ABSTRACT
La hemorragia posparto es la principal causa de muerte obstétrica. Presentamos el caso de una gestación y parto normales tras la embolización bilateral de ambas arterias uterinas, por hemorragia posparto en la gestación anterior. La paciente requirió de una nueva embolización bilateral de arterias uterinas en esta segunda gestación con buen resultado obstétrico. La embolización arterial pélvica en el manejo de la hemorragia posparto refractaria al tratamiento médico, permite en ocasiones evitar el tratamiento quirúrgico, conservando la fertilidad de la paciente.
The postpartum hemorrhage is the main cause of obstetric death. We report a case of normal pregnancy and delivery after bilateral embolization of uterine arteries due to postpartum hemorrhage in a previous pregnancy. A new bilateral embolization of uterine arteries was needed in this second pregnancy with good obstetric results. The pelvic arterial embolization in the management of postpartum hemorrhage refractory to medical treatment, avoids the surgical treatment, preserving fertility.
Subject(s)
Humans , Female , Pregnancy , Adult , Uterine Artery Embolization , Postpartum Hemorrhage/therapy , FertilityABSTRACT
Se presenta el caso de una primigesta de 32 años que acude en la semana 38,3 por cefalea de carácter migrañoso de aparición brusca e intensidad moderada de dos días de evolución, asociada a fotopsias y a pérdida definida de un campo de la visión lateral izquierda. Tras descartar otra focalidad neurológica y preclampsia se comprueba el bienestar fetal y es valorada por oftalmólogos y neurólogos diagnosticando una cuadrantapnosia superior izquierda asociada a un síndrome de vasoconstricción cerebral reversible. La resonancia magnética revela un infarto cerebral en el territorio de la arteria cerebral posterior derecha y se comprueba en la angio-resonancia el defecto de repleción. Valorando la posibilidad de un inicio espontáneo del parto y la necesidad de iniciar tratamiento médico con ácido acetil salicílico para resolver el ictus se realiza una cesárea urgente con anestesia general con excelente resultado obstétrico y materno.
We report a case of a 38.3 weeks first prengancy woman o 32 year old who comes to the emergency service because she referred a two day acute migraine headache of sudden appereance with spintherism and a loose of a part of the left visual field. She did not had convulsive seizures nor strength or sensitive looses. Blood pressure was incongruous with preeclampsia, and she did not have proteinuria. After reassuring about well fetal being she is studied by ophtalmologists and neurologist who diagnose an of upper-left quadrantapnosia due to a reversible cerebral vasoconstriction syndrome. NMR and angio-NMR show a cerebral infarction in the right back cerebral artery area. Because of the risk of an spontaneous start of birth labour and the need of salicilyc acid treatment we decided to finish the pregnancy practising an urgent caesarean section under general anesthesic with an excellent mother and fetal result.
Subject(s)
Humans , Adult , Female , Aspirin/therapeutic use , Cerebral Infarction/complications , Migraine Disorders/etiology , Migraine Disorders/drug therapy , Vasoconstriction , Cesarean Section , Hemianopsia/etiology , Magnetic Resonance Imaging , Pregnancy Complications , Pregnancy OutcomeABSTRACT
La acromegalia es el exceso de secreción de hormona de crecimiento (HC). Esta alteración está relacionada con esterilidad y con complicaciones maternas durante el embarazo por aumento de la secreción de la HC. Presentamos el caso de una gestante diagnosticada de acromegalia persistente a pesar de haber sido operada vía transesfenoidal y tratada con cabergolina. Durante la gestación, la paciente no presentó complicaciones metabólicas ni tensionales, observándose un progresivo descenso de los niveles del factor de crecimiento insulínico-1 (IGF-I). El feto tuvo un crecimiento acorde con la amenorrea hasta la semana 31 en la que hizo una restricción del crecimiento con oligoamnios y alteración en el doppler en la semana 37. Se finalizó la gestación realizando una cesárea naciendo un recién nacido de 2400 gramos sin complicaciones neonatales. Aunque el curso del embarazo de las gestantes con acromegalia transcurre generalmente sin complicaciones, presentamos el primer caso descrito de un crecimiento intrauterino retardado en una paciente con acromegalia.
Pregnancy in acromegalic patients is an infrequent event, due to perturbed gonadotroph function. On the other hand, pregnancy may cause an enlargement of the adenoma or an increase of growth hormone (GH) secretion. We report the case of a pregnant acromegalic woman who had been previously operated by transphenoidal approach and treated with cabergolin. A progressive decrease of insuline-like growth factor-1 (IGF1) level during pregnancy without tumoral syndrome or visual troubles was shown during pregnancy. Neither metabolic complication nor hypertension were detected. Ultrasound performed at 31th week showed a decrease of the fetal growth. At 37th week, an intrauterine growth restriction and oligohydramnios was diagnosed. It was performed a cesarean section and it was delivered a healthy 2700 grams male newborn. Our report suggests that pregnancy could not influence negatively in acromegalic patient but may be associated with intrauterine growth restriction.
Subject(s)
Humans , Male , Adult , Female , Pregnancy , Infant, Newborn , Acromegaly/complications , Acromegaly/therapy , Pregnancy Complications/therapy , Fetal Growth Retardation , Cesarean Section , Pregnancy OutcomeABSTRACT
Background: The permanent surveillance of antimicrobial susceptibility of Shigella sp in the Temuco Regional Hospital, allowed us to define the empirical use of antimicrobials in dysenteric syndrome. Aim: To study antimicrobial susceptibility of Shigella strains collected from 1997 to May 2001 and compare the results with those reported in 1990. Material and methods: Two hundred and seventeen Shigella strains, coming from stool cultures of pediatric patients, were studied. Results: In the period 1989-1990 Shigella flexneri was the main species isolated (83 percent) whereas, in the period 1997-2001, Shigella sonnei (55.8 percent) predominated. In the second period, an increase of antimicrobial resistance, as compared with the period 1989-1990, was observed for ampicillin (74.5 and 42 percent respectively), for cotrimoxazol (57.5 and 45 percent respectively) and tetracycline (64 and 8 percent respectively). Chloramphenicol resistance increased from 0 to 57.5 percent. In the second period no resistance to ciprofloxacin was detected. There was simultaneous resistance to four drugs in 30 percent of the strains, predominating multiresistance in S flexneri (52.1 percent). Conclusions: In the two periods studied, a significant increase was detected in the resistance of Shigella strains to antimicrobials
Subject(s)
Humans , Shigella , Microbial Sensitivity Tests , Anti-Bacterial Agents/pharmacokinetics , In Vitro Techniques , Ampicillin Resistance , Drug Resistance, BacterialABSTRACT
El Hospital Regional de Temuco realiza vigilancia permanente de susceptibilidad a antimicrobianos en shigella detectándose desde 1996 resistencia progresiva a cloranfenicol, droga de elección en el tratamiento empírico frente a la sospecha de shigellosis. Se estudiaron 200 cepas de shigella aisladas de pacientes pediátricos que consultaron por diarrea entre julio 1997 y octubre 2000. La identificación bioquímica y serológica de las especies se realizó mediante metodología tradicional. La susceptibilidad a antimicrobianos de uso habitual, se midió mediante método de difusión en agar (Kirby-Bauer). Distribución por especies: shigella sonnei 64,5 por ciento y S. flexneri 35,5 por ciento. Se detectó 73 por ciento de resistencia a ampicilina, 56,5 por ciento a cloranfenicol, 45 por ciento a cotrimoxazol y 0 por ciento a ciprofloxacino. S. flexneri presentó resistencia y multirresistencia significativamente mayor. La resistencia limita las posibilidades terapéuticas, lo que incentiva a continuar con la vigilancia, para establecer normas de tratamiento y controlar la selección y diseminación de cepas multirresistentes
Subject(s)
Humans , Diarrhea/microbiology , In Vitro Techniques , Microbial Sensitivity Tests , Drug Resistance, Multiple , Shigella/drug effects , Ampicillin Resistance , Chloramphenicol Resistance , Ciprofloxacin/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
O suporte nutricional tem sido considerado um recurso terapêutico importante no tratamento de crianças hospitalizadas e gravemente doentes. Com o conhecimento do padrao de suporte nutricional utilizado pela unidade de internaçao hospitalar, pode-se detectar falhas e propor medidas para a sua otimizaçao. OBJETIVO. Avaliar o padrao terapêutico e de monitorizaçao do suporte metabólico em uma Unidade de Terapia Intensiva Pediátrica e propor medidas mínimas para melhorar a sua qualidade. PACIENTES E MÉTODO. Foram analisados os prontuários de 37 crianças admitidas na unidade durante um ano e que receberam suporte nutricional por um período igual ou superior a 15 dias. RESULTADOS. Em um período de 425 dias de suporte nutricional, a via parenteral exclusiva foi utilizada em 8O,5 por cento do tempo e a via digestiva (sonda nasoenteral ou oral), em 19,5 por cento do tempo. A avaliaçao nutricional prévia foi realizada em apenas três pacientes (8,1 por cento). Apenas 29,7 por cento das crianças tiveram suas necessidades energéticas satisfeitas, e este objetivo foi alcançado apenas nas que estavam recebendo nutriçao enteral. A relaçao nitrogênio/calorias nao-protéicas variou de 1:8O a 1:250. A oferta de oligoelementos por via parenteral foi adequada, exceçao feita ao zinco. A administraçao das vitaminas A, B2, E, C, pantenol e niacina esteve aquém da recomendada; biotina, vitamina B12, e folado nao foram administrados. A monitorizaçao nutricional incluiu o peso corpóreo e as dosagens de albumina sérica e de triglicérides, e foi realizada na maior parte dos pacientes, embora de modo eventual e nao uniforme. Conclusao. Houve falhas na implementaçao do suporte nutricional, a saber: inadequaçao da oferta protéica e de micronutrientes, monitoraçao nutricional e metabólica deficiente e uso pouco freqüente de nutriçao por via enteral. Sugere-se uma rotina mínima para a monitorizaçao de pacientes em nutriçao parenteral e enteral e a organizaçao de uma equipe multidisciplinar encarregada da coordenaçao do suporte nutricional.
Subject(s)
Child , Humans , Infant , Child, Preschool , Infant, Newborn , Intensive Care Units, Pediatric/standards , Nutritional Support/standards , Enteral Nutrition , Nutrition Assessment , Parenteral Nutrition , Retrospective Studies , Statistics, NonparametricABSTRACT
The porphyrinogenic and carcinogenic ability of hexachlorobenzene (HCB) was assayed in male and female gold hamsters, and histological examinations of tissue alteraions were performed. So it was studied, in liver: a) prophyrin content which was significantly increased at five months of HCB treatment, specially in males, and the pattern of accumalated porphyrins which was altered independent of the sex, b) haem pathway enzymes: delta aminolaevulinicacid synthase, ferrochelatase and porphyrinogen carboxylyase (PCL); among which only PCL appeared to be altered just at ten months of HCB feeding. While thyroid gland and kidney remained unaltered along the treatment time, liver and spleen exhibited a noticeable size variation and morphological alterations. In fact the spleen in treated animals was hypotrophic showing a red pulp less developed with respect to the Malpighian corpuscles and many macrophages with iron deposits. Respect to the liver, enlargement in size of hepatocytes, high content of iron deposits, no PAS positive structures in the cytoplasm, several small lipid droplets, microsteatosis although no cytonecrosis, polymorphic nuclei, and proliferations of nucleoli were observed. Therefore HCB is able to cause precancerous pathology and to induce porphyria in hamster, but not hyperthyroidism, upon this experimental conditions. By the way, males were found to be a good experimental model, better than females, to study the earliest relations between porphyria and cancer.
Subject(s)
Animals , Male , Female , Cricetinae , Spleen , Liver , Hexachlorobenzene/toxicity , Porphyrins/analysis , Spleen/pathology , Liver/enzymology , Liver/pathology , Thyroid Gland , Heme/metabolism , Hexachlorobenzene/pharmacology , Kidney/drug effects , Mesocricetus , Organ SizeSubject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Meningitis/cerebrospinal fluid , Latex Fixation Tests/methodsABSTRACT
Se desarrolló un ELISA modificado, Dot immunobinding assay para detectar anticuerpos antigonocócicos en el suero de pacientes con infección gonocócica. Fueron analizadas 20 muestras provenientes de hombres con gonorrea confirmada mediante técnicas bacteriológicas tradicionales y otras 20 de niños mayores de 1 año sin antecedentes de infección. Todos los sueros de hombres infectados presentaron reacción positiva en alguna dilución. El grupo control fue negativo con excepción de una muestra. La sensibilidad del test fue 1 y la especificidad 0,95. El valor predictivo positivo 0,95 y el valor predictivo negativo igual a 1