Artículos 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.
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
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.
Novel IL31RA gene mutation and ancestral OSMR mutant allele in familial primary cutaneous amyloidosis
(2010) Lin, Ming-Wei; Lee, Ding-Dar; Liu, Tze-Tze; Lin, Yong-Feng; Chen, Shang-Yi; Huang, Chih-Cheng; Weng, Hui-Ying; Liu, Yu-Fen; Tanaka, Akio; Arita, Ken; Lai-Cheong, Joey; Palisson, Francis; Chang, Yun-Ting; Wong, Chu-Kwan; Matsuura, Isao; McGrath, John A; Tsai, Shih-Feng
Primary cutaneous amyloidosis (PCA) is an itchy skin disorder associated with amyloid deposits in the superficial dermis. The disease is relatively common in Southeast Asia and South America. Autosomal dominant PCA has been mapped earlier to 5p13.1–q11.2 and two pathogenic missense mutations in the OSMR gene, which encodes the interleukin-6 family cytokine receptor oncostatin M receptor beta (OSMRb), were reported. Here, we investigated 29 Taiwanese pedigrees with PCA and found that 10 had heterozygous missense mutations in OSMR: p.D647V (one family), p.P694L (six families), and p.K697T (three families). The mutation p.P694L was associated with the same haplotype in five of six families and also detected in two sporadic cases of PCA. Of the other 19 pedigrees that lacked OSMR pathology, 8 mapped to the same locus on chromosome 5, which also contains the genes for 3 other interleukin-6 family cytokine receptors, including interleukin-31 receptor A (IL31RA), which can form a heterodimeric receptor with OSMRb through interleukin-31 signaling. In one family, we identified a point mutation in the IL31RA gene, c.1562C4T that results in a missense mutation, p.S521F, which is also sited within a fibronectin type III-like repeat domain as observed in the OSMR mutations. PCA is a genetically heterogeneous disorder but our study shows that it can be caused by mutations in two biologically associated cytokine receptor genes located on chromosome 5. The identification of OSMR and IL31RA gene pathology provides an explanation of the high prevalence of PCA in Taiwan as well as new insight into disease pathophysiology
Uso Racional de Corticoides en el Paciente con Shock Séptico
(2010) Roque, Jorge
Introducción: El shock séptico (SS) es una de las mayores causas de mortalidad en unidades de cuidados intensivos pediátricas. Objetivo: Revisar qué sabemos hasta ahora del papel que juega el eje hipotálamopituitaria-adrenal (HPA) en el SS y si hay evidencia científica que apoye el uso de glucocorticoides en el transcurso de este cuadro. Sabemos que de la habilidad del eje HPA para montar y sostener en el tiempo una adecuada respuesta al stress provocado por un SS dependerá si el paciente evoluciona a la mejoría o se agrava. En algunos pacientes debido a múltiples mecanismos, la prolongación del SS puede llevar a un déficit de cortisol, resultando en una insuficiencia adrenal aguda o funcional, la que se reflejaría en que los niveles de cortisol no responderían con un incremento significativo frente a una prueba de estimulo con ACTH. Entre los diversos reportes revisados, no existe consenso sobre cual sería la concentración “normal” de cortisol durante el stress y más aun no está claro si esto se correlacionaría con la mortalidad en el caso de los niños. Las guías de shock séptico en pediatría y neonatología del American College of Critical Care Medicine recomiendan en que tipo de pacientes con SS se debiera considerar tratamiento con hidro
Autoría en artículos biomédicos: El caso de imaginología
(2010) Silva F., Claudio
La definición de autoría es un tema de discusión permanente, donde se ven involucrados elementos de prestigio y carrera académica. Siendo una potencial fuente de conflictos, debe ser manejado con extrema rigurosidad, para evitar dificultades al momento de presentar resultados científicos. Se presenta una revisión de los criterios internacionales referidos a autoría, aceptados a la fecha, y la postura del cuerpo editorial de la Revista Chilena de Radiología. Palabras clave: Autoría por obsequio, Autoría fantasma, Autoría por coerción, Comité Internacional de Editores de Revistas Médicas, Requisitos de uniformidad para manuscritos enviados a revistas biomédicas
Permanent group effect on nucleofugality in aryl benzoates
(2010) Campodónico, Paola; Ormazábal-Toledo, Rodrigo; Aizman, Arie; Contreras, Renato
We herein report on the group electrophilicity of molecular fragments present in the title compounds to describe leaving group abilities in reactions of aryl benzoates toward CN. It is found that the presence of electron-withdrawing substituents in the permanent group enhances its electrophilicity, thereby contributing to the stabilization of the tetrahedral intermediate involved in the stepwise pathway. On the other hand electron-releasing substituents attached to the permanent group enhance the nucleofugality of the leaving groups in these systems. Substituent effects are used to rationalize the activation/deactivation patterns induced by electron-withdrawing and electron-releasing groups at the aromatic rings.
Nasolaryngoscopic Validation of a Set of Clinical Predictors of Aspiration in a Critical Care Setting
(2010) Caviedes, Ivan R.; Lavados, Pablo; Hoppe, Arnold; Lopez, Marıa A
Antecedentes: la aspiración es frecuente en pacientes con trastornos neurológicos agudos y disfunción de la deglución. Su incidencia en accidentes cerebrovasculares, tan alta como 51%, aumenta la mortalidad hasta 3 veces. La neumonía, su principal complicación, aumenta aún más la morbilidad, la mortalidad y los costos de atención al paciente. El objetivo de este estudio fue evaluar un conjunto de predictores de aspiración al lado de la cama ["voz húmeda", prueba de deglución de agua de 3 onzas y auscultación cervical en una unidad de cuidados intensivos (UCI)] y compararlos con la nasolaringoscopia como estándar de oro. Métodos: Realizamos un estudio prospectivo, no ciego, de predictores de riesgo de aspiración al lado de la cama en 65 pacientes consecutivos de UCI con un trastorno neurológico agudo o una afección médica o quirúrgica grave con disminución del nivel de conciencia. Resultados: Se detectó aspiración endoscópica en 17 pacientes. Las sensibilidades para la voz húmeda, la prueba de deglución de agua de 3 onzas y la auscultación cervical fueron 58.82%, 88.23% y 82.35%; las especificidades fueron 78,26%, 62,50% y 80,43%. Los valores predictivos positivos fueron 50%, 45,45% y 60,86%, y los valores predictivos negativos fueron 83,72%, 93,75% y 92,50%, respectivamente. Las razones de probabilidad positivas fueron 2,70, 2,35 y 4,20, respectivamente. La asociación de 2 predictores clínicos positivos, voz húmeda y auscultación cervical o voz húmeda y prueba de deglución de agua de 3 onzas, mejoró la especificidad a 92,85% y 84,61%, valores predictivos positivos a 83,33% y 69,23%, y cocientes de probabilidad a 10,76 y 5,85 , respectivamente. Conclusiones: Los predictores clínicos de cabecera para los riesgos de aspiración son una herramienta de cribado útil para los pacientes de la UCI que presentan factores de riesgo para esta complicación.
Reactivity of benzohydrazide derivatives towards acetylation reaction. Experimental and theoretical studies
(2010) Campodónico, Paola; Aliaga, Margarita E.; Santos, José G.; Castro, Enrique A.; Contreras, Renato
We herein report an experimental and theoretical study on the acetylation reaction of benzohydrazide derivatives towards p-nitrophenyl acetate (NPA). The kinetic data are consistent with a stepwise mechanism with the nucleophilic attack as the rate determining step. From the theoretical analysis it is found that benzohydrazide derivatives establish intramolecular proton rearrangement. The enol form appears as the active species for nucleophilic attack. A reaction mechanism incorporating keto-enol pre-equilibria is proposed. The study is completed with a local reactivity analysis describing the most reactive centers for nucleophilic attack together with a site activation analysis describing inductive substituent effect
The relationship between knowledge of HIV, self-perceived vulnerability and sexual risk behavior among community clinic workers in Chile
(2010) Cabieses, Báltica; Ferrer, Lilian; Villarroel, Luis; Tunstall, Helena; Norr, Kathleen
Objective Testing the hypothesis of an association between knowledge and sexual risk behaviour (SRB) amongst community-clinic workers in Chile, explained by the confounding effect of self-perceived vulnerability to HIV. Methods A cross-sectional survey was analyzed; it was nested within a quasiexperimental study of 720 community-clinic workers in Santiago. The SRB score combined the number of sexual partners and condom use (coded as “high”/”low” SRB). Knowledge of HIV (a 25-item index) was coded as “inadequate”/”adequate” knowledge. Self-perceived vulnerability to HIV was categorised as being “high”/ ”moderate”/”low”. Control variables included socio-demographics, religiousness and educational level. Percentages/averages, Chi-square tests and logistic regression (OR-estimations) were used for descriptive, association and confounding analysis. Results Respondents were 78.2 % female, 46.8 % married and 67.6 % Catholic. Mean age was 38.9 (10.5 SD) and 69 % had university/diploma level. Self-perceived HIV vulnerability was “low” in 71.5 % cases. A negative association between knowledge and SRB was found (OR=0.55;CI=0.35–0.86), but self-perceived vulnerability did not have a confounding effect on this relationship. This relationship also persisted after being adjusted for multiple control variables (e.g. age, sex, type of primary centre, educational level, and religiousness). Conclusions Some community-clinic workers had inaccurate knowledge of HIV, which was associated with SRB. Self-perceived vulnerability did not have a confounding effect; however, future studies should further analyze occupational risk of HIV as a possible driving factor in health workers´ perception of their risk. Focused training programmes should be developed to enhance basic knowledge of HIV in this group
DIAGNÓSTICO INCIDENTAL DE TUMOR VESICAL POR ECOGRAFÍA GINECOLÓGICA TRANSVAGINAL
(2010) Yamamoto, Masami; de Alvarado, Mercedes; Figueroa, Manuel; Barroso, Juan Pablo; Caicedo, Luis Alberto; Jorge Carrillo, Jorge; Insunza, Alvaro; Paiva, Enrique
Se presenta el caso clínico de una mujer de 60 años que acude al Servicio de Ginecología y Obstetricia del Hospital Padre Hurtado, bajo la sospecha de un mioma cervical pequeño. Se realiza una ecografía transva-ginal la cual evidencia incidentalmente un tumor vesical sólido, vascularizado, intravesical y dependiente de la mucosa. La paciente no refería espontáneamente hematuria. El estudio urológico definitivo es de un carcinoma papilar de células transicionales. El tratamiento endoscópico logró la resección completa del tumor. El hallazgo ecográfico permitió realizar el diagnóstico en una forma poco habitual para esta enfermedad, aprovechando una instancia definida para otros fines. Se rescata la importancia de observar detenidamente todas las estructuras pélvicas al alcance visual del equipo de ecografía.

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