S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100001 Tricotilomanía, tricofagia y el Síndrome de Rapunzel Jaramillo-Borges Yasmín Maria ,HNN 01 2007 2007 49 4 5
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100002 De la atención de la enfermedad hacia la promoción de la salud, contruyendo un nuevo paradigma García-González Rossana Ávila-Agüero María Luisa ,Directora General de Salud ,Ministra de Salud 01 2007 2007 49 6 8
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100003 Oportunidad de servir Rojas Montero José Federico ,Presidente Colegio de Médicos y Cirujanos 01 2007 2007 49 9 10
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100004 Investigación, poblaciones y muestra Camacho-Sandoval Jorge ,UNA 01 2007 2007 49 11 12
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100005 Hiperaldosteronismo primario, una nueva perspectiva Gómez- Hernández Karen Chen-Ku Chih Hao ,Caja Costarricense de Seguro Social 01 2007 2007 49 13 20

Hace cincuenta años se describió por primera vez el hiperaldosteronismo primario que hasta hace poco se consideraba un síndrome infrecuente y una causa excepcional de hipertensión arterial. De cada 10 pacientes hipertensos habrá en promedio uno de ellos con este padecimiento, convirtiendo a tal grupo de enfermedades en la causa más frecuente de hipertensión potencialmente curable. Este incremento en la prevalencia se debe quizás al aumento en la sensibilidad de las pruebas de tamizaje utilizadas. Si bien es cierto, los nuevos hallazgos no implican necesariamente el tamizaje generalizado de la población de hipertensos; es importante que el médico que la controla esté familiarizado con el tema para que lo considere y lo sospeche en el manejo y seguimiento de sus pacientes.

Primary aldosteronism was first described fifty years ago, and until recently it was considered uncommon and an exceptional cause of hypertension. Now we know that approximately one out of every 10 patients with hypertension will have some form of hyperaldosteronism, making this group of diseases the number one cause of potentially curable hypertension. This increase in prevalence is probably due to improved screening strategies. Although, these new findings do not necessarily imply the need to screen all the patients with hypertension, it is fundamental that physicians treating hypertensive patients be familiarized with primary hyperaldosteronism so that they consider this possibility as they manage and follow this individuals patients.

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A systematic review of the literature Endocrinol Metab Clin North Am 2002 31 Veglio F Morello F Rabbia F Leotta G Mulatero P Recent advances in diagnosis and treatment of primary aldosteronism Minerva Med 2003 94 Williams GH Dluhy RG Braunwald E Isselbacher KJ Petersdorf RG Wilson JD Martin JB Fauci AS Enfermedades de la corteza suprarrenal Harrison: Principios de Medicina Interna Harrison: Principios de Medicina Interna 1989 II 7 Interamericana McGraw Hill Litchfield WR Dluhy RG Primary aldosteronism Endocrinol Metab Clin North Am 1995 24 Gordon R Mineralocorticoid hypertension Lancet 1994 344 Nadar S Lip G Beevers DG Primary hyperaldosteronism Ann Clin Biochem 2003 40 Loh KC Koay ES Khaw MC Emmanuel SC Young Jr WF Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore J Clin Endocrinol Metab 2000 85 Rossi E Regolisti G Negro A Sani C Davoli S Perazzoli F High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives Am J Hypertens 2002 15 Rayner BL Opie LH Myers JE Trinder YA Davidson JS Screening for primary aldosteronism normal ranges for aldosterone and renin in three South African population groups S Afr Med J 2001 91 Gordon RD Stowasser M Tunny TJ Klemm SA Rutherford JC High incidence of primary aldosteronism in 199 patients referred with hypertension Clin Exp Pharmacol Physiol 1994 21 Kumar A Lall SB Ammini A Peshin SS Karmarkar MG Talwar KK Seth SD Screening of a population of young hypertensives for primary hyperaldosteronism J Hum Hypertens 1994 8 Lim P Dow E Brennan G Jung MacDonald TM High prevalence of primary aldosteronism in the Tayside hypertension clinic population J Hum Hypertens 2000 14 Fardella C Mosso L Gomez-Sanchez C Cortes P Soto J Gomez L Pinto M Huete A Oestreicher E Foradori A Montero J Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology J Clin Endocrinol Metab 85 Schwatz GL Prevalence of unrecognized primary aldosteronism in essential hypertension American Journal of Hypertension 2002 14 part 2 Schwartz GL Turner ST Prevalence of unrecognized primary aldosteronism in essential hypertension Am J Hypertens 2002 15 Kreze A Okalova D Vanuga P Putz Z Kodaj J Hrnciar J Occurrence of primary aldosteronism in a group of ambulatory hypertensive patients Vnitr Lek 1999 45 Strauch B Zelinka T Hampf M Bernhardt R Widimsky J Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region Journal of Human Hypertension 2003 17 Ganguly A Prevalence of Primary Aldosteronism in Unselected Hypertensive Populations: Screening and Definitive Diagnosis The Journal of Clinical Endocrinology & Metabolism 2001 86 Connell JMC Is there an epidemic of primary aldosteronismo? Journal of Human Hypertension 2002 16 Padfield PL Primary aldosteronism, a common entity? the myth persists Journal of Human Hypertension 2002 16 White PC Disorders of Aldosterone Biosynthesis and Action N Engl J Med 1994 331 Schenermann J. B Sayegh S.I Kidney Physiology Kidney Physiology 1998 Lippincott-Raven Rodríguez FJ López-Vidriero E Jara A Mineralocorticoides, Hiperaldosteronismos, Hipoaldosteronismos Endocrinología Endocrinología 2001 Madrid Médica Panamericana Beevers G Lip G O’Brien E ABC of hypertension The pathophysiology of hypertension British Medical Journal 2001 322 Weber K Aldosterone in congestive heart failure N Engl J Med 345 Guyton AC Hall JE Texbook of medical physiology Texbook of medical physiology 2000 10 W.B. Saunders Company Berne RM Levy MN Fisiología Fisiología 2001 3 Madrid Harcourt Valtin H Schafer J.A Renal function: Mechanisms preserving fluid and solute balance in health Renal function: Mechanisms preserving fluid and solute balance in health 1995 3 Little, Brown and Company Nadar S Lip G Beevers DG Primary hyperaldosteronism Ann Clin Biochem 2003 40 Onusko E Diagnosing secondary hypertension Am Fam Physician 2003 67 Gill JR Bartter FC Overproduction of sodium retaining steroids by the zona glomerulosa is adrenocorticotropin dependent and mediates hypertension in dexametasone suppressible aldosteronism J Clin Endocrinol Metab 1981 53 Luft FC Mendellian forms of hypertension and mechanisms of disease Clinical Medicine & Research 2003 1 Dluhy RG Lifton RP Glucocorticoid remediable aldosteronismo J Clin Endocrinol Metab 1999 84 Lim PO Young WF McDonald T A review of the medical treatment of primary aldosteronismo J Hypertens Blumenfeld JD Sealey JE Schlussel Y Vaughan D Sos TA Atlas SA Diagnosis and treatment of primary hyperaldosteronism Ann. Intern. Med 1994 121 Tanabe A Naruse M Naruse K Hase M Yoshimoto T Tanaka M Seki T Demura R Demura H Left ventricular hypertrophy is more prominent in patients with primary aldosteronism than in patients with other type of secondary hypertension Hypertension Res 1997 20 Nishimura M Uzu T Fujii T Kuroda S Nakamura S Inenaga T Kimura G Cardiovascular complications in patients with primary aldosteronism Am J Kidney Dis 33 Rocha R Funder JW The pathophysiology of aldosterone in the cardiovascular system Ann. N. Y. Acad. Sci 2002 970 Rossi GP Sacchetto A Pavan E Palatini P Graniero GR Canali C Pessina A Remodeling of the left ventricle in primary aldosteronism due to Conn´s adenoma Circulation 1997 95 Rossi GP Di Bello V Ganzaroli C Sacchetto A Cesari M Bertini A Excess aldosterone is associated with alterations of myocardial texture in primary aldosteronism Hypertension 2002 40 McMahon GT Dluhy RG Glucocorticoid-remediable aldosteronism Cardiol. Rev 2004 12 Struthers AD Aldosterone-induced vasculopathy Mol. Cell. Endocrinol 2004 217 Young Jr WF Primary aldosteronism: update on diagnosis and treatment Endocrinologist 1997 7 Gennari FJ Hypokalemia N Engl J Med 1998 339 Cotran RS Kumar V Collins T Patología structural y functional Patología structural y functional 2000 6 McGraw-Hill Interamericana Ulick Stanley Blumenfeld JD Atlas SA Wang JZ Vaughan ED The unique steroidogenesis of th aldosteronoma in the differential diagnosis of primary aldosteronismo J Clin Endocrin Metab 1993 76 Stowasser M Huggard PR Rossetti TR Bachmann AW Gordon RD Biochemical evidence of aldosterona overproduction and abnormal regulation in normotensive individuals with familial hyperaldosteronism type I J Clin Endocrin Metab 1999 84 Hiramatsu K Yamada T Yukimura Y A screening test to identify aldosterona producing adenoma by measuring plasma renin activity: results in hypertensive patients Arch Intern Med 1981 141 Montori VM Young Jr WF Use of plasma aldosterone concentrationto-plasma renin activity ratio as a screening test for primary aldosteronism. A systematic review of the literature Endocrinol Metab Clin North Am 2002 31 Bravo EL Primary aldosteronism. Issues in diagnosis and management Endocrinol Metab Clin North Am 1994 23 Grim CE Evolution of diagnostic criteria for primary aldosteronism: why is it more common in "drug-resistant" hypertension today? Curr Hypertens Rep 2004 6 Mulatero P Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents J. Clin. Endocrinol. Metab 2004 89 Mulatero P Dluhy RG Giacchetti G Boscaro M Veglio F Stewart PM Diagnosis of primary aldosteronism: from screening to subtype differentiation Trends in Endocrinology and Metabolism 2005 16 Gordon RD Primary aldosteronism J Endocrinol Invest 1995 18 Buhler FR Laragh JH Baer L Vaughan ED Brunner HR Propanol inhibition of rennin secretion: a specific approach to diagnosis and treatment of rennin-dependent hypertensive diseases N Engl J Med 1972 287 Gordon MS Williams GH Hollenberg NK Renal and adrenal responsiveness to angiotensin II: influence of b-adrenergic blockade Endocr Res 1992 18 Tiu SC Choi CH Shek CC Ng YW Chan FK Ng CM Kong AP The Use of Aldosterone-Renin Ratio as a Diagnostic Test for Primary Hyperaldosteronism and Its Test Characteristics under Different Conditions of Blood Sampling The Journal of Clinical Endocrinology & Metabolism 2005 90 Brown MJ Hopper RV Calcium-channel blockade can mask the diagnosis of Conn´s syndrome Postgrad Med J 1999 75 Mulatero P Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism Hypertension 2002 40 Young WF Jr Primary aldosteronism: a common and curable form of hypertension Cardiol Rev 1999 7 Oliveros-Palacios MC Godoy-Godoy N Colina-Chourio JA Effects of doxazosin on blood pressure, rennin-angiotensin-aldosterone and urinary kallikrein Am J Cardiol 1991 67 Gallay BJ Ahmad S Xu L Toivola B Davidson RC Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone renin ratio Am J Kidney Dis 2001 37 Lei Xu Viering E Davidson RC Toivola B The diagnosis of primary hyperaldosteronism (PHA) using plasma aldosterone-to-renin activity ratio Am J Clin Pathol 1994 102 Schawartz GL Turner ST Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity Clin Chem 2005 51 Tanabe A Naruse M Takagi S Imaki T Takano K Variability in the Renin/Aldosterone Profi le under Random and Standardized Sampling Conditions in Primary Aldosteronism J Clin Endocrinol Metab 88 Francois P Jeunemaitre X Would wider screening for primary aldosteronism give any health benefits? European Journal of Endocrinology 2004 151 Stowasser M Gordon RD Rutherford JC Nikwan NZ Daunt N Slater GJ Diagnosis and management of primary aldosteronism JRAAA 2001 2 Magill SB Raff H Shaker JL Brickner RC Knechtges TE Kehoe ME Findling JW Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronismo J Clin Endocrinol Metab 2001 86 White EA Schambelan M Rost CR Biglieri EG Moss AA Korobkin M Use of computed tomography in distinguishing the cause of primary aldosterism N Engl J Med 1980 303 Mulatero P Morello F Veglio F Genetics of primary aldosteronism J Hyperten 2004 22 Jackson EK Hardman JG Limbird LE Diuretics Goodman and Gilman’s the pharmacological basis of therapeutics Goodman and Gilman’s the pharmacological basis of therapeutics 2001 10 ^eNew York McGraw-Hill Flórez J Armijo JA Flórez J Fármacos diuréticos Farmacología humana Farmacología humana 1997 3 Barcelona Masson Mosby’s Drug Consult Mosby’s Drug Consult Nadler JL Hsueh W Horton R Therapeutic effect of calcium channel blockade in primary aldosteronism J Clin Endocrin Metab 1985 60 Carpene G Rocco S Opacher G Mantero F Acute and chronic effect of nifedipine in primary aldosteronism Clin Exp Hypertens 1989 11 Stokes GS Monaghan JC Ryan M Woodward M Efficacy of an angiotensin II receptor antagonist in managing hyperaldosteronism J Hypertens 2001 19 Smith DC Weber CJ Amerson JR Laparoscopic Adrenalectomy: New Gold Standard World J. Surg 1999 23 Shen WT Lim RC Siperstein AE Laparoscopic vs open adrenalectomy for the treatment of primary hyperaldosteronism Arch Surg 1999 134 Chavez J Pasieka JL Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series The American Journal of Surgery 2005 189 Plouin PF Amar L Chatellier G Trends in the prevalence of primary aldosteronism, aldosterone producing adenomas, and surgically correctable aldosterone dependent hypertension Nephrology, Dialysis, Transplantation 2004 19 Kearney PM Whelton M Reynolds K Muntner P Whelton PK He J Global burden of hypertension: analysis of worldwide data Lancet 2005 365
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100006 La relación entre el asma y la enfermedad pulmonar obstructiva crónica Solano-Ortiz Marcia Ávila-de Benedictis Lydiana Soto-Quirós Manuel ,Caja Costarricense de Seguro Social 01 2007 2007 49 21 25

Asma y enfermedad pulmonar obstructiva crónica (EPOC) son enfermedades pulmonares comunes con semejanzas y diferencias. Estudios genéticos recientes han dado información importante acerca de los múltiples loci susceptibles para cada enfermedad. Estudios del genoma han mostrado resultados similares en al menos una región cromosomal en ambas enfermedades, así como también evidencia de la interacción con factores ambientales (por ejemplo, el fumado activo en los pacientes con EPOC, o el pasivo en aquellos con asma). Existen pocos estudios recientes acerca del remodelamiento de la vía aérea y su importancia en pacientes asmáticos persistentes crónicos, lo que podría explicar de cierta forma la progresión de estas personas a enfermedades pulmonares obstructivas crónicas.

Asthma and COPD are common pulmonary diseases with similarities and differences. Recent genetic studies have given important information about multiple susceptible loci for both diseases. Studies of the genome have showed similar results in at least a chromosomal region in both diseases and demonstrate the interaction the environmental factors (for example, active smoking in the patients with COPD, or passive smoking in those with asthma). Currently there are few recent studies about airway remodelling and its importance in chronic persistent asthmatic patients, this might explain in some way the progression of these persons to chronic obstructive pulmonary diseases.

 Asma EPOC bronquitis crónica enfisema pulmonar Teoría Holandesa obstrucción de la vía aérea remodelamiento de la vía aérea COPD smoking remodeling of de airway Postma D Boezen M Rationale for Dutch Hypothesis - allergy and Airway hiperresponsiveness as Genetic Factors and their interaction with environment in the development of asthma and COPD Chest 2004 126 Smith O Helms J Genetic/environmental determinants of adult chronic obstructive pulmonary disease and possible links with childhood wheezing Ped Resp Rev 2001 2 Jenkins C Thompson P Gibson P Wood-Baker R Distinguishing asthma and chronic obstructive pulmonary disease: why, why not and how? Med J Aust 2005 183 Bleecker E Similarities and differences in asthma and COPD- The Dutch Hypothesis Chest 2004 126 Meyers D Larj M Lange L Genetics of asthma and COPD. Similar resultants for different phenotypes Chest 2004 126 Adcock I Ford P Ito K Barnes P Epigenetic and airways disease Respir Res 2006 7 Sandforf A Weir T Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: American Thoracic Society Am J Respir Crit Care Med 1995 152 Siafakas N Vermeire P Pride N Backer V Optimal assessment and management of chronic obstructive pulmonary disease (COPD): The European Respiratory Society Task Force Eur Resp J 1995 8 The GOLD global strategy for the management and prevention of COPD Am J Respir Crit Care Med 2001 163 Silverman M Wilson N Asthma- time for change of name Arch Dis Child 1997 77 Mannino DM Gagnon RC Petty TL Obstructive lung disease and low function in adults in the United States; data from the national health and nutrition examination survey, 1988-1994 Arch Intern Med 2000 160 Goeman D Douglass J Understanding asthma in older Australians: a qualitative approach Med J Aust 2005 183 Anderson G Morrison J Molecular biology and genetics of allergy and asthma Arch Dis Child 1998 78 Borg B Reid D Walters E Johns D Bronchodilator reversibility testing: laboratory practices in Australia and New Zealand Med J Aust 2004 180 Iniciativa global para manejo y prevención del asma: GINA Iniciativa global para manejo y prevención del asma: GINA 2004 Silva G Sherrill D Guerra S Barbee R Asthma as a risk factor for COPD in a longitudinal study Chest 2004 126 Silverman E Speizer F Risk factors for the development of chronic obstructive pulmonary disease Med Clin North Am 1996 80 Meyer P Mannino D Redd S Characteristics of adults dying with chronic obstructive pulmonary disease Chest 2002 122 Word. Health Report Word. Health Report 2000 Ginebra Mannino D Epidemiology, prevalence, morbidity and mortality, and disease heterogeneity Chest 2002 121 Xu X Rijcken B Schouten J Weiss S Airways responsiveness and development and remission of chronic respiratory symptoms in adults Lancet 1997 350 Yates M How is the diagnosis of asthma in older people established in clinical practice? Med J Aust 2005 183 Abramson M Respiratory symptoms and lung function in older people with asthma or chronic obstructive pulmonary disease Med. J Austr 2005 183 Sandforf A Chagani T Weir T Connett J Anthonisen N Paré P Susceptibility genes for rapide decline of lung function in the lung health study Am J Respir Crit Care Med 2001 163 Tobin M Chronic obstructive pulmonary disease, pollution, pulmonary vascular disease, transplantation, pleural disease, and lung cancer in AJRCCM 2002 Am J Respir Crit Care Med 2003 167 Palmer J Functional Genomics of Lung disease Am. J. Resp. Cell and Molecular Biology 2004 31 Hofhuis W Jongste J Merkus P Adverse health effects of prenatal and Postnatal tobacco smoke exposure on children Arch Dis Chile 2003 88 Ulrick CS Backer V Nonreversible airflow obstruction in life-long nonsmokers with moderate to severe asthma Eur Respir J 1999 14 Sciurba F Physiologic Similarities and Differences between COPD and Asthma Chest 2004 126 Grootendorst D Rabe K Mechanisms of bronchial hyperreactivity in asthma and chronic obstructive pulmonary disease Proc Am Thorac Soc 2004 1 Lewis S Pavord I Stringer J Knox A Weiss S Britton J The Relation Between Peripheral Blood Leukocyte Count and Respiratory Symptoms, Atopy, Lung Function, and Airways Responsiveness in Adults Chest 2001 119 Marc M Korosec P Kosnik M Kern I Flezar M Suskovic S Complement factors C3a, C4a, C5a, in chronic obstructive pulmonary disease and asthma Am J Respir Cell Mol Biol 2004 31 Keatings V Collins P Scott D Barnes P Differences in interleukin-8 and tumor necrosis factor-alpha in induced sputum form patients with chronic obstructive pulmonary disease or asthma Am J Respir Crit Care Med 1996 153 Basyigit I Yildiz F Yildirim E Boyaci H Ilgazli A Body mass index and serum and sputum TNF-alpha levels relation in asthma and COPD J Tuberc Thorax Tuberk Toraks 2004 52 Donohue J Therapeutic Responses in Asthma and COPD Chest 2004 126 Selroos O Pietinalho A Lofroos A Riska H Effect of early vs. late intervention with inhaled corticosteroids in asthma Chest 1995 108 Hudon C Turcotte H Laviolette M Carier G Boulet L Characteristics of bronchial asthma with incomplete reversibility or airfl ow obstruction Ann Alergy Asthma Immunol 1997 78 Vonk J Jongepier H Panhuysen C Schouten J Bleecker E Postma D Risk factors associated with the presence irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up Xuan W Marks G Toelle B Belousova E Peat J Berry G Risk factors for onset and remission of atopy, wheeze, and airway hiperresponsiveness Thorax 2002 57 Elias J The relationship between asthma and COPD Chest 2004 126 Bunbacea D Campbell D Nguyen L Carr D Barnes P Robinson D Parameters associates with persistent airflows obstruction severe asthma Eur Respir J 2004 204 Gaga M Fixed obstruction in severe asthma: not just a matter of time Eur Respir J 2004 234 Backman K Greenberger P Patterson R Airways obstruction in patients with long-term asthma consistence with "irreversible asthma" Chest 1977 122 Molfino N Genetics of COPD Chest 2004 125 Lomas D Silverman E The genetics of chronic obstructive pulmonary disease Respir Res 2001 2 Hersh C DeMeo D Lazarus R Celedón J Raby B Benditt J Genetic Association analysis of functional impairment in chronic obstructive pulmonary disease Am J Respir Crit Care Med 2006 173
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100007 Indicaciones para el uso de terapia de reemplazo hormonal oral en mujeres menopáusicas mayores de 50 años Fernández Morales Donald ,Caja Costarricense de Seguro Social 01 2007 2007 49 26 32

El uso de la terapia de reemplazo hormonal oral ha sido una controversia en los últimos años, como consecuencia de una serie de estudios aleatorios que contradicen los lineamientos anteriores. Algunos autores refieren sus observaciones respecto a estas investigaciones, así como las limitaciones. Sin embargo, se demuestra que las únicas indicaciones que persisten para su uso son el tratamiento del síndrome menopáusico, al menor tiempo y la menor dosis posible, y como segunda elección, la osteoporosis. El objetivo de esta revisión es ofrecer un apoyo a los profesionales en medicina que prescriben terapia de reemplazo hormonal en mujeres menopáusicas mayores de 50 años.

The use of oral hormonal replacement therapy has been controversial during the last years because randomized studies opposed all the previous guidelines. Some authors referred their observations and the limitations of these investigations. But it is demonstrated that the only indication that still persists is the treatment of the menopausal syndrome, using the lowest dose during the shortest time possible, and probably as a second option, in the management of osteoporosis. The objective of the present review to is support the medical physicians that prescribe hormonal replacement therapy for menopausal women older than 50 years of age.

 Terapia de reemplazo hormonal síntomas vasomotores atrofi a urogenital tromboembolismo cáncer de seno invasivo enfermedad cerebrovascular hormone replacement therapy vasomotor symptoms urogenital atrophy thromboembolism invasive breast cancer Harlap S The benefits and risks of hormone replacement therapy: An epidemiologic overview Am J Obstet Gynecol 1992 166 Ziel H Finkle W Increased risk of endometrial carcinoma among users of conjugated estrogens N Engl J Med 1975 293 Udoff L Continuous estrogen-progestin replacement therapy in postmenopausal women Continuous estrogen-progestin replacement therapy in postmenopausal women 2003 Wellesley^eMA Archer D Pickar J Bottiglioni F Bleeding patterns in postmenopausal women taking continuous combined or sequential regimens of conjugated estrogens with medroxiprogesterone acetate Obstet Gynecol 1994 83 Effects of hormone replacement therapy on endometrial histology in postmenopausal women JAMA 1996 275 Clisham R Ziegler D Lozano K Judd H comparison of continuous versus sequential estrogen and progestin therapy in postmenopausal Women Obstet Gynecol 1991 77 Eiken P Kolthoff N Compliance with 10 years oral hormonal replacement therapy Maturitas 2002 41 Guidelines for counseling postmenopausal women about preventive hormone therapy Ann Intern Med 1992 117 Hormone replacement therapy Hormone replacement therapy 1992 166 ^eWashington, DC ACOG Nanas H Katz D American College of Preventive Medicine Practical policy statement, perimenopausal and postmenopausal hormone replacement therapy Am J Prev Med 1999 17 Mosca L Grundy S Judelson D King K Limacher M Oparil S Guide to preventive cardiology for women Circulation 1999 99 Grady D Rubin S Petitti D Hormone Therapy to prevent disease and prolong life in postmenopausal women Ann Intern Med 1992 117 Grimes D Lobo R Perspectives on the women’s health initiative trial of hormone replacement therapy Obstet Gynecol 2002 100 Keating. Cleary P Rossi A Zaslavsky A Ayanian J Use of hormone replacement therapy by postmenopausal women in the United States Ann Intern Med 1999 130 Ravnikar V Compliance with hormone therapy Am J Obstet Gynecol 1987 156 Dawood Y Tidey G Menopause Curr prob Obstet Gynecol Fertil 1993 16 Freedman R Pathophysiology and treatment of menopausal hot fl ashes Semin Reprod Med 2005 23 Greendale G Reboussin B Hogan P Barnebei V Shumaker S Johnson S Barret-Connor E Symptom relief and side effects of postmenopausal hormones: results from the postmenopausal estrogen/ progestin intervention trial Obstet Gynecol 1998 92 Nelson H Commonly used types of postmenopausal estrogen for treatment of hot fl ashes JAMA 2004 291 MacLennan A Lester S Moore V Terapia de reemplazo estrogénico por vía oral versus placebo para el tratamiento de los sofocos (Revisión Cochrane traducida) La Biblioteca Cochrane Plus La Biblioteca Cochrane Plus 2005 2 Oxford Update Software Ltd Barret-Connor E Estrogen and Estrogen - Progestogen replacement: therapy and cardiovascular diseases Am J Med 1993 95 ^sSuppl 5A Effects of estrogen or estrogen/ progestin regimens on heart disease risk factor in postmenopausal women: the Postmenopausal Estrogen / Progestin Interventions (PEPI) Trial JAMA 1995 273 Editorials. PEPI in Perspective. Good answers spawn pressing Questions JAMA 1995 273 Hulley S Grady D Bus T Furberg C Herrington D Riggs BL Vittinghoff E Randomized trial el estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen / progestin Replacement Study (HERS) Research Group JAMA 1998 280 Grady D Herrington D Bittner V Blumenthal R Davidson M Hlatky M Hsia J Hulley S Herd A Khan S Newby LK Waters D Vitinghoff E Wenger N Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow - up (HERS II) JAMA 2002 288 Risk and benefi ts of estrogen plus progestin in health postmenopausal women: principal results from the women’s health initiative randomized controlled trial JAMA 2002 288 Liu J Menopausal hormone therapy: a paradigm shift? Fertil Steril 2003 80 Effects of conjugated equine estrogens in postmenopausal women with hysterectomy. The womens health initiative randomizad controlled Trial JAMA 2004 291 Hulley S Grady D The WHI Estrogen-Alone Trial - Do Things Look Any Better? JAMA 2004 291 Sánchez G Carmona L Roque M Sánchez L Bonfi ll X Terapia de reemplazo hormonal para la prevención de enfermedades cardiovasculares en mujeres posmenopáusicas (Revisión Cochrane traducida) 2005 Oxford Update Software Ltd Postmenopausal hormone replacement therapy for primary prevention of chronic conditions: recommendations and rationales Ann Intern Med 2002 137 Informe del panel asesor de la NAMS sobre la terapia hormonal de la posmenopáusica Menopause 2003 10 Recommendation statement from the Canadian task force on preventive health care. Postmenopausal hormone replacement therapy for primary prevention of cardiovascular and cerebrovascular disease CMAJ 2004 170 Recommendations for estrogen and progesterone use in peri and postmenopausal women: October 2002 position statement of the North American Menopause Society Menopause 2004 11 Ballagh S vaginal hormone therapy for urogenital and menopausal symptoms Sem Reprod Med 2005 23 Clinical Practice Guidelines. The detection and management of vaginal atrophy J Obstet Gynecol Can 2004 26 Barnabei V Cochrane B Aragaki A Nygaard I Williams S McGovern P Menopausal symptoms and treatment-related effects of estrogen and progestin in the women’s health initiative Obstet Gynecol 2005 105 Cardozo L Bachmann G McClish D Fonda D Birgerson L Meta-Analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: Second Report of the Hormones and Urogenital Therapy Committee Obstet Gynecol 1998 92 Bachmann G Nevadunsky N Diagnosis and treatment of atrophic vaginitis Am Fam Physician 2000 61 Cardozo L Lose G McClish D Versi E Koning H A Systematic review of estrogens for recurrent urinary tract infections: Third report of the hormones and urogenital therapy committee Int Urogynecol J 2001 12 Grady D Brown J Vittinghoff E Applegate W Varner E Snyder T Postmenopausal hormones and incontinence: The heart and estrogen/ progestin replacement study Obstet Gynecol 2001 97 Moehrer B Hextall A Jackson S Estrógenos para la incontinencia urinaria en mujeres (Revisión Cochrane traducida) 2005 3 Oxford Compton J Sex steroids and bone Physiological Reviews 2001 81 Couley J Seeley D Ensrud K Ettinger B Black D Cummings S Estrogen replacement therapy and fractures in older women Ann Intern Med 1995 122 Cauley J Black D Barrett-Connor E Harris F Shields K Applegate W Cummings R Effects of hormones replacement therapy on clinical fractures and height loss: the heart and estrogen/ progestin replacement study (HERS) Am J Med 2001 110 Hulley S Furberg C Barrett-Connor E Cauley J Grady D Haskell W Noncardiovascular Disease Outcomes During 6.8 Years of hormone therapy. Heart and estrogen/progestin replacement study follow-up (HERS II) JAMA 2002 288 Cauley J Robbins J Chen Z Cummings S Jackson R LaCroix A Effects of estrogen plus progestin on risk of fracture and bone mineral density. The women’s health initiative randomized trial JAMA 2003 290 Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions ( PEPI) trial JAMA 1996 276 Torgerson D Bell-Syer S Hormone replacement therapy and prevention of nonvertebral fractures. A meta-analysis of randomized trial JAMA 2001 285 Wells G Tugwell P Shea B Guyatt G Peterson J Zytaruk N Meta-Analysis of the effi cacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women Endoc Reviews 2002 23 Banks E Beral V Reeves G Balkwill A Barnes I Fracture incidence in relation to the pattern of use of hormone therapy in postmenopausal women JAMA 2004 291 Greendale G Wells B Marcus R Barrett-Connor E How many women lose bone mineral density while taking hormone replacement therapy? Results from the postmenopausal estrogen/progestin interventions trial Arch Intern Med 2000 160 Greendale G Espeland M Stone S Marcus R Barrett-Connor E Bone mass response to discontinuation of long-term hormone replacement therapy. Results from the postmenopausal estrogen/ progestin interventions (PEPI) safety follow-up study Arch Intern Med 2002 162 Greenspan S Emkey R Bone H Weiss S Bell N Downs R Significant differential effects of alendronate, estrogen or combination therapy of the rate of bone loss after discontinuation of treatment of postmenopausal osteoporosis Ann Intern Med 2002 137 Cheung A Feig D Kapral M Diàz N Dodin S CMAJ 2004 170 Simon J Hsia J Cauley J Richard C Harris F Fong J Postmenopausal hormone therapy and risk of stroke. The heart and estrogen-progestin replacement study Circulation 2001 103 Wassertheil S Hendrix S Limacher M Heiss G Kooperberg C Baird A Effect of estrogen plus progestin on stroke in postmenopausal women. The women’s health initiative: a randomized trial JAMA 2003 289 Breast cancer and hormones-replacement therapy in the million women study Lancet 2003 362 Anderson G Judd H Kaunitz A Barad D Beresford S Pettinger M Effects pf estrogen plus progestin on gynecologic cancers and associated diagnostic procedures. The women’s health initiative randomized trial JAMA 2003 290 Risch H Postmenopausal estrogen - only, but not estrogen + progestin, was associated with increased risk of ovarian cancer Evid based Obstet Gynecol 2003 5
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100008 Incidencia de esclerosis lateral amiotrófica en Costa Rica Rodríguez- Paniagua Pilar Salas- Herrera Isaías Cartín- Brenes Mayra ,Caja Costarricense de Seguro Social 01 2007 2007 49 33 37

Justificación y objetivo: Hasta el momento no se ha publicado un estudio que nos permita conocer cuál es la incidencia de ELA en nuestro país. El objetivo de este estudio fue establecer la incidencia de esta enfermedad en Costa Rica, y describir las características de los pacientes diagnosticados en nuestro país desde enero de 1998 a noviembre de 2001. Materiales y métodos: Utilizando diferentes fuentes de información se identificaron los casos de ELA en el periodo de 1998 al 2001. Se calculó la tasa de incidencia por persona año, se analizaron variables como sexo, distribución geográfica, grupo étnico, edad al diagnóstico, clasificación de la enfermedad, métodos diagnósticos y tratamientos. Resultados: Entre enero de 1998 y diciembre del 2001, 102 casos de ELA son diagnosticados en Costa Rica, la tasa incidencia anual en población de 15 años y mas es de 0.97 (I.C. 95 % 0.8 a 1.2) por 100.000 personas año. Se revisaron 76 expedientes. Veintiocho fueron mujeres y cuarenta y ocho hombres, presentándose una mayor incidencia en hombres, con una razón de masculinidad de 1.7, todos de raza blanca. La edad al diagnóstico fue de 58.4 años para las mujeres y 53.1 años para los hombres (p = 0.15). El 75% de los casos se encuentran en tres provincias: San José, Alajuela y Cartago, con tasas de incidencia similares. La tasa de incidencia aumenta conforme aumenta la edad en las mujeres, mientras en los hombres se muestra la tasa más alta en la década de los sesenta. El 36.8% de los casos fueron clasificados como ELA bulbar, mientras que el 55.3% como espinal, el 7.9% restante como bulbo espinal. Conclusión: El estudio muestra cómo la incidencia de esta enfermedad es similar a la de los países que muestran las incidencias mas bajas. La incidencia se mantuvo estable en el período analizado, la enfermedad afecta más a hombres que a mujeres.

Objective. Amyotrophic lateral sclerosis is a degenerative disease of the central nervous system that is characterized by progressive affection of the upper and lower motor neuron. Until now, there has not been a publication that refers to its incidence in our country. The present investigation is based on the analysis of patients seen with the diagnosis of this illness from January 1998 to November 2001. Methods. Incidence rate per person-years was calculated and variables such as sex, age of diagnosis, ethnics, geographic distribution, classification of the disease, treatment and diagnostic methods were analyzed. Results. Between January 1998 and December 2001 a total of 102 cases were diagnosed with ALS in Costa Rica, the annual incidence rate 0.97 (I.C. 95 % 0.8 a 1.2) per 100.000 person-years. 76 medical records were reviewed. Twenty eight were females and forty eight males, the M: F ratio was 1.7. The average age of diagnosis was 58.4 years for females and 53.1 years for males (p = 0.15). The geographic distribution showed that 75% of the patients live in San José, Alajuela and Cartago, with a very similar incidence rate. The incidence increases with age in women, while in men shows a peek of onset at the sixth decade. Conclusion. The study shows that the incidence of ALS in our country appears to be similar to those countries with lower rates of incidence. The incidence rate was stable in the years of the study; the disease affects more men than women.

 Esclerosis lateral amiotrófica incidencia Costa Rica Amyotrophic Lateral Sclerosis incidence Costa Rica Nelson L McGuire V Longtreth, Matkin C Population-Based Case-control study of amyotrophic lateral sclerosis in western Washington State. I Cigarette smoking and alcohol consumption Am J Epidemiol 2000 151 Rowland L Shneider N Amyotrophic Lateral Sclerosis N Engl J Med 2001 344 Nelson L McGuire V Longtreth, Matkin C Population-Based Case-Control Study of Amyotrophic Lateral Sclerosis in Western Washington State II Diet. Am J Epidemiol Chió A Incidence of ALS in Italy Neurology 2001 56 McGuire V Longstreth W T Koepsell T van Belle G Incidence of Amyotrophic Lateral Sclerosis in three counties in western Washington State Neurology 1996 47 Traynor BJ Codd MB Corr B Forde C Frost E Hrdiman O Incidence and prevalence of ALS in Ireland. 1995-1997. A population-based study Neurology 1999 52 Brooks B Clinical Epidemiology of Amyotrophic Lateral Sclerosis Neurol Clin 1996 54 Johansen C Olsen J Mortality from Amyotrophic lateral Sclerosis, Other Chronic Diseases, and Electric Shocks among Utility Workers Am J Epidemiol 1998 148 Riggs J Amyotrophic Lateral Sclerosis, Heterogeneous Susceptibility, Trauma, and Epidemiology Arch of Neurol 1996 53 Walling A Amyotrophic lateral Sclerosis: Lou Gehrig’s disease American Family Physician 1999 59 Traynor B Codd M Corr B Forde C Frost E Hardiman O Clinical features according to El Escorial and Airlie House diagnostic criteria Arch Neurol 2000 57 Miller R.G Rosenberg J.A Gelinas D.F Mitsumoto H Newman D Sufit R Practice parameter: The care ot the patient with amyotrophic lateral sclerosis (an evidence based review) Neurology 1999 52 Szklo M Nieto J Epidemiology: Beyond the Basics Epidemiology: Beyond the Basics 2000 Aspen Publishers, Inc Albert S M Murphy P L Del Bene M L Rowland L P A prospective study of preferences and actual treatment choices in ALS Neurology 1999 53
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100009 Estudio de la estacionalidad del dengue en la costa pacífica de Costa Rica (1999-2004) Wong- McClure Roy Suárez- Pérez Marilys Badilla- Vargas Xiomara ,Caja Costarricense de Seguro Social 01 2007 2007 49 38 41

El virus del dengue constituye la causa más común de enfermedades por arbovirus en el mundo. El estudio analiza el comportamiento estacional del dengue en la región Pacífico Central de Costa Rica, durante el período comprendido entre 1999 y 2004. Materiales y métodos: La información fue tomada del Ministerio de Salud de Costa Rica y del Instituto Meteorológico Nacional. Para el análisis de la estacionalidad de dengue se utilizaron el número de casos de esta enfermedad para la estimación de promedios móviles y las características de los brotes epidémicos. Se definió como brote epidémico un total de 20 ó más casos de dengue por semana epidemiológica. Resultados: Durante el período analizado se observó un incremento en el número de casos de dengue por año. Al observar la distribución de los casos incidentes del dengue cada año se resaltó un patrón anual estacional. Los brotes del dengue se presentaron al menos una vez al año, entre las semanas epidemiológicas 18-29 (abril-julio), que coincidían con la estación lluviosa. Discusión: Se evidencia que en la región Pacífico Central, el dengue es una enfermedad predecible en cuanto a su comportamiento estacional, por lo que se recomienda intensificar las medidas de prevención para combatirla, así como preparar los servicios para la atención de pacientes, en las semanas epidemiológica previas a las de mayor promedio en el número de casos, según el patrón estacional.

Aim: This study analyzed the Dengue’s seasonal behaviour in the Central Pacific Region of Costa Rica, during the period from 1999 to 2004. It is known that the dengue virus is the most common cause of arbovirus diseases in the world. Material and methods: We got the data from the Costa Rican Ministry of Health and the National Meteorological Institute. From this data, moving averages were calculated to evaluate its seasonal behaviour and the features of the outbreaks. In this study an outbreak of dengue is defined when there are 20 or more cases reported per week. Results: During this period under study, an increase in the number of dengue cases per year was observed; its numerical behaviour throughout this interval, reflected a pattern in which the outbreaks appeared between the 18 th through the 29 th epidemiological week (April - July) which coincided with the rainy season in the region. Discusion: The conclusion drawn from this study is that in the Central Pacific region, the dengue disease shows a predictable pattern in relation to the rainy season. For this reason, intensifying preventive measures, as well as, preparedness for patient treatment is strongly recommended, before the epidemiological week with highest average of cases and the seasonal pattern.

 Dengue estacionalidad del dengue dengue en Costa Rica Dengue Costa Rica El control de las enfermedades transmisibles El control de las enfermedades transmisibles 2001 17 ^eWashington, DC OPS Fauci A Braunwald E Martin J Kasper D Isselbacher K Wilson J Principios de medicina interna Principios de medicina interna 1998 14 ^eNueva York Mc Graw Hill Gibbons R Vaughn W Dengue: An Escalating Problem. Clinical Review BMJ 2002 321 Gubler D Dengue and Dengue Hemorrhagic Fever Clin Microbiol. Rev 1998 11 Dengue and Dengue Haemorrhagic Fever Dengue and Dengue Haemorrhagic Fever Dengue Fever Dengue Fever Alfaro A Navas L Pérez E Barrantes J Rodríguez M Pizarro D Hallazgos clínicos detectados al ingreso de los pacientes hospitalizados para predecir la evolución a dengue hemorrágico Memorias de Academia Nacional de Ciencias. El Dengue 2001 7 Normas técnicas para el control del dengue y dengue hemorrágico Normas técnicas para el control del dengue y dengue hemorrágico 2000 1 San José Ministerio de Salud Von S López R Woodall J Morens D Chiribiga J Casta A Epidemic Dengue Fever in Puerto Rico, 1977: A Cost Análisis Am J Trop Med Hyg 1979 28 Hemispheric plan to expand and intensify efforts to combat Aedes aegypt Hemispheric plan to expand and intensify efforts to combat Aedes aegypt Dengue y dengue hemorrágico en las Américas: guías para su prevención y control Dengue y dengue hemorrágico en las Américas: guías para su prevención y control 1995 548 ^eWashington, D.C OPS Costo de la atención del dengue Costo de la atención del dengue Siqueira J Turchi C Coelho G da Rocha A Dengue and dengue hemorrhagic fever, Brazil, 1981-2002 Emer Infec Dis 2005 11 Perez R Dengue surveillance, United States, 1986- 1992 MMWR CDC Surveill Sum 1994 J ul 43 Observaciones meteorológicas Observaciones meteorológicas 1977 Tegucigalpa CETTNA El clima en Costa Rica El clima en Costa Rica
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100010 Glucemia postcarga en diabetes gestacional Orozco- Saborío Leonardo Moya- Moya Fiorella ,Caja Costarricense de Seguro Social 01 2007 2007 49 42 46

Objetivo: Determinar el valor umbral de glucosa postcarga más sensible y con mayor valor predictivo positivo para el diagnóstico de diabetes gestacional en pacientes con embarazos de 24 -28 semanas. Métodos: Estudio observacional. Se identificó a partir de los archivos del Servicio de Laboratorio del hospital, a toda mujer embarazada a la que se le realizó la curva de tolerancia oral a la glucosa (100g glucosa), la cual se indicó a partir de valores de glucosa postcarga (50g glucosa) de 130 mg/dl. La cuantificación de los niveles de glucosa se efectúo con el sistema SYNCHRON CX (glucosa oxidasa), y se utilizaron los criterios de The National Diabetes Data Group para los valores de las pruebas. Se hizo un análisis estadístico univariado y multivariado con modelo de regresión logístico y construcción de curva ROC (Receiver Operating Characteristic: curvas en las que se presenta la sensibilidad en función de los falsos positivos para distintos puntos de corte) para la determinación de sensibilidad y especificidad. Se utilizó el paquete estadístico STATA, versión 7, 2000. Resultados: Se revisaron 137 casos, de los cuales 123 cumplieron con los criterios de inclusión. La situación más favorable para la población en estudio se encontró en el percentil 60 (Q 60), para un valor de 148 mg/dl con una sensibilidad del 68.8% y una especificidad del 65.1%. Un valor de glucosa postcarga de 177 mg/dl, tiene una sensibilidad del 37.5 % y una especificidad del 96.2%, y un valor de 133 mg/dl, tiene una sensibilidad del 87.5% y una especificidad del 12.3%. Conclusiones : Un valor de 140 mg/dl de glicemia postcarga puede ser mantenido como valor umbral del test de tamizaje glucosa postcarga, si el objetivo del tamizaje es reconocer pacientes con una curva de tolerancia a la glucosa positiva. Valores mayores a 177mg/d en la glucosa postcarga comprometen la indicación de la curva de tolerancia a la glucosa para diagnosticar diabetes gestacional, por su alta especificidad.

Objective: To determine the most sensitive and positive predictive cut-off value for the oral glucose challenge screening test for the diagnosis of gestational Diabetes Mellitus in women with pregnacies between the 24-28 weeks. Methods: Observational study. From the files of the hospital’s laboratory service, every pregnant woman who had an oral glucose tolerance (100g of glucose) test; this test was had been indicated because values of more or equal to 130 mg/dl during of oral glucose challenge screening test (50g of glucose). The glucose levels were quantified by the SYNCHRON CX system. The National Diabetes Data Group criteria were used. Logistic regression model was utilized, and ROC (Receiver Operating Characteristic) curve analysis was done to determine the sensitivity and specificity. The STATA statistical program, version 7, 2000 was used. Results: 123 cases were included in the analysis. The cut-off value of the oral glucose challenge screening test for our population was 148 mg/dl. A value of the oral glucose challenge screening test of 177 mg/dl has a sensitivity of 37.5% and a specificity of 96.2%. A value of 133 mg/dl has a sensitivity of 87.5% and a specificity of 12.3%. Conclusion: An oral glucose challenge screening test of 140 mg/dl can be kept as the cut-off value, if the goal of the screening test is to recognize patients with a positive oral glucose tolerance test. Values greater than 177 mg/dl after the oral glucose challenge screening test, determine the need of the oral glucose tolerance test to diagnose gestational diabetes for its high specificity.

 Diabetes gestacional tamizaje valor umbral Gestational diabetes challenge screening test cut-off value Metzger BE the organizing committee: summary and recommendations of the third international workshop-conference on gestational Diabetes Mellitus Diabetes 1991 40 ^sSuppl. 2 Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the expert committee on the diagnosis and classification of Diabetes Mellitus Diabetes Care 1997 20 O`Sullivan JB Diabetes Mellitus after GDM Diabetes 1991 29 ^sSuppl 2 Peters RK Kjos SL Xiang A Buchanan TA Long term diabetogenic effect of single pregnancy women with previous gestational diabetes mellitus Lancet 1996 347 Landon M Catalano P Gabbe S Gabbe S Niebyl J Simpson J Diabetes mellitus Obstetrics normal and problem pregnancies Obstetrics normal and problem pregnancies 2002 ^ePhiladelphia Churchill Livingstone Moore T Creasy R Resnik R Diabetes in pregnancy Maternal-Fetal medicine Maternal-Fetal medicine 2004 ^ePhiladelphia Saunders Naylor D Sermer M Chen E Farine D Selective screening for gestational diabetes mellitus N Engl J Med 1997 337 Cousins L pregnancy complications among diabetic women: review 1965-1985 Obstet Gynecol Surv 1987 42 Lemen PM Wigton TR Miller-McCarthey AJ Cruikshank DP Screening for gestational diabetes mellitus in adolescent pregnancies Am J Obstet Gynecol 1998 178 Carpenter MW Rationale and performance of test for gestational diabetes Clin Obstet Gynecol 1991 34 Coustan DR Nelson C Carpenter MW Carr SR Rotondo L Widness JA Maternal age and screening for gestational diabetes: a population-based study Obstet Gynecol 1989 73 Coustan DR Methods of screening for and diagnosing of gestational diabetes Clin Perinatol 1993 20 Coustan DR Screening and diagnosis of gestational diabetes Semin Perinatol 1994 18 Bonomo M Gandini ML Mastropasqua A Begher C Valentini U Faden D Which cutoff level should be used in screening for glucose intolerance in pregnancy? Am J Obstet Gynecol 1998 179 Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance Diabetes 1979 28
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100011 Apendicitis crónica, ¿existe o no? Sánchez- Arias Mario ,Hospital La Católica 01 2007 2007 49 47 50

Por décadas se ha enseñado en las escuelas de medicina y en los textos de cirugía, que la apendicitis es un proceso agudo, que se inicia por la obstrucción de la luz apendicular y no tiene retroceso. Sin embargo, en no pocos casos, se presentan dolores agudos en el cuadrante inferior derecho del abdomen, que no son tan claros como para hacer el diagnóstico de apendicitis aguda y que desaparecen espontáneamente o con tratamiento, en muchos de los cuales se procede con cirugía y para sorpresa, el examen histológico de la pieza muestra datos de inflamación crónica. El presente artículo presenta una serie retrospectiva descriptiva de 6 casos, operados 5 de ellos por apendicitis aguda y el último con diagnóstico preoperatorio clínico y ultrasonográfico de apendicitis crónica. Los casos fueron recolectados en un periodo de 8 años en el Hospital Clínica Católica (actual Hospital La Católica), con una frecuencia extrapolada del 5%, siendo el 67% masculinos, con un promedio de evolución de 64 días; el 83% con dolor en la fosa ilíaca derecha (FID) y todos con comprobación histológica de inflamación crónica y obliteración fibrosa. Hubo un 100% de alivio del dolor después de la apendicectomía. Particularmente, se reporta el caso número 6, con clínica de 3 episodios de dolor recurrente en 1 año en FID y ultrasonido de apendicitis crónica, en quien se hizo el diagnóstico preoperatorio, se operó electivamente 2 días después del diagnóstico y el resultado histológico fue consistente con apendicitis crónica. Se concluye que sí existió el cuadro de apendicitis crónica y se recomienda remover quirúrgicamente el apéndice (abierto o laparoscópico) en los pacientes que tienen dolor crónico o recurrente en cuadrante inferior derecho del abdomen.

For many years it has been taught in medical schools and surgery textbooks that appendicitis is exclusively an acute process. Although not all the cases of right lower quadrant pain are so clear to diagnose acute appendicitis, in a certain percentage of those cases we proceded with appendectomy and the histopathologycal findings showed chronic inflammation. In the present communication, I present a retrospective analysis of 6 cases. The first 5 were operated with a preoperative diagnosis of acute appendicitis, and the last one with a preoperative diagnosis of chronic appendicitis. These cases were collected over 8 years at the former Hospital Clínica Católica. The frecuency was 5% of the total cases of appendectomy performed by the author, 67% were males and 33% were females, with an average preoperative course of 64 days. Right lower quadrant pain was present in 83% and all the cases had a positive biopsy for chronic inflammation and fibrosis. One 100% were asymptomatic after surgery. Special attention should be paid to case number 6 who had 3 consulations for recurrent right lower pain during the last year an ultra sound was consistent with chronic appendicitis. I made the diagnosis pre-operatively and operated on him electively. The biopsy was also positive for chronic inflammation. Because of that I concluded that chronic appendicitis is a real entity and recommend surgery (open or laparoscopic) in those patients with chronic or recurrent pain in the right lower abdominal quadrant

 Abdomen agudo apendicitis dolor abdominal crónico Acute abdomen apendicitis chronic abdominal pain Mattei P Sala J.E Yeo CJ Chronic and recurrent apendicitis are uncommon entities often misdiagnosed J of Am C of S 1994 178 Wells S.A, Jr Appendicitis Current Probl Surg Octo be r 42 Storer E.H Appendix: in principles of surgery Appendix: in principles of surgery 2000 7 ^eNew York MacGrow-Hill Sinanan MN Greenfield L.J Acute abdomen and appendicitis surgery, scientific principles and practice surgery, scientific principles and practice 1993 ^ePhiladelphia J.B. Lippincott Co Condon R.E Telford GL Sabinston Jr Appendicitis textbook of Surgery. The biological basis of modern surgical practice textbook of Surgery. The biological basis of modern surgical practice 1991 14 ^ePhiladelphia W.B. Sauders Falk S Schutze U Guth H Slutte D Chronic recurrent appendicitis Pediatr Surg 1991 1 Talbet J.L Zuidema GD Appendicitis: a reappraisal of an old problem Surg Clin Nort Am 1966 46 Leardi S Delmonaco S Ventura T Chiominto A DeRubeis G Simi M Recurrent abdominal pain and appendicitis Minerva Chir 2000 55 Homer MJ Braver JM Recurrent apendicitis: re-examination a controversial diasease Gastrointest Radiol 1979 4 Crabbe M.M Norwood SH Robertson HD Silva JS Recurrent an chronic appendicitis Surg Gynecol Obstet 1986 163 Paredes E Salas JM Ocaña BE Indicación de la apendicectomía en el dolor abdominal recividante Cir Pediát 2004 17 Petras R.E Sernberg SS Nonneoplastic intestinal diseases Diagnostic Surgical Pathology Diagnostic Surgical Pathology 1999 3 ^ePhiladelphia Williams & Williams Onders RP Mittendorf EA Utility of laparoscopy in chronic abdominal pain Surgery 2003 134 Shaoul R Rimar Y Mogilner J Polk R Jaffe M Chron and recurrent appendicitis. A case report World J Gastroenterol 2005 21 Rao PM Rhea JT Novelline R.A McCabe CJ The computed tomography appearance of recurrent appendicitis Am J Emerg Med 1995 16 Carnett JB Boles RS Fallacies concerning chronic appendicitis JAMA 1927 91 Barber MD Mclaren J Riney JP Recurrent appendicitis Br J Surg 1997 84 Lewis FR Holcroft JW Boey J Dumphy JE Appendicitis: acritical review of diagnosis and treatment in 1000 cases Arch Surg 1975 110 Choi YH Fischer E Hoda SA Appendiceal C.T. in 140 cases Clin Imaging 1998 22 Rao PM Rhea JT Novelline RA Sensitivity and specifi city of the individual CT signs of appendicitis J Comput Asset Tomogr 1997 21 Wan Winter JT Beyer DA Chronic appendicitis diagnosed preoperatively as an ovarian dermoid J Pediatr Adolesc Gynecol 2004 17 Neumayer L Kennedy A Imagind in a appedincitis: a review with special emphasis on the treatment of women Obstet Gynecol 2003 102 Pena BM Taylor SA Fishman SJ Mandl KD Cost and effectiveness of US and limited tomography for diagnosing appendicitis in children Pediatrics 2000 106 Lane MJ Lou DM Huynh MD Jeffry RB Mindelsun RE Latz DS Suspected acute appendicitis: nonenhaced helical CT in 300 ptes Radiology 1999 213 Chai D Lim HK Loe WJ Kim SH Dimy H The most useful findings for diagnosing acute appendicitis on costrast-enhanced helical CT Acute Radiol 2003 44 Pelsong RE Warneck NG Abu-yousedf M Diagnosis of acute appendicitis on transvaginal ultrasonography J Ultrasound Med 1994 Wilson EB Cole JC Nipper ML Cooney DR Smith RW Computed tomography and ultrasonography in the diagnosis of appendicitis. When are they indicated? Arch Surg 2001 136 Fayes JA Toy NJ Flanagan T The appendix as the cause of chronic lovwer abdominal pain Am J Obstet Gynecol 1995 172 Long KH Bannon MP Zietlow SP Helgeson ER Harmsen WS Smith CD Prospective randomized comparision of laparoscopy appendectomy with open appendectomy: clinical and economic analyses Surgery 2001 129 Erikson S Styrud J Interval appendicectomy a restrospective study Eur J Surg 1998 168 Klingensmith ME Soybel DI Broocks DC Laparoscopy for chronic abdominal pain Surg Endosc 1996 10
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100012 Historia de la cirugía laparoscópica en Costa Rica Orlich-Carranza Claudio Vega-Vega Marlen ,Academia Nacional de Medicina ,HSJD 01 2007 2007 49 51 53
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100013 Tratamiento médico en pacientes con infestación por Angiostrongylus costaricensis Huertas- Franco Verny Camacho- Fernández Álvaro Segura- Fonseca Juan J Páez- Montalbán Carlos ,Caja Costarricense de Seguro Social 01 2007 2007 49 54 58

Se presentan dos casos de infestación por Angiostrongylus costaricensis; uno grave, que requirió resección quirúrgica y dos cursos de tratamiento con albendazol para su resolución exitosa, y otro en el que el tratamiento temprano, cuando apenas se sospechaba la presencia de parásito, permitió al paciente curarse sin complicaciones. La infección humana por A. costaricensis es una entidad clínica acerca de la que existe escasa experiencia con terapia antiparasitaria. Los reportes de tratamiento en la bibliografía son pocos y no concluyentes. Los casos de infestación grave pueden ser mortales si se manejan en la forma tradicional de esperar y resolver únicamente la complicación quirúrgica, mientras que el tratamiento temprano puede resolver el problema sin complicaciones.

These are two cases of Angiostrongylus costaricensis infestation. In case #1 surgical treatment was followed by persistence of abdominal problems and eosinophilia. The case was finally resolved with 2 courses of treatment with albendazol. Case #2 was diagnosed early and successfully treated with albendazol. The patient presented marked leukocytosis with eosinophilia after the medication was started, and no adverse effects to the treatment were detected. The patient became asymptomatic 4 days after completing the 7 day course of albendazol.

 angiostrongilosis angiostrongylus costaricensis albendazol angiostrongilosis angiostrongylus costaricensis albendazol Céspedes R Salas J Mekbel S Troper L Mulner F Morera P Granulomas entéricos y linfáticos con intensa eosinofilia tisular producidos por un estrongilídeo (strongylata) Acta Méd Costarric 1967 10 Morera P Granulomas entéricos y linfáticos con intensa eosinofilia tisular producidos por un estrongilídeo (Strongylata Railliet y Henry 1913) II Aspecto patológico (Nota previa) Acta Méd Costarric 1967 10 Morera P Céspedes R Angiostrongilosis Abdominal. Una nueva parasitosis humana Acta Méd Costarric 1971 14 Mojon M Human angiostrongyliasis caused by Angiostrongylus costaricensis Bul Acad Natl Med 1994 178 Morera P Pérez F Mora F Castro L Visceral larva migrans-like syndrome caused by Angiostrongylus costaricensis Am J Trop Hyg 1982 31 Ruiz PJ Morera P Spermatic artery obstruction caused by Angiostrongylus costaricensis Am J Trop Med 1983 32 Nuñez R Mirambell F Angiotrongilosis abdominal un caso de conducta conservadora Rev Med Hosp Nac Niños 1981 16 Morera P Bontempo I Acción de algunos antihelméticos sobre Angiostrongylus costaricensis Rev Méd Hosp. Nac Niños 1985 20 Lobo Sanahuja Loría R González G Angiostrongilosis abdominal: Aspectos clínicos, tratamiento y revisión de la literatura Bol Med Hosp. Infant Mex 1987 44
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100014 Síndrome de Rapunzel Arce-Víquez Luis Arce-Campos William ,Caja Costarricense de Seguro Social 01 2007 2007 49 59 61

Se reporta el caso de una niña de 12 años con historia de problemas de aprendizaje y tricofagia de 2 años de evolución, hepatoesplenomegalia y anemia ferropénica. Se requirió manejo quirúrgico se encontró un tricobezoar que se extendía a duodeno. El síndrome de Rapunzel consiste en un tricobezoar que se extiende hacia el intestino delgado, su sintomatología usualmente es inespecífica y por lo general su evolución es benigna. Los bezoares gástricos pueden ocurrir en estómagos normales a causa de la ingestión de objetos que no atraviesan el píloro. Actualmente, la mayoría de bezoares ocurren como complicación de cirugía gástrica, donde hay una función alterada del píloro hipoperistalsis y bajas concentraciones de ácido gástrico. El tricobezoar suele se presentarse en mujeres jóvenes, por la ingesta voluntaria y compulsiva de pelos (trigofagia), a menudo refl ejo de un desajuste de la personalidad.

We report herein the case of a 12 year- old girl who had a history of learning difficulties and trichophagia, hepatosplenomegaly and iron deficiency anemia, Surgical handling was required finding a huge trichobezoar extending into the duodenum. A trichobezoar extending towards the small intestine, is called Rapunzel syndrome. Its symptoms are not specific and in general its course is benign. Gastric bezoars can occur in the normal stomach due to the ingestion of objects that can not cross the pylorus. Most of the bezoars happen as complication of gastric surgery because of an altered pyloric function, hypoperistalsis and low concentrations of gastric acid. Tricobezoars usually present in young women due to voluntary and compulsive intake of hair (trichophagia) that often is the reflection of a personality disorder.

 Síndrome de Rapunzel tricobezoar tricofagia Rapunzel syndrome trichobezoar trichophagia Duran F López B Martínez V Alamo M Jacobo D Rapunzel Syndrome Rev. Esp Enferm Dig 2005 West W Duncan N CT appearances of the Ranpuzel syndrome: an unusual form of bezoar and gastrointestinal obstruction Pediatr Radiol 1998 28 Aguilar A Rodríguez G Hernández M Sindrome de Rapunzel: reporte de un caso Act Méd Costarric 2003 45 Martín A Hair apparent: Rapunzel syndrome AMJ Psychiatric 2005 162 Curioso W Rivera J Curioso WI Síndrome de Rapunzel: Reporte de un caso y revisión de literatura Rev Gastroenterológica Perú 2002 22 El Hajjam M Lakhlouifi A Bouzidi A Kadari R CT features of of a voluminous gastric trichobezoar Eur J Pediatr Surg 2001 11 Ripolles T García A Martínez MJ Gil P Gastrointestinal bezoars: sonographic and CT characteristics Am J Roentgenol 2001 177 Dalshaug GB Wainer S Hollar GL The Rapunzel syndrome causing atypical intussusption in a child: a cause report J Pediatric Surgery 1999 34 Klipfel A Kessle E Schein M Rapunzel syndrome causing gastric emphysema and small bowell obstruccion Surgery 2003 133
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100015 Embolización selectiva de la arteria carótida externa en el manejo de pacientes con tumoraciones benignas en la cavidad nasal y la cara, primeras experiencias en el Hospital México Solano- Villarroel José Luis Saavedra- Hernández Giovanna ,Caja Costarricense de Seguro Social 01 2007 2007 49 62 66

Justificación: El angiofibroma juvenil nasofaríngeo es uno de los tumores benignos de la cavidad nasal más comunes en los adolescentes, el cual causa epistaxis recurrente, obstrucción nasal, rinorrea y otras manifestaciones clínicas. Los hemangiomas faciales son tumoraciones benignas muy frecuentes en la infancia, y secundariamente al tumor los pacientes pueden presentar deformidades faciales e inclusive sangrados intermitentes. En la actualidad, la embolización de la arteria carótida externa está siendo más utilizada en el manejo de estos pacientes, ya que es un procedimiento mínimamente invasivo y produce una evolución clínica más favorable en los pacientes; también se ha descrito una menor pérdida sanguínea durante el procedimiento quirúrgico y en el postoperatorio, con disminución de la mortalidad. Además, proporciona al paciente una recuperación más pronta y acorta la estancia hospitalaria. Objetivo: Describir las primeras experiencias con la embolización de la arteria carótida externa en pacientes con angiofibroma juvenil nasofaringeo y hemangiomas faciales, en el Hospital México. Resultados: Cuando se hizo la embolización prequirúrgica de los angiofibromas juveniles nasofaringeos, la resección del tumor en pacientes cursó sin ninguna complicación. Además, los pacientes no tuvieron sangrado durante el postoperatorio inmediato. Tras la embolización de las pacientes con hemangiomas se documenta mejoría clínica, disminuyendo la lesión macroscópica en la cara y los sangrados secundarios al hemangioma (en un caso). En ambas enfermedades la recuperación de los pacientes fue muy satisfactoria, sin presentarse ninguna complicación y con una estancia hospitalaria muy corta. Conclusión: Desde hace varios años la embolización prequirúrgica ha sido utilizada en el extranjero como coadyuvante en el manejo de diversas condiciones. Actualmente, está siendo implementada en el medio para el manejo de diferentes problemas, tales como el angiofibroma juvenil nasofaringeo y los hemangiomas faciales, con muy buenos resultados. Con la embolización de la arteria carótida externa, un procedimiento mínimamente invasivo, se logra mejoría en los pacientes mencionados, al reducir el tamaño tumoral y el sangrado durante el procedimiento quirúrgico; posterior a este, disminuyen las complicaciones derivadas. Este procedimiento es un método muy conveniente para el manejo de tal tipo de pacientes, ya que es una técnica que no provoca mayores molestias, proporciona resultados más favorables, mejora la calidad de vida y ayuda a que la recuperación sea más pronta.

Justification: Juvenile nasopharyngeal angiofroma is one of the most common benign tumors seen in the nasal cavity in adolescents, it causes recurrent epistaxis, nasal obstruction, spelling and other clinical manifestations. On the other hand, facial hemangiomata are benign tumors very frequent in childhood, the patients can present intermittent bleeding and facial deformities. At the present time, embolization of the external carotid artery is being used frequently in the handling of these patients, since it is a lesser invasive procedure that has shown to provide a more favorable clinical outcome in these patients. Less operative and postoperative bleeding has been described, diminishing the mortality. It also speeds the patients recovery, shortening in this way the hospital stay. Objective: To describe the first experiences with the use of the embolization of the A external carotid artery in patients with juvenile nasopharyngeal angiofi bromas and facial hemangiomas at the México Hospital. Results: Surgical escisión of the previously embolized tumors was uneventful. After embolization the two patients with hemangiomata showed clinical improvement diminishing the size of the lesion and the bleeding of the hemangioma (in one patient). In both entities the recovery of the patients was very satisfactory, without complications and their hospitalization was very short. Conclusion: Presurgical embolization has been used to help in the handling of diverse conditions. At the moment, it is being implemented in our hospital in the manegement of different problems, such as juvenile nasopharyngeal angiofi broma and facial hemangioma with excellent results. Embolization of the external carotid artery, a lesser invasive procedure as achieved tumor diminution, bleeding during the surgical procedure and the lees complications that can be derived from these conditions. This procedure is a more convenient method for handling this type of patients, since it is a technique that does not cause greater complications, it provides more favorable results, it improves the quality of life of the patient and helps them to recover faster.

 Angiofibroma juvenil nasofaringeo arteria carótida embolización hemangioma Carotid artery embolization juvenile nasopharyngeal angiofi broma hemangioma Grynbauskas V Parker J Friedman M Juvenile Nasopharyngeal Angiofibroma Otolaryngol Clin North Am 1986 19 Chandler J Goulding R Moskowitz L Quincer R Nasopharyngeal Angiofibroma: stanging and management Ann Otol Rhinol Laryngol 1984 93 Ikawa T Koba K Tanaka N Ishikawa T Two cases of Nasopharyngeal Angiofibroma, effect of preoperative transarterial embolization Auris Nasus Larynx 1984 11 Brunkner A Frieden I Hemangioma of infancy J Am Acad Dermatol 2003 48 Drulet B Esterly N Frieden I Hemangiomas in Children N Engl J Med 1999 341 Berg J Walter J Thinanagayam V Evidence for loss of heterozygosity of 5q in sporadic hemangiomas, are somatics mutations involved en hemangioma formation? J Clin Pathol 2001 54 Kim H Colombo M Frieden I Ulcerated hemangiomas: clinical characteristics and response to therapy J Am Acad Dermatol 2001 44 Merland J Marache P Herbreteau D Superfi cial and peripheral vascular malformations. Role of interventional radiology and embolization J Mal Vasc 1992 17 Onesti G Manzzochi M Mezzana P Suderi N Diffent types of embolization before surgical excision of hemangiomas of the face Acta Chir Plast 2003 45 Marler J Mulliked J Current management of hemangioma and vascular malformations. Role of interventional radiology and embolization J Mal Vasc 1992 14 Li J Quan J shan X Wang L Evaluation of the effectiveness of preoperative embolization in surgery for nasopharyngeal angiofibroma Eur Arch Otorhinolaryngol 1998 255 Thuesen A Jakobsen j Nepper R Treatment of juvenile angiofi broma with particle embolization and endoscopic surgery Ugerkr Laeger 2005 167 Dobbelaere P Pellerin P Donazzan M Clarisse J Indications of Selective embolizations in maxillofacial pathology Rev Stomatol Chir Maxillofac 1984 85 Moulin G Chagnaud C Gras R Gueguen E Dessi P Gaubert J Juvenile nasopharyngeal Angiofibroma: comparison of blood loss during removal in embolized group versus nomembolized patients Acta Otolaryngol Chir Cervicofac 1994 111 De Vincentiis M Gallo A Minni A Torri E Tomassi R Della R Preoperative embolization in the treatment protocol for Rhinopharyngeal Angiofibroma: comparison of the effectiveness of various materials Acta Otorhinolaryngol Ital 1997 17 Kaufman S Martin L Zuckerman A Peripheral transcatheter embolization with platinum microcoils Radiology 1992 198 Casasco A Houdart E Biondi A Jhaveri H Herbreteau D Aymard A Major complications of percutaneous embolization of skull base tumors Am Jour Neurol 1999 20 Onerci M Gumus K Cil B Eldem B A rare complication of embolization in juvenile nasopharyngeal angiofibroma Int J Pediatr Otorhinolaryngol 2005 69
S0001-600220070001 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022007000100016 Costa Rica en el exterior , 01 2007 2007 49 20 20