ABSTRACT
El siguiente estudio continúa la serie de publicaciones sobre decisiones clínicas en el diagnóstico, tratamiento y costo-utilidad en Hepatología, usando las herramientas de la Medicina Basada en Evidencia (MBE). En un escenario clínico en que se sospecha la presencia de ascitis, la real utilidad de los hallazgos clínicos no ha sido bien establecida. Usando un modelo de búsqueda basado en una pregunta clínica, tres estudios y un artículo de revisión son identificados. Uno de estos estudios es extensamente analizado, incluyendo criterio de validez interna (gold standard, criterios de selección de pacientes, reproducibilidad de los hallazgos y temporalidad), análisis de resultados y discusión de la aplicabilidad. Cuatro signos clínicos (flancos abultados, matidez en los flancos, matidez desplazable y signo de la ola) fueron examinados de manera independiente por tres gastroenterólogos. Los resultados muestran que, usando la ultrasonografía como gold standard, 21 por ciento de los pacientes tenía ascitis. La sensibilidad y especificidad de las maniobras examinadas fue de 50 por ciento a 94 por ciento, y 29 por ciento a 82 por ciento, respectivamente. La matidez en los flancos fue el más sensible y el signo de la ola el más específico. La metodología del estudio está limitada por el reducido número de pacientes, la falta de adecuados criterios de selección de casos y la ausencia de información acerca la temporalidad de los síntomas. Otros signos presentes en cirrosis son descritos y brevemente analizados, usando MBE. Concluimos que los signos del examen físico son útiles en el diagnóstico de ascitis, siendo la matidez en los flancos y el signo de la ola los más útiles. La ecotomografía se recomienda en casos de duda diagnóstica.
Subject(s)
Humans , Middle Aged , Ascites/diagnosis , Liver Cirrhosis/diagnosis , Physical Examination/methods , Evidence-Based Medicine , Splenomegaly/physiopathology , Jaundice/physiopathology , Biomedical Research/methods , Periodical , Reproducibility of Results , Signs in Homeopathy , Sensitivity and Specificity , Signs and Symptoms , Telangiectasis/physiopathologyABSTRACT
There is no objective data on the value of individual clinical symptoms or signs in the diagnosis of enteric fever in a febrile patient. The purpose of the study was to assess the value of some clinical and simple laboratory features in the diagnosis of enteric fever. One hundred & six patients with microbiologically confirmed enteric fever and 170 patients with other established febrile illnesses were included in the evaluation. History of stepladder pattern of rise of temperature, loose motions, relative bradycardia and coated tongue proved to be powerful markers of enteric fever with high specificity (100%, 94.71%, 94.71%, 94.12% respectively), positive and negative predictive values. Headache, hepatomegaly and splenomegaly were moderately powerful. ESR and WBC count appeared to have little value in the diagnosis of enteric fever. Pattern of onset and loose motions did not discriminate between typhoid and paratyphoid fever. Most of these patients had illness persisting beyond one week by which viral infections and infectious enterocolitides were largely excluded. Elucidation of power of these markers in distinguishing enteric fever from other febrile illnesses with the help of better designed prospective studies would lessen our dependence on expensive and time consuming laboratory investigations.
Subject(s)
Adolescent , Adult , Aged , Blood Sedimentation , Body Temperature , Bradycardia/physiopathology , Child , Diarrhea/physiopathology , Enterocolitis/diagnosis , Evaluation Studies as Topic , Female , Fever/physiopathology , Headache/physiopathology , Hepatomegaly/physiopathology , Humans , Clinical Laboratory Techniques/economics , Leukocyte Count , Male , Middle Aged , Paratyphoid Fever/diagnosis , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Splenomegaly/physiopathology , Time Factors , Tongue/pathology , Typhoid Fever/diagnosis , Virus Diseases/diagnosisABSTRACT
O estudo das esplenomegalias pode permear pistas decisivas para a realizaçao do diagnóstico sindrômico e etiológico de grande número de enfermidades, nos domínios da medicina interna. Neste artigo foram revisados os aspectos morfofuncionais essenciais do baço, da fisiopatologia e da clínica das esplenomegalias, tendo sido conferida especial ênfase às etapas propedêuticas do reconhecimento das principais doenças sistêmicas, que, dentre várias peculiaridades, apresentam inequívoca conotaçao diagnóstica com aumento anormal do órgao esplênico.
Subject(s)
Spleen/physiology , Splenomegaly/physiopathology , Spleen/physiopathology , Splenomegaly/classification , Splenomegaly/diagnosis , Splenomegaly/etiologyABSTRACT
Describimos el caso de un paciente de 24 años, con un cuadro clínico de 33 meses de evolución de un lupus eritomatoso sistémico asociado a lesiones pápulo-nodulares en miembros superiores e inferiores en el tronco. La biopsia de piel de las lesiones papulo-nodulares demostró acúmulos de mucina y abundantes mastocitos en la dermis intercalados con tejido colágeno. Revisamos la literatura y sólo se han informado 18 casos, ninguno en Latinoamérica. A diferencia de los casos descritos en la literatura médica, no hay informe de poliserositis, adenomegalias y esplenomegalia asociados a la mucinosis pápulo-nodular como se describe en este paciente. Las lesiones cutáneas se manifestaron con la actividad lúpica y la respuesta a la prednisona fue adecuada.
Subject(s)
Humans , Female , Adult , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/physiopathology , Mucinoses/classification , Mucinoses/complications , Mucinoses/diagnosis , Mucinoses/drug therapy , Mucinoses/epidemiology , Mucinoses/etiology , Mucinoses/physiopathology , Mucinoses/therapy , Mucinosis, Follicular/complications , Mucinosis, Follicular/diagnosis , Mucinosis, Follicular/drug therapy , Mucinosis, Follicular/epidemiology , Mucinosis, Follicular/etiology , Mucinosis, Follicular/physiopathology , Mucinosis, Follicular/therapy , Splenomegaly/complications , Splenomegaly/etiology , Splenomegaly/physiopathologyABSTRACT
This study was conducted on forty subjects, thirty male patients with bilharzial hepatosplenomegaly and ten healthy control subjects matched for age and sex. Platelets were studied quantitatively and platelet functions were assessed by bleeding time, clot retraction, platelet adhesion and aggregation. Immunological investigations including determination of serum immunoglobulins [IgG, IgM, and IgA], serum complement [C3c and C4], circulating immune complexes [CICs], as well as clot retraction test for detection of platelet antibodies. There was a significant reduction of platelet count and a negative correlation between the platelet count and the platelet antibodies in patients group. Diminished platelet functions were demonstrated by decreased platelet adhesion, decreased clot retraction, and impaired adenosine diphosphate [ADP] aggregation. No statistical correlation was found between the impairment of aggregation and the degree of inhibition of clot retraction. On the contrary, and inverse correlation was demonstrated between clot retraction and platelet antibodies. Significant higher levels of IgG and IgM in patients' group were detected whereas serum IgA levels showed no statistical difference. Significantly increased levels of serum C3c were demonstrated and there was an inverse correlation between C3c levels and platelet count, however, there was no correlation between serum C3c and platelet antibodies. Serum levels of C4 were not significantly deviated from normal levels. Serum levels of CICs were higher in patients' group and a significant positive correlation was found between these complexes and serum IgG levels. In conclusion, the present study proved the presence of platelet antibodies in patients with bilharzial hepatosplenomegaly. The observed quantitative and qualitative platelet defects in those patients had been correlated to the presence of platelet antibodies and the concomitant immunological disturbances
Subject(s)
Blood Platelets/chemistry , Hepatomegaly/physiopathology , Splenomegaly/physiopathologyABSTRACT
Se describe un caso de Leishmaniasis visceral (Kala azar)) autoctono. Se trato de un nino de 7 meses de edad proveniente de la provincia Angel Sandoval, y nor-este del Departamento de Santa Cruz, (Bolivia); cercano a la frontera con el Brasil. El paciente tenia fiebre, hepato-esplenomegalia y pancitopenia. En el mielograma se encontro amastigotes de Leishmania e hipoplasia. La reaccion de formol-gelificacion fue positiva. Se demostro la ocurrencia de Leishmaniasis visceral en el Departamento de Santa Cruz
Subject(s)
Humans , Male , Infant , Leishmaniasis, Visceral/physiopathology , Bolivia , Fever/physiopathology , Leishmaniasis, Visceral/mortality , Splenomegaly/physiopathologyABSTRACT
The effect of hepatosplenic bilharziasis on female sex hormones has been investigated in twenty women. The patients were segregated into two equal groups according to the presence or absence of ascites. The result were compared with ten healthy women. The study revealed that in early non ascitic stage there was concomitant rise in estradiol and prolactin level with reduction in the gonadotropins level and testosterone and insignificant changes in progosterone. After developing ascites all hormones including progesterone were much lowered with infertility