Medicina y Ciencias de la Salud

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The effectiveness of joint mobilization techniques for range of motion in adult patients with primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis
(01/11/2018) Zavala-González, Jonathan; Pavez-Baeza, Francisco; Gutiérrez-Espinoza, Héctor; Olguín-Huerta, Cristián
Objective : To determine the effectiveness of joint mobilization techniques in the range of motion in adult patients with primary adhesive shoulder capsulitis. Methods : Systematic review with meta-analysis. The search was performed in the MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus and Web of Science databases. The eligibility criteria were studies that used an oscillatory and/or maintained joint mobilization technique applied alone or added-on to a treatment program in patients with primary adhesive capsulitis at any stage. Two authors carried out the selection of studies and the extraction of data, independently. Risk of bias was evaluated according to the tool proposed by Cochrane. Results : We included 14 studies with variable risk of bias. Posterior mobilization compared to any other technique was not significantly different (0.95 degrees; 95% CI: -5.93 to 4.02), whereas compared to a control group, the difference is 26.80 degrees (CI 95%: 22.71 to 30.89). When applying a set of joint techniques versus a control group, for abduction the difference is 20.14 degrees (95% CI: 10.22 to 30.05). In both cases, the results are statistically significant, and the effect size is moderate. Conclusions : The evidence is not conclusive about the effectiveness of joint mobilization. When compared with treatments that do not include manual therapy, joint mobilization seems to have a favorable effect on the range of motion and pain reduction in patients with primary adhesive shoulder capsulitis.
Flat-head positioning increases cerebral blood flow in anterior circulation acute ischemic stroke. A cluster randomized phase IIb trial.
(Sage Publications, 11/09/2017) Olavarria, Veronica; Lavados, Pablo; Muñoz Venturelli, Paula; Gonzalez, Francisca; Gaete, Javier; Martins, Sheila; Arima, Hisatomi; Anderson, Craig; Brunser, Alejandro
Background Whether lying-flat improves blood flow in patients with acute ischemic stroke is unknown. Our aim was to investigate if lying-flat "changes" cerebral blood flow velocities assessed by transcranial Doppler in acute ischemic stroke patients. Methods In a multicenter cluster clinical trial, we randomly assigned patients within 12 h from onset of a neurological deficit due to cerebral ischemia of the anterior circulation to lying-flat or upright head positioning. The primary outcome was a change of 8 cm/s or more in mean cerebral blood flow velocities on transcranial Doppler to the middle cerebral artery at 1 and 24 h post-randomization, adjusted for imbalance in baseline variables. Secondary outcomes included serious adverse events and physical functioning at 90 days. Results Ninety-four of 304 patients screened were recruited. The primary outcome occurred in 11 (26%) of 43 patients in the lying-flat group and in 6 (12%) of 51 in the upright group at 1 h (adjusted odds ratio, 3.81; 95% CI, 1.07 to 13.54), and in 23 (53%) and 18 (36%) patients in these respective groups at 24 h (adjusted odds ratio, 3.04; 95% CI, 1.08 to 8.53). There were no between-group differences in serious adverse events, including pneumonia, heart failure or mortality, nor in functional outcome at 3 months (adjusted common odds ratio, 1.38; 95% CI 0.64 to 3.00). Conclusion The lying-flat head position was associated with a significant increase in cerebral blood flow velocities at one and 24 h within the ipsilateral hemisphere of anterior circulation acute ischemic stroke, without serious safety concerns. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT01706094.
Do not resuscitate orders for pediatric patients: The role of a clinical ethics committee in a developing country
(1996) Beca, Juan Pablo; Guerrero, José Luis
Coadministration of a 9-Valent Human Papillomavirus Vaccine With Meningococcal and Tdap Vaccines
(Elsevier, 2001) Schilling, Andrea; Macias Parra, Mercedes; Gutierrez, Maricruz; Restrepo, Jaime; Ucros, Santiago; Herrera, Teobaldo; Engel, Eli; Huicho, Luis; Shew, Marcia; Maansson, Roger; Caldwell, Nicole; Luxembourg, Alain; Sobanjo ter Meulen, Ajoke
BACKGROUND: This study in 11- to 15-year-old boys and girls compared the immunogenicity and abstract safety of GARDASIL 9 (9-valent human papillomavirus [9vHPV] vaccine) administered either concomitantly or nonconcomitantly with 2 vaccines routinely administered in this age group (Menactra [MCV4; Neisseria meningitidis serotypes A/C/Y/W-135] or Adacel [Tdap; diphtheria/tetanus/acellular pertussis]). METHODS: Participants received 9vHPV vaccine at day 1 and months 2 and 6; the concomitant group (n = 621) received MCV4/Tdap concomitantly with 9vHPV vaccine at day 1; the nonconcomitant group (n = 620) received MCV4/Tdap at month 1. Antibodies to HPV-, MCV4-, and Tdap-relevant antigens were determined. Injection-site and systemic adverse events (AEs) were monitored for 15 days after any vaccination; serious AEs were monitored throughout the study. RESULTS: The geometric mean titers for all HPV types in 9vHPV vaccine 4 weeks after dose 3, proportion of subjects with a fourfold rise or greater in titers for 4 N meningitidis serotypes 4 weeks after injection with MCV4, proportion of subjects with antibody titers to diphtheria and tetanus $0.1 IU/mL, and geometric mean titers for pertussis antigens 4 weeks after injection with Tdap were all noninferior in the concomitant group compared with the nonconcomitant group. Injection-site swelling occurred more frequently in the concomitant group. There were no vaccine-related serious AEs. CONCLUSIONS: Concomitant administration of 9vHPV vaccine with MCV4/Tdap was generally well tolerated and did not interfere with the antibody response to any of these vaccines. This strategy would minimize the number of visits required to deliver each vaccine individually.
Medicina en televisión: un problema ético
(Sociedad Médica de Santiago, 2004) Beca, Juan Pablo; Salas Ibarra, Sofía
Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice.
How the carotid body works: Different strategies and preparations to solve different problems
(Sociedad de Biología de Chile, 2005) Zapata, Patricio; Larraín, Carolina
This is a review of the different experimental approaches developed to solve the problems in our progress towards a comprehensive understanding of how arterial chemoreceptors operate. An analysis is performed of the bases, advantages and limits of the following preparations: studies of ventilatory reflexes originated from carotid bodies (CBs) in the entire animal; recordings of CB chemosensory discharges in situ; CB preparations perfused in situ; CB explants in oculo; CB explants in ovo; CB preparations incubated in vitro; CB preparations superfused in vitro; CB preparations perfused and superfused in vitro; CB tissue slices in vitro; cells acutely dissociated from CBs; CB cells in tissue culture; petrosal ganglia superfused in vitro; petrosal ganglion cells in tissue culture; and co-cultures of CB and sensory ganglion cells. A brief historical account is given of the passage from one preparation to the next one. Emphasis is placed on personal experience with the different preparations whenever possible. Examples are given of the importance of selecting the appropriate experimental preparation for solving each particular theoretical problem. In fact, brilliant ideas on how the CB works have been unproductive until finding the adequate experimental approach to explore the validity of such ideas.
Neutralizing antibodies in survivors of Sin Nombre and Andes hantavirus infection
(Centers for Disease Control and Prevention, 2006) Valdivieso, Francisca; Vial, Pablo; Ferres, Marcela; Ye, Chunyan; Goade, Diane; Cuiza, Analía; Hjelle, Brian
We evaluated titers of homotypic and heterotypic neutralizing antibodies (NAbs) to Andes and Sin Nombre hantaviruses in plasma samples from 20 patients from Chile and the United States. All but 1 patient had high titers of NAb. None of the plasma samples showed high titers against the heterologous virus.
Relación estudiante de medicina-enfermo: visión de los estudiantes.
(Sociedad Médica de Santiago, 2007) Beca, Juan Pablo; Browne, Francisca; Repetto, Paula; Ortiz, Armando; Salas, Camila
Background: The relationship between medical students and patients has special characteristics that require to be well understood to prepare both students and tutors. Aim: To learn about medical students' thoughts and experiences once they start working with patients, how do they solve difficulties or problems and their perceptions about professional roles and patient rights. Material and methods: Qualitative study based on semi-structured interviews applied to 30 volunteer third year medical students who were beginning their clinical practice. The answers to open questions were transcribed and then analized and grouped by topics and categories. Results: Helping others was the main motivation to go to medical school. Other reasons were scientific interest and social status. Students felt prepared to communicate with patients. However they felt anxious, stressful and fearful of not being competent or not being able to answer patients' questions. There were some differences between male and female students' feelings. Nevertheless students declared that they had rewarding experiences with patients. They all recognized that patients have the right to reject being treated by students. The answers also showed that the first clinical experiences led to significant changes in their views of the medical profession. Conclusions: Students are aware of their trainee condition, the benefits that they obtain being in contact with patients and of their limitations. Patients must voluntarily accept to be subject of the students' training program and informed consent procedures need to be developed.
XV-2c and KM 19 haplotype analysis in Chilean patients with cystic fibrosis and unknown CFTR gene mutations
(Sociedad de Biología de Chile, 2007) Repetto, Gabriela; Puga, Alonso; Delgado, Iris
Cystic fibrosis (CF) is caused by mutations in the CFTR gene. More than 1600 mutations have been described, with frequencies that differ worldwide according to the ethnic origin of patients. A small group of mutations are recurrent on several populations. It has been shown that they each tend occur on specific chromosome 7 haplotypes, supporting the notion of a single origin for them. Less than 50% of mutations in Chilean patients have been identified to date. To indirectly assess the possible presence of a predominant founder mutation in the remaining unknown alíeles, we evaluated 2 polymorphic markers, XV-2c and KM.19, tightly linked to the CFTR locus. The study was done in Chilean CF patients with unknown or deltΔF508 (ΔF508) CFTR mutations and their haplotypes were compared to affected family-based controls. ΔF508 showed marked linkage disequilibrium with XV-2c/KM.19 haplotype B, with 90% of alíeles on that haplotype. There was no difference in haplotype distribution between unknown mutations and normal controls. These results support a European origin for ΔF508 alíeles in Chilean patients, and make unlikely the presence of a predominant founder mutation in the so-far unknown alíeles.
Búsqueda de afecciones genéticas como etiología de déficit intelectual en individuos que asisten a escuelas de educación especial
(Sociedad Médica de Santiago, 2008) Alliende, María Angélica; Campora, Laura; Curotto, Bianca; Toro, Jessica; Valiente, Alf; Castillo, Marcela; Cortés, Fanny; Trigo, César; Alvarado, Cecilia; Silva, Manuel; Caru, Margarita
Background: Mental retardation or intellectual disability affects 2% ofthe general population, but in 60% to 70% of cases the real cause ofthis retardation is not known. An early etiologic diagnosis of intellectual disability can lead to opportunities for improved educational interventions, reinforcing weak areas and providing a genetic counseling to the family Aim: To search genetic diseases underíying intellectual disabilities of children attending a special education school. Material and methods: A clinical geneticist performed the history and physical examination in one hundred and three students aged between 5 and 24 years (51 males). A blood sample was obtained in 92 of them for a genetic screening that included a standard karyotype, fragile X molecular genetic testing and search for inborn errors of metabolism by tándem mass spectrometry. Results: This approach yielded an etiological diagnosis in as much as 29 patients. Three percent of them had a fragile X syndrome. Inborn errors of metabolism were not detected. Conclusions: This type of screening should be done always in children with intellectual disability to establish an etiological diagnosis.
Botulismo infantil. Comunicación de un caso clínico y revisión de la literatura
(Sociedad Chilena de Infectología, 2009) Arriagada, Daniela; Wilhelm, Jan; Donoso, Alejandro
El botulismo es un trastorno poco frecuente en nuestro país. De las formas conocidas, el botulismo infantil da cuenta de la mayoría de los casos. Comunicamos el caso clínico de un paciente de siete meses, sexo masculino, sin antecedentes mórbidos. Historia de dos semanas de coriza, tos y decaimiento. Tras la ingesta de miel presentó exacerbación de la sinto-matología respiratoria, constipación y debilidad muscular progresiva. Se analizó muestra de heces resultando positiva para Clostridium botulinum grupo I tipo A. El estudio electromiográñco fue compatible con el diagnóstico. Presentó hipertensión arterial, atribuyéndose a disfunción autonómica, con buena respuesta a bloqueadores de los canales de calcio. Recuperó progresivamente el tono muscular. En un control ambulatorio se apreciaba importante regresión de la sinto-matología. El botulismo infantil es una enfermedad potencialmente letal de no tratarse oportunamente y de difícil diagnóstico, ya que su presentación es similar a otros cuadros clínicos. Es necesario educar a padres y personal médico sobre las medidas de prevención para los lactantes bajo doce meses de edad.
Deactivating Cardiac Pacemakers and Implantable Cardioverter Defibrillators in Terminally Ill Patients
(2009) Beca, Juan Pablo; Rosselot, Eduardo; Asenjo, René; Anguita, Verónica; Quevedo, Rafael
A 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker (CPM) implanted, regulated to go off at frequencies of below 70 beats per minute. Given the patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a coma
Clasificación PIRO en sepsis grave y shock séptico pediátrico: Nuevo modelo de estratificación y su utilidad en pronóstico
(Sociedad Chilena de Infectología, 2010) Arriagada, Daniela; Díaz, Franco; Donoso, Alejandro; Cruces, Pablo
Introducción: La compresión de la sepsis como un proceso dinámico, resultado de la interacción entre hospedero y agente infeccioso, ha llevado al sistema de estratificación "PIRO" (P) Predisposición, (I) Injuria/ Infección, (R) Respuesta y (O) disfunción de Órganos, clasificación orientada a predecir la muerte en pacientes con sepsis, a ganar adeptos. Sin embargo, faltan estudios clínicos que lo validen. Objetivo: Evaluar la certeza de la clasificación "PIRO" en sepsis grave y shock séptico para predecir mortalidad. Pacientes y Método: Estudio retrospectivo efectuado en una UCI pediátrica de 13 camas durante 24 meses (enero 2006 a diciembre 2007). Uno de los cuatro autores registró las características demográficas, clínicas y microbiológicas de la totalidad de pacientes ingresados con diagnóstico de sepsis grave y shock séptico, agrupándolos según sobrevida. Fueron clasificadas estas variables según sistema PIRO Se evaluó la asociación de estas variables con la mortalidad. Resultados: 42 pacientes, edad 11 meses (3,2-58) y mortalidad 19%. Las variables asociadas a mortalidad fueron: (P) antecedente de patología crónica (OR: 7; IC95% 0,95-51) e inmunodeficiencia (6,2; 1,1-35,2); (R) leucopenia (9; 1,96-41,72); (O) disfunción de 3 o más órganos (6,1; 1,22-31). Ninguna de las variables (I) se asoció a mortalidad. Conclusiones: El sistema "PIRO" es un modelo en desarrollo para una clasificación individual, de fácil aplicación. Permite reconocer factores asociados a un resultado fatal, en la presente casuística dado por inmunodeficiencia, leucopenia y fallo de tres o más sistemas. Es importante realizar estudios transversales para definir una etapificación PIRO consensuada y luego validarla prospectivamente.
Pólipo fibrovascular esofágico. Estudio por imágenes multimodalidad
(2010) Gallegos, Marcela; Cortés, Claudio; Díaz, Juan Carlos; Navarrete, Claudio; Castillo, Cecilia; Silva F., Claudio
Presentamos una mujer de 47 años que presenta disfagia. Una tomografía computarizada de tórax y una deglución de bario mostraron una masa endoluminal que se extendía a cuatro vértebras. Una ecografía endoluminal localizó el pedículo de la masa, que fue extirpado endoscópicamente. El estudio anatomopatológico reveló un pólipo fibrovascular. Tras 18 meses de seguimiento, el paciente se encuentra asintomático.
"Profilaxia del Abandono": Cien Años de Protección de la Infancia en Chile
(2010) Schonhaut, Luisa
Durante los Siglos XIX y principios del XX, la mortalidad infantil en Chile se encontraban entre las más elevadas del mundo y en los sectores populares era frecuente que los niños crecieran en medio de la orfandad, el abandono y la vagancia. Las instituciones de acogida y protección, que eran sustentadas por filantropía religiosa y aristocrática, tenían pobres indicadores de sobrevida; los derechos de la infancia recién emergían. Tras las grandes epidemias de fines del 1900 se sensibilizó el cuerpo médico, impulsando actividades de promoción y prevención primaria, que iban más allá del ámbito biomédico puro, lo que derribó los paradigmas existentes. En la segunda mitad del siglo se avanzó a pasos agigantados en las condiciones de vida, en el saneamiento ambiental y los niveles de educación. Con la creación del Servicio Nacional de Salud se organizó la atención médica y se generaron políticas públicas de amplia cobertura, las que nos llevaron a estándares comparables con países desarrollados. Objetivo: Recorrer la historia de la infancia en nuestro país y comentar la labor de algunas instituciones que tuvieron gran impacto en la salud materno infantil, como la Casa Nacional del Niño, el Patronato Nacional de la Infancia y el Seguro Obrero Obligatorio. A partir de ello, se reflexiona sobre los retos actuales y futuros de la pediatría. Conclusiones: Chile ha pasado por una rápida transición epidemiológica y demográfica que ha traído consigo nuevos desafíos en el ámbito de la salud infantil, relacionados fundamentalmente con los estilos de vida, desarrollo y salud mental. En consonancia, los pediatras deberíamos ampliar la mirada asistencialista incorporando el enfoque de desarrollo y las dimensiones psicosocial y emocional en el cuidado de los niños. Siguiendo nuestra herencia de pediatría social, deberíamos continuar abogando por la igualdad de oportunidades y por el efectivo cumplimiento de los derechos de la infancia.
Infección por Helicobacter pylori en pacientes sintomáticos con patología gastroduodenal benigna. Análisis de 5.664 pacientes
(2010) ROLLÁN, ANTONIO; RIQUELME, ARNOLDO; PADILLA, OSLANDO; VILLARROEL, LUIS; NILSEN, EVA; PRUYAS, MARTHA; VERDUGO, PATRICIA; CALVO, ALFONSO; Espino, Alberto; ORTEGA, JUAN PABLO
Infection with Helicobacter pylori (H. pylori) is highly prevalent in Chile, but there are no systematic studies in patients with upper gastrointestinal symptoms. Aim: To determine the prevalence of H. pylori infection, according to age, gender and endoscopic pathology in a large sample of patients. Methods: We studied 7,893 symptomatic patients submitted to upper gastrointestinal endoscopy between July 1996 and December 2003 in the context of a screening program of gastric cancer in a high risk population. H. pylori infection was determined by rapid urease test (RUT) in antral mucosa. We excluded 158 patients with gastric cancer (2%) and 2,071 patients without RUT. Results: We included 5,664 patients, mean age 50.7 ± 13.9 years, women 72.1%. Endoscopic diagnoses were normal in 59.3%, erosive esophagitis in 20%, gastric ulcer (GU) in 8.1%, duodenal ulcer (DU) in 6.4%, and erosive gastropathy in 6.2%. RUT was positive in 78% of patients. After adjusting for age and sex and with respect to patients with normal endoscopy, frequency of H. pylori infection was 86.6% in DU (OR 2.1, 95% CI 1.5-2.8, p < 0.001); 81.4% in GU (OR 1.8, 95% CI 1.4-2.4; p < 0.001 ); 79.9% in erosive gastropathy (OR 1.4, 95% CI 1.03-1.8; p = 0.03) and 77.4% in erosive esophagitis (OR 1.1, 95% CI: 0.9-1.3; p = NS). The probability of H. pylori infection decreased significantly with age, more markedly in men with normal endoscopy. Conclusions: Prevalence of H. pylori infection is very high in symptomatic Chilean patients and even higher in those with gastroduodenal ulcer or erosions, while in patients with erosive esophagitis is similar to those with normal endoscopy. The frequency of infection decreases with age, probably as a consequence of rising frequency of gastric mucosal atrophy
Neuro-retinitis asociada a enfermedad por arañazo de gato: Presentación de dos casos y revisión de la literatura
(2010) Munita, José; Pérez G, Jorge; Araos, Rafael; López G, Juan P; Stevenson A, Ricardo; González A., Patricia; Pérez C, Daniel; Noriega R, Luis M
La infección por Bartonella henselae se presenta característicamente con adenopatías regionales y fiebre de intensidad variable, entidad conocida como enfermedad por arañazo de gato . Alrededor de 5 a 10% de los casos desarrolla compromiso ocular, entre los que destacan el síndrome óculo-glandular de Parinaud, la neuro-retinitis y la retino-coroiditis focal. A continuación se presentan dos pacientes con infección aguda por B. henselae y compromiso ocular. Ambos recibieron tratamiento y evolucionaron con recuperación completa de la visión.
Conocimientos, actitudes y percepciones de enfermeros y estudiantes de enfermería hacia VIH/Sida
(2010) Cabieses, Báltica; Conejeros, Irma; Emig, Helga; Ferrer, Lilian; Cianelli, Rosina
Objetivo. Describir las actitudes, conocimientos y percepciones que tienen los enfermeros y estudiantes de Enfermería en torno a las personas que viven con VIH/SIDA (PVVS). Metodología. Estudio bibliográfico en el que se hizo búsqueda en seis bases de datos electrónicas con las palabras claves: “actitud”, “conocimientos”,“enfermería”, “percepciones”, “VIH/SIDA”. Se consideraron publicaciones entre 1998-2007. Resultados. Se recuperaron 560 artículos que se limitaron por su pertenencia a publicaciones de investigaciones científicas o reportes ministeriales. Finalmente se seleccionaron un total de 38 publicaciones, cuyo análisis mostró que el nivel de conocimientos de enfermeros y estudiantes de Enfermería en torno a PVVS es bueno y las actitudes frente a VIH/SIDA han mejorado en el tiempo. Los enfermeros y estudiantes de enfermería han sido capaces de identificar tanto aspectos positivos como negativos en el cuidado de PVVS, a nivel personal y profesional, debido a que existe una percepción más favorable. Conclusión. Existen pocos estudios en Latinoamérica y Chile que estudien las actitudes y conocimientos de la población de estudio en torno a PVVS. Según las publicaciones encontradas el conocimiento y las actitudes han mejorado debido a que la percepción es más favorable
Recomendación sobre Curvas de Crecimiento Intrauterino
(2010) Milad, Marcela; Novoa, José M.; Fabres, Jorge; SAMAMÉ, Mª MARGARITA; ASPILLAGA, CARLOS
Sternal and vertebral fractures, a well-known association, usually overlooked: review of six clinical cases
(2010) Silva G, Alvaro; de la Fuente D, Paulina; Schmidt-Hebbel N, Andrés; Valencia C, Manuel; Riera M, José Antonio; del Río A, Javier; Merello T, Bernardo; Thibaut L., Carlos
the association of sternal and vertebral fractures has previously been described in the literature. Theselesions are frequently overlooked at the initial evaluation. The purpose of this study was to review and discuss the diagnostic methods used to diagnose these lesions and to highlight the importance of early recognition of these fractures. Methods: we performed a retrospective análisis of six patients who suffered sternal and concomitant vertebral fractures. Clinical charts and imaging studies were reviewed. Results: all patients were diagnosed with sternal fractures at the initial evaluation, but only two were diagnosed with vertebral fractures. Conclusion: failure to recognize these fractures at initial evaluation may be associated with thefact that the upper horacic region is difficult to explore. In the presence of sternal fractures, a vertebral fracture must be ruled out even though major injuries are not present. A computer tomography (CT) scan and magnetic resonance imaging (MRI) should be obtained despite negative X-rays if clinical suspicion is present.

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