Osteosíntesis mínimamente invasiva con placa anatómica bloqueada en fracturas desplazadas del tercio medio de clavícula / Minimally invasive osteosynthesis with blocked anatomical plate in displaced fractures of the middle third of the clavicle

Resumen: El tratamiento quirúrgico de las fracturas desplazadas del tercio medio de clavícula ha ganado popularidad durante la última década, ya que permite acortar el período de recuperación, acelerando la reincorporación laboral y deportiva, al mismo tiempo que disminuye significativamente el riesgo de no unión. Sin embargo, las molestias relacionadas con el abordaje cutáneo como dolor e irritación a nivel de la cicatriz, las alteraciones sensitivas persistentes (hipoestesia, hiperestesia o disestesias) y la inconformidad cosmética continúan siendo motivo de preocupación por parte de los pacientes, alterando su percepción subjetiva del resultado quirúrgico obtenido. En tiempos recientes la técnica mínimamente invasiva se ha descrito para el manejo de este tipo de fracturas, demostrando reducir las posibles complicaciones de la técnica tradicional abierta mientras que mantiene sus principales beneficios, optimizando además la capacidad biológica reparativa de la clavícula, ya que respeta la vascularización del foco de fractura. El objetivo de este artículo es describir paso a paso la técnica quirúrgica mínimamente invasiva para el manejo de fracturas desplazadas del tercio medio de clavícula, reportando además los resultados clínicos obtenidos en una serie de casos intervenidos con esta técnica.

Abstract: Surgical management of displaced midshaft clavicular fractures has gained popularity in the last decade due to reductions in functional recovery times and lower rates of nonunion. However, several complications related to the open approach have been described and remain concerning for patients. These potential sequelae include scar pain, local irritation, peri-incisional numbness, and cosmetic deformity, all of which may contribute to unsatisfactory subjective outcomes. Recently, minimally invasive plate osteosynthesis (MIPO) technique has been described for the treatment of these fractures. This approach presents the opportunity to reduce shortcomings of the traditional open approach while maintaining its benefits, respecting the biological healing environment and preserving blood supply to the fracture site. The purpose of this study is to provide a step-by-step description of the MIPO surgical technique for management of displaced midshaft clavicular fractures and report the clinical outcomes of a case series using this technique.

Vigilancia epidemiológica del virus Occidental del Nilo en las llanuras orientales de Colombia / Epidemiological surveillance of West Nile virus in the Eastern Plains of Colombia

RESUMEN Objetivo. Identificar la presencia del virus del Oeste del Nilo en equinos y mosquitos en ocho municipios del departamento del Meta. Materiales y métodos. La investigación contó con el aval del Comité de bioética de la Universidad de los Llanos. Se analizaron mediante pruebas serológicas y moleculares 613 muestras de equinos criollos y de raza cuarto de milla, destinados a actividades deportivas y de trabajo, con un rango de edad de 2 a 15 años, en los transectos: Villavicencio-Restrepo-Cumaral, San Martín - Castilla la Nueva-Granada y Puerto López-Puerto Gaitán, analizados en 62 pool y 213 mosquitos. Los pool de sueros de equinos y mosquitos fueron analizados por ELISA y PCR. Resultados. No se encontraron animales seropositivos mediante la prueba de ELISA y las pruebas moleculares también fueron negativas. Conclusiones. Aunque en este estudio no se evidenció la presencia de anticuerpos IgM por la técnica de Elisa y las pruebas moleculares (RT-PCR) también fueron negativas para circulación viral, en los municipios objeto de estudio, es importante indicar que la detección molecular en sueros, requiere unos niveles de viremia representativos y que el animal se encuentre en la fase aguda de la enfermedad. Aunque es posible que la población equina se mantenga libre de contacto con el virus, se debe mantener la vigilancia epidemiológica frente a este importante patógeno para la salud humana, especialmente por la presentación de brotes de otros virus zoonóticos como la Encefalitis Equina del Este y Encefalitis Equina Venezolana en los departamentos del Meta y Casanare, contiguo a este.

ABSTRACT Objective. Identify the presence of West Nile virus in horses and mosquitoes in eight municipalities of the department of Meta. Materials and methods. The research was supported by the Bioethics Committee of the University of Los Llanos. 613 samples of Creole and quarter-mile equine horses, intended for sports and work activities, with an age range of 2 to 15 years, were analyzed using serological and molecular tests in the transects: Villavicencio-Restrepo-Cumaral, San Martín- Castilla la Nueva-Granada and Puerto López-Puerto Gaitán, analyzed in 62 pools and 213 mosquitoes. The pool of sera of horses and mosquitoes were analyzed by ELISA and PCR. Results. No seropositive animals were found by the ELISA test and molecular tests were also negative. Conclusions. Although in this study the presence of IgM antibodies was not evidenced by the Elisa technique, and molecular tests (RT-PCR) were also negative for viral circulation, in the municipalities under study, it is important to indicate that the molecular detection in sera, it requires representative levels of viremia and that the animal is in the acute phase of the disease. Although it is possible that the equine population remains free of contact with the virus, epidemiological surveillance should be maintained against this important pathogen for human health, especially due to the outbreak of other zoonotic viruses such as Eastern Equine Encephalitis and Encephalitis Venezuelan Equine in the departments of Meta and Casanare, adjacent to this.

Incidencia de la morosidad de las cuentas por cobrar en la rentabilidad y la liquidez: estudio de caso de una Empresa Social del Estado prestadora de servicios de salud / The incidence of delinquent accounts receivable in profitability and liquidity: a case study on the state social enterprise

OBJETIVOS: determinar la incidencia de la morosidad de las cuentas por cobrar en la rentabilidad y liquidez de la Empresa Social del Estado Hospital Universitario Erasmo Meoz, período 2005-2009, realizada en la ciudad de Cúcuta, Departamento Norte de Santander, Colombia. METODOLOGIA: se aplicó una investigación de tipo documental, para determinar y analizar los indicadores financieros referentes a la morosidad de las cuentas por cobrar, rentabilidad y liquidez; por lo tanto, se requirió de la revisión y consulta detallada de fuentes primarias (estados financieros e informes) de la Empresa Social del Estado Hospital Universitario Erasmo Meoz período 2005 - 2009 RESULTADOS: en particular, se evidenció el crecimiento acelerado de los costos y los gastos sin ningún control con respecto al aumento en las ventas, igualmente el crecimiento de las cuentas por cobrar, lo cual incidió directamente en la sostenibilidad financiera del Hospital. DISCUSION: ante la problemática que refleja el Hospital por la alta morosidad de cartera y la insostenibilidad financiera, la Institución requiere con urgencia promover lineamientos y estrategias financieras que conduzcan al mejoramiento de la competitividad y oportunidad en la prestación de servicios de salud de tercer y cuarto nivel de complejidad, beneficiándose los usuarios más pobres de la región y su área de influencia.

OBJECTIVE: to determine the incidence of delinquent accounts receivable on the profitability and liquidity of the Erasmo Meoz University Hospital State Social Enterprise, 2005-2009 period, carried out in the city of Cúcuta, Norte de Santander Department, Colombia. METHODOLOGY a documentary research was carried out in order to determine and analyze the financial indicators referring to delinquent accounts receivable, profitability and liquidity; however a detailed review and inquiry into the primary sources (financial statements and reports) for the Erasmo Meoz University Hospital State Social Enterprise in the 2005-2009 period was required. RESULTS: pin particular there was accelerated growth of costs and expenses with no control with respect to a rise in sales. Likewise the accounts receivable grew, directly impacting the Hospital's financial sustainability. DISCUSSION: faced with the problem reflected by the Hospital in its high portfolio delay in payment of liabilities and financial unsustainability, the Institution urgently needs to introduce guidelines and financial strategies which promote greater competition and opportunity in the provision third and fourth level of complexity healthcare services, thus benefiting the region's poorer residents and its area of influence.

Resultados del Programa Nacional de Implantes Cocleares: Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau / Results of the National Cochlear Implant Program: ENT Department Barros Luco Trudeau Hospital

Introducción: La hipoacusia sensorioneural bilateral profunda es la tercera causa de discapacidad en Chile, con una incidencia de entre 1 a 3 casos por cada 1.000 nacidos vivos, siendo muchos casos susceptibles de ser tratados mediante implante coclear. Objetivo: Describir resultados de la cohorte de pacientes implantados en el Hospital Barros Luco Trudeau. Material y método: Estudio de cohorte retrospectiva. Se reportan los resultados de la totalidad de pacientes implantados en el período 2003-2011. Resultados: Fueron implantados 80pacientes. La mediana de edad de implantación fue 48 meses. Treinta y siete (46,25%) pacientes fueron mujeres, 7 (8,75%) fueron prematuros, y 14 (17,5%) tenían el antecedente de meningitis bacteriana. Sesenta y ocho (85%) fueron diagnósticos prelinguales, 9 (11,25%) poslinguales, y 3 (3,75%) perilinguales. El PTP promedio prequirúrgico fue 111,82 dB, y el posquirúrgico con implante 25,36 dB (p <0,0001). Respecto a integración, el 100% de los pacientes poslinguales, el 67,7% de los prelinguales, y el 100% de los perilinguales se encuentran integrados a sus actividades. Se ha observado el 5% de complicaciones: una parálisis facial, un hematoma infectado y dos alergias a cera de hueso. Conclusión: Los resultados de este programa son altamente satisfactorios. Todos los pacientes se encuentran en seguimiento hasta la fecha con una buena adherencia terapéutica y rehabilitación. La evaluación de este programa permite plantear que debería ampliarse.

Introduction: Profound bilateral sensorioneural hearing loss is the third leading cause of disability in Chile, with an incidence of 1 to 3 cases for every 1.000 born, which may be managed with cochlear implants. Aim: Describe results of the cohort of patients implanted at Barros Luco Trudeau Hospital. Material and method: Retrospective cohort study. We report the results of all patients implanted in the period from 2003 to 2011. Results: 80 patients were implanted. The median age at implantation was 48 months. 37 (46.25%) patients were female, 7 (8.75%) were premature, and 14 (17.5%) had a history of bacterial meningitis. 68 (85%) were prelingual diagnosed, 9 (11.25%) post-lingual, and 3 (3.75%) perilinguals. The average preoperative PTP was 111.82 dB, and postoperative was 25.36 dB (p <0.0001). Regarding integration, 100% of postlingual patients, 67.7% of prelingual, and 100% of perilinguales are fully integrated into their activities. There have been 5% complications: one facial paralysis, one infected hematoma, and two bone wax allergies. Conclusion: The results of this program are highly satisfactory. All patients are up to date with good adherence and rehabilitation. The evaluation of this program allows us to suggest that should be expanded.

Cryptococcoma of the brain in an immunocompetent man.

Cryptococcosis is a common opportunistic systemic disease in immunocompromised patients. Pulmonary or brain cryptococcosis is the most common clinical presentation. Immunocompetent patients can also be affected, especially in tropical and subtropical zones where the life cycle of the causal agent, Cryptococcus gattii, is completed. We present a previously healthy man with progressive intracranial hypertension and a right paraventricular mass on CT scan and MRI. Cryptococcus gattii yeasts were isolated from the cerebrospinal fluid. A ventriculoperitoneal shunt was placed and the patient was treated with amphotericin B, fluconazole and dexamethasone. The patient died due to severe intracranial hypertension.

Evaluación de la toxicidad subaguda del Camu-camu (Myrciaria dubia) administrado por vía oral en ratas / n vitro evaluation of the subacute toxicity of oral administration of (Myrciaria dubia) Camu-camu in rats / I

Camu-camu, es un árbol frutal, oriundo de la amazonía sudamericana que crece en las orillas anegables de ríos amazónicos. Pertenece al género Myrciaria, especie dubia. Presenta gran importancia nutritiva. Su alto contenido en ácido ascórbico (2780 mg/100 g de pulpa) le confieren propiedades antioxidantes. Objetivo: Evaluar la toxicidad subaguda (30 días) del Camu-camu. Material y método: Utilizamos 33 ratas albinas, macho, Holtzman, distribuidas en 3 grupos equitativos: Grupo I (grupo control), se le administró agua destilada, Grupo II y Grupo III, se les administró por vía oral el extracto seco de Camu-camu a las dosis de 100 y 200mg/Kg, respectivamente. Al inicio del experimento (basal), a las 15 y a los 30 días, se determinó: hemoglobina, WBC, urea, albúmina, creatinina, proteínas GGT, TGP, TGO, en sangre, y peso corporal; además, se realizó el examen histológico de hígado, riñones, bazo y estómago al finalizar el estudio (30 días). Resultados: Los valores de hemoglobina, albúmina y proteínas, fueron mayores que las del grupo control (p<0.05); a su vez, los valores de GGT fueron menores que los del grupo control (p<0.05). No encontramos evidencias de toxicidad sub-aguda, en ninguno de los 2 grupos expuestos, en el examen histopatológico. Conclusión: El Camu-camu, a las dosis y formas de administración, del presente trabajo, carece de efectos tóxicos para las ratas.

Camu-camu, is a native fruit tree of the South American jungle and grows at the borders of amazonian rivers. It belongs to Myrciaria generous and dubia specie and has a great nutritional importance. Contains a high amounts of ascorbic acid, (2780mg/100g of pulp), that is why it is good antioxidant. Objective: To evaluate the subacute toxicity of the atomized Camu-camu. Material and method: We used 33 Holtzman albino male rats, distributed in 3 equitable groups: Group I, the control group, only received distilled water, Groups II and III received 100 and 200 mg/Kg of Camu-camu, respectively. Blood samples were taken for biochemical analysis at the beginning, 15th and 30th days (at the end), to determinate Hb, WBC, urea, albumin, total proteins, creatinine, GGT, TGP, TGO and the weight of the animals; we also do the histological examination of liver, kidneys, spleen and stomach at the end of the experiments (day 30th). Results: The values of albumin, total proteins and hemoglobin were higher than the control group (p<0.05) while the values of GGT were lower that control group (p<0.05). We didnÆt find evidences of subacute toxicity in any of the 2 groups exposed to Camu-camu in the histopathological examination. Conclusion: Camu camu hadn´t toxic effect, in rats, with oral administration during 30 days.

Predictores de coledocolitiasis en población de alto riesgo sometida a pancreatocolangiografía retrógrada endoscópica en el Hospital Arzobispo Loayza / Predicting of choledocholithiasis in population of high risk submissive an endoscopic retrograde cholangiopancreatography in yhe Hospital Arzobispo Loayza

Introducción: La coledocolitiasis es una complicación frecuente de la litiasis vesicular. La pancreatocolangiografía retrógrada endoscópica (PCRE) es el "gold Standard" para su diagnóstico y tratamiento, sin embargo debido a su significativa morbilidad y mortalidad, otros métodos diagnósticos han sido planteados, tales como la colangiografía intraoperatoria (CIO) y la colangioresonancia (CRMN), reservado a la PCRE sólo para fines terapéuticos. Objetivo: Verificar la utilidad de los predoctores de coledocolitiasis descritos en la literatura. Material y Método: Estudio correlacional, observacional, transversal prospectivo que se realizó entre agosto del 2004 y enero del 2005 en el Hospital Arzobispo Loayza. Conocidos criterios clínicos, bioquímicos y ecográficos predictores de coledocolitiasis fueron analizados en 151 pacientes sometidos a PCRE. Usando análisis univariado y multivariado, se identificaron los factores de riesgo para coledocolitiasis, en el total de pacientes del estudio, así como en los pacientes colecistectomizados o no antes de la PCRE. Resultados: El análisis univariado en el total de pacientes encontró que la edad, ictericia, colangitis, biblirrubina directa, amilasa, deshidrogenada láctica (DHL), dilatación del colédoco (>8mm) y coledocolitiasis por ecografía, estuvieron asociados con coledocolitiasis. Cuando se evaluó por separado, el análisis multivariado en los tres grupos se encontró que sólo la dilatación del colédoco por ecografía fue el único predictor de coledocolitiasis en el grupo de pacientes post-operados. Conclusiones: Ningún indicador único es capaz de predecir, con total exactitud, la presencia de coledocolitiasis. Pero los parámetros descritos en la literatura, son de utilidad en nuestro medio.

Introducction: The choledocholithiasis is a frequent complication of gallstone disease. The endoscopic retrograde cholangiopancreatography (ERCP) is suitable for its diagnosis and treatment. That approach has both significative morbility and mortality so others methods of diagnosis have been proposed such as intraoperatorycholangiography (IOC) and magnetic resonance cholangiography (MRC), reserving ERCP only for therapy purpose.OBJETIVES: Verify the utility of choledocholithiasis predictors described in literature MATERIAL AND METHODS: This study is a correlational observational transversal prospective approach. It was performed at the Arzobispo Loayza Hospital from August 2004 to January 2005. Many clinical, biochemical and ecographyc predictorsof choledocholithiasis were analyzed in 151 patient underwent to ERCP. In all people under study and analyzing separately patients underwent to cholecystectomy or not previous to ERCP, it was identified some risk factors for choledocholithiasis by means of both univariate and multivariate analysis.RESULTS: The univariate analysis showed a relationships among age, icterus, cholangytis, direct bilirrubin, amylase, lactic deshidrogenasa, ductal dilatation (minor 8mm) and choledocholithiasis. In all groups, the multivariate analysis determined that ductal dilatation by ecography was the unique predictor for choledocholithiasisin the group of patients postoperated.CONCLUSIONS: None single indicator was able to predict with accuracy thecholedocholithiasis. However, the parameters described in the literature are useful in our country.

Validación del puntaje de Cedars-Sinai en la predicción de resangrado y mortalidad en la hemorragia digestiva alta no variceal / Validation of the score of Cedars-Sinai in the prediction of re-hemorrhage and mortality in the gigestive hemorrhage high nonvariceal

Introducción: La hemorragia digestiva alta es un serio problema de salud, con índices de mortalidad no modificados durante los últimos años, a pesar de mejoría en el manejo. Objetivo: Validar el puntaje de Cedars-Sinai, para predicción de resangrado y mortalidad en el Hospital Nacional Arzobispo Loayza. Material y Métodos: Estudio prospectivo longitudinal, en pacientes con hemorragia digestiva alta; recolectando datos demográficos, clínicos y endoscópicos. Se aplicó el puntaje de Cedars-Sinai para clasificar a los pacientes: de bajo riesgo, riesgo medio y riesgo alto. Los resultados finales considerados fueron resangrado y mortalidad. La calibración se efectuó mediante Chi cuadrado, y la discriminación de puntaje se evaluó por análisis de curvas operativas del receptor (ROC). Se consideró buena discriminación un área bajo la curva mayor de 0.5. Resultados: Se evaluaron 143 pacientes, predominando el sexo masculino (54.5 por ciento), la edad media fue 57.8 años. La melena (48.95 por ciento) y la hematemesis (16.08), fueron los síntomas más frecuentes. Del total, 36,3 por ciento tomaban algún medicamento; correspondiendo AINEs a 55.7 por ciento e Inhibidores de la enzima covertidora de la angiotensina (IECA), el 25 por ciento. El 56.6 por ciento presentó comorbilidad asociada. Se diagnosticó úlcera gástrica (32.15 por ciento), úlcera duodenal (30.75 por ciento), gastritis erosiva-hemorrágica (20.3 por ciento), neoplasia gástrica avanzada (6.3 por ciento) y lesiones vasculares (4.9 por ciento). El resangrado y la mortalidad fueron 8.4 por ciento y 4.2 por ciento, respectivamente. El grupo de bajo riesgo no presentó eventos adversos; el de riesgo medio 7.25 por ciento y el de riesgo elevado, 13.2 por ciento. Las áreas bajo la curva fueron para resangrado (0.79 más menos 0.13; p=0.01) y mortalidad (0.73 más menos 0.12; p=0.01) y considerando ambos (0.66 más menos 0.12; p=0,034). Conclusiones: Este puntaje es aplicable en nuestro medio; adecuado para...

Introduction: Upper gastrointestinal hemorrhage is a serious health problemwith mortality rates that have remained unchanged for the last years in spite ofimprovements in management. OBJECTIVES. Validating the Cedars Sinai score for predicting rebleeding and mortality at the Arzobispo Loayza National Hospital. MATERIAL AND METHODS. Prospective longitudinal study in patients with upper gastrointestinal hemorrhage, collecting demographic, clinical and endoscopie data. The Cedars-Sinai score was applied in order to classify patients: low risk, medium risk and high risk. The final results were rebleeding and mortality. Calibration was done by X2, and the discrimination of the score was assessed by analysis of ROC curves.An area below the curve greater than 0.5 was considered good discrimination.RESULTS: We evaluated 143 patients, predominantly male (54.5 percent), the median age was 57.8. Melena (48.95 percent) and hematemesis (16.08) were the most frequent symptoms.Out of the total number of patients, 36.3 percent was taking some type of medication; NSAID's were taken by 55.7 percent and ACEI's by 25 percent. Associated comorbidity was found in 56.6 percent. The following diagnoses were made: gastric ulcer (32.15 percent), duodenal ulcer (30.75 percent), erosive hemorrhagie gastritis (20.3 percent), advanced gastric neoplasia (6.3 percent) and vascular lesions (4.9 percent). Rebleeding and mortality were 8.4 percent and 4.2 percent, respectively. The low risk group did not show any adverse events; the medium risk group, 7.25 percent and the high risk group, 13.2 percent. The areas under the curve were for rebleeding (0.79:1:0.13;p=0.01) and mortality (0.73:1:0.12;p=0.01) and considering both (0.66:1:0.12; p=0,034). CONCLUSIONS. This score is applicable in our environment and it is suitable for predicting rebleeding and mortality in patients with upper gastrointestinal hemorrhage, especially for mortality.

Efecto de dosis bajas de calcitonina sobre la remodelación ósea en mujeres postmenopáusicas con alto recambio / Effects of low calcitonin doses on bone remodeling in postmenopausal women with high bone turnover rate

Background: Calcitonin is specially indicated for the treatment of osteoporosis in women that cannot receive estrogen replacement therapy or that have a high bone turnover rate. Aim: To study the effects of low intranasal calcitonin doses on bone remodeling in postmenopausal women with a high bone turnover. Patients and methods: Forty one healthy women aged 56 ñ 6 years old, with a mean lapse after menopause of 7.6 ñ 6.5 years and with a high bone turnover rate, evidenced by an urinary hydroxyproline (mg/dl)/creatinine (g/dl) ratio of 52.4 ñ 7.2, were studied. They were randomly assigned to receive 100 or 50 U/calcitonin thrice a week during 3 months or to a control group that received placebo. All received 500 mg/day calcium carbonate. Urinary hydroxyproline/creatinine ratio was measured a 0, 15, 30, 60 and 90 days. Plasma bone fraction of alkanine phosphatases was measured at 0, 30 and 90 days. Results: Initial urinary hydroxyproline/creatinine ratio and plasma bone fraction of alkanine phosphatases were similar in all study groups and there was no change in these parameters during the study period. Conclusions: Intranasal calcitonin in doses of 100 U thrice a week or less, does not modify accelerated bone turnover in postmenopausal women

Síndrome de Cushing por secreción ectópica de ACTH: análisis del mecanismo fisiopatológico de la hipokalemia: comunicación de dos casos / Cushing syndrome with severe hipokalemia caused by ectopic ACTH secretion: report of two cases

We report a 42 years old male and a 66 years old female with a Cushing syndrome caused by ectopic ACTH secretion secondary to a carcinoid tumor. These patients had both severe hypokalemia, resistant to medical treatment and that subsided with bilateral adrenalectomy and supplementation with dexametasone. Cushing syndrome caused by ectopic ACTH secretion is characterized by a severe and rapidly evolving hypercortisolism. Hypokalemia is present in 90 percent of cases and is probably caused by a defect in 11 ß hydroxysteroid dehydrogenase, that limits the binding of cortisol to aldosterone receptor, metabolizing it to cortisone. Therefore, this alteration will increase the mineralocorticoid action of cortisol

Frecuencia de insulino resistencia y dislipidemia en mujeres jóvenes con síndrome de ovarios poliquísticos / Frequence of insulin resistence and dislipidemia in young women with polycystic ovarian syndrome

Se realizó una caracterización clínica, hormonal, de lipoproteínas y de resistencia insulínica en 31 pacientes con síndrome de ovarios poliquísticos sin tratamiento médico. Destaca la importante frecuencia de factores de riesgo cardiovascular en ellas; todas tienen índice de masa corporal aumentando, siendo el 71 por ciento obesas; 6,5 por ciento tienen presión arterial diastólica elevada; 35,5 por ciento de ellas presenta hipercolesterolemia, 13 por ciento tiene hipertrigliceridemia, y 83 por ciento son insulino resistentes. Estos hallazgos justifican la evaluación metabólica en mujeres anovulatorias hiperandrogénicas para indicar las medidas terapéuticas necesarias no sólo desde el punto de vista hormonal y de fertilidad, sino también desde el aspecto metabólico

Poliadenopatías cervicales por enfermedad de Kikuchi y Fujimoto / Cervical polyadenopathies by Kikuchi's and Fujimoto's diseases

Kikuchi and Fujimoto disease is a benign subacute necrotizing lymphadenitis, probably associated to a viral infection, that affects mostly young Asian women. We report a 19 years old woman, with a vast familiar history of thyroid disease (3 uncles with papillary thyroid carcinoma and one with Hashimoto thyroiditis). After an upper respiratory infection, she presented with painless cervical adenopathies. Cervical ultrasound examination detected an 8 mm thyroidal nodule. She was operated with the diagnosis of thyroidal cancer. The pathological examination confirmed that the nodule was papillary thyroidal cancer, but the study of the resected lymph nodes, revealed a Kikuchi and Fujimoto disease

Macrotumor suprarrenal diagnosticado por tomografía axial computarizada: experiencia clínica en 33 casos / Adrenal macrotumor diagnosed by computarized tomography: clinical experience in 33 cases

Thirty three patients aged 9 to 86 years old, 15 female, with an adrenal macrotumor diagnosed by CAT scan, were analized. Thirty percent of tumors were functioning (70 percent secreted cathecolamines and 30 percent cortisol). Eighty two percent had an adrenal localization and 18 percent were para-adrenal. Thirty four percent were malignant. These tumors were mostly non functioning, 70 percent occured in men and 67 percent were metastatic. Most adrenal macrotumors in this series were non functioning and 36 percent were malignant

Rendimiento comparativo entre biopsia y citología obtenidas por aspiración con aguja fina en nódulos sólidos del tiroides / Comparative useful between biopsy and cytology obtained by fine needle aspiration in thyroid nodules

The correct management of thyroid nodules requires an accurate histological diagnosis to doscard carcinoma. One hundred and forty three thyroid nodules were punctured with a 21 G needle under continous aspiration obtaining a sample for cytological and histological diagnosis. Fifty patients were subjected to a thyroidectomy. The age of studied patients ranged from 12 to 78 years old and 94 percent were female. Mean nodule diameter was 2.7ñ1.4 cm. Two percent of procedures were complicated with local hematomas, that subsided spontaneously. A diagnosis of cancer was reached in 16 percent of all patients and 46 percent of operated patients. Cytology had a 50 percent sensitivity, 87.5 percent specificity, a 89.4 percent positive predictive value and a 87.5 percent negative predictive value. The figures for fine needle aspiration biopsy were 82.6, 100, 100 and 87 percent respectively. Fine needle aspiration biopsy has a better diagnostic accuracy than cytology and is a simple and safe procedure

Insuficiencia cardíaca grave como complicación de hipotiroidismo primario / Severe cardiac failure as complication of primary hypothyroidism

We report a 29 years old female admitted due to a congestive cardiac failure that failed to respond to therapy with furosemide and enalapril. Serum thyroid hormone profile showed a TSH over 40 uIU/ml, a thyroxine of 0.8 ug/dl and a triiodothyronine below 20 ng/dl. Levothyroxine therapy was started with remission of cardiac failure. The study of thyroid function in patients with cardiac failure of unknown origin and resistant to therapy, should be bore in mind

Neoplasia endocrina múltiple tipo 2A: presentación de un caso de evolución inhabitualmente agresiva / Multiple endocrine neoplasia type 2A: report of a case with an aggressive outcome

We report a 28 years old woman who consulted for diarrhea of 2 years and thyroid nodule. A medullary thyroid carcinoma was diagnosed and a thyroidectomy performed. There was a local relapse 2 months later and distant metastases were found 5 months later. A MIBG-1131 scontigraphic image of the adrenal lead to the suspicion of a bilateral pheochromocytoma. The surgical resection of the adrenals confirmed the diagnosis. There was no response to chemotherapy and the patient continued with severe hypercalcemia, repeated infections, persistent diarrhea and cachexia, dying one year after the aggressive presentation of a multiple endocrine neoplasia type 2A

Elevación asintomática de fosfatasas alcalinas plasmáticas secundaria a hiperfosfatasemia familiar benigna en un paciente / Asymptomatic elevation of alkaline phosphatases secondary to benign familial hyperphosphatasemia in a patient

We report a 33 years old male consulting for abdominal pain. Initial diagnostic work up showed high levels of alkaline phosphatases, that were confirmed in a new blood sample. Using electrophoresis, total alkaline phosphatases were 198 U/l (normal values=30-117) and the bone fraction was 101 U/l (normal values=0-35). Bone scintiscan and endocrinological assessment were normal. One year later, the same values persisted. Studying the family, 3 of 4 brothers had the same alterations in alkaline phosphatases. It was concluded that these subjects had the rare condition known as benign familial hyperphosphatasemia

Hipocortisolismo por déficit selectivo de CRH de resolución espontánea: análisis de un caso / Hypocortisolism related to selective deficiency of CRH with spontaneous resolution: a case analysis

Hypocortisolism derived from hypothalamic deficiency of corticotropin releasing hormone is a highly unusual cause of adrenal insufficiency and its pathogenesis is still not fully understood. We report a mildly symptomatic patient having repeated low basal plasma cortisol levels with normal cortisol response to ACTH and lisine-vasopresine; however, she showed a clearly limited response to deep hypoglycemia, while GH reached a normal concomitant response. After 7 years of cortisol replacement the endogenous cortisol returned spontaneously to normality. The rest of pituitary function has been always normal

Etiología de la apendicitis aguda: ¿es la posición anatómica un factor predisponente? / Etiology of acute appendicitis: is the anatomic position a predisposing factor?

En el lapso comprendido entre enero y diciembre de 1984, en el Hospital Universitario del Valle se realizó un estudio comparativo de 44 pacientes con apendicitis aguda no complicada, y 38 controles de pacientes fallecidos por otras causas, para verificar y tratar de establecer sl la posicion anatomica es constante en la poblacion normal, como en las personas que padecen esta enfermedad, en dos poblaclones con edades comparables. La posicion retrocecal se encontró en un 75 por ciento de las personas que presentaron dicha patologia, comparable con un 20 por ciento de la poblacion normal (p:0.001), siendo la posicion ileal o transversa y descendente o pelvica y ascendente anterior las de mayor predominio en los controles (79 por ciento). Se describen las complicaciones y su relacion con la posicion anatómica, asi como otras alteraciones encontradas, y se hace un recuento historico de la literatura sobre el tema.