Intoxicación por plomo: clínica, diagnóstico y factores ambientales condicionantes / Lead poisoning: clinics, diagnosis and environmental related factors

The environmental lead in the linotype room was 25 percent over the accepted values. Twelve of the 20 workers were poisoned and 3 were highly exposed. Poisoned workers were working in areas with high environmental lead concentrations, were in direct contact with the metal, had plasma lead concentrations over 70 ug/dl and an average exposure time over 17 years. Their clinical picture was not specific and related to plasma and environmental lead concentrations, length of exposure and type of contact. Lead poisoning must be suspected among workers exposed to high environmental concentrations and its treatment consists in withdrawing poisoned subjects from polluted areas.

Peritoneo diálisis crónica intermitente: 12 años de experiencia / Intermittent peritoneal dialysis: a 12 years experience

Since 1981, we have treated 46 adults aged 56 ñ 21 years, of whom 17 were diabetic, with intermittent peritoneal dialysis. Their main time on dialysis has been 21 months with an accumulated experience of 493 months/patient. The program included 2 dialyses per week, 25 exchanges of 21 session and 30 min of dwell time. Arterial pressure control has been satisfactory. Diabetic patients had a lower levels of serum calcium, alkaline phosphatases and m-PTH. The incidence of peritonitis has been 1 episode/14 months/patient and the causative agent has been Staphylococcus aureus in 47 percent of episodes. Mean catheter duration has been 15 months and 1 episode/34 months/patient of exit site infection has been recorded and Staphylococcus aureus has beeb the causative agent in 83 percent episodes. The risk of acquiring the first peritonitis was 12 percent at 3 months, 23 percent at 6 months and higher for non diabetic patients. Actuarial survival of treated patients at 12 and 24 months was 89 and 67 percent respectively. No differences in survival were recorded between diabetic and non diabetic patients. Fifty two percent of patients that dropped out continued on hemidialysis, 23 percent, 11 percent abandoned treatment, 8 percent continued on chronic ambulatory peritonela dialysis and 60 percent received a kidney allograft. We conclude that intermittent peritoneal dialysis is a good alternative treatment of chronic renal failure, even in diabetic patients

Accidente vascular encefálico, hipertensión arterial y ritmo circadiano / Stroke hypertension and circadian rhythm

Con el fin de estudiar un posible ritmo circadiano en la hora de presentación de los accidentes vasculares encefálicos (AVEs) y la influencia que en el tiene la hipertensión arterial, se analizaron 144 pacientes, ingresados al Hospital A Nef entre enero de 1988 y julio de 1992. De los AVEs, el 72 por ciento eran isquémicos y el 28 por ciento hemorrágicos. Estaban asociados a hipertensión arterial el 79 por ciento de ellos. Para el estudio del ritmo circadiano se esatablecieron 2 períodos: A.- 08.00-21.00 horas (diurno) y B.- 21.01-07.59 horas (nocturno). el 73 por ciento de los AVEs se presentaron en el período A o diurno (p<0.01) y el análisis realizado según tipo de accidente vascular encefálico, reveló un predominio diurno en la hora de presentación de los isquémicos (p<0.01) y la ausencia de un predominio por alguno de los períodos analizados para los hemorrágicos (NS). La presencia de hipertensión arterial no fue un factor determinante en la hora de presentación de los AVEs

Consumo de alcohol y glomerulonefritis por depósito mesangial de IgA: enfermedad de Berger / Alcohol comsumption and glomerulonephritis by mesangial IgA store: Berger's disease

Alcohol ingestion is considered as a possible pathogenic agent for Berger's disease, since IgA mesangial deposits have been described in liver cirrhosis. Aiming to assess this issue, 28 patients with Berger's disease (BD) and 40 patients with other glomerulopathies (NBD) were subjected to an enquiry about alcohol ingestion. Data was corroborated with 21 closed relatives of BD patients and 34 relatives of NBD patients. No differences were observed in report alcohol intake between BD patients and their relatives, however relatives of NBD patients understimated their alcohol intake. No differences in alcohol intake, either self reported or reported by relatives, were observed between BD and NBD patients. It is concluded that no differences in alcohol intake were observed between patients with Berger's disease and subjects with other glomerulopathies

Serología en fiebre tifoídea: experiencia en 104 casos / Serology in typhoid fever: experience in 104 cases

El propósito de este trabajo fué valorar la importancia que podría tener una reacción positiva aislada para el Antígeno O de la Salmonella Thyphi en el diagnóstico de la Fiebre Tifoídea, para lo cual se revisaron 104 fichas de casos confirmados y se compararon con 104 controles escogidos al azar. Para títulos iguales o superires a 1:80 una reacción de hemaglutinación para antígeno O, en cualquier momento de la enfermedad, tuvo un valor predictivo de positividad, calculado estadísticamente, de 95,9%, lo que unido al cuadro clínico y al hemograma clásico petmitirían iniciar el tratamiento antibiótico, mientras se espera los resultados bacteriológicos que habitualmente demoran en llegar

Citomegalovirus y trasplante renal / Cytomegalovirus and kidney transplantation

Se describe el caso de un paciente transplantado renal portador de una infección por citomegalovirus (CMV). Paciente de 39 años de edad, sexo masculino, sometido a un transplante renal con riñón de cadáver, con buenos resultados terapéuticos. A los 82 días de evolución y luego de terapia con Metil Prednisolona para el control de una crisis de rechazo, presenta fiebre, mialgias, hepatitis, neumonitis y leucopenia. El CMV fue aislado de muestras de orina del paciente y sus títulos de anticuerpos en el plasma aumentaron de 1:16 (pre transplante) a 1:128. Su curso clínico fue tórpido, prolongado pero satisfactorio, siendo dado de alta del Hospital 48 días después de su ingreso. Se analiza el cuadro clínico y de laboratorio, el sistema inmuno competente y el efecto de las drogas inmunosupresoras en una infección por CMV en este tipo de enfermo