hospital México ,Hospital México ,Hospital México 09 2000 2000 42 134 138

La Linfangioleiomiomatosis pulmonar es una enfermedad muy rara, que afecta sólo mujeres en edad reproductiva. Se presenta con disnea progresiva, pneumotórax a repetición y, ocasionalmente, con hemoptisis y quilotórax. El TAC de alta resolución muestra quistes pulmonares bilaterales de tamaño variable hasta bulas francas. Histológicamente, se aprecian múltiples cavidades de paredes finas, dilatación de vasos linfáticos, venas, arterias, bronquiolos y sacos alveolares, por proliferación de haces de músculo liso que comprime las estructuras antes mencionadas y que causa entonces su dilatación. El pronóstico es malo, ya que las pacientes desarrollan insuficiencia respiratoria, lo que las conduce a la muerte. La enfermedad se asocia a la ingesta de estrógenos, píldoras anticonceptivas y se exacerba con el embarazo-, por ello se ha tratado con medróxi-progesterona y tamoxifén, con estabilización de la evolución en algunos pero no en todos los casos. Eventualmente, algunas pacientes pueden necesitar transplante pulmonar. Presentamos el caso de una mujer de 38 años con tres episodios de pneumotórax espontáneo y documentación radiológica e histológica de linfangioleiomiomatosis pulmonar.

Pulmonary lymphangioleiomyomatosis is an uncommon disease, that affects only women of child-bearing age. The patients present themselves with progressive dyspnea, frequent episodes of spontaneous pneumothorax and, occasionally, with hemoptysis and chylothorax. High resolution CAT sean shows bilateral lung cysts of variable size up to frank bullae. Histologically, numerous thin walied cavities are seen, and dilatation of lymphaties, veins, arteries, bronchioles and alveolar sacs with extensiva smooth muscle proliferation, which engulfs the previously mentioned structures and causes their dilatation. The patients eventually develop respiratory insufficieney and die. This disease is associated with estrogen intake, contraceptivas and becomes worse during pregnancies. Thus, it has been treated with medroxi-progesterone and tamoxifen, with stabilization of the clinical course in some but not in all the cases. We present here the case of a 38 year old female with three episodes of spontaneous pneumothorax and radiological and microscopic documentation of pulmonary lymphangioleiomyomatosis.

 pneumotórax disnea linfangioleiomiomatosis Taylor JR Ryu J Colby TV Raffin TA Lymphangioleiomyomatosis: Clinical course in 32 patients NEJM 1990 323 ^s18 Urban T Lazor R Lacronique J Murris M Labrune S Valeyre D Cordier JF Pulmonary lymphangioleiomyomatosis: A study of 69 patients Medicine 1999 78 Bernstein SM Newell JD Adamczyk D Mortenson RL King TE Lynch DA How common are renal, angiomyolipomas in patients with pulmonary lymphangioleiomyomatosis? Am J Respir Crit Care Med 1995 152 Jao J Gilbert S Messer R Lymphangiomyoma and tuberous sclerosis Cancer 1972 29 Castro M Shepherd CW Gomez MR Lie JT Ryu H Pulmonary tuberous sclerosis Chest 1995 107 Salazar C Araya H Alvarado EM Soto L Pneumotórax catamenial Rev Med de CR y CA 1997 LIV ^s541 Zapatero J González-Palacios F Ortíz de Saracho J Sánchez J Candelas J Linfangioleiomiomatosis pulmonar con respuesta al trata miento con medroxi-progesterona y tamoxifén Cirugía Española 1995 58 Moss A Computed tomography of the body Computed tomography of the body Philadelphia Webb WR Advances in chest radiology The Radiologic Clinics ot North America The Radiologic Clinics ot North America 1994 32 Philadelphia W.B. Saunders Burgener F Kormano M Diagnóstico por TAC Diagnóstico por TAC 1998 Madrid Ed Marban Libros Chan JKC Tsang WYW Pan MY Tang MC Pan SW Fletcher CDM Lymphangiomyomatosis and angiomyolipoma: Closely related entities characterized by hamartomatous proliferation of HMB-45 positiva smooth muscle Histopathology 1993 22 Graham ML Spelsberg TC Dines DE Payne WS Bjornsson J Lie JT Pulmonary lymphangiomyomatosis:: with particular reference to steroid-receptor assay studies and pathologic correlation Mayo Clin Proc 1984 59
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300009 , 09 2000 2000 42 139 139
S0001-600220000003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022000000300010 , 09 2000 2000 42 141 142