ABSTRACT
Resumen El síndrome de persona rígida es un cuadro neuro lógico infrecuente caracterizado por rigidez muscular de tronco y extremidades y espasmos musculares ga tillados por estímulos sensoriales o emocionales, que progresa hacia la postración. Cuenta con un mecanismo fisiopatogénico con base inmunológica, en el cual los autoanticuerpos, como el antiGAD65, cumplen un rol central. Asimismo, la detección de dichos anticuerpos corrobora el diagnóstico ante un paciente con cuadro clínico sugestivo. Un 4 a 6% de los casos tienen neoplasias subyacentes. El tratamiento se basa en el manejo sintomático, inmunomodulador y de la enfermedad de base en los casos paraneoplásicos. Reportamos un caso de síndrome de persona rígida clásico asociado a timoma y describimos las características principales de esta entidad.
Abstract Stiff-person syndrome is a rare neurological condi tion characterized by muscular rigidity of the trunk and extremities and muscle spasms triggered by sensory or emotional stimuli, which progresses towards prostra tion. It has a pathophysiogenic mechanism with an immunological basis, in which autoantibodies, such as antiGAD65, play a central role. Likewise, the detec tion of these antibodies corroborates the diagnosis in a patient with a suggestive clinical picture. Four to 6% of cases have underlying neoplasms. Treatment is based on symptomatic, immunomodulatory, and underlying disease management in paraneoplastic cases. We re port a case of classic stiff person syndrome associated with thymoma and review the main characteristics of this entity.
ABSTRACT
Resumen La hiperhidrosis es un trastorno caracterizado por la producción excesiva de sudor por las glándulas sudoríparas ecrinas que influye negativamente en las actividades sociales, laborales y fundamentalmente en la calidad de vida. Se divide en primaria o secundaria. La primaria es una enfermedad benigna caracterizada por una excesiva sudoración con mayor frecuencia en palmas, plantas, axilas y cara. Su incidencia es del 1% de la población y su causa es desconocida. La mayoría de los tratamientos médicos no logran un buen control sintomático y frecuentemente son transitorios. La simpaticotomía torácica bilateral videoasistida se ha vuelto el tratamiento de elección en pacientes muy sintomáticos. En el período de 1998 a 2018 se realizaron 174 simpaticotomias bilaterales videoasistidas por hiperhidrosis primaria, de las cuales 102 cumplieron los criterios de inclusión. Se excluyeron a 72 pacientes. El 20.5% fueron hombres y el 79.5% mujeres con una edad media de 29.22 años. En cuanto a la localización fue palmoplantar axilar en un 50.9%, axilar en un 23.5%, palmoplantar en un 10.7%, palmar en un 7.8%, palmoaxilar 6.8% y facial 5.8%. Los pacientes con sudoración palmar presentaron 94.9% de mejoría, axilar 84.51%, plantar 46.25% y facial 84% respectivamente. El post operatorio arrojó una media de internación de 1.1 días. Como efecto no deseado, se presentó sudoración compensatoria en 53 casos y complicaciones postoperatorias en 18 casos. Concluimos que es una técnica segura, que resuelve de manera significativa la sudoración, mejorando la calidad de vida.
Abstract Hyperhidrosis is a disorder consisting of excessive sweating through the different body sweat glands, which produces a negative impact socially and in work-related activities in those that suffer this condition. There are primary and secondary forms. The primary form is a benign condition with excessive sweating mainly in palms, soles of feet, axillae and face. It affects a 1% of the population, and its cause is unknown. Most medical treatments are unsuccessful, and at best, transitory. In patients who are very troubled by the condition, videoassisted bilateral thoracic sympathicotomy has become the elective treatment. In the period ranging from 1998 to 2018, 174 procedures were undertaken for primary hyperhidrosis, of which 102 satisfied the inclusion criteria. 72 patients were excluded. A 20.5% were males, and 79.5% were females, with an average age of 29.22 years at surgery. As to localization of sweating, a 50.9% was palmar-plantar-axillary, 23.5% axillary, 10.7% palmarplantar, 7.8% palmar, 6.8% palmar-axillary, and a 5.8% facial. Those patients with palmar sweating showed a 94.9% improvement, those with axillary sweating a 88.51%, with plantar a 46.25% and those with facial sweating a 84% improvement. The average admission time was 1.1 days. As an undesired effect, compensatory sweating occurred in 53 cases and postoperative complications in 18 cases. We conclude this is a safe technique, that diminishes sweating significantly, improving patient's quality of life.
Subject(s)
Humans , Male , Female , Adult , Quality of Life , Hyperhidrosis/surgery , Sympathectomy , Treatment Outcome , Thoracic Surgery, Video-AssistedABSTRACT
Resumen La enfermedad de Whipple es una enfermedad multisistémica crónica, causada por la bacteria Tropherima whipplei. Se han descripto aproximadamente 1200 casos en la literatura. La incidencia mundial se estima en 9.8 casos por millón de personas. Los datos provenientes de Sudamérica y Europa muestran que afecta a varones de mediana edad. Se cree que los factores inmunológicos del huésped son los que influyen en el curso de la infección y no el genotipo del agente. Dado que las características clínicas no suelen ser específicas y el espectro de manifestaciones en órganos individuales puede ser subestimado, el diagnóstico sigue siendo muy difícil. Presentamos un caso confirmado por histopatología con compromiso multisistémico. Consideramos importante su difusión dados los escasos casos documentados en Sudamérica y la relevancia de tener presente la sospecha diagnóstica para el abordaje terapéutico precoz que mejora el pronóstico de esta rara enfermedad.
Abstract Whipple's disease is a chronic mutisystem disease caused by the bacteria Tropherima whipplei. Approximately 1200 cases have been described in the literature. The worldwide incidence is estimated at 9.8 cases per million people. Data from South America and Europe show that it affects middle-aged males. It is believed that host immunological factors rather than agent genotypic traits influence the course of the infection. Since the clinical characteristics are usually nonspecific and the wide spectrum of manifestations in individual organs may be underestimated, the diagnosis remains challenging. We present a case with multisystem compromise confirmed by histopathology. We consider its publication important given the few cases documented in South America and the relevance of bearing in mind the importance of an early diagnosis for a prompt treatment that improves the prognosis of this rare disease.
Subject(s)
Humans , Male , Middle Aged , Aged , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Whipple Disease/complications , Whipple Disease/diagnosis , Whipple Disease/drug therapy , Europe , Tropheryma , Anti-Bacterial Agents/therapeutic useABSTRACT
La proteinosis alveolar es un enfermedad caracterizada por el acúmulo anormal de surfactante en el espacio alveolar lo que conlleva a disrupción en el intercambio gaseoso. Su fisiopatogenia es variada y en los adultos la forma secundaria es la más frecuente. Presentamos el caso de una paciente con leucemia mieloide aguda en tratamiento compasivo con gemtuzumab ozogamicina, e infecciones respiratorias a repetición que se presenta con disnea progresiva y tos seca. Luego de descartar causa embólica y cardíaca, se realiza tomografía que evidencia opacidades en vidrio esmerilado de distribución difusa y engrosamiento de septos, por lo que ante la sospecha de infección se realiza lavado broncoalveolar que revela líquido blanquecino evidenciando en la citología inclusiones en macrógrafos PAS positivo. Con el diagnóstico de proteinosis alveolar secundaria a enfermedad de base, se reinició tratamiento quimioterápico. Presentó progresión de infiltrados y mayor requerimiento de oxígeno falleciendo pocos días después. (AU)
Subject(s)
Pulmonary Alveolar Proteinosis , Leukemia, MyeloidABSTRACT
La arteriopatía por marihuana debe ser considerada en pacientes jóvenes con arteriopatía periférica sin factores de riesgo para ateroesclerosis. Se ha descrito por primera vez en 1960 y existen más de 100 casos en la literatura. Si bien se tiende a considerar como una entidad independiente de la tromboangeítis obliterante o enfermedad de Leo Buerger, debido a los hallazgos la consideramos dentro del espectro de esta última. Presentamos dos casos de pacientes jóvenes con enfermedad vascular periférica asociada al consumo de marihuana, luego de excluir otras enfermedades. El tratamiento es el cese del consumo. Es indispensable valorar el uso de drogas en pacientes jóvenes que se presentan con arteriopatía periférica.
The marijuana arteriopathy should be considered in young patients with peripheral arterial disease with no risk factors for atherosclerosis. It was described for the first time in 1960 and since then there have been about 100 cases published in the literature. Although it tends to be considered as an independent entity of thromboangiitis obliterans or Leo Buerger´s disease, in the light of the last findings it is possible to consider it within the spectrum of the latter. We present two cases of young patients with peripheral vascular disease associated with marijuana use where other associated illnesses had been excluded and where the mainstay of treatment has been the cessation of marijuana consumption. It is essential to assess drug use in young patients presenting with peripheral arterial disease.
Subject(s)
Humans , Male , Adult , Marijuana Abuse/complications , Peripheral Arterial Disease/chemically induced , Thromboangiitis Obliterans/chemically induced , Cannabis , Risk Factors , Treatment Outcome , Peripheral Arterial Disease/therapyABSTRACT
El vértigo es definido como la sensación de movimiento ilusorio del cuerpo o de los objetos que le rodean. Es una de las causas más comunes de consulta en los departamentos de emergencia, y 2 a 3% de la población mundial consulta anualmente por este síntoma. De acuerdo al compromiso vestibular en el oído interno o en el sistema nervioso central o ambos, puede clasificarse en vértigo periférico, central o de origen mixto, siendo la principal causa del periférico el vértigo posicional paroxístico benigno. La valoración semiológica y anamnesis es fundamental para el diagnóstico. En el examen físico inicial, la diferenciación de un vértigo de origen central de otro de origen periférico, puede realizarse mediante el análisis del nistagmo, la valoración del impulso cefálico y la desviación ocular, que se integran en un sistema denominado HINTS, por sus siglas en inglés (Head Impulse, Nystamus type, Test of Skew), y por la realización de pruebas que evalúen también la vía vestíbulo-cerebelosa. Además, la realización de una audiometría tonal, aumentaría la sensibilidad diagnóstica de 71 a 89% en la evaluación inicial. El diagnóstico apropiado es la base para el tratamiento y control de esta condición clínica en el mediano y largo plazo.
Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.
Subject(s)
Humans , Vertigo/diagnosis , Vertigo/physiopathology , Vestibular Neuronitis/diagnosis , Vestibular Neuronitis/therapy , Dizziness/diagnosis , Dizziness/physiopathology , Dizziness/therapy , Benign Paroxysmal Positional Vertigo/diagnosis , Benign Paroxysmal Positional Vertigo/physiopathology , Benign Paroxysmal Positional Vertigo/therapy , Meniere Disease/diagnosis , Meniere Disease/physiopathology , Meniere Disease/therapy , Migraine Disorders/therapyABSTRACT
La trombosis venosa profunda (TVP) del miembro superior es una entidad poco frecuente, se estima que representa el 10% de todos los casos de TVP. Clásicamente se clasifican en primarias (idiopáticas, por compresión de la vena subclavia o relacionadas con el ejercicio) y secundarias (cáncer, trombofilia, traumatismo, cirugía del hombro, asociadas a catéteres venosos o de causa hormonal). El síndrome de Paget- Schrötter es una trombosis primaria de la vena subclavia en la unión subclavio-axilar, ya sea por movimientos repetitivos o relacionada al ejercicio; llevando a microtrauma en el endotelio con la consiguiente activación de la cascada de coagulación. Clínicamente se presenta de forma brusca con dolor, edema y sensación de pesadez en el miembro afectado. El tratamiento varía desde trombolíticos y anticoagulación a la intervención quirúrgica, dependiendo del tiempo de evolución. Presentamos cuatro casos de trombosis de vena subclavia relacionada con el ejercicio.
Deep vein thrombosis (DVT) of the upper limb is a rare entity, estimated to account for 10% of all cases of DVT. Classically, they are classified into primary (idiopathic, due to subclavian vein compression or exercise related) and secondary (cancer, thrombophilia, trauma, shoulder surgery, associated to venous catheters or due to hormonal causes). The Paget- Schrötter syndrome is a primary thrombosis of the subclavian vein in the subclavian-axillary junction, related either to repetitive movements or to exercise; leading to microtrauma in the endothelium with consequent activation of the coagulation cascade. Clinically, it presents abruptly with pain, edema and feeling of heaviness in the affected limb. The treatment varies from thrombolytics and anticoagulation to surgical intervention, depending on the time of evolution. We present four cases of exercise-related subclavian vein thrombosis.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Subclavian Vein/pathology , Axillary Vein/pathology , Upper Extremity Deep Vein Thrombosis/pathology , Subclavian Vein/diagnostic imaging , Axillary Vein/diagnostic imaging , Phlebography , Ultrasonography, Doppler , Edema , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/drug therapy , Anticoagulants/therapeutic useABSTRACT
Cough may be associated with complications such as syncope, urinary incontinence, pneumothorax, and less frequently, pulmonary hernia and costal fractures. Chronic cough is a cause of rib fractures and when they occur it is likely to affect more than one rib. We report a 53 year-old obese male in treatment with enalapril 10 mg for hypertension with a dry cough lasting five months. He consulted for bilateral chest pain and a Chest X ray examination showed symmetrical fractures in the seventh left and right ribs. Enalapril was discontinued, cough and pain subsided in two weeks.
Subject(s)
Humans , Male , Middle Aged , Rib Fractures/etiology , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Enalapril/adverse effects , Cough/cerebrospinal fluid , Rib Fractures/diagnostic imaging , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Enalapril/therapeutic use , Tomography, X-Ray Computed , Chronic Disease , Cough/complications , Hypertension/drug therapyABSTRACT
El angioedema inducido por inhibidores de la enzima convertidora de angiotensina es una entidad poco frecuente caracterizada por edema en piel y mucosas, debido al aumento de la permeabilidad vascular provocada por la inhibición de la enzima convertidora y el subsiguiente aumento de la bradiquinina. De manera frecuente cursa con compromiso facial y de mucosas, siendo infrecuente el compromiso intestinal o de vía aérea. El angioedema intestinal puede presentarse asociado a angioedema facial o aislado, siendo este último excepcional. Cursa con episodios recurrentes de dolor, distensión abdominal y diarrea acuosa con recuperación completa en dos o tres días. Si bien es una entidad poco frecuente, el hecho de que esté asociada a fármacos utilizados con frecuencia nos hace incluirla en el diagnóstico diferencial del dolor abdominal recurrente. Presentamos un caso de angioedema intestinal aislado, asociado al uso de enalapril.
Angioedema induced by angiotensin converting enzyme inhibitors is a rare entity characterized by skin and mucosal edema, due to increased vascular permeability caused by inhibition of the converting enzyme and subsequent increase in bradykinin. It frequently presents with facial and mucosal involvement, being uncommon the intestinal or airway compromise. Intestinal angioedema may be associated with facial or isolated angioedema, the latter being exceptional. It is associated with recurrent episodes of pain, abdominal distention and watery diarrhea which complete recovery in two or three days. Although it is a rare entity, the fact that it is associated with frequently used drugs makes us include it in the differential diagnosis of recurrent abdominal pain. We report a case of isolated intestinal angioedema associated with the use of enalapril.
Subject(s)
Humans , Female , Aged , Enalapril/adverse effects , Intestinal Diseases/chemically induced , Angioedema/chemically induced , Antihypertensive Agents/adverse effects , Hypertension/drug therapy , Intestinal Diseases/diagnostic imaging , Intestine, Small/diagnostic imaging , Angioedema/diagnostic imagingABSTRACT
In the political and social context of World War periods and unstoppable technological advances, health professionals in the early twentieth century tried to orientate the practice of medicine towards a modern anthropological concept close to the biomedical perspective, which defends the dignity of a person. Threatened by the risks represented by collectivism and the meanness of the prevailing repressive governments, a personal struggle for the defense of life aroused, which was socially expressed by the advent of bioethics, psychoanalytic theories and the concept that environment has an important role in peoples health and welfare. And above all, the appearance of a paradoxical claim of religious ideals as support of science in times of overall crisis.
Subject(s)
Humans , Male , Female , Religion and Medicine , Saints/history , World War I , World War II , Altruism , History, 19th Century , History, 20th CenturyABSTRACT
Las neuronopatías o ganglionopatías sensitivas, o enfermedades del ganglio dorsal, representan un subgrupo de enfermedades del sistema nervioso periférico, frecuentemente asociadas a trastornos disinmunes o paraneoplásicos, y a agentes tóxicos. Los pacientes típicamente presentan ataxia temprana, pérdida de los reflejos osteotendinosos y síntomas sensitivos positivos, presentes tanto en partes proximales como distales del cuerpo. Estudiamos retrospectivamente 10 casos con un diagnóstico final de neuronopatía sensitiva. El síntoma de presentación fue el de una neuropatía sensitiva de curso subagudo en todos los casos, con parestesias en el 100% de los casos. Otras manifestaciones fueron: hipoestesia (10/10), ataxia de la marcha (8/10), síntomas autonómicos (3/10) y parestesias periorales (3/10). La electrofisiología mostró un patrón de compromiso sensitivo axonal, con respuestas motoras normales. El diagnóstico final fue neuronopatía sensitiva adquirida en todos, asociada a síndrome de Sjögren en dos, a lupus eritematoso en uno, a artritis reumatoidea en uno, a cáncer en dos (paraneoplásica) e idiopática en cuatro. En los casos paraneoplásicos, los tumores fueron un carcinoma de pulmón de células pequeñas (con anticuerpos anti-Hu positivos) y un carcinoma epidermoide de pulmón. Ocho pacientes fueron tratados con inmunoterapia, con altas dosis de metilprednisolona endovenosa y/o con inmunoglobulina endovenosa; con pobre respuesta en cuatro casos, mejoría neurológica en cinco, y sin cambios en uno. El presente trabajo muestra el patrón clinico y electrofisiológico de las neuronopatías sensitivas subagudas, y la relevancia de un tratamiento temprano.
Sensory neuronopathies or ganglionopathies, or dorsal root ganglion disorders, represent a subgroup of peripheral nervous system diseases, frequently associated with dysinmune or neoplastic disorders and with toxic agents. A degeneration of both central and peripheral sensory proyections is present. Patients typically show early ataxia, loss of deep tendon reflexes and positive sensory symptoms present both in proximal and distal sites of the body. We retrospectively studied 10 cases with a final diagnosis of sensory neuronopathy. Sensory neuropathy was the presenting symptom and the course was subacute in all cases. Paresthesias in upper limbs were a predominant manifestation (100%). Other manifestations included: hypoesthesia (10/10), gait ataxia (8/10), autonomic symptoms (3/10) and perioral paresthesias (3/10). Electrophysiology showed sensory axonal neuronal pattern, with normal motor responses. Final diagnosis was acquired sensory neuronopathy in all patients, associated with Sjögren’s syndrome in 2, with lupus erythematosus in 1, with rheumatoid arthritis in 1, with a cancer in 2 (paraneoplastic) and idiopathic in 4. In paraneoplastic cases, the tumor was small cell lung cancer in 1 (with positive anti-Hu antibodies), and epidermoid lung cancer in the other. Eight patients were treated with immunotherapy, high dose intravenous methylprednisolone and/or intravenous immunoglobulin; with poor response in 4 cases, neurologic improvement in 5, and without any change in 1 patient. The present work shows the typical clinical and electrophysiological pattern of subacute sensory neuronopathy, and the relevance of early treatment.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Ataxia/diagnosis , Ataxia/drug therapy , Carcinoma, Squamous Cell/complications , Small Cell Lung Carcinoma/complications , Lung Neoplasms/complications , Paresthesia/diagnosis , Arthritis, Rheumatoid/complications , Ataxia/complications , Sjogren's Syndrome/complications , Immunoglobulins, Intravenous/therapeutic use , Fatal Outcome , Gait Ataxia/diagnosis , Gait Ataxia/drug therapy , Anti-Inflammatory Agents/therapeutic useABSTRACT
Intravascular lymphoma is a rare subtype of extranodal diffuse large B-cell lymphoma characterized by clonal proliferation of lymphocytes inside of small and medium caliber vessels. Its incidence is estimated at one case per million. The clinical picture is very variable, but frequently has skin and central nervous system involvement. It is diagnosed by demonstrating pathological blood vessel infiltration by lymphoma cells. We report a 44 years old male presenting with fever, malaise and erythematous lesions in the abdominal wall. An abdominal wall biopsy showed dilated vascular vessels with atypical cells in their lumen, compatible with large B-cell intravascular lymphoma. He was treated with rituximab, cyclophosphamide, adriamycin, vincristine and prednisone and an autologous hematopoietic stem cell transplantation, achieving a complete remission that has lasted two years.
Subject(s)
Adult , Humans , Male , Lymphoma, Large B-Cell, Diffuse/pathology , Vascular Neoplasms/pathology , Abdominal Wall/blood supply , Biopsy , Erythema/complications , Hematopoietic Stem Cell Transplantation , Lymphoma, Large B-Cell, Diffuse/therapy , Remission Induction , Vascular Neoplasms/therapyABSTRACT
El síndrome de Hughes-Stovin es una entidad infrecuente caracterizada por trombosis venosa profunda y aneurismas de la arteria pulmonar, siendo su etiología y patogenia desconocida. Algunos autores la consideran una variante de la enfermedad de Behcet. Su curso natural es generalmente fatal. Se presenta con tos, disnea, hemoptisis, dolor torácico y fiebre. El tratamiento es con esteroides y agentes citotóxicos hasta la cirugía. Presentamos el caso de un hombre de 41 años que consultó por disnea, hemoptisis y dolor torácico, llegándose al diagnóstico de trombosis venosa profunda de miembro inferior derecho, trombo-embolismo de pulmón y aneurismas de arterias pulmonares. Recibió tratamiento con corticoides en altas dosis y 6 pulsos de ciclofosfamida de 1 gramo durante 6 meses, con regresión completa de los aneurismas y de la sintomatología.
The Hughes-Stovin syndrome is a rare entity characterized by deep vein thrombosis and pulmonary artery aneurysms of unknown etiology and pathogenesis. Some authors considered a variant of Behcet's disease. Its natural course is usually fatal. The symptoms are cough, dyspnea, hemoptysis, chest pain and fever. The treatment goes from steroids and cytotoxic agents to surgery. We present the case of a 41 year old man who shows dyspnea, hemoptysis, and chest pain leading to the diagnosis of deep venous thrombosis of the right leg, lung thromboembolism and pulmonary artery aneurysms. He was treated with high-dose corticosteroids and 6 cyclophosphamide pulses of 1 gram each per 6 months with complete regression of aneurysms and symptomatology.
Subject(s)
Humans , Male , Adult , Pulmonary Artery , Pulmonary Embolism/diagnosis , Aneurysm, Ruptured/diagnosis , Venous Thrombosis/diagnosis , Syndrome , Behcet Syndrome/diagnosis , Hemoptysis/etiologyABSTRACT
Armand Trousseau (1801-1867) was born in Tours, France on October 14, 1801. He graduated as a physician in the same city under the direction of Pierre Bretonneau and received his doctorate in 1825 in Paris. He was the first physician to practice tracheotomy in diphtheria and perform thoracenteses to remove air or fluid from the pleural space. He recommended tracheal intubation in different scenarios. He described the first cases of laryngeal tuberculosis and the presence of carpopedal spasm in hypocalcemia, a sign that has his name. He also described the association between migratory thrombophlebitis and neoplasia, which is known as Trousseau’s syndrome. Ironically, on January 1, 1867 he diagnosed in himself a deep vein thrombosis of the left upper limb and told one of his disciples “I am lost; I have no doubt about the nature of my disease”. He died of gastric cancer at the age of 66 years on June 23, 1867. He carried out an educational and medical work. He instructed his students about the rather instantaneous thought process in clinical medicine. He always conducted his clinical work with the certainty of a sound scientific background. Contemporary physicians should take advantage of the example and lessons of Armand Trousseau.
Subject(s)
History, 19th Century , Clinical Medicine/history , Hypocalcemia/history , FranceABSTRACT
Presentamos el caso de una mujer con diagnóstico de anorexia nerviosa que desarrolló cardiomiopatía de takotsubo precipitada por estrés emocional y alteraciones del medio interno. Evolucionó favorablemente con manejo conservador. Los casos de cardiomiopatía inducida por estrés, descriptos en pacientes con trastornos de la conducta alimentaria, suelen alcanzar mayor gravedad y se asocian con la prolongación del intervalo QT por desequilibrios electrolíticos, arritmias ventriculares e hipoglucemia. Se realiza una revisión del compromiso cardiovascular en pacientes con anorexia nerviosa.
We report the case of a woman with anorexia nervosa who developed takotsubo cardiomyopathy triggered by emotional stress and electrolyte disturbances. The patient improved with conservative management. Descriptions of stress-cardiomiopathy in association with eating disorders are often of higher severity and related to QT prolongation because of electrolyte abnormalities, ventricular arrhythmias and hypoglycemia. A review of cardiovascular compromise in patients with anorexia nervosa is performed.