ABSTRACT
Takotsubo cardiomyopathy (MTT) is an acute ventricular dysfunction and reversible in absence of coronary disease. It is a rare presentation of pheochromocytoma and paraganglioma (FPGL). It was described for the first time in 1990 by Sato et al, the physiopathology is not clear yet. It is associated with high levels of catecholamines, vasospasm in the micro vascularization, rupture of atheromatous plaque and myiocarditis. The clinical presentation is similar to an acute myocardial infarction because of that the FPGL must be considered in patients without obstructive coronary lesions. We present a case of a 50 years old women with history of Arterial Hypertension, active smoking and Neurofibromatosis, who is admitted to emergency room with an acute myocardial pain.
Subject(s)
Humans , Female , Middle Aged , Takotsubo Cardiomyopathy/etiology , Pheochromocytoma/complications , Pheochromocytoma/diagnosis , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/diagnosis , Takotsubo Cardiomyopathy/diagnosis , Catecholamines/analysis , Pheochromocytoma/surgery , Adrenal Gland Neoplasms/surgeryABSTRACT
El síndrome de respuesta inflamatoria sistémica es una complicación frecuente en el período posoperatorio cardiovascular. Su gravedad es variable y múltiples factores generan una disfunción endotelial que se expresa de diferentes formas en la hemodinamia del paciente, ya sea con cuadros clínicos similares al shock frío o al shock caliente, según el mecanismo fisiológico predominante. Utilizamos un método de monitoreo mínimamente invasivo, configurando perfiles hemodinámicos basales e inducidos por fármacos, de tal modo de realizar un manejo racional de agentes vasoactivos. El propósito de este trabajo es mostrar la aplicación del monitoreo hemodinámico funcional, graficar la variabilidad de la hemodinamia en el período posquirúrgico y evidenciar la respuesta clínica al azul de metileno. Para tal fin, se presenta a modo de ejemplo un paciente con shock vasopléjico.(AU)
Cardiac surgery with cardiopulmonary bypass in children is associated with a systemic inflammatory response syndrome of different degree. The endothelial dysfunction may be followed by acute circulatory dysfunction that results in different hemodynamic profiles like cold or warm shock. Hemodynamic variables were measured with a minimal invasive method of hemodynamic monitoring and they were grouped in order to define profiles and evaluate the response to therapy. The goal of this work is to describe the functional hemodynamic monitoring in the care of pediatric cardiac surgery patients through the presentation of a child with vasodilatory shock and his response to the administration of methylene blue.(AU)
Subject(s)
Humans , Thoracic Surgery , Postoperative PeriodABSTRACT
In the U.S.T. Charity Hospital for the past 14 years, 1946-1959, a total of 127 cases of schistosomiasis were admitted. The majority 150 in number, came after 1950Majority of these patients came either from Leyte or Samar, 48 from the former and 34 from the later with a slight female predominance of 56.7% and a major age distribution between 10-30 years or 68.52%Diagnosis was confirmed in 49 instances by at least one diagnostic aid, Group I, and in others without objective proof but by clinical and epidemiological evidence, Group II. The remainder of the cases, though not showing schistosomiasis in the usual form, disclosed the disease at autopsy, and/or biopsyOn the basis of Pesigans grading, our cases chiefly belong to Grades C and D with a few in Grade E. Lack of cases in Grade A and B was probably due to the distant location of our hospital from endemic areas, and therefore the unlikelihood of getting early casesClinically abdominal complaints were the predominant feature, in the form of diarrhea or dysentery, abdominal pain, liver involvement including portal hypertension, jaundice and splenomegaly. Hematemesis and melena featured in 14% of the casesStools examination with acid-ether concentration technique proved the more reliable objective diagnostic aid in our series, followed by skin test and of course histological studiesThe frequency of involvement of the appendix in our cases stresses this particular aspect of the disease. The liver, colon, lungs and spleen were also frequently affected. In most instances, co-existing parasitic disease is also found. Of special interest are 4 cases which showed co-existing malignancy of either liver or intestines, a finding deserving further study. Likewise, calcification in one of the abdominal viscera appears to be one important clue in this disease, especially in a patient coming from an endemic areaAs far as Fuadin therapy is concerned, as used in this series, results were variable. In some cases control of diarrhea, relief of abdominal pain, subsidence of fever were achieved. In the advanced cases with irreversible hepato-splenomegaly, no noticeable change was observed. (Summary)
ABSTRACT
La parálisis periódica tirotóxica es una rara complicación del hipertiroidismo, excepcional en el mundo occidental, que se incluye dentro del grupo de las parálisis periódicas hipopotasémicas. Su incidencia aproximada entre hipertiroideos orientales es del 2 por ciento y alcanza tan solo del 0.1 por ciento al 0.2 por ciento en la raza blanca. el 90 por ciento de los más de 500 casos publicados son originarios del Japón. Por su extraordinaria rareza en nuestro medio creemos interesante comunicar un caso que hemos tenido ocasión de observar. En este reporte, se describe un paciente de 30 años con tirotoxicosis y crisis de parálisis hipokalémica de un año de evolución. Fue posible presenciar una crisis de parálisis flácida, con niveles séricos de potasio de 1.7 mEq/L.
Subject(s)
Male , Adult , Hyperthyroidism , ThyrotoxicosisABSTRACT
DNA extracted from peripheral blood of two Ecuadorian patients showing severe digestive pathology was amplified by the polymerase chain reaction using a Trypanosoma cruzi specific oligonucleotide primers derived from the primary sequence of a cDNA encoding for a 24 kDa excretory/secretory protein. The positive PCR results together with the clinical findings confirmed that both patients had a digestive pathology due to Chagas' disease. This pathology could be more frequent than previously described in the chagasic endemic regions of Andean countries.
DNA obtido do sangue periférico de dois pacientes equatorianos, que apresentavam severa patologia digestiva, foi amplificado pela "polymerase chain reaction" (PCR) utilizando os oligonucleotídoes específicos do Trypanosoma cruzi, derivados de uma seqüência primária de cDNA codificado de 24 kDa proteína excretória/secretória. Os resultados positivos da PCR junto com os achados clínicos confirmam que os dois pacientes tinham uma patologia digestiva de origem chagásica. Esta patologia poderia ser mais freqüente que a descrita previamente nas regiões endêmicas chagásicas das cidades dos Andes.
Subject(s)
Aged , Animals , Female , Humans , Male , Middle Aged , Chagas Disease/complications , Digestive System Diseases/etiology , Antibodies, Protozoan/blood , Chronic Disease , DNA, Protozoan/blood , Chagas Disease/diagnosis , Digestive System Diseases/diagnosis , Ecuador , Polymerase Chain Reaction , Trypanosoma cruzi/genetics , Trypanosoma cruzi/immunologyABSTRACT
Se estudiaron 102 pacientes diabéticas embarazadas en el lapso de julio de 1976 a diciembre de 1985, referidas a la Consulta de Alto Riesgo Obstétrico (CARO) desde nuestra consulta prenatal. La clasificación se hizo de acuerdo a los criterios de P.White, encontrando un 58,80% clase A, 23,50% clase B, 8,8% clase C y 8,8% de pacientes con angiopatías de los diferentes tipos; además se reclasificaron de acuerdo a los signos de mal pronóstico de Pedersen. Se encontraron las siguientes causas de morbilidad materna: hipoglicemia, 24,5%; infección urinaria, 23%; preeclampsia leve, 22,5%, y cetoacidosis, 10,7%. El termino de la gestación ocurrió en edades inversamente proporcionales al grado de complicación vascular. La manera de finalizar el embarazo fue en 31,4% de partos eutócicos, 14,7% partos instrumentales y 53,9% de cesáreas segmentarias. El 72,5% de los recién nacidos estuvo dentro del rango de peso normal; un 15,7% pesó más de 3.850 grs y un 11,8% pesó menos de 2.500 grs. Las causas de morbilidad fetal fueron: prematuridad, 17,6%; hipoglicemia, 17,6%; hiperbilirrubinemia 9,8%, y síndrome de dificultad respiratoria, 3,9%. En nuestra serie hubo un 3.9% de malformaciones fetales y un 4,9% de mortalidad fetal. No hubo muertes maternas
Subject(s)
Pregnancy , Adult , Middle Aged , Humans , Female , Pregnancy Complications , Pregnancy in Diabetics/therapyABSTRACT
El objetivo de este estudio fue tratar de determinar diferentes tipos de dislexias segun sea el tipo de confusiones sensoriales que se cometen al decodificar. Mediante un test de lectura en voz alta se agruparon deslexicos visuales, dislexicos auditivos, dislexicos mixtos y dislexicos sin confusiones sensoriales de dos edades, 8-9 y 10-11 anos.Las comparaciones de promedios indicaron diferencias significativas entre los cuatro subgrupos en pruebas de decodificacion lectora comprension lectora silenciosa y pruebas verbales. Los subgrupos mas alterados fueron los dislexicos con confusiones auditivas y con confusiones mixtas. Los dislexicos visuales y sin errores sensoriales presentaron menos retardo lector. Estas diferencias tienden a dejar de ser significativas a los 10-11 anos