ABSTRACT
Background: We report a 56year old male hypertensive, who presented with a posterior reversible encephalopathy syndrome (PRES) as an initial manifestation of Guillain-Barré syndrome (GBS). His first symptoms were right hemiparesis and hemihypoesthesia, followed by headache, dizziness, dysarthria and a general feeling of discomfort. On the third day, flaccid tetraparesis, impairment of consciousness, epileptic seizures and respiratory failure appeared, along with severe hypertension. Cerebral Magnetic Resonance Imaging showed the characteristic PRES lesions. Cerebrospinal fluid analyses revealed albumin-cytological dissociation and nerve conduction studies showed an axonal demyelinating polyradiculoneuropathy, which confirmed the diagnosis of GBS. Treatment with intravenous immunoglobulin was given together with antihypertensive therapy and mechanical ventilation, achieving an important clinical and imaging remission of PRES, but maintaining tetraparesis during the hospitalization. Twelve months after discharge and regular motor rehabilitation, the patient achieved complete autonomy on the activities of daily living. It has been postulated that the autonomic failure and the elevation of circulating pro-inflammatory cytokines in GBS may be the cause of a breach in the blood-brain barrier, thus causing PRES, that can completely remit with an adequate management.
Subject(s)
Humans , Male , Middle Aged , Guillain-Barre Syndrome/complications , Hypertension/complications , Posterior Leukoencephalopathy Syndrome/etiology , Diagnosis, Differential , Guillain-Barre Syndrome/diagnosis , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/diagnosisABSTRACT
Background: Front temporal dementias (FTD) are neurodegenerative disorders characterized by alterations in behavior, affection and language, with relative sparing of episodic memory. There are three major forms of FTD: the frontal or behavioral form, progressive non-fluent aphasia and semantic dementia (that may begin as a fluent progressive aphasia). Aim: To report a retrospective clinical experience of patients with frontotemporal dementia. Material and methods: Review of 3,700 records of neuropsychological assessments of patients with behavioral disturbances, studied between 1981 and 2008. Of these, 63 patients (59 percent females) complied with the criteria for frontotemporal dementia. Results: There were 47 cases with the frontal variant, four with non-fluent progressive aphasia and six with fluent progressive aphasias (2 evolved to semantic dementia). The mean age of onset was 60±11 years. There were no familiar cases of FTD. Conclusions: It is clinically difficult to diagnose FTD, since evaluation of attitude or language is required. In addition to structural images, functional images were helpful in some cases, but the definitive diagnosis is anatomical.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Frontotemporal Dementia/diagnosis , Chile/epidemiology , Frontotemporal Dementia/classification , Frontotemporal Dementia/epidemiology , Retrospective StudiesABSTRACT
Entre las Escherichia coli diarreogénicas la categoría E. coli enteroagregativa (ECEA) es una de las más importantes y frecuentemente asociada a diarreas infantiles. El presente estudio se realizó con la finalidad de detectar los factores de virulencia que caracterizan a esta categoría patogénica mediante hibridación por colony blot usando sondas de ADN específicas. Se evaluaron 233 cepas aisladas en el laboratorio del Hospital de Emergencias Pediátricas durante los meses de diciembre 1998 y abril de 1999. Del total de muestras analizadas, se encontró que 17,16 por ciento de las cepas poseen el factor de virulencia característico de esta categoría. Los resultados obtenidos demuestran que un importante número de aislamientos de niños con diarrea presentan E. coli enteroagregativa.
Amongst Escherichia coli causing diarrheal disease, enteroaggregative E. coli is one of the most important organisms, and it is frequently associated to diarrhea in infants. The study was performed aiming at detecting virulence factors for the aforementioned organism, using colony blood hybridization with specific deoxyribonucleic acid (DNA) probes. 233 samples isolated in the Pediatric Emergency Hospital Laboratory between december 1998 and april 1999. Of all samples analyzed, it was found that 17,16 per cent of them have the typical virulence factor for their category. The resultsprove that an important proportion of isolates in children with diarrheal disease have enteroaggregative E. coli.
Subject(s)
Humans , Male , Child , Female , Diarrhea, Infantile , Escherichia coli/classificationABSTRACT
Background: Tracheobronchomalacia is characterized by a deficiency in the cartilaginous support of the trachea and bronchi and hypotony in the myoelastic elements, that lead to different levels of airway obstruction. Aim: To report our experience in the treatment of traqueobronchomalacia. Material and methods: Retrospective review of 24 patients with tracheomalacia of different levels (3 tracheobronchomalacia, 3 laryngotracheomalacia) and 8 patients with bronchomalacia. Results: The age at diagnosis ranged from 9 days to 9 years. Clinical presentation was recurrent wheezing in 19 patients, stridor in 6 and atelectasis in 4. The associated factors were neurological impairment in 8, congenital heart disease in 10 and prolonged mechanical ventilation in 4. The diagnosis was done by flexible bronchoscopy in all patients, using sedation and allowing spontaneous breathing. At the moment of diagnosis, treatment consisted in oxygen supply in 14 patients, physiotherapy in 21, õ2 adrenergic agonists in 27, racemic epinephrine in 8, mechanical ventilation in 12, ipratropium bromide in 5 and inhaled steroids in 13. After diagnosis, 24 patients received bronchodilator therapy with ipratropium bromide, 15 received racemic epinephrine and 22 received inhaled steroids. In 21, õ2 adrenergic agonists were discontinued. Thirteen patients required ventilation support and home oxygen. Twenty two patients showed a satisfactory clinical evolution and 6 patients died. Conclusions: The clinical presentation of tracheobronchomalacia is varied and diagnosis is done by flexible bronchoscopy. Treatment will depend on the severity of the disease, but õ2 adrenergic agonists should be excluded
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Bronchial Diseases , Laryngeal Diseases , Tracheal Diseases/diagnosis , Bronchial Diseases , Bronchoscopy , Laryngeal Diseases , Retrospective Studies , Follow-Up Studies , Tracheal Diseases/therapy , Severity of Illness Index , Respiration, ArtificialSubject(s)
Humans , Male , Adult , Adenoma, Sweat Gland/surgery , Adenoma, Sweat Gland/diagnosis , Forehead/pathologyABSTRACT
Se presentan cuatro casos de tumores de locvaliozación facial ( melanoma amelanótico, carcinoma espinocelñular, carcinoma basocelular y rabdomiosarcoma), con características agresivas, de rápida evolución, los cuales plantearon dificultad en el diagnóstico clínico al momento de la consulta. Se realizó biopsis de las lesiones y estudio histopatológico, no arribando mediante éste al dignostico definitivo, debido al grado de inferenciación de los mismos. Recurrimos a la inmunohistoquímica como método final para confirmar el diagnóstico.
Subject(s)
Humans , Male , Female , Middle Aged , Facial Neoplasms/diagnosis , Biopsy, NeedleABSTRACT
Se presentan tres casos de pacientes con linfomas cutáneos de células T, cuya forma clínica de presentación inhabitual, plantearon diversos diagnósticos al momento de la consulta ; llegando a su diagnóstico definitivo por medio de exploración física (cutánea y general) completa, estudio histopatológico, exámenes bioquímicos y en casos dudosos por inmunohistoquímica. Se hace referencia a la terapéutica implementada en particular.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lip Neoplasms , Lymphoma, T-Cell, Cutaneous/diagnosis , Lymphoma, T-Cell, Cutaneous/therapy , Breast Neoplasms , Mycosis FungoidesABSTRACT
Se comunica un caso clínico de la enfermedad de Dowling Degos en una mujer de 68 años,la cual presentó hallazgos clínicos e histopatológicos típicos de la enfermedad. Realizamos una revisión bibliográfica, abarcando la literatura desde el año 1974 a 1994, dentro de los cuales incluimos revistas nacionales y extranjeras. Los casos argentinos publicados son escasos; debiodo a esto, creemos de interés incorporar a la casuística nuestro paciente. Después de haber revisado la literatura, concluímos al igual que otros autores, que la enfermedad de Dowling Degos es una variante de un mismo complejo genodermatológico