RESUMEN
Here, we report a case of nocturnal enuresis persisting into adulthood treated with Kampo medicine. A 21-year-old woman had a history of nocturnal enuresis every night during childhood and once every 2-3 nights during school age. Although the frequency of urinary incontinence decreased to 1-2 times/week at 19 years of age, nocturnal enuresis persisted into adulthood. She was diagnosed with mild strain of the rectus abdominis muscles and palpable abdominal aortic pulsation above the umbilicus, and keishikaryukotsuboreito (decoction) therapy was initiated. She did not experience urinary incontinence at night for 3 weeks, except for one episode immediately after treatment commencement. She tended to urinate only 4 times from the time she awoke until bedtime ; therefore, we added a small amount of goreisan to her treatment regimen to increase the urinary output and daytime frequency of urination. The frequency of urination increased from 4 to 7 times and stabilized. We discontinued goreisan administration 2 months later, and keishikaryukotsuboreito monotherapy was continued. We did not observe recurrent nocturnal enuresis and, therefore, switched the decoction to an extract. After the symptom stabilized, the dosage of keishikaryukotsuboreito was reduced by half. Nocturnal enuresis occurred only once when the patient missed a dose for 3 consecutive days but did not recur for over 4 months after strict adherence to medication. This case report highlights the role of Kampo therapy as an effective therapeutic option for nocturnal enuresis persisting into adulthood.
RESUMEN
Fundamento: la tuberculosis es un problema serio de salud mundial. La propagación de la infección por el VIH agudiza su impacto. La tuberculosis extrapulmonar supone el 10-20 % del total que padecen los enfermos inmunocompetentes. Caso clínico: se presenta un paciente de treinta y dos años de edad, sexo masculino, raza mestiza, procedente del área rural, con antecedentes de ser paciente con VIH/SIDA, que es ingresado en los servicios de atención clínica del hospital Universitario Manuel Ascunce Domenech, por presentar adenopatías latero- cervical derecha e inguinales, de dos meses de evolución, fiebre inicial de 39˚C, tos escasa, sin expectoración. Para la confirmación del diagnóstico clínico inicial de posible tuberculosis ganglionar, se indica entre los complementarios, la Punción Aspirativa con Aguja Fina y se realiza cultivo microbiológico de la muestra obtenida. Conclusiones: el presente tema adquiere importancia en la actualidad, en la que el diagnóstico rápido de la enfermedad tuberculosa es una necesidad, evita tratamientos innecesarios, posibilita el cultivo y permite seleccionar qué pacientes requieren biopsias ganglionares y estudio histopatológico para diagnóstico diferencial y definitivo de la enfermedad. Así como constituye una herramienta más de confirmación del diagnóstico clínico de sospecha, a menos costo.
Background: tuberculosis (TB) is a serious worldwide health problem. The spread of HIV infection increases its impact. Extrapulmonary tuberculosis accounts for 10-20 % of TB which suffers inmmunocompetent patients. Clinical case: a 32 years old, male patient, Afro-American descendent, coming from a rural area with a history of HIV/AIDS patient is presented. The patient was admitted in the internal medicine service at the Manuel Ascunce Domenech University Hospital, presenting right laterocervical and inguinal adenopathies of two month of evolution, fever of 39oC, intermittent cough without expectoration. To confirm the initial clinical diagnosis of possible ganglial tuberculosis, fine-needle aspiration biopsy was recommended as a complementary examination and microbiological culture of the sample was performed. Conclusions: this patient´s case has developed importance today, in which quick diagnosis of tuberculosis is a necessity, avoiding unnecessary treatments, enables microbiological culture and allows selecting which patients require ganglion biopsies and histopathological study for differential and definitive diagnosis of the disease. As well as, it is one tool for confirmation of clinical diagnosis of suspicion, at lower cost.