ABSTRACT
Abstract: Dural metastases are an unusual form of spread in treated sinonasal malignancies. An analysis is presented of 20 cases of dural metastases diagnosed during imaging follow-up in a selection of cases in which anterior craniofacial resection was performed. They included 12 undifferentiated sinonasal carcinomas, 7 olfactory neuroblastomas, and 1 adenoid cystic carcinoma case. Dural metastases appeared on an average of 7.3 years after treatment in olfactory neuroblastoma. The maximum distance from malignancy to dural metastases was 14 cm for olfactory neuroblastoma, and 4.3 cm for undifferentiated sinonasal carcinoma. Dural metastases in the Burr holes were observed in 50% of undifferentiated sinonasal carcinoma, and 29% of olfactory neuroblastomas. Dural metastases presented as a nodular (60%), multinodular (10%), cystic (15%), and plaque (15%) pattern. These are suggestive of a local venous spread mechanism related to tumour rupture during surgery of anterior cranial fossa. Long-term follow-up with cranial inclusion would be indicated, given the possible late and distant presentation of dural metastases.
Resumen: Presentamos las metástasis durales como forma inusual de diseminación de tumores nasosinusales malignos tratados; se revisan 20 casos diagnosticados durante el seguimiento imagenológico a un grupo tratado con resección craneofacial anterior. Evaluamos metástasis durales en 12 carcinomas nasosinusales indiferenciados, 7 neuroblastomas olfatorios y un carcinoma adenoquístico. En neuroblastomas olfatorios aparecieron metástasis durales en promedio 7,3 años postratamiento. La distancia máxima del tumor a la metástasis fue de 14 cm para neuroblastoma olfatorio y de 4,3 cm para carcinoma nasosinusal indiferenciado. Observamos metástasis durales en los agujeros de trepanación en el 50% de los carcinomas nasosinusales indiferenciados y en el 29% de los neuroblastomas olfatorios. Las metástasis durales presentaron patrón nodular (60%), multinodular (10%), quístico (15%) y en placa (15%). Proponemos un mecanismo venoso local de diseminación relacionado a disrupción tumoral o quirúrgica de la fosa craneal anterior. El seguimiento a largo plazo con inclusión craneal estaría indicado por la posible presentación tardía y distante de metástasis durales.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Dura Mater/pathology , Meningeal Neoplasms/diagnostic imaging , Meningeal Neoplasms/secondary , Paranasal Sinus Neoplasms/pathology , Head and Neck Neoplasms/pathology , Retrospective StudiesABSTRACT
La injuria renal aguda (IRA) es un evento mórbido de gran impacto en la vida de las personas. La tasa de letalidad de la IRA ha sido un tema relevante y se han estudiado muchos factores relacionados. Objetivos: Determinar el perfil epidemiológico de los pacientes con IRA en un hospital de Lima y los factores asociados a la mortalidad durante el periodo de hospitalización. Material y métodos: Estudio descriptivo, retrospectivo de una cohorte de pacientes incidentes con diagnóstico de IRA. Se calculó la letalidad bruta y la ajustada a tiempo de permanencia hospitalaria. Se usó la regresión multivariante de Cox, así como el mejor modelo para regresión logística binaria asociada a letalidad. Se aceptó una significancia estadística de p<0,05. Resultados: Se identificaron 90 pacientes con IRA en los años 2002, 2003 y 2004 (incidencia de 30, 39 y 21 pacientes/año, respectivamente). Su permanencia hospitalaria fue 13,44 ± 1,66 (promedio±1ES) días, la tasa bruta de letalidad 39% y la tasa ajustada 2,89 fallecidos/100 días de hospitalización. Las variables relacionadas al riesgo de muerte en el tiempo fueron el estado de shock, el diagnóstico de sepsis y la disfunción respiratoria al momento de la admisión. Conclusiones: La gravedad clínica como condición al momento de la admisión al centro hospitalario, el estado séptico y la presencia de disfunción respiratoria, fueron los factores que influenciaron en el pronóstico de supervivencia de pacientes con IRA. (AU)
Acute kidney injury (AKI) is a morbid event of great impact on the lives of people. The fatality rate of the IRA has been prominent and studied many related factors. Objectives: To determine the epidemiological profile of patients with AKI in a hospital in Lima and factors associated with mortality during the hospitalization. Methods: A retrospective descriptive study of a cohort of incident patients diagnosed with AKI was performed. Gross lethality was calculated and adjusted to length of hospital stay. Multivariate Cox regression was used as well as the best model for binary logistic regression associated with lethality. Statistical significance of p<0.05 was accepted. Results: 90 patients with AKI were identified in 2002, 2003 and 2004 (incidence of 30, 39 and 21 patients / year, respectively). Their average hospital stay was 13.44 ± 1.66 days, crude case fatality rate of 39% and an adjusted rate of 2.89 deaths/100 days of hospitalization, variables related to the risk of death at the time also was shock, sepsis diagnosis and respiratory dysfunction at the time of admission. Conclusions: The critical condition of admission to a hospital, a septic state and the presence of respiratory dysfunction, are the elements that influence the prognosis of survival of patients with AKI. (AU)
Subject(s)
Humans , Male , Female , Renal Insufficiency , Renal Insufficiency/mortality , Hospitalization , Epidemiology, Descriptive , Retrospective Studies , Cohort StudiesABSTRACT
Objetivo: Determinar la correlación entre diversos índices de bioimpedancia eléctrica (IBE) y el score APACHE II (sAII) en pacientes con shock séptico. Material y métodos: Se incluyeron 30 pacientes >14 años con shock séptico de la unidad de cuidados intensivos (UCI) adultos del Hospital Nacional Cayetano Heredia-Perú a quienes se calculó el (sAII) y se midió el ángulo de fase, índice de impedancia y relación LIC/LEC, correlacionándolos posteriormente mediante Pearson y regresión lineal múltiple. Resultados: El 60% fueron varones, la edad promedio fue 60 ± 20,92 años, talla 1,61 ± 0,06m, peso 65,46 ± 8,7 Kg. y tiempo de ingreso a UCI 8,4 ± 5,99 horas. El 86,6% requirió ventilación mecánica, el foco infeccioso más frecuente fue respiratorio (63,3%). El promedio del sAII fue 18,83 ± 9,23, la permanencia en UCI 8,4 ± 5,99 días y la letalidad al mes 50%. Solamente se encontró correlación negativa con significancia estadística (r = -0,46; p = 0,01) entre el ángulo de fase (AF) y el (sAII). Ni el índice de impedancia ni la relación LIC/LEC tuvieron correlación significativa. El mejor predictor de mortalidad fue el AF: todos los que fallecieron tuvieron un AF<6grados (promedio 3,67 ± 0,63), p<0,05. Conclusiones: Únicamente el AF se correlacionó con el score (sAII) y fue el índice que mejor predijo mortalidad en pacientes con shock séptico, siendo superior al score APACHE II (sAII).
Objective: To determine the correlation between various indexes of bioelectrical impedance (IBE) and APACHE II score (sAII) in patients with septic shock. Material and methods: We included 30 patients > 14 years old with septic shock admitted to the Adults intensive care unit (ICU) at the Hospital Nacional Cayetano Heredia û Peru. The (sAII) was calculated and various IBE parameters were measured (phase angle, impedance index and relationship ICF/ECF). Correlations were calculated by multiple linear regression and Pearson. Results: 60% were male, mean age was 60 ± 20.92 years, height 161 ± 6 cm, weight 65.46 ± 8.7 kg and time of admission ICU was 8.4 ± 5.99 hours. 86.6% required mechanical ventilation, the most common infection was respiratory in origin (63.3%). The mean sAII was 18.8 ± 9.2, ICU stay was 8.4 ± 5.99 days and mortality was 50% per month. We only found a statistically significant negative correlation (r = - 0.46, p = 0.01) between the phase angle (FA) and (sAII). Neither the impedance index nor the relationship ICF/ECF had significant correlation. The best predictor of mortality was FA: those who died had an FA <6 degrees (average 3.67 ± 0.63), p <0.05. Conclusions: Only FA correlated with the score (sAII) and was the index that best predicted mortality in patients with septic shock, exceeding the APACHE II score (sAII).
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , APACHE , Shock, Septic/therapy , Electric Impedance/therapeutic useABSTRACT
The classical manifestations of Behçet disease are mouth ana genital ulcers, cutaneous lesions ana ocular involvement. The central nervous system is affected in 5 to 59 percent of the cases, usually in the form of meningoencephalitis or sinus venous thrombosis. We report a 17-year-old femóle presenting with a two weeks history of progressive headache, nausea and blurred vision. An initial magnetic resonance was normal. Fifteen days later she was admitted to the hospital due to progression of visual impairment. Shegave a history of oral ulcers and arthralgias. A new magnetic resonance was normal. A lumbar puncture showed a cerebrospinal fluid with a protein concentration of 14 mg/dl, aglucose concentration of 64 mg/dl, 20fresh red blood cells and a pressure of 26 cm H(2)0. The diagnosis of a pseudotumor cerebri, secondary to Behçet disease was raised and the patient was treated with colchicine and acetazolamide. The evolution was torpid and an anterior uveitis was alsofound. After discharge, she continued with oral and genital ulcers and was treated with infliximab. Despite treatment, headache persists.
Subject(s)
Adolescent , Female , Humans , Behcet Syndrome/complications , Pseudotumor Cerebri/etiology , Acetazolamide/therapeutic use , Behcet Syndrome/diagnosis , Behcet Syndrome/drug therapy , Colchicine/therapeutic use , Pseudotumor Cerebri/diagnosis , Pseudotumor Cerebri/drug therapyABSTRACT
Background: Orthotopic liver transplantation (OLT) is the treatment of choice for multiple acute and chronic end-stage liver diseases as well as for selected cases of liver malignancy and ¡iver-site metabolic disorders. Neurological impairment is a major source of morbidity and moñality following OLT. Aim: To describe the incidence and the type of neurological complications occurring in the post-operative period of OLT in patients transplanted in our hospital. Material and methods: Between March 1994 and August 2007, 76 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications have been obtained from our program data base and patient charts. Results: Twenty three patients (30.3 percent) had CNS complications following OLT. The leading complications were immunosuppressive drug-related neurological impairment in nine patients (39.1 percent), peripheral nerve damage in five patients (21.7 percent), central pontine myelinolysis in four patients (17.4 percent), cerebrovascular disease in three (13 percent) and CNS infection in three (13 percent). Most CNS events (90 percent) occurred in the first 2 weeks after OLT. Five patients with neurological complications died (22 percent). Conclusions: CNS complications occurred in almost one fifth of the population studied, and they had a poor outcome, as previously reported).
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Liver Transplantation/adverse effects , Peripheral Nervous System Diseases/etiology , Postoperative Complications/epidemiology , Central Nervous System Diseases/epidemiology , Central Nervous System Diseases/etiology , Cerebrovascular Disorders/etiology , Chile/epidemiology , Hospitalization/statistics & numerical data , Liver Transplantation/methods , Longevity , Peripheral Nervous System Diseases/epidemiology , Population Surveillance/methods , Postoperative Complications/mortality , Retrospective Studies , Survival Analysis , Young AdultABSTRACT
Se presenta el primer caso de Atresia Coanal (bilateral) en el país. Luego de ocho días con cuadro de distress respiratorio grave, fue referido desde Baní al Hospital Robert Reid Cabral, Santo Domingo, donde dos días, tras su ingreso, se hizo diagnóstico clínico (Atresia Coanal) mediante sonda nasogástrica a través de las fosas nasales, confirmando mediante radiografía de cráneo lateral y hirtz, con medio de contraste. la anomalía fue corregida mediante procedimiento quirúrgico de urgencia, usando técnica de abordaje la vía transnasal. Atresia, atresia de coanas, pediatría
Subject(s)
Humans , Female , Infant, Newborn , Choanal AtresiaABSTRACT
Ha habido importantes avances en el conocimiento del metabolismo del triptofano, la síntesis de serotonina y los receptores serotoninérgicos encefálicos. Se ha determinado la efectividad terapéutica del 5-hidroxitriptofano en la depresión, insomnio, dolor crónico, mioclonías, etc. Eso sí, ha surgido inquietud al establecerse, como efecto adverso del tratamiento con L-triptofano, la producción del síndrome de mialgia-eosinofilia con compromiso importante de las fuerzas debido a una polineuropatía
Subject(s)
Humans , 5-Hydroxytryptophan/pharmacology , Receptors, Serotonin/physiology , Tryptophan/pharmacology , Depressive Disorder/drug therapy , Myoclonus/drug therapy , Serotonin/chemical synthesis , Eosinophilia-Myalgia Syndrome/chemically induced , Sleep Initiation and Maintenance Disorders/drug therapyABSTRACT
Los autores comunican dos casos de absceso paravertebral cuya forma de presentación fue síndrome lumbociático. Se comentan las características del cuadro clínico, destacando el tipo de dolor. Se discuten los exámenes de laboratorio señalando la utilidad de la tomografía computada de abdomen y pelvis. Se sugiere el drenaje quirúrgico amplio como el tratamiento de elección y se menciona la posibilidad de meningitis como complicación grave