Embarazo en hemodiálisis crónica: experiencia de un hospital universitario / Pregnancy during chronic hemodialysis. A series of cases

Background: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. Aim: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. Materials and Methods: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. Results: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 [625-1,575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29-36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14-25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29-34] weeks. Neonatal median hospitalization length was 4 [4-32] days, with 18% of neonatal deaths. Conclusions: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential.

DISEÑO DE UNA PLATAFORMA INTEROPERABLE PARA UN OBSERVATORIO DE HÁBITOS Y ESTILOS DE VIDA SALUDABLE / DESIGN OF A INTEROPERABLE OBSERVATORY PLATFORM FOR HABITS ANDHEALTHY LIFESTYLES / CONCEPÇÃO DE UMA PLATAFORMA INTEROPERÁVEL PARA UM OBSERVATÓRIO HÁBITOS E ESTILOS DE VIDA SAUDÁVEIS

Esta investigación muestra el diseño de una plataforma interoperable que hace uso del estándar HL7 (Health Level Seven) y permite el registro y análisis de datos relacionados con estilos de vida saludable y prácticas de actividad física en adultos y adultos mayores de las zonas rurales de Colombia. El proyecto se centra en la utilización de las TIC para generar un sistema interoperable que permita la consolidación de los datos, con el fin de facilitar cifras epidemiológicas, hacer diagnósticos que permitan generar estrategias de promoción de la salud y prevención de la enfermedad en las que se promueva la actividad física; y consolidar un marco de referencia para las entidades interesadas. Esta plataforma provee un servicio de integración que puede ser utilizado por entidades externas, compartiendo así información relacionada con hábitos y estilos de vida saludables. Dicha plataforma, utiliza tecnología web ASP.net, con un modelo arquitectural MVC (Modelo Vista Controlador), lenguaje C#, un motor de base de datos SQLServer y servicios web a nivel de integración que usa HL7 como estándar de intercambio de mensajes. Se generó una prueba de control realizada en el año 2014, en ocho municipios del departamento de Cundinamarca en los cuales se aplicaron 304 instrumentos, con los cuales se alimentó la plataforma.

This research shows the design of an interoperable platform that uses the HL7 standard (Health Level Seven) and allows the record and analysis of data related to healthy lifestyles and practices of physical activity in adults and older adults in rural areas of Colombia. The project focuses on the use of ICT to generate an interoperable system that allows the consolidation of data, in order to facilitate epidemiological records, make diagnoses that generate strategies for health promotion and disease prevention in which promote physical activity; and build a framework for stakeholders. This platform provides an integration service that can be used by external entities, to reporting information related to habits and healthy lifestyles. This platform uses web ASP.net technology with architectural model MVC (Model View Controller), C # language, a database SQLServer motor and web services to integration with HL7 standard for the exchange of information. Was performed a control test in to 2014, in eight municipalities of the department of Cundinamarca in which 304 instruments were applied to upload to the platform.

Esta pesquisa mostra o desenho de uma plataforma interoperável que usa o HL7 (Health Level Seven) padrão e permite a gravação e análise de dados relacionados com os estilos de vida saudáveis e prática de atividade física em adultos e idosos nas zonas rurais da Colômbia. O projecto centra-se na utilização das TIC para gerar um sistema de interoperabilidade que permite a consolidação de dados, a fim de facilitar números epidemiológicos, fazer diagnósticos que podem gerar estratégias para promover a saúde e prevenção de doença em que promoção da atividade física; e construir uma estrutura para as partes interessadas. Esta plataforma fornece um serviço de integração que pode ser usado por entidades externas, a partilha de informações relacionadas a hábitos e estilos de vida saudáveis. Esta plataforma, utilizando a tecnologia web ASP.net com um padrão de arquitetura MVC (Model View Controller), a linguagem C#, banco de dados SQLServer do motor e nível de integração de serviços web usando a troca de mensagens HL7 padrão. Um teste de controle realizado em 2014, em oito municípios de Cundinamarca em que foram aplicados 304 instrumentos, com os quais a plataforma foi alimentado foi gerado.

Cytotoxic effect of double emulsion (w/o/w) cuso4 loaded pla nanoparticles on mkn-45 gastric adenocarcinoma cell line / Efecto citotóxico de nanopartículas de pla de doble emulsión (w/o/w) cargadas con cuso4 sobre la línea célular de adenocarcinoma gástrico mkn-45

Poly (L-lactic acid) (PLA) nanoparticles have the approval of the main institutions for drugs administration and therapeutics. However, the use of lactic acid polymer is controversial because lactic acid has been proposed as an energy source for cancer cells. The aim of this study was to evaluate the cytotoxic, apoptotic and cell cycle properties of PLA and CuSO4-loaded PLA biodegradable nanoparticles on MKN-45 gastric adenocarcinoma cell line. PLA nanoparticles for the delivery of the anticancer active principle CuSO4 were obtained using the double emulsion method. PLA and CuSO4 loaded PLA nanoparticles were morphologically characterized and their size determined using transmission electron microscopy (TEM). The cytotoxicity of this drug delivery system was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay; apoptosis was evaluated using YO-PRO-1/Propidium Iodide and cell cycle analysis throughout flow cytometry. CuSO4-loaded PLA nanoparticles were effective inhibitors of MKN45 cancer cell growth. They increased cytotoxicity and apoptosis, and induced G1/Go cell cycle arrest;whereas the anticancer activity was increased using a 96 h treatment of a minimal (1mM) concentration of CuSO4 loaded in 40 µM PLA nanoparticles. The treatment with 40 µM lactic acid and PLA (40 µM) did not increase the rate of cell survival assays related to the control, which indicate that PLA use as a polymer carrier not induce proliferation of MKN-45 cancer cells. Our research presents novel data about the effect of PLA nanoparticles and CuSO4 on gastric cancer cell line MKN45.

Las nanopartículas de ácido poli L-láctico (PLA) tienen la aprobación de las principales instituciones de administración de medicamentos y terapéutica. Sin embargo, el uso de polímero de ácido láctico es controvertido ya que el ácido láctico se ha propuesto como una fuente de energía para las células cancerosas. El objetivo de este estudio fue evaluar las propiedades citotóxicas, la apoptosis y sobre el ciclo celular de las nanoparticulas de PLA biodegradable y de estas PLA nanopartículas cargadas con CuSO4 en la línea celular de adenocarcinoma gástrico MKN-45. Las nanopartículas de PLA para la administración del principio activo CuSO4 contra el cáncer se obtuvieron utilizando el método de doble emulsión. Las nanopartículas de PLA y PLA cargadas con CuSO4 se caracterizan morfológicamente y su tamaño fue determinaron usando microscopía electrónica de transmisión (TEM). Se evaluó la citotoxicidad de este sistema de administración de fármacos utilizando la 3 - (4,5-dimetiltiazol-2-il) -2,5-ensayo difeniltetrazolio (MTT); la apoptosis se evaluó usando yoduro de propidio/YO-PRO-1 y el análisis de ciclo celular por citometría de flujo. Las nanopartículas cargadas con CuSO4-PLA fueron eficaces inhibidores del crecimiento de las células MKN-45 cancerosas. Aumentaron citotoxicidad y la apoptosis, e inducen la detención del ciclo celular en G1/Go, mientras que la actividad contra el cáncer se incrementó con el uso de un tratamiento de 96 horas con una concentración mínima (1 mM) de CuSO4 cargado en nanopartículas con 40 µM de PLA. El tratamiento con 40 µM de ácido láctico y 40 µM PLA no aumentó la tasa de supervivencia de células en relación con el control, lo que indica que el uso de PLA como un polímero portador que no induce la proliferación de células de cáncer MKN-45. Nuestro estudio presenta nuevos datos sobre el efecto de las nanopartículas de PLA con CuSO4 en la línea celular de cáncer gástrico MKN-45.

La esclerosis múltiple en el embarazo: reporte de tres casos en el Hospital Universitario de San Ignacio (HUSI) / Multiple Sclerosis in Pregnancy

Introducción: Se presentan tres casos de pacientes con esclerosis múltiple (EM),diagnosticadas previo al embarazo, y que fueron evaluadas en la Unidad de MedicinaMaterno-Fetal durante sus controles y parto en el Hospital Universitario de SanIgnacio, centro de referencia nivel IV que atiende población embarazada de altoriesgo obstétrico perteneciente al régimen contributivo. Objetivo: Describir lasformas de presentación, fisiopatología, etiología y cuadro clínico de la EM, así comosu comportamiento en el embarazo. Metodología: Se realizó una búsqueda de laliteratura en las bases PubMed, Medline y Cochrane utilizando las palabras clave, pararecopilar información tanto en inglés como en español desde el 2000 al 2011. Despuésse eligieron artículos de revisión y de investigación en EM y embarazo. Conclusiones:Las pacientes con diagnóstico de EM en el embarazo parecen tener un menor riesgode sufrir una recaída, especialmente durante el último trimestre. Sin embargo, vieneseguido de una alta probabilidad de recaída durante los tres meses posteriores, comose observó en dos de los casos descritos en este estudio...

Introduction: Three cases of patients withmultiple sclerosis (MS), diagnosed before pregnancy,and were evaluated at the Departmentof Maternal-Fetal and birth control during theHospital Universitario San Ignacio, level IV referralcenter serving pregnant population highrisk obstetric pertaining to contributory scheme.Objective: To describe the clinical presentationsof the pathophysiology, etiology and clinicalfeatures of MS, as well as their behavior duringpregnancy. Methodology: Electronic search wasconducted in PubMed, Medline, and Cochraneusing the keywords to collect information inboth English and Spanish from 2000 to 2011. Afterreview articles were selected and research inmultiple sclerosis and pregnancy. Conclusions:There seems to be a lower risk of relapse duringpregnancy and especially during the last quarter.However, it is followed by a high probability ofrelapse within three months, as observed in twocases described in this study...

Hipoxemia espuria por hiperleucocitosis: Reporte de un caso y revisión de la literatura / Spurious hypoxemia due to hyperleukocytosis: Report of one case

Background: Arterial gasometry is considered the gold standard for establishing a diagnosis of respiratory failure of any etiology. However, there are some circumstances in which it loses specificity, making necessary to consider other tests such as pulse oximetry to adequately determine hypoxemia. We report a 67 years old patient with sudden hypoacusia, right hemiparesis and polypnea. His laboratory exams on admission, showed extreme hypoxemia in several readings, without correlation to the patient's clinical condition nor the pulse oximetry, and a leukocytosis of 800.000 cells x ml, with many immature cells. Chronic myeloid leukemia was diagnosed and treatment with hydroxyurea was initiated, achieving normalization in the arterial gases in accordance with the fall of the white cell count. Interpretation of laboratory findings according to the general clinical context of the patient allowed to suspect a spurious hypoxemia, saving the patient from unnecessary and risky interventions.

Hacia el fortalecimiento de la medicina familiar y la atención primaria en los sistemas de salud: IV Cumbre Iberoamericana de Medicina Familiar / Towards the strengthening of family medicine and primary care in health systems: IV Ibero-American Summit of Family Medicine

A treinta y tres años de la Declaración de Alma Ata en 1978, respecto de la Atención Primaria de la Salud (APS), el mundo ha podido observar diferentes grados de avance dependiendo de la región geográfica y económica que se analice; por ejemplo, los países de ingresos altos como Japón, Suecia o Finlandia, poseen actualmente una Esperanza de Vida al Nacer (EVN) de alrededor de 80 años. Los países de ingresos medios como Brasil, México, Chile, Colombia y muchos otros de América Latina, permiten una EVN por arriba de los 72 años; sin embargo, existen naciones de ingresos bajos -como algunos Estados Africanos- en que este indicador se aproxima a los 50 años. Resulta conveniente recordar que en América Latina a mediados del siglo pasado la EVN también se aproximaba a los 50 años. Por otra parte, debemos considerar que otros indicadores de calidad de vida también han sufrido modificaciones importantes, tal es el caso de la mortalidad. (AU)

Malestar psicofisiológico en profesionales de la salud pública de la Región Metropolitana / Psychophysiological distress among health care professionals working in Chilean public hospitals

Background: The public health reform in Chile resulted in changes in working conditions and organization of health centers. Aim: To examine the presence of psychophysiological symptoms in professionals of public hospitals in the Metropolitan Region and their association with current working conditions. Material and Methods: A questionnaire of quality of working life was applied to a sample of 80 physicians and 110 nurses. The questionnaire considers scales and open questions. Results: Nurses had a higher level of discomfort than physicians (p < 0.01) and had significantly higher scores for emotional distress, physical fatigue, digestive disorders, headache, insomnia, back pain and muscle tension (p < 0.01). There were statistically significant negative correlations between psychophysiological distress and working conditions (r = -0.418), social climate (r = -0.395), satisfaction with the organization (r = -0.337) and psychosocial well-being (r = -0.267). A regression model showed that 21 percent of the variance in psychophysiological distress was explained by working conditions, psychosocial well-being and adaptation to the organization. Conclusions: There is a relationship between the high prevalence of psychophysiological symptoms and bad working conditions of public health professionals.

Rol de Klotho y FGF23 en la regulación del fosfato y calcio plasmático / Klothos role and FGF23 in the regulation of phosphate and plasmatic calcium

Recently, two proteins have been discovered, named Klotho and FGF23, which are involved in several physiologic phenomena. One of the most relevant is the reduction of phosphatemia and the increase of phosphaturia. This effect is mainly caused by the activation of the membrane receptor FGFR1 by a joined action of Klotho and FGF23 (called Klotho/FGF23 pathway). It has been proved that Klotho/FGF23 suppresses production and secretion of parathyroid hormone (PTH) in parathyroid gland, reduces active vitamin D levels by inhibition of 1α-hydroxylase synthesis and increased expression of 24-hydroxylase in the kidney. It is also described that FGF23 expression is promoted by active vitamin D and plasmatic phosphate. Because of that, it has been proposed the existence of a bone-kidney-parathyroid endocrine axis, which regulates serum phosphate levels. Although it has not been studied yet, it is likely that Klotho and FGF23 also have a role in regulation of serum calcium levels, due to the effects of Klotho/FGF23 over key calcium regulators. The discovery of Klotho/FGF23 axis has expanded our knowledge concerning the endocrine mechanisms of the calcium-phosphate metabolism, and it might also help in the development of new clinical approaches and treatments of calcium and phosphate disorders.

Función y disfunción endotelial / Endothelial function and dysfunction

El endotelio es el principal regulador de la homeostasis vascular, modula el balance vasoconstricción/vasodilatación, inhibe la proliferación/migración de células musculares de la pared vascular (VSMC), y también modula la hemostasia. La disfunción endotelial es un evento que precede los cambios morfológicos característicos de la aterogénesis y contribuye al desarrollo de complicaciones de la placa ateroesclerótica. Además, la evidencia disponible indica que el desarrollo de disfunción endotelial participa en el daño cardiovascular en condiciones que abarcan desde procesos fisiológicos como el envejecimiento, hasta procesos fisiopatológicos diversos como hipertensión arterial, insuficiencia cardíaca, insuficiencia renal, diabetes mellitus, coagulación intravascular, preeclampsia, enfermedades inflamatorias y la apnea del sueño(1, 2). El objetivo del presente artículo es revisar brevemente la función endotelial, definir disfunción endotelial en un contexto amplio y presentar los mecanismos generales que conducen a disfunción endotelial en relación a las enfermedades cardiovasculares más prevalentes.

The endothelium is the main regulator for vascular homeostasis. The functions of the endothelium include regulation of the balance between vasoconstriction and vasodilation, inhibition of proliferation and migration of smooth muscle cells (VSMC) from the vascular wall and modulation of hemostasis. Endothelial dysfunction precedes the morphological changes characteristic of atherogenesis and contributes to the development atherosclerotic plaques. Also, current evidence indicates that the development of endothelial dysfunction is associated with cardiovascular damage in several physiological conditions such as arterial hypertension, heart and renal failure, diabetes mellitus, intravascular coagulation, preeclampsia, inflammatory disease and sleep apnea (1,2). The purpose of this article is to provide a brief review of endothelial dysfunction, broadly define endothelial dysfunction, and to present general mechanisms that are correlated with endothelial dysfunction in most prevalent cardiovascular diseases.

Adenocarcinoma gástrico primario concomitante con tumor estromal gastrointestinal: Reporte de un caso y revisión de literatura / Concomitant presence of a gastric adenocarcinoma and gastrointestinal stromal tumor: Report of one case

The concomitant presence of a primary gastric adenocarcinoma and a gastrointestinal stromal tumor in the stomach is uncommon. We report a 68-year-old male with an advanced gastric adenocarcinoma. During gastrectomy, a nodular intramural lesion was found. The pathological study, revealed a gastrointestinal stromal tumor, positive form CD117. After six months of follow up, there is no evidence of recurrence of either tumor.

Colitis quística profunda posradioterapia: Caso clínico / Colitis cystica profunda: Report of one case

Colitis cystica profunda is a benign condition that can be confused with adenocarcinoma. We report a 35year-old woman that received radiotherapy for a uterine cervical carcinoma who presented intermittent hematochezia three times after ending the therapy. This episode was diagnosed and treated as a radiation colitis and the patient remained asymptomatic for six years. After this period she presented again intermittent hematochezia and a rectal mass that was surgically removed. The pathology report disclosed a colitis cystica profunda.

La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa / Intensified insulin therapy plus antineuritic medication is more effective than antineuritics alone in painful diabetic neuropathy

Background: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. Aim: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin. Material and methods: Review of medical records of 17 type-2 diabetic patients, aged 63±11 years and a duration of diabetes of 15±8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in ~0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points. Results: After 1 year, glycosilated hemoglobin decreased from 10.0±1.4 percent to 7.7±1.2 percent (p~=0.003). Pain decreased from 10 to 5.1±3.3 at one month, 2.3±3.2 at six months, and 3.1±3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance. Conclusions: The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reduction.

Resultados clínicos de la resincronización ventricular en pacientes con insuficiencia cardíaca severa / Results of intraventricular resynchronization in patients with severe cardiac failure

BACKGROUND: Intraventricular resynchronization with pacemakers is a promising therapy for patients with refractory cardiac failure and intraventricular conductions delay. However its long term effects are not well known. AIM: To report the results of this therapy in patients with cardiac failure. PATIENTS AND METHODS: Fourteen patients (11 male), whose mean age was 68 years, with a severe and refractory cardiac failure, have been treated in our unit using intraventricular resynchronization with pacemakers. Eight had a coronary heart disease and six a dilated myocardiopathy. The pacemaker was implanted transvenously, with conventional stimulation in atrium and right ventricle. The left ventricle was stimulated through an epicardial vein, accessed through the coronary sinus. RESULTS: In one patient the high thresholds did not allow a left ventricular stimulation. In the other 13 patients, a clinical improvement was observed in 11 (85 per cent), that has been sustained for a mean of 8.2 months. The ejection fraction improved form 23.5 to 32.4 per cent (p < 0.001), the 6 min walking test improved from 347 to 437 m (p = 0.003) and the functional capacity changes from 3.3 to 2.7 (p < 0.001). Three patients died during follow up. One was the patient in whom the stimulation failed and two had a sudden death. No complications of the procedure were observed. CONCLUSIONS: In this series, intraventricular resynchronization with pacemakers was effective in 11 of 13 patients, improving functional capacity and ejection fraction. Sudden death could be avoided adding a defibrillator to the pacemaker system.

Sobrevida del injerto en los primeros 100 trasplantes renales del Hospital Carlos Van Buren / Survival of grafts in the first 100 renal transplants at the Carlos Van Buren hospital in Chile

Background: Renal transplant is the best therapeutic alternative for chronic renal failure, although it is not exempt of risks. Aim: To report the survival of renal transplant recipients and grafts and the main complications at a public hospital in Chile. Patients and methods: This is a non experimental, open historical cohort study, with reposition of the first 100 transplants in 94 patients, performed at the Carlos van Buren Hospital between 1984 and 1998. Seventy grafts came from cadaveric donors and 30 from live donors. As immunosuppressive therapy, prednisone + azathioprine was used in 48 transplants and the same regimen plus cyclosporine in 52. Results: Mean age of recipients was 36 ñ 23 years old. Ten years actuarial survival of patients was 80.5 percent in transplants from cadaveric donors and 86 percent in transplants from live donors. Ten years graft survival was 57.5 percent in transplants from cadaveric donors and 42 percent in transplants from live donors. The period in which the transplant was performed (first or second half of the observation period), type of donor, HLA B-DR compatibility and sensitization ( percent PRA) had no effect on survival. Twenty five subjects lost their graft, 12 due to acute steroid resistant rejection, 10 due to chronic graft nephropathy and three due to renal artery thrombosis. Fifteen subjects died with a functioning graft, 10 due to infections, two due to an acute myocardial infarction, two due to an acute pancreatitis and one due to a brain tumor. Conclusions: Survival of grafts and renal transplant recipients was not influenced by the type of donor, period of transplantation and immune variables. Main causes of recipient death were infections and the main cause of graft failure was acute rejection

Encefalopatía de Wernicke y diálisis: dos casos clínicos / Wernicke's encephalopathy and dialysis: 2 clinical cases

Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man had two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes

Nocardiosis en un paciente con trasplante renal / Nocardiosis in a renal transplanted patient

We report a unilateral pulmonary nocardiosis in a 51 years old male that received a renal allograft. The clinical picture appeared 68 days after transplantation and the culture of a bronchoalveolar lavage showed the presence of Nocardia ateroides. Cyclosporine and azathioprine were discontinued and trimethoprim-sulphamethoxazole was started with a good clinical response. Afterwards, azathioprine was restarted and the patient is asymptomatic at the present moment

Neurofibromatosis tipo-1

Paciente de 56 años de edad con cuadro compatible de Neurofibromatosis tipo-1; quien presenta lesiones generalizadas en piel (pápulas y nódulos), manchas café con leche de diferentes tamaños, lentiginosis axilar, 3 familiares directos establecidos por national Institute of Head. La biopsia de piel reporta neurofibroma compatible con la enfermedad de Von-Recklinghausen.

Divertículo de Meckel y hemorragia digestiva en el adulto / Meckel's diverticulum and digestive tract hemorrhage in the adult

Se presentan dos casos de hemorragia digestiva en el adulto originada en el divertículo de Meckel. En ambos casos se efectuó intervención quirúrgica, consistente en la resección intestinal de la zona diverticular, con buen resultado. Se comenta la escasa frecuencia de la complicación hemorrágica, en esta anomalía anatómica especialmente en el adulto. Los autores se manifiestan partidarios de la remoción del divertículo, en caso de hallazgo incidental, dada la gravedad de su complicación

Síndrome nefrótico en artritis reumatoidea tratada con penicilamina / Penicillamine- induced nephrotic syndrome

Presentamos un caso de Artritis Reumatoídea seronegativa, tratada con Penicilamina durante 11 meses desarrollando un Síndrome Nefrótico a lesiones mínimas, que remite espontáneamente a los dos meses de suspendida la droga