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SPLEEN AND BLEEDING polycythemia

polycythemia IN HEIGHT AND THE BLEEDING

According Monge, 1928, chronic mountain sickness (MMC) is a disease that affects native or resident of the height. The pathophysiology is explained by the Polycythemia or excessive erythrocytosis secondary to pulmonary hypoventilation, hypoxemia. See this blog CHRONIC altitude sickness. " Fernando Acosta

diligent doctor of Cerro de Pasco in the eighties always repeated that at Cerro de Pasco at 4330 m, many locals over 40 years, with economic capacity to do so, to meet and hear frequently about the deaths of friends or relatives by a stroke called "sprawl" related to polycythemia, fleeing to lower altitudes sometimes out of fear or sometimes because they felt some discomfort secondary to hyperviscosity of polycythemia and left their villages with no penalty to keep ahead in their development.

Polycythemia with excessively high hemoglobin levels above the physiological level according to altitude, up to 29 g / dl of hemoglobin have had the opportunity to see, apart from an indication of their descent to sea level treatment final, has tried to be determined by pharmacological methods as medroxyprogesterone, the almitrine, methylxanthines, adrenergic blockers, ACE inhibitors, acetazolamide, etc.. Fabiola León Velarde nationally recognized researcher on the height of the Cayetano Heredia University in Lima led the group consensus of Xining, China in 2004 looking for a pharmacological solution polycythemia.


Sangria with isovolemic replacement the only option today

However, MMC and polycythemia overwhelmed 4-5% of the population in height between 40-60 years (see this blog HEIGHT ADJUSTMENT AND HEMOGLOBIN ) and pharmacological treatment is feasible, for the moment for such a large population living more than 3000 meters.

The other problem of infeasibility in treatment is the inability of all the affected population is transferred to sea levels.

Thus far the only treatment of polycythemia is bleeding or so-called phlebotomy in Anglo-Saxon literature.

bleeding or removal of a quantity of blood through a peripheral vein has been known since the time of the Inca Empire in our country with large populations of height. J. Sánchez Castillo revises Garcilaso de la Vega in his blog PERUVIAN HISTORY OF MEDICINE, which used this technique called Hampicamayoc bleeding or purging probablemente para resolver empíricamente síntomas relacionados a la policitemia.

Porque si se ha demostrado correlato fisiopatológico en este tratamiento, Cruz y Marticorena en el Hospital de Chulec describieron en “Phlebotomy improves Pulmonary Gas Exchange in Chronic Mountain Polycythemia, Respiration 1979: 38: 305-313”, y encontraron que la sangría mejoraba el intercambio de gases y la espirometría en los pacientes policitémicos.

Las sangrías hasta la fecha, por lo tanto, son el procedimiento de elección para el tratamiento de la policitemia sintomática y estas se siguen realizando en nuestros hospitales ubicados a gran altura. Se realizan SANGRÍAS CON REPOSICIÓN isovolemic physiological solutions.

Oscar Sedano of Huancayo, another renowned medical researcher of the height, in his "non-pharmacological reduction of excessive erythrocytosis induced by isovolemic hemodilution in the MMC" has shown that isovolemic replenishment associated with the bleeding, reduce the symptoms for more time after three indentations of up to 15 months and also measured the rate of reduction of hemoglobin for each assignment of bleeding as follows: 1st: 4.1%, 2nd: 6.2%, 3rd: 5.5%.

In conclusion so far the only viable treatment for remaining in the polycythemic height is bleeding with isovolemic replacement.

Dr. Achilles MONROY

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PERU, La Oroya, TUMORS

Huancayo, 120 km south of La Oroya. Panoramic view of the most populous city in the central highlands of Peru

In Satipo, 170 km east of La Oroya. Typical house of the Peruvian Amazon

Miraflores, Lima. (A 175 km west of La Oroya), Peruvian capital on the central coast

Map of Peru, with its three regions, Lima pointing (on the coast) and La Oroya (in the mountains)

THE THREE REGIONS OF PERU

receive visits

As countries around the world, although some friends have no idea of \u200b\u200bthe location of Peru in South America, we ask: where is La Oroya?, where we write this blog.

Pathology of La Oroya and other data and photos are on this blog article " GENERAL MORBIDITY 3730 m "

why we want to point out that Peru with 28 million inhabitants, is divided into three regions:
1 .-
Coast (Pacific Ocean): painted yellow (in the map of the 3 regions of Peru), whose cities are 52% of the population. the capital Lima, is located in the heart of the Peruvian coast and is marked by a yellow arrow.

2 .- La Sierra : painted brown, formed by the Cordillera de Los Andes, with populations living in high altitudes, home to 37% of the Peruvian population (about 10 million people).

La Oroya is located 175 kilometers east of Lima, 3730 m, 130 km south of Cerro de Pasco (4300 m) and 120 km north of Huancayo (3200 m). It is also marked with a yellow arrow. 3 .-

La Selva: painted green with different shades and home to 11% of the Peruvian population.

Dr. Achilles Monroy

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HEIGHT HEIGHT: CAROTID BODY TUMOR

THE CAROTID BODY TUMOR

We discussed in a previous article of this blog: " Corpuscle CAROTID IN THE HEIGHT IS BIGGER AND HEAVY "already Arias Stella in 1973 had reported this finding and that just happens to hemoglobin increased over the years. Also that hypoxia may alter the histopathologic structure of this tissue to produce a hyperplastic response and perhaps tumors called chemodactomas, chemodeclarnas or paragangliomas associated with hypoxic stimulus height. So

these carotid body tumors called paragangliomas besides being very rare at sea level, so are in the height but 20 times more frequent.

This time, among many articles, we have chosen a published in Acta Andina 1995; 4 (1): 3-12 where the Bolivian Medical Hospital Dr. L. Obrero de Bolivia Wayllace and Belgian doctors Haot Jules, Jacques Rahier Catholic University of Leuven, Brucella, make an elegant review clinical aspects of the entity. We have dared to make a didactic summary of that article.

not touch the current aspects of diagnosis and nuclear magnetic resonance angiography (goldstandard examination for diagnosis), or the surgical aspects of the "Classification Shambin" because of specialty items, and lack of expertise not comment.

Dr. Achilles Monroy

paraganglioma in young female height

asymptomatic selective carotid arteriography shows vascular paraganglioma at the carotid bifurcation

COMPARATIVE CLINICAL STUDY OF CAROTID BODY TUMORS

Luis Wayllace, Jules Haot, Jacques Rahier

SUMMARY.
parallel to the carotid body hyperplasia (CC), there is an increased incidence of tumors of this organ in height. This comparative study of tumors of the carotid body (TCC) of La Paz, Bolivia (3600 meters) and Brussels-Belgium (sea level) this frequency is 20 times higher in native high in patients originating from regions sea level.

The profile of patients with TCC is different altitude or sea level. The TCC in height are usually unilateral, occur in middle-aged individuals (51.1 + 11 years) with a female preponderance (89%), are exceptionally evil, are rarely associated with other paragangliomas and inheritance seems to play no role in pathogenesis. Among patients

sea level are two situations: there is a first group similar to the high TCC affecting middle-aged patients (mean 50 years) without known heredity for this type of injury or for other paragangliomas and the second group consists of younger individuals (mean 29.4 years) where the TCC developed in a context Hereditary neuroendocrine tumors. The frequency of malignant TCC is highest at sea level in height and is independent of the heredity of injuries. SUMMARY


. Closely
to carotid body hyperplasia, Carotid Body Tumor (CBT) Are frequently seen in high altitude regions. In this comparative clinical study CBT We Have Seen That in La Paz, Bolivia (3600 m) Are More Frequent Than 20 folds at sea-level (Belgium).

There Are Several clinical Difference between high altitude and sea-level CBTs. The Former group is Composed Mainly by middle aged (51 + 11 years) with Predominance female (89%). Tumors Are Usually unilateral, They Are Almost never Malignant and They Are Usually Not associated with other paragangliomas. Heredity seems not to play any significant etiopathogenic role.

In the sea-level CBT series there are two groups: the former resembles clinically to the high-altitude series: patients are middle aged (average 50 years) without hereditary background for CBT neither for paragangliomas. The second group is composed by younger patients (average 29.4 y.) where CBT grow within an hereditary background of neuroendocrine tumor.Malignant CBT are more frequently seen in the sea? level regions. Malignancy seems not to be hereditary-related.


INTRODUCCIÓN
El Tumor de Cuerpo Carotídeo (TCC), como el Cuerpo Carotídeo (CC) del que se origina, ha motivado controversias since its first description by March in 1891. The understanding of the nature of this injury has evolved over time, in fact, she was seen on vascular injury (Marchand 1891), a hamartoma (Oberndorfer 1905), a form of hyperplasia exaggerated chemoreceptor tissue (Saldaña et al. 1973) or finally as a true neoplasm provided with clinical and biological characteristics, genetic and epidemiological individuals (Parry et al. 1982).

Despite numerous reports in the literature, TCC is an uncommon injury, which has yet interesting epidemiological aspects. So, after work Arias-Stella (1969) and Arias-Stella and Valcarcel (1973) who observed hyperplasia of the carotid bodies in response to chronic stimulation by hypoxia in height, was that tumors arising in this tissue are more common chemoreceptor in high altitude regions in areas at sea level. These early works were followed by several studies of large series of TCC in the Andean regions of Peru (Saldaña et al. 1973), Bolivia (Rios and Wayllace Dalenz 1977; Aramayo et al. 1989) and Ecuador (Pacheco Ojeda et al. 1982) and Mexico (Krause-Senties 1971, Rodriguez Cuevas et al. 1986). Most of these reports consider to chronic hypoxic stimulation and the decisive factor for the occurrence of these injuries , considered by some as an exaggerated form of hyperplasia or tumors as true by others.

This study compared two sets of patients with carotid body tumors. The former consists of native high-altitude regions of Bolivia (3600 - 4000 m) and the second consists of people from areas located at sea level in Belgium. RESULTS



In the series of La Paz, about 29 628 pathology tests performed, we found 34 cases of carotid body tumors (CBT) lo que representa una prevalencia de 1/1000 y un solo caso de tumor del glomus yugular (TGY), mientras que en la serie de Bruselas, basado en 220 135 exámenes evaluados se encontraron 22 paragangliomas cervicales: 11 casos de TGY y 11 casos de TCC; éste último representando una prevalencia de 1/20 000. La proporción de los TCC es por lo tanto 20 veces más alta en La Paz que en Bruselas mientras que la proporción del TGY es a la inversa más alta en Bruselas que en La Paz.

Mujer adulta con gran paraganglioma izquierdo en la serie de La Paz

Aspectos Clínicos en la Serie de La Paz

La totalidad of patients in this series were from regions between 3600 and 4000 meters above sea level (asl). The series consisted of 30 women and 4 men and the mean age was 51.1 years (25 - 79 years).

All patients except one had a single TCC . 16 with location on the left side, 17 on the right side and in one patient the location was bilateral. No patient had a family history of TCC. The duration of symptoms ranged from 5 months to 20 years. The most common initial symptom was the presence of a latero-cervical mass in most of the patients were painless, sometimes throbbing. Three patients reported discomfort at the tumor.

General symptoms, headache was noted in 4 patients, in one of them this was accompanied by dyspnea on moderate effort. Two patients experienced dizziness. Two patients were hypertensive and one had progressed to permanent drowsy sleep to perform a massage of the TCC.

On physical examination, peripheral cyanosis was recognized evident in three patients. Examination of the cervical region showed that most patients the tumor mass was painless except for 5 persons in whom manipulation caused pain. In 9 patients, TCC was adherent to the deep planes and in 3 people, the mass was mobilized laterally but not vertically. On palpation, 8 TCC were pulsating and showed an increase in local temperature. On auscultation, 3 tumors showed a systolic murmur. The rich vascularity of the tumor mass favored the angiographic diagnosis was possible in all cases (Fig. 2).

One patient who underwent partial resection of a large tumor, showed a significant recurrence 4 years after the first intervention. A woman died during the immediate postoperative neurological and pulmonary complications. The other patients had no recurrence or metastasis during follow-up period ranged from 2 to 7 years.

preoperative embolization was not performed in any patient's tumor.

arteriography showing carotid paraganglioma in bifurcacióm left in the series of La Paz

DISCUSSION
The carotid body tumor (CBT) is a relatively rare lesion since a comprehensive review completed by Zak and Lawson in 1982 estimated the total reported cases, including Soviet and American literature, between 900 and 1000. For our part, we have found 1033 extra cases in the literature during the period from 1982 to 1992.

All Latin American series, both Peruvian, Mexican, Ecuadorian and Bolivian indicate an increased rate of TCC at elevations above 1500 meters above sea level.

is noteworthy that the height increase in the number of tumors paraganglionic system appears to be limited to the carotid body (CB). Simultaneously with the TCC, we found a single case of TGY in La Paz. In Brussels, however they are more numerous than the CBT (11 patients had TCC TGY and 7 patients during the study period).

The female population is predominant in the high series where it ranges between 74 and 93% with an average of 89%. Most are unilateral without showing preference for one side. The bilateral TCC are exceptional in height (Saldaña et al. 1973). None of the patients had a hereditary predisposition.

The bilaterality of the TCC, the multicentricity of paragangliomas and association with neuroendocrine tumors are observed in parallel with a greater frequency of hereditary factors most often in the series from regions located at sea level. In the literature review conducted in 1982, Zak and Lawson found a relatively high rate of hereditary tumors, the order of 209 cases over 1000 TCC reviewed.

A striking fact is that on 180 cases of carotid body tumors in height, no author mentioned malignant tumors, while the plain series indicate malignancy rates ranging from 4 to 23% (Glenner and Grimley 1974, Zak and Lawson 1982, Parry et al. 1982, et al Klieve . 1989).

Our results of La Paz were not conclusive regarding the neuroendocrine role of the TCC, as it is a series where all but one of the TCC patients had unilateral and therefore retained a functional carotid body.

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FOUNDATIONS OF NATURAL AND SIMULATED ALTITUDE IN CARDIAC REHABILITATION

Walking on Mount Meiggs, near to 5085 m
Ticlio
hypobaric chamber that simulates different altitudes



HEIGHT AND HEIGHT NATURAL SIMULATED IN CORONARY HEART REHABILITATION

Our teacher Emilio Marticorena in 1994, first reported that the natural hypoxia in the Andes could be used as a effective procedure for coronary cardiac rehabilitation, this procedure was complemented later when he retired Chulec Hospital to work in the Air Force Hospital in Lima using simulated hypoxia using hypobaric chambers.

This procedure was mainly based on anatomical studies (Arias Stella), physiological (Moret) and biochemical (Harris) in the heart of man height.

Three related studies published by the CIBA Foundation in London in 1971 in a tribute to Professor Simposiun Alberto Hurtado, are discussed in this regard by Dr. Marticorena in an article in Acta Andina 2001; 9 (1-2): 63 to published below.

Dr. Achilles Monroy

USE OF NATURAL AND SIMULATED ALTITUDE IN CORONARY HEART REHABILITATION

Dr. Emilio A. Marticorena
Professor Emeritus of Medicine, UNMSM

In 1971, three of the participants in the Ciba Symposyum Physiology Height in 1971 - in London - England, in honor of Professor Alberto Hurtado, respectively presented their observations:

1) The extensive coronary vasculature in individuals of height (A) for specimens of sea level (SL) (1) .
2) Reduced coronary flow more efficiently in the native myocardial Height (2) .
3) Increased myocardial enzyme activity of succinic dehydrogenase in animals under Height (3) .

These three separate research approaches, aimed at exploring the myocardium of Height and Sea Level, have contributed to the development of procedures currently use natural hypoxia (Peruvian Andes) and simulated altitude (hypobaric chamber) for the purpose - specific-Coronary Cardiac Rehabilitation (RCC) .

In this sense, Peru, in the world that moves first to the height (5000 m) in coronary patients with and without myocardial infarction Cardiac Rehabilitation for Coronary (4-5) .

* See article in this blog: "CLIMBING MEDICAL "

Returning to the form of simulated altitude (hypobaric chamber), is reported by Peru in 1994 (4-5) . That same year, mentions the first Soviet experience (6) .

currently in Peru deepen the mechanisms that attempt to explain how he would act rehabilitating myocardial hypoxia, whereas it is probably the level of molecular biology where such arrangements would take place (7-8) .

Finally, it is a privilege for the commentator of these lines of research have dealt with tightly on the significance which means the contribution of researchers: Arias Stella, Moret and Harris in the current management of RCC with hypoxia, Peru and outside.

HIGH ALTITUDE PHYSIOLOGY . CARDIAC AND RESPIRATORY ASPECTS A CIBA FOUNDATION SYMPOSIUM IN HONOUR OF PROFESOR ALBERTO HURTADO, LONDON 1971

Summary
Anatomy of the coronary circulation at high altitude.
ARIAS- STELLA J Y TOPILSKY M. (1)

Using the method of preparing casts of the coronary arterial system through aortic injection of rapidly polymerising acrylic resin at a pressure of 150-200 mmHg, followed by fixation and corrosion, a different pattern has been found in the vascularization of individuals from Cerro de Pasco (4375 msnm) from that seen in subjects from sea level. These results are compared with those recently obtained in our laboratory by Dr. Carmelino in subjects from Puno (3466 - 4287 msnm), using the post mortem stereoangiographic method. Both studies show the number of branches That Leaving the main coronary trunks is great and the peripheral ramifications Are More Numerous at high altitudes. The Physiological and Clinical Significance of These Findings is discussed.

* See this blog article: " THE HEART IS BIGGER, HEAVIER AND HEIGHT vascularized "


Coronary blood flow and myocardial metabolism in man at high altitude
MORET PR (2)

Coronary blood flow and myocardial metabolism Studies in Normal Subjects Were living in Peru and Bolivia at Three Different altitude: Lima (150 m), La Paz (3700 m) and Cerro de Pasco (4375 m). Coronary blood flow is lower at high altitude, as is the oxygen consumption of the myocardium, with the result that myocardial efficiency is greater. The lower coronary flow at high altitude is not compensated for by any increased oxygen transport capacity of the blood. Substrates usually extracted by the heart -glucose, lactate, pyruvate and free fatty acids- are the same at high and low altitude, but at high altitude the heart consumes more carbohydrates, especially lactate, and there are no signs of anaerobic metabolism. The lower coronary blood flow and oxygen consumption and absence of signs of anaerobic metabolism at high altitude suggest an adaptation of cellular metabolism to low oxygen pressure. Six patients with chronic mountain sickness were also studied. Coronary blood flow was higher than in the normal groups, and in some cases the myocardium seems to be slightly underperfused. The percentage oxygen extraction is increased, in contrast to the normal subjects, and the extraction of metabolites also differs.


Some observations on the biochemistry of the myocardium at high altitude
HARRIS P (3)

Measurements of succinic dehydrogenase and lactic dehydrogenase activity have been made on myocardial homogenates from guinea pigs, rabbits and dogs indigenous to high altitude and compared with measurements made on the same species at sea level. A consistent increase in the activity of succinic dehydrogenase was found in the high altitude animals but no significant difference in lactic dehydrogenase.
Analyses of the lipid content of the myocardium have shown that there is a consistent increase in total lipid, total phospholipid, cholesterol and sphingomyelin in the myocardium of the three species of animal at high altitude.

BIBLIOGRAFÍA

1. Arias Stella J y Topilsky M: Anatomy of the coronary circulation at high altitude, High Altitude Physiology: Cardiac and Respiratory Aspects, A Ciba Foundation Symposium, Edit. R. Porter and J. Knight, Churchill Livingstone, London, pp. 149-154, 1971.
2. Moret PR: Coronary blood flow and myocardial metabolism in man at high altitude, High Altitude Physiology Cardiac and Respiratory Aspects, A Ciba Foundation Symposium Edit. R. Porter and J. Knight, Churchill Livingstone, London, pp. 131-144, 1971.
3. Harris P: Some observations on the biochemistry of the myocardium at high altitude, High Altitude Physiology Cardiac and Respiratory Aspects, A Ciba Foundation Symposium, Edit. R. Porter and J. Knight, Churchill Livingstone, London, pp 125-129.1971.
4. Marticorena EA (1984-85) New technique in cardiac rehabilitation and coronary primary prevention: use of high altitude. Areh. Inst Biol. and. 13: 189-206.
5. EA Marticorena, Marticorena JM, Contreras A et. al. (1994) Cardiac Patients bypassed coronary rehabilitation of natural and simulated high altitude techniques. First World Congress of High Altitude Medicine and Physiology, La Paz, Bolivia. Abst. 101.
6. Thinkov AN, Kotz Yl, Alyoshin IA (1994) The first experience of Treatment of Patients with ischemic heart disease using the method of adaptation to intermittent hypoxia in an altitude chamber, Hypoxia Med J 2: p. 73, Abst. 115.
7. Marticorena EA (1998) Molecular basis of hypoxic coronary cardiac rehabilitation and simulated natural height, Rev. Peruvian cardiologist. XXIV: 2:177-186.
8. Col. Marticorena EA (2001) Endothelial relaxing factor (ON) coronary rehabilitation hypobaric chamber, Rev. Peruvian cardiologist. 27: 2:148-9.

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Hultgren HERBERT STANFORD RESEARCH

Book published in 1997 by Hultgren


HERBERT N. Hultgren

We had the opportunity to meet Dr. Hultgren, School of Medicine, Stanford, some of his occasional visits Chulec Hospital of La Oroya, when in the eighties coordinated with our leader Dr . Emilio Marticorena. Since 1964 both had worked hard in the High Altitude Pulmonary Edema in patients Chulec Hospital, having been involved in several series catheterization found that the pulmonary edema was associated with pulmonary hypertension with normal or low pressure in the pulmonary artery wedge, publishing their findings in Circulation and other magazines.

was very fond of La Oroya and Chulec Hospital and in the last years of his life he finished writing the book High Altitude Medicine.

publish a prestigious tribute to his life as a researcher of Medicine height.

Dr. Achilles Monroy

In Memoriam
Herbert N. Hultgren, MD, 1917-1997 William H.
Barry, MD, Salt Lake City, Utah

Herbert N. Hultgren, Professor of Medicine Emeritus at Stanford, Died in October 1997 at age 80 of complications of acute myelogenous leukemia. Herb was a native of northern California and graduated from Stanford University in 1939 and from its School of Medicine in 1943. He completed residency training in medicine and pathology at Stanford and served in Europe in World War II with the US Army Medical Corps. He was a research fellow in cardiology at the Thorndike Memorial Laboratory in Boston, Mass, and then returned to Stanford in 1948, where he established the first cardiac catheterization laboratory in northern California and in 1955 became chief of cardiology at Stanford.

In 1968, after the Stanford Medical School had relocated from San Francisco to Palo Alto, Calif, Herb was appointed chief of cardiology at the Palo Alto Veterans Administration Hospital, a position he held until 1984. I worked with him at Stanford as a cardiology fellow and then as junior faculty member in the cardiology division from 1970 to 1977. I and numerous Stanford students, residents, and faculty benefited enormously from contact with Herb, as he was a superb teacher, clinical cardiologist, and clinical investigator. He was chairman of the American Board of Internal Medicine Subspecialty Board on Cardiovascular Disease from 1972 to 1975 and was a founding member of the Association of University Cardiologists, serving as its president in 1970.

Herb was recognized as a world authority on altitude sickness and was the first US investigator to define (in Medicine in 1961) the clinical characteristics of high-altitude pulmonary edema, although the pathophysiological basis of this condition was unknown. In 1962, while serving as chief of cardiology at the University of Utah, Hans Hecht published a case report of pulmonary hypertension with a normal left atrial pressure (measured at right heart catheterization via a patent foramen ovale) in a physician who had developed pulmonary edema while skiing at Alta, Utah. A pulmonary artery wedge pressure could not be recorded, and Hecht and associates concluded that hypoxia-induced spasm of the postcapillary pulmonary veins might be the cause of high-altitude pulmonary hypertension and edema. In 1964, Hultgren and associates published a remarkable study in Circulation in which they performed right heart catheterization in a series of patients with high-altitude pulmonary edema admitted to Chulec General Hospital in the city of La Oroya, at 12 300 feet in the Peruvian Andes. This study established that this form of pulmonary edema was consistently associated with very significant pulmonary hypertension and documented that it occurred with a normal or low wedge pressure. Herb subsequently advanced the still-accepted hypothesis that edema resulted from hypoxia-induced focal pulmonary artery constriction, with overperfusion of lesser-affected segments causing a pulmonary capillary leak.

Herb was an avid mountaineer and climbed many of the highest peaks in North and South America. He was chairman of the Medical Committee of the American Alpine Club from 1974 to 1980. When I was at the Palo Alto Veterans Administration Hospital, Herb was fond of taking junior faculty and fellows to the Barcroft high-altitude research laboratory on White Mountain Peak, at an altitude of 12 500 feet. Herb always took an echocardiogram machine to the laboratory on the chance that one of us would develop high-altitude pulmonary edema so that he could demonstrate that this occurred in the presence of normal echocardiographic ventricular function. Although none of us ever did develop this disorder, we were routinely embarrassed by Herb's endurance at high altitude on our climbs to the top of White Mountain Peak, at 14 246 feet. Herb's endurance was also demonstrated by his decision to undergo chemotherapy at age 79 so that he could complete work on his excellent book, High-Altitude Medicine, which was published last June.

Herb was also very interested in ischemic heart disease and was cochair (with T. Takaro) of the Veterans Administration cooperative study comparing the use of coronary artery bypass graft surgery with medical treatment in patients with ischemic heart disease. This was one of the first large, randomized, multicenter trials that assessed benefits of a specific treatment in cardiovascular disease. Analysis of data from this study clearly established the beneficial effects of surgery on survival in patients with left main disease and on exercise hemodynamics in patients with ischemic ventricular dysfunction. It had a major impact on practice and on subsequent design and application of clinical trials in cardiology. During his career, Herb was author of 176 papers and 34 book chapters. In 1990, his numerous clinical contributions were recognized when he received the prestigious Albion W. Hewlett Award at Stanford, which honors "the physician of care and skill who has committed to discovering and using biologic knowledge, wisdom, and compassion to return patients to productive lives."

Herb and I became close friends during the years I spent with him at the Veterans Administration Hospital and remained so subsequently. I was fortunate to be able to enjoy many backpacking and trout-fishing trips with Herb. In spite of his remarkable professional and personal achievements, Herb remained totally self-effacing and modest. He is survived by his wife, Barbara, three sons, and one grandson. His family and friends, as well as the cardiology and mountaineering Communities, owe much to this Remarkable man.

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ALTITUDE MEDICINE IN PERU GENERAL MORBIDITY

Butrón Hospital Manuel Nuñez, Puno

REVIEW OF THE HISTORY OF MEDICINE OF THE HEIGHT IN PERU

In 1992 was published in the journal Medical Herediana 3 ( 2): 74-77 The enclosed article, which reflects the history of research in Peru to date.

information little known them critically reviewed by Drs. David Frisancho Pineda, Oscar Frisancho Velarde, father and son, both physicians and recognized researchers Puno of High Altitude Medicine is presented for information and source is acknowledged. Dr. Achilles

Monroy

Height Investigations in Peru

Frisancho David, Oscar Frisancho

in 1590, was first published in English, "The History Natural y Moral de las Indias, written by the Jesuit José de Acosta, who had been in Peru from 1572 to 1574. In the third book is a description of his journey across the mountains of Pariacaca to 4500 meters above sea level, where he and his companions had different symptoms as "deadly sorrow", "retching and vomiting, some had" vomiting and cameras, almost all had a sense of death, even the beasts (horses) "is becalmed, so that there is sufficient to move spurs" . These complaints, says the chronicler, did not last but 3 to 4 hours until they went down to a lower altitude. The cause of these complaints was attributed to the "air element is there so subtle and delicate that it is not provided to human respiration, which requires thicker and warmer." He also referred to cold air and "penetrating" (1)

Most authors accept this story as correspondence to acute mountain sickness or altitude sickness. We agree with this thesis have observed and cared for many people affected by the severe mismatch to the task. In summary we can say that the story of the Jesuit Acosta, is the first clinical description of altitude sickness or acute mountain sickness.

Since that time, many travelers, scientists, explorers, soldiers, etc.., Have fallen victim to altitude sickness, describing his discomfort in his diaries, notes and publications; Humboldt in 1802 to explore the heights of Chimborazo (Ecuador), Darwin in 1835 to cross the Andes on their journey from Santiago to Mendoza, and Liberator St. Martin in 1820 on his way from the Andes are famous personalities who suffered (2).

Jourdanet Denis, a French surgeon, had spent several years in Mexico, interested in problems of acclimatization in height, supported by his government planned to expand its overseas dominions. In 1861 he published in Paris two books about his comments, unfortunately its conclusions are clouded by his belief in the supposed European racial superiority in relation to the U.S. (3).

Jourdanet interested the young French physiologist Paul Bert, in the study of the lowest barometric pressure altitude. In 1878, Bert described his Animal experiments in hypobaric chambers introduced for the first time saying that the crucial factor of the causes of death in exposure to high altitude was the partial pressure of oxygen and barometric pressure not by reducing the partial pressure of oxygen, decreasing the amount of oxygen available to the human body (3.4). Bert

convinced his assistant Francois Gilbert Viault, to conduct the first scientific expedition to the Andes. Viault biologist and physiologist at the University of Bordeaux (France), with the approval of the Faculty of Medicine of Lima and accompanied the bachelor Juan Mayorga left Lima on October 4, 1889 to Morococha mining camp (Junín) located at 4.500 meters above sea level (4).

Viault spent a month and a half in Morococha, demonstrating a "significant increase" the number of red cells in the native high, postulating that the polycythaemia was an adaptive mechanism to match. His blood gas studies showed that the proportion of oxygen in the blood of animals subjected to the environment of the height was the same as at sea level, this finding rebutted the presumption of probable Jourdanet "anoxyemia" height of the settler (5).

In 1921 an expedition of the Universities of Oxford and Yale, led by physiologist English Joseph Barcroft, visited Cerro de Pasco, Peru's population at 4300 meters above sea level for three months Studies on the effects of altitude on humans. Barcroft published a book in which he stated that the tall man was physically and mentally inferior to men in sea level (6).

When they met in Lima, the findings of Barcroft, caused surprise, particularly Dr. Carlos Monge Medrano. Monge decided to organize an expedition to La Oroya to refute Barcroft.

Monge in 1924 had told his students about their observations of a mismatch type of man on high: "The height erythremia" whose symptoms disappear when the patient drops to sea level. "These erythema healed on the coast, returning to the great heights" have serious symptoms again. " In 1925 to present their research at the National Academy of Medicine called it "The disease of the Andes" (7.8).

In April 1927, Carlos Monge Medrano, Alberto Hurtado, Enrique Encinas, César Heraud and 8 medical students, under the auspices of the Universidad Mayor de San Marcos started the first scientific expedition to the Peruvian Andean region (La Oroya, Ticlio and Morococha), its objectives were to determine the effects of altitude on the human body. The results published in the Annals of the Faculty of Medicine "showed great physical ability and mental normality of the natives, adapted to the environment for millennia in height, on the other hand extended the initial observations on Monge's Disease the Andes and chronic mountain sickness (7,9,10). On this trip

Carlos Monge Medrano, demonstrated his ability as a physiologist and promoted the study of pathology Andes. Submitted its report to the University of San Marcos, National Academy of Medicine, and in the VII Pan American Sanitary Conference held in Lima this year (1928) (10).

The Paris Faculty of Medicine in 1929 organized a scientific meeting, to discuss the "Disease of the Andes", Carlos Monge was introduced by the famous professor Henry Louis Vasquez, author of several works on polycythemia vera.

Days after Professor Roger GH, submitted a report to the French Academy of Medicine, concluding that the disease of the Andes, was a peculiar disease of the regions of high and should be called the "Monge disease" (10) .

Monge studies published in French, were reviewed in 15 European medical journals, beginning an era of scientific bonanza for the "Peruvian Medical School."

Academies of Rome (1928), Turin (1928), Paris (1929), Buenos Aires (1934), Santiago (1934), the Universities of Lyon and Chicago (1936), the Washington Sanitary Conference (1936); heard attentively to the presentations of Professor Monge on biological problems at altitude (10). Alberto Hurtado

Abbey, after completion of his graduate studies at Harvard University in 1927, he joined the Faculty of Medicine, San Fernando, actively participating in the first scientific expedition to the high Peruvian (10). Howard decided to devote himself entirely to research, early work in those years are devoted the study of anthropometry and hematology of native high (9), (10), (11).

Hurtado in 1937 entered the Academy of Medicine, to work "physiological and pathological aspects of life at altitude," emphasizing the processes of adaptation and pulmonary gas exchange in humans high (10), (11) , (12). That same year described for the first time in the world Edema High Altitude Pulmonary (10).

In 1944 Humberto Hurtado and Aste discovered the rightward shift of the dissociation curve of hemoglobin in high altitude dwellers. This finding was well interpreted by the authors, who indicated that they facilitated the release of oxygen in tissues (12). About

Monge and Hurtado joined many physicians from different specialties, participate in the 8 Andean expeditions to different areas of Peru, between 1927 to 1932 (10), (13). In 1931, being rector of the Universidad Mayor de San Marcos Dr. José Antonio Encinas, created the Institute of Andean Biology and Pathology. Dr. Carlos Monge Medrano was its first director.

In 1940 the institution was formalized as the National Institute of Andean Biology in 1944 finally joined the University of San Marcos. There they worked Alberto Hurtado, Humberto Aste, Andrés Rotta, Cesar Merino Cesar Reynafarje, Reynafarje Baltazar, Cesar Faura, Fausto Garmendia, Tulio Velasquez, Emilio Picon. Dr. Tulio Velásquez it now runs (11).

In 1961, when he founded the University of Medical and Biological Sciences (now the University Peruana Cayetano Heredia), was also born the Institute of High Altitude Research (IIA). Founded by Alberto Hurtado with 8 research laboratories has been directed by Humberto Aste, Federico Moncloa, Roger Guerra García, Eduardo Pretell, Luis Ruiz and Francisco Sime (12).

Other researchers have noted internationally for its contributions to the knowledge of the biology of man and height are: Javier Arias Stella, Sixto Recavarren, Carlos Monge Cassinelli, Dante Penaloza, Pablo Mori, Jorge Berrios, Luis Llerena, Mario Saldana, Hever Kruger, Luis Sobrerilla, José Whittembury (12), (13).

has been extensive and meritorious scientific work of the Peruvian Medical School Height, your contributions are not only referring to human beings, but also to life at the height of the animals and plants (11), (13).

recognition to all this work, crystallized in the "Premio Bernardo A. Houssay ", awarded in 1972 to Professor Alberto Hurtado by the Organization of American States (OAS). This grand prize has lifted all his collaborators and disciples.

In the National Congresses of Medicine Height: La Oroya (1981), Puno (1983), Cerro de Pasco (1985), Huanuco (1987) and La Oroya (1989), International Conference on Biology Height: Puno ( 1987), La Oroya (1978), Arica (1988), Cuzco (1990), have discussed various aspects of life and pathology in height.

participated in these events the Institute of Andean Biology, Research Institute of height, the Bolivian Institute of Andean Biology (led by Jorge Ergueta), the Pathology Institute of Peace (whose director is Gustavo Zubieta), Center Medical Research Height (directed by Emilio Marticorena of Chulec Hospital of La Oroya). Daniel Alcides Carrión Association (Cerro de Pasco). The Universidad Nacional del Altiplano (Puno) and the Medical Corps Hospital Manuel Núñez Butrón (Puno).

many biological phenomena remain to be addressed, and we believe that the Andean college students have at their disposal a great natural laboratory. Would be worthy rivals of Monge and Hurtado, who gave luster to the Peruvian medical science.


REFERENCES

1.Acosta J. Natural and Moral History of the Indies. Edit. Fondo de Cultura Economica, Mexico 1962.
2. E. Encinas Soroche: definition, history, theories discussed, diagnosis, prophylaxis and treatment. Annals of the Faculty of Medicine, Year: XI, No. 1 and 2, April-June. 1928, p.: 210-248.
3.Villena A. First scientific expedition to the Andes: Centenary. Dominical (El Comercio, Lima), December 10, 1989. 4.Pamo
O. Issues of Medical History in Peru. Megaprint Lima Ediciones SA 1990. 5.Viault
F. On the amount of oxygen in the blood of animals on the high plains of South America. Medical Chronicle 1891, 8:155-157. J. 6.Barcroft
Observations upon the effect of high altitude on the Physiological Process of the Human Body, Carried out in the Peruvian Andes, chiefly at Cerro de Pasco. Transactions of the Royal Philosophical Society of London 1923; 211.
7.Monge C. Disease of the Andes: clinical studies. Annals of the Faculty of Medicine, Lima 1928, 11 (1-2): 76-209.
8.Monge C. L'Altitude Erythrémies them. Préface du Professeur Roger GH, Masson et Cie. Editeurs. Paris 1929. Peruvian 9.Aste
H. Contribution to the study of the biology of high altitude (Introduction to the topic.) Friday Medical Journal 1974, 25: 24-28. R. García 10.Guerra
Biomedical research in Peru. Cope Journal 1974; 5: 27. 11.Velásquez
T. Height: national problem. Proceedings of the First Conference Medicine and Surgery of the height La Oroya (Peru) 1978, p.: 9-14. 12.Universidad
Cayetano Heredia. Research Institute 1961-1986.Betaprint Height SRL Ediciones, Lima 1987. M. 13.Cueto
Scientific Excellence in the periphery. Grade-Ed Concytec, Lima (Peru) 1989.

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3730 m

La Oroya Antigua, on the left bank of the Mantaro River


Bello rainbow 6pm. on 10 September 2009 on the casting and La Oroya Antigua (Photo: Angelica Lopez)


Chulec Area, which is located in Medical Center Chulec


GENERAL MORBIDITY IN THE 2008

OROYA

view based on information from the Ministry of Health of Peru, dominated by respiratory diseases in medical practice throughout the country, we are presenting the information in the pathology found in three different hospitals in La Oroya in 2008, as a first information, given that the national statistical information has a considerable delay.

1 .- ESSALUD, Social Security Hospital workers serving the area, their wives and children under 18. 2 .-

HEALTH CENTER OROYA, Centre Hospitalier Ministry of Health clinic, which caters to the population without health insurance and whose population is predominantly children, women and elderly. 3 .-

Chulec MEDICAL CENTER, Small Private Hospital Center Doe Run Company, which serves parents and children of workers who have no access to social security, some private insurance systems and case dependent on the Company.

This information will allow our readers an idea of \u200b\u200bthe epidemiological profile of an industrial town about 50 000 inhabitants, 3730 meters, located in the Peruvian Andes to 3 hours east of Lima, called La Oroya and that is also known as: "The Metal Capital of South America" \u200b\u200b for being one of the largest metallurgical centers of the world since 1922 .

At the same time will demystify some tissues paradigms speculate on the main disease in this city.

Dr. Achilles MONROY




Source: Essalud



Source: MINSA



Source: Medical Center Chulec

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AFFINITY OF HEMOGLOBIN FOR OXYGEN AT THE HEIGHT

dissociation curve of hemoglobin

AFFINITY OF HEMOGLOBIN FOR OXYGEN AT THE HEIGHT IS DIMINISHED

want to add some ideas to read the previous article of this blog: " MAN IS THE HEIGHT FULLY ADAPTED? "we have sought to complement, so we extend some concepts and images that help us better understand the dissociation curve of hemoglobin.

Saturation is the percentage relationship between hemoglobin bound to oxygen or oxyhemoglobin (HbO2) and total hemoglobin. That is to say between the content O2 present in the blood and their potential to contain it.

hemoglobin and oxygen form to join a labile compound, oxyhemoglobin (HbO2). The physical and chemical characteristics of this union have not been properly interpreted, but their behavior in breathing is one of the most interesting and wonderful functional systems has created nature.



The amount of hemoglobin that binds oxygen in the blood is proportional to the pressure of O2. However, HbO2 and pO2 relationship is not linear but exponential curve that represents it is called DISSOCIATION CURVE OF HEMOGLOBIN.

Saturation is fully operational at pressures of 100 mm Hg, when the pressure decreases the oxygen is released. Early

Great Falls tension required to release small amounts of oxygen, as well as low pressure for example at 60 mm Hg saturation is still 90%. As you descend the relationship is reversed and the middle of the curve small changes in pressure sufficient to release large amounts of oxygen.

Hb binds oxygen for your call "affinity." As full saturation is on the horizontal part of the curve, it is very difficult to determine the pressure of O2 to get to 100% saturation and preferably Use the "value of pO2 is necessary for 50% saturation" to describe quantitatively the affinity.

height in the affinity of hemoglobin for oxygen is reduced to facilitate the acquisition of oxygen to the tissues . Benesh has shown that the oxygen affinity of hemoglobin can be reduced by their interaction with organic phosphates (2-3 DPG) in red blood cells. This can already see the 24 hours up to the task.

Saturation and Hemoglobin Level

Altitude Hypoxia increases organic phosphates contained in red blood cells that are responsible for the increase the use of oxygen to the tissues.

The physiological significance of this affinity is evident. The O2 Hb can release more easily and relatively higher pO2.

Other environmental conditions such as pH, temperature, pCO2 and 2-3 DPG can shift the dissociation curve of hemoglobin.

(Based on Adaptation to high altitude of C. Reynafarje and network)

Dr. Achilles MONROY

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heart attack

The
Myocardial Infarction

typical pain transfixing chest which is at sea level


normal EKG Waves Classic


QS in II, III, aVF old diaphragmatic myocardial


HEIGHT CARDIAC INFARCTION WITHOUT PAIN PRESENTS TYPICAL

Hope Hospital in Cerro de Pasco (now defunct in the mid-90), also called American Hospital having been founded in the time of the Cerro de Pasco Copper Corporation, at 4330 meters, Dr. Fernando Acosta reviewed the issue, drawing on his experience as a cardiologist working at height, where he realized that the prevalence of ischemic heart disease was very low if not rare in contrast to the case at sea level (which is a condition of every day).

be tracked for a decade looking for possible suspects in heart disease patients. In 2014 found 135 cases evaluated different carriers and valvular cardiovascular disease, congenital heart disease, chronic lung cor, conduction disorders, rhythm and others.

Only 6 cases were classified as having sequelae of myocardial infarction by electrocardiographic results found. All were male and ages were 55 to 74 years. All were born at levels greater than 4000 m and permanently residing in Cerro de Pasco.

The evaluation of these 6 cases have been explained at length in the study, and reported that they all refused or did not remember any symptoms related to infarction as acute chest pain transfixing. They used the Rose questionnaire, ECG, biochemical tests and stress test.

One of them was diagnosed in a cardiovascular surgical risk, in whom he detected a typical evolution of Asymptomatic Myocardial Infarction.

Consider that a heart attack pain is the translation of myocardial anoxia due to coronary occlusion. Literature also describes painless heart attacks, but acute myocardial failure associated with acute symptoms such as acute pulmonary edema, arrhythmias, fainting or sudden shock. Thus

description Acosta - supported by our clinical observation (who worked with him, is that the clinical behavior of myocardial infarctions in height is different than described in the literature, are quiet or silent and asymptomatic.

been reported also in this blog in the article " THE HEART IS BIGGER, HEAVIER AND HEIGHT vascularized "(even showing images of the coronary circulation), which at birth, at sea level, many coronary vessels are obliterated, understandable process that there is no pressing need to keep them open enough oxygen. But this process does not occur in those born to great heights as the city of Cerro de Pasco, where the vessels would remain open and channeled during the time they remain in their habitat as a mechanism for adaptation to hypoxia, enzymatic and metabolic changes that occur in the myocardial cell in which oxygen extraction by the myocardium should be increased to what is required an increase in vascularization and intercoronary anastomosis.

These anatomical changes in the coronary vasculature not seem to be met in sea level natives living at high altitude.

have also found low prevalence of hypercholesterolemia in the native high, resulting in low frequency of atheromatous plaques in artery walls at autopsy.

The very low prevalence of 3 per thousand mentioned by Acosta would be a compensatory mechanism for life in this condition, "it would seem that was magnanimous nature with native high as in these frigid lands there coronary risk factors"

Cerro de Pasco with his former lagoon in the old town Patarcocha

(Based on: Silent heart attack at the height, Fernando Acosta Raez, "Proceedings of the Third National Congress High Altitude Medicine, 1985, Cerro de Pasco ")

Dr. Achilles MONROY

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SILENT IN THE HEIGHT UNPUBLISHED BIOGRAPHY of Daniel Alcides Carrión

Daniel Alcides Carrión, genuine photos

5 OCTOBER: DAY PERUVIAN MEDICAL

This time, we pay tribute to Daniel Alcides Carrion, martyr of the Peruvian Medicine on who has written many biographies and who have made numerous comments about his sacrifice on October 5, 1885.

However, we have always recognized medical Carrionas his example and sacrifice. All of Peru has also done many institutions, schools, hospitals, medical associations and even a province of Peru has its name and the nation had declared NATIONAL HERO, MARTYR OF THE PERUVIAN MEDICINE 25,342 BY LAW, Oct. 4 1991.
merit
The latter has contributed one of our most illustrious doctors Researchers at the height of the hospital's Hope Chulec Cerro de Pasco and La Oroya, Dr. Fernando Acosta Raez, a cardiologist and he required of all medical activities for the Day of Medicine until he retired, who from the 80's transmitting all its fervor and paid tribute to Carrión making a different profile to know that we're used to hearing, as civil hero, a condition that was gaining ground so that later in 1991 will feed into

Law
share

with you a summary of the unpublished biography.

Dr. Achilles Monroy

Daniel Alcides Carrión TRIBUTE TO THE CENTENARY OF HIS DEATH 1985

UNPUBLISHED SPEECH BY DR. FERNANDO ACOSTA EN CERRO DE PASCO Raez

I make you aware of that undoubtedly there were two circumstances that impacted on the life of Daniel Alcides Carrión, the unfortunate war with Chile from 1979 to 1984 and then participate in two men of medical science, both of Chilean nationality: Sanfurgo and Left. Daniel Alcides Carrión

was born on August 13, 1857 in this affluent city of Cerro de Pasco, under which we are sheltering sky, meeting in tribute to his favorite son, was 22 years old and lived and contemplating contingencies specific to a country shaken by both contemporary social strife, as the high volatility of institutional care of the nation and finally the Chilean invasion Peruvian territory.

Baltazar Carrión, doctor and lawyer Ecuador, Carrion's father


Dolores García Navarro, cerreña of Quilacocha lady, mother of Carrión Carrion

brilliantly after completing high school, had already entered the Faculty of Medicine, San Fernando, when the invader Chilean infighting advantage of Peruvian leaders began to invade the south of our country, until the day comes that does threaten to enter Lima.

As the invading Chilean army had been ravaged and looted the villages of southern Peru and Lima approached, men of all ages were able to organize in the midst of a disorganized government. Those patriots to defend the city of Lima took up stones, sticks, and the few weapons they had.

The country wound his pride had intended for something very sublime Carrión. Students of the Faculty of Medicine San Fernando lived national instability at the same time were encouraging their patriotism. It is then that students were to integrate sanfernandinos Battalion Independence "assigned to the fields of San Juan and Miraflores where there went into action and just in the heat of battle and the whirlwind of bullets found at Carrion heading towards the most advanced in the trenches in support of friends and fellow countrymen, and many others fulfilling their sacred commitment to the motherland with great heroism.

The invader by their numerical superiority and better organization and availability of weapons and harmful following slogans, begins to destroy all evidence of progress and nationalism. Thus Lima's museums destroyed, plundered the National Library of Medicine and the Faculty makes a barracks occupied by the Chileans.

then the break occurs Faculty Carrión Sanfernandina and like his colleagues, he secretly began to attend the address of their teachers to take classes. In these dire circumstances for the country, did his years Carrión second, third and fourth of the Faculty of Medicine.

During the years of medical training, Carrion went to visit his mother lives in this, his hometown Cerro de Pasco, sometimes made it through the crossing of the Cordillera de la Viuda, sometimes by Matucana.

Warts Bridge near Matucana, at the time of the construction of Central Railway

A sadness and nostalgia in the aftermath of the war in the country, Carrion joined the memory of he saw and deep drama unfolding in the construction of the railway from Lima to La Oroya, where many workers died of fever in La Oroya. So many died that it was said that each sleeper to be placed in the building represents a human life.

When in 1883, by the Treaty of Ancon, peace is signed between Peru and Chile, Carrion is integrated into hospital "Two May, where he resumed his university studies and extend their knowledge about the disease that so disturbed him.

happens then the second major event that impacts the soul of Daniel Alcides Carrión patriot. The Left Chilean doctor who had studied in Germany with Virchow, published his work entitled "Microbe of the Peruvian wart" in the "Archiv fur Anatomie und Phisiologic Pathologishe Klinisk Medicin und fur", published in German and translated into Castilian, with large diffusion Lima by the Chileans, with intentions of apparent supremacy.

Against this publication, doctors and medical students were moved in her deepest feelings of patriotism, especially when the country was recovering from a painful war effort had greatly intensified nationalist sentiment of all Peruvians. The reaction was immediate and emphatic Carrion said the following words: "I know it gives me to see guys like Izquierdo Chilean doctor who could barely see a few tumors, is set to give opinions and write about a disease that no better than the Peruvian doctors do their part knowingly "

was already convinced by their studies and detailed histories of two separate nine cases observed in recent years, preparing his bachelor's thesis and was certain etiological unity of La Oroya fever with the wart and the only way to prove it was with an inoculation as conclusive proof. The possibility that nobody would agree or offer to an investigation of this kind, do you germinate the idea of \u200b\u200binoculation as practiced sound evidence and only weapon to show the Chilean defeated on the field of science.

And so an August 27, 1885, despite the pleas of his teachers and fellow students insist inoculation, the same as it is practiced by Dr. Evaristo Chavez, with blood drawn from a patient's verrucous tumor Carmen Walls of the bed of the Board No 5 Our Lady of Mercy Hospital on May 2. Carrión

this action, testified to his heroism and deep love of country. From the date of inoculation, Carrion noted his observations in his diary of sick, which constitutes an exciting reading.

At that day, the same clinical history is not 10, his colleagues noted, step by step and day by day and reading his martyrdom cause such an impact, that all physicians Carrión in each week of Peruvian medicine, attempting to live the passion of the last days of Carrion.

We read in the October 3, 1885: "Today the patient experiences a worsening of all symptoms, it is of weakness that will not allow himself to sit up from his bed. In the morning view was presented to Dr. Flores, who recommended his transfer to a more hygienic. Carrion is concerned, vacillating between leaving the home of her godmother, who assists him with solicitous love and decides not to attend a clinic with its undeniable benefits. But today at 11 am. Is persuaded to move to the French Hospital, Having been made because this medical lords was necessary to perform a blood transfusion Jan that day, fully understood it was better to do at that facility. We proceeded to dress and put on a sofa and as he prepared the table that was to lead, goes to Mr. Izaguirre, first-year student of medicine with these solemn words: I have not killed my friend, now your turn to finish the work already begun following the path that I drew ... Embrace your respectable then godmother, hide their true state asking her beloved mother, then leads a last look at the home hospital, mute witness to their suffering misses an furtive tear, and faints into the arms of his friends. "

French Hospital, where he died Carrión on October 5, 1885

These fragments of the Journal of Carrion's disease show the martyr to a higher ideal, with a deep longing for vindication of national pride and reach the summit in search Indeed, with a deep sense of nationalism and great dignity of science.

at 11 the night of October 5, 1885, without being made and offered blood transfusion after uttering the phrase "est finit" Daniel Alcides Carrión enters immortality. Then it

medical gentlemen, and gentlemen, let us be aware that the best tribute to our Carrión field, will make us be "equipped with large medical moral values \u200b\u200bthat allow us to approach the patient with love and not obligation, to understand the patient who suffers and not the patient difficult or intractable, that our devotion to the sick leave is not victimized by the trouble, that our decisions against the patient are the result of meditation and not the product of routine and fatigue, do not forget that a long sentence of consolation rather than a pill and make sure that the patient sees in us to a friend who confess their anxieties, their sorrows and secrets and we hope to finally understanding and loyalty "

Fulfilling these desires, the Tribute to Carrión, not only will by this date marks the anniversary of his death, but will be daily and permanently in every one of our medical acts. Viva

our national hero and martyr of the Peruvian Medicine Daniel Alcides Carrión!

(Summary biography published in Proceedings of the Third National Congress of Medicine Altura, Cerro de Pasco, October 1985)

photos from last year CM Chulec

Doctors in La Oroya Chulec Hospital, October 2008



Doctors in La Oroya Chulec Hospital, October 2007




Chulec Hospital of La Oroya, which survives and refuses to die anyway.
No year since its founding in 1921, doctors, residents, interns, serum and staff have failed to do a tribute to Carrión.
In 2009 for reasons other is resting and sleepy but the doctors always will honor Carrión October 5







Medical Equipment 2008 Chulec Medical Center in the front of the Hospital

Storage Auctions Pittsburgh 2010

PLATELETS IN HEIGHT