Miastenia Gravis en el Hospital Santo Tomás 1990-1997 / Myasthenia gravis in Santo Tomás Hospital 1990-1997

Myasthenia Gravis is an infrequent disease. Diagnosis and treatment must be done early to avoid high morbidity that can compromise patients lives. Nine cases were identified during the eight year 1990-1997 at the Santo Tomas Hospital of Panama city but one had to be excluded because he refused treatment. Most of the patients (7/8) had symptoms for more than 3 months. The diagnosis of Myasthenia Gravis requires a high index of suspicion and the clinical impressión must be confirmed by various diagnostic studies that include the edrophonium test, the repetitive stimulation test, the therapeutic test with pyridostigmine, the determination of acetylcholine anti-receptor antibodies and a CT Scan of the thorax. Medical treatment consists mainly of anticholinesterase agents and surgical treatment consists of thymectomy by means of an extended transternal ablation. Operative results were excellent, seven out of eight improved

Trichomonas en un empiema pleural / Trichomonas in pleural empyema

Trichomonas sp. was found in a patient with empyema and chronic obstructive pulmonary disease. This is a uncommon finding. A wet mount of pleural fluid is recommended to be observed by light microscopy

Trauma cardíaco penetrante / Penetrating cardiac trauma

The author reviewed the clinical records of 40 patients with the diagnosis of penetrating cardiac trauma operated on in a period of 38 months in order to confirm the prognostic value of trauma indexes: Physiologic Index, Revised Trauma Scale and Index of Penetrating Cardiac Trauma. Thirty-eight patients were men and two were women with an average age of 26.8 years. Thirty-one patients suffered knife wounds and nine were wounded by bullets. The 15 unstable patients (systolic Blood Pressure 80 mmHg after infusion of crystalloid solutions) were submitted to thoracotomy. The 25 stable patients underwent the performance of a pericardial (subxiphoid) window for diagnosis, followed by sternotomy if the result was positive. There were 5 deaths all of which occurred in the operating room due to exsanguination. In all these cases Revised Trauma Scale was less than 3 and the Physiologic Index was grade III in four and grade II in one patient. Our results indicate that the Revised Trauma Scale and the Physiologic Index are good prognostic indicators of survival and that patients with Physiologic Index grade I and II have good probabilities for survival if they are operated on promptly