Revista Medica Clinica Las Condes最新文献

Cáncer de colon obstructivo 阻塞性结肠癌

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.05.004

Mario Abedrapo MD, Víctor Cortés MD

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Editorial. Tema central. Emergencias quirúrgicas 出版商。中心问题。紧急手术

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.06.005

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“Instante crítico” “关键时刻”

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.06.004

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Hemorragia digestiva baja en el adulto: conceptos claves en la actualización del diagnóstico y tratamiento 成人低消化道出血：更新诊断和治疗的关键概念

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.06.001

Roberto Salas MD, Gonzalo Rebolledo MD, Alejandro J. Zarate MD

{"title":"Hemorragia digestiva baja en el adulto: conceptos claves en la actualización del diagnóstico y tratamiento","authors":"Roberto Salas MD, Gonzalo Rebolledo MD, Alejandro J. Zarate MD","doi":"10.1016/j.rmclc.2026.06.001","DOIUrl":"10.1016/j.rmclc.2026.06.001","url":null,"abstract":"<div><div>Lower gastrointestinal bleeding (LGIB) is a frequent cause of emergency department consultation and hospitalization, particularly among older adults with cardiovascular comorbidities and those receiving antithrombotic therapy. Although most episodes are self-limited, a significant subgroup of patients develop persistent or recurrent bleeding requiring structured evaluation and targeted intervention. Current evidence supports the selection of candidates for outpatient management using the Oakland score. Early computed tomography angiography impacts prognosis in patients with brisk bleeding. Colonoscopy remains the main diagnostic and therapeutic tool, allowing bowel preparation to be achieved in selected cases within as little as 3hours. Angiography with superselective embolization has demonstrated excellent outcomes with low complication rates. In anticoagulated patients, specific recommendations exist regarding anticoagulation reversal and antiplatelet management, tailored according to patient characteristics, clinical presentation, and the type of agent used. Tranexamic acid has not shown benefit in LGIB and is associated with serious adverse events. Surgical management is reserved for cases refractory to endoscopic or angiographic therapies, with an emphasis on accurate localization of the bleeding source to allow targeted resection and minimize morbidity and mortality.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 353-358"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Trauma penetrante cervical 创伤穿透颈椎

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.06.002

Felipe Bustos Muñoz MD

{"title":"Trauma penetrante cervical","authors":"Felipe Bustos Muñoz MD","doi":"10.1016/j.rmclc.2026.06.002","DOIUrl":"10.1016/j.rmclc.2026.06.002","url":null,"abstract":"<div><div>Penetrating cervical injuries present a significant diagnostic and therapeutic challenge due to the high density of vital structures contained within a confined anatomical space. Traditionally, management was guided by the anatomical zone classification (I–III), with routine surgical exploration recommended for zone II injuries. However, over recent decades this approach has evolved toward a selective “no-zone” strategy, based on the patient's hemodynamic stability, the presence of hard or soft signs of trauma, and the use of high-resolution imaging. Computed tomography angiography has played a central role in this paradigm shift, providing high sensitivity and specificity for detecting vascular and aerodigestive injuries requiring operative intervention, and has become the gold standard for evaluating stable patients. In hemodynamically stable individuals, endoscopic studies play a secondary role but may be used selectively in patients considered for non-operative management. This selective approach has reduced the incidence of negative cervical explorations while maintaining complication rates comparable to more aggressive strategies. This study aims to review the most up-to-date diagnostic and therapeutic approaches to penetrating neck trauma.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 294-302"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Heridas faciales 面部受伤

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.05.007

Susana Benítez MD, Brenda Gámez MD, Juan Pablo Camacho MD

{"title":"Heridas faciales","authors":"Susana Benítez MD, Brenda Gámez MD, Juan Pablo Camacho MD","doi":"10.1016/j.rmclc.2026.05.007","DOIUrl":"10.1016/j.rmclc.2026.05.007","url":null,"abstract":"<div><div>Facial wounds represent a unique therapeutic challenge due to the anatomical and functional characteristics of the facial region, including its rich vascular supply, high concentration of specialized structures, and considerable aesthetic, functional, and social significance. These features require a specific diagnostic and therapeutic approach, from the initial assessment in the emergency department to definitive surgical repair. For this narrative review, recent scientific literature was analyzed and complemented by the authors’ clinical experience to integrate the available evidence and provide practical recommendations for the management of these injuries. The fundamental principles include a comprehensive initial evaluation, conservative debridement, timely primary closure, the strategic use of local anesthetics through regional nerve block techniques, and the early recognition of associated injuries or involvement of specialized anatomical structures. The systematic application of these measures is essential to optimize both functional and aesthetic outcomes, reduce morbidity, and prevent long-term complications. Successful management relies on careful surgical planning supported by up-to-date reconstructive knowledge and meticulous anatomical repair aimed at preserving both facial function and appearance. The objective of this review is to update and synthesize the classical and contemporary principles of the surgical management of facial wounds, emphasizing the importance of the initial assessment, precise anatomical repair, and the early recognition of potential complications and injuries involving specialized anatomical sites.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 285-293"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Hemorragia digestiva alta: fisiopatología, estratificación del riesgo y manejo integral 高消化道出血：生理病理学、风险分层和综合管理

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.05.006

Priscilla López MD, Mohan Ramchandani MD

{"title":"Hemorragia digestiva alta: fisiopatología, estratificación del riesgo y manejo integral","authors":"Priscilla López MD, Mohan Ramchandani MD","doi":"10.1016/j.rmclc.2026.05.006","DOIUrl":"10.1016/j.rmclc.2026.05.006","url":null,"abstract":"<div><div>Upper gastrointestinal bleeding (UGIB) is a frequent and potentially life-threatening emergency that requires initial resuscitation, risk stratification, endoscopic hemostasis, and early escalation when hemostasis fails. The incidence is estimated at 50–150 cases per 100,000 inhabitants, with a global downward trend attributed to gastroprotection strategies and the eradication of Helicobacter pylori. However, the healthcare burden remains considerable due to population aging and increased exposure to antithrombotic and anti-inflammatory drugs, while mortality continues to be clinically relevant, ranging from 7% to 13%.</div><div>In terms of etiology, 80–90% of episodes are due to non-variceal causes, predominantly peptic ulcer disease, which accounts for 40–55% of cases. Variceal UGIB, although less common, is usually more severe due to portal hypertension, with mortality of approximately 7–15%, exceeding 15% at six weeks in patients with decompensated cirrhosis, such as Child-Pugh B–C or MELD ≥15, in whom underlying hepatic dysfunction determines prognosis more than the bleeding itself.</div><div>Endoscopy is the diagnostic and therapeutic cornerstone in non-variceal UGIB and, after adequate resuscitation, should ideally be performed within 24hours. Modern management prioritizes strategies that minimize rebleeding, and recognizes the rescue or bridging role of technologies such as over-the-scope clips and topical agents when standard control fails or is not applicable. In variceal bleeding, early initiation of vasoactive drugs and antibiotics is recommended, followed by urgent endoscopy within 12hours after resuscitation and the use of band ligation or tissue adhesives depending on the subtype. When these measures fail, bridging therapies, such as balloon tamponade or stenting, and TIPS are considered, including early TIPS in high-risk patients according to criteria such as Baveno VII.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 314-330"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Diagnóstico dermatológico del lupus eritematoso cutáneo crónico: una revisión narrativa 慢性皮肤红斑狼疮的皮肤学诊断：叙述综述

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.05.002

Andry Devia-Pardo MD, Ayda Mongui-Fonseca MD, Lina Marroquín-Bravo MD, Juan Pablo Pinchao-Manga MD

{"title":"Diagnóstico dermatológico del lupus eritematoso cutáneo crónico: una revisión narrativa","authors":"Andry Devia-Pardo MD, Ayda Mongui-Fonseca MD, Lina Marroquín-Bravo MD, Juan Pablo Pinchao-Manga MD","doi":"10.1016/j.rmclc.2026.05.002","DOIUrl":"10.1016/j.rmclc.2026.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic cutaneous lupus erythematosus (CCLE) represents a lupus subtype with specific dermatological manifestations, frequently associated with significant morbidity (scarring alopecia, disfigurement) and potential progression to systemic lupus erythematosus (SLE). Its diagnosis is complex due to clinical heterogeneity and overlap with other dermatoses.</div></div><div><h3>Objective</h3><div>To synthesize diagnostic criteria for CCLE through critical analysis of clinical, histopathological, and dermoscopic findings, emphasizing atypical subtypes (verrucous, panniculitis).</div></div><div><h3>Methods</h3><div>Narrative review in PubMed, Scopus, Cochrane, and SciELO using terms: “chronic cutaneous lupus erythematosus”, “dermatologic manifestations”. Included clinical studies, systematic reviews, and meta-analyses (excluded isolated case reports and animal models).</div></div><div><h3>Analysis and Synthesis</h3><div>CCLE variants (discoid, verrucous, panniculitis) share chronicity, photosensitivity, and destructive lesions. Clinically, they present as erythematosquamous plaques (discoid), hyperkeratotic nodules (verrucous), or lipoatrophic depressions (panniculitis). Histopathology reveals periadnexal lymphocytic infiltrate, basal membrane degeneration, and follicular plugging, leading to irreversible sequelae like scarring alopecia.</div></div><div><h3>Conclusions</h3><div>Integrated assessment (clinical, dermoscopy, histopathology) is essential for accurate CCLE subtyping and diagnostic precision. A need persists for standardized algorithms incorporating emerging techniques (cutaneous biomarkers). Early diagnosis prevents irreversible sequelae and informs systemic prognosis.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 384-391"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Rehabilitación oncológica: rol de la especialización 癌症康复：专业化的作用

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.06.003

Karol Ramírez-Parada PT, PhD, Scarlet Muñoz-Flores PT, César Sánchez MD

{"title":"Rehabilitación oncológica: rol de la especialización","authors":"Karol Ramírez-Parada PT, PhD, Scarlet Muñoz-Flores PT, César Sánchez MD","doi":"10.1016/j.rmclc.2026.06.003","DOIUrl":"10.1016/j.rmclc.2026.06.003","url":null,"abstract":"<div><div>Oncological rehabilitation is a key strategy to address the adverse effects of cancer and its treatments, promoting functionality, quality of life, and social reintegration for individuals diagnosed with cancer. In Chile, a significant gap persists between the rehabilitation needs of this population and the availability of specialized services, revealing both structural and educational challenges. In this context, the recent official recognition of new healthcare specialties presents a concrete opportunity to strengthen the role of rehabilitation within oncology teams.</div><div>Despite the growing relevance of rehabilitation in cancer care, important gaps remain in both undergraduate and postgraduate training of rehabilitation professionals. Oncology content is still limited within the academic curriculum, with low homogeneity across programs and weak articulation between training levels. These conditions hinder the development of progressive educational trajectories that would lead from basic training to advanced clinical expertise in oncological rehabilitation.</div><div>This article highlights the need to implement clinical specialization programs in oncological rehabilitation as a cornerstone for building a comprehensive and integrated network of care within the Chilean health system. It also proposes moving toward models used in countries with consolidated oncology rehabilitation systems, where specialized education is structured, formally recognized, and aligned with national health priorities.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 397-404"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Manejo quirúrgico de las hernias de la pared abdominal en contexto de urgencia: revisión bibliográfica y recomendaciones prácticas 紧急情况下腹壁疝气的手术管理：文献综述和实践建议

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Revista Medica Clinica Las Condes Pub Date : 2026-05-01 Epub Date: 2026-06-27 DOI: 10.1016/j.rmclc.2026.05.009

Sebastián Sapiain G. MD, Maher Musleh K. MD, María Elena Vial B. MD

{"title":"Manejo quirúrgico de las hernias de la pared abdominal en contexto de urgencia: revisión bibliográfica y recomendaciones prácticas","authors":"Sebastián Sapiain G. MD, Maher Musleh K. MD, María Elena Vial B. MD","doi":"10.1016/j.rmclc.2026.05.009","DOIUrl":"10.1016/j.rmclc.2026.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal wall hernias are a frequent cause of emergency surgical consultation. Timely management is essential to reduce complications, morbidity, mortality, and healthcare costs.</div></div><div><h3>Objective</h3><div>To review the current evidence regarding the surgical management of ventral, inguinal, and femoral hernias in emergency settings, and to provide practical recommendations applicable to routine hospital practice.</div></div><div><h3>Methods</h3><div>A narrative review of the literature was performed using PubMed, Scopus, and Cochrane databases (2018–2025), complemented by institutional documents and protocols. HerniaSurge and WSES guidelines, recent systematic reviews, and relevant studies on emergency abdominal wall hernia repair were included.</div></div><div><h3>Results</h3><div>Laparoscopic repair is safe and feasible in selected patients with incarcerated or strangulated hernias, allowing assessment of bowel viability and reducing overall postoperative morbidity. Mesh repair is acceptable in clean-contaminated surgical fields, whereas its use should be avoided in cases of gross contamination. Female sex, femoral hernia type, and larger defect diameter are associated with an increased risk of incarceration.</div></div><div><h3>Conclusions</h3><div>Management must consider hemodynamic status, contamination degree, and surgical expertise. Institutional protocols, early surgical management, and training in minimally invasive techniques are essential to improve outcomes in emergency abdominal wall hernia repair.</div><div>essed. A multidisciplinary approach is essential to optimize diagnosis and treatment.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 3","pages":"Pages 331-337"},"PeriodicalIF":0.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148558267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0