Neumotórax espontáneo debido a bulas subpleurales: presentacion de un caso / Spontaneous pneumothorax and subpleural bulla: case report

Pneumothorax is defined as the presence of air within the pleural cavity. It may be traumatic, iatrogenic, spontaneous secondary or primary. In the latter cause, the most frequent are subpleural and apical bulla in longiline patients, with connective tissue diseases and smokers. Treatment should be conservative in patients who present a small pneumothorax. Instead, a probe should be installed if it is greater. In the presence of frequent recurrences or persistent air leakage, pleurodesis should be considered, or resection of the bullous should be practiced. In this article we review a patient with Elhers Danlos syndrome, who presents a primary spontaneous pneumothorax due to subpleural bulla

El neumotórax se define como la presencia de aire dentro de la cavidad pleural. Puede ser traumático, iatrogénico, espontáneo secundario o primario, dentro de esta última causa la más frecuente son las bulas subpleurales y apicales, en pacientes longilíneos, portadores de enfermedades del tejido conectivo y fumadores. En neumotórax pequeños el tratamiento debe ser conservador, en cambio en los de mayor cuantía se debe proceder a la instalación de una sonda pleural. Frente a recidivas frecuentes o persistencia del escape aéreo, se debe considerar la pleurodesis o bien practicar la resección de las bulas.En el presente artículo se reporta a un paciente con síndrome de Elhers Danlos que presenta un neumotórax espontáneo primario debido a bulas subpleurales.

Injuries Associated with the 580 km University Student Grand Voluntary Road March: Focus on Foot Injuries

College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 +/- 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.

Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Activated charcoal and baking soda to reduce odor associated with extensive blistering disorders.

BACKGROUND: Skin disease leading to extensive blistering and loss of skin is associated with a characteristic smell. Odor can cause physiologic disturbances such as increase in heart rate and respiratory rate. It can also cause nausea and vomiting and is disturbing to bystanders. AIMS: To test odor reducing capability of activated charcoal. METHODS: In this blinded experimental study we used putrefied amniotic membrane to produce odor and studied the effectiveness of activated charcoal and soda-bi-carbonate to reduce odor. RESULTS: Statistical analysis with Kruskal Wall's Chi Square Test and Man Whitney U test showed significant reduction of odor using activated charcoal by itself or along with soda-bi-carbonate. CONCLUSION: We recommend the usage of activated charcoal with/without soda bicarbonate as an inexpensive practical measure to reduce foul odor associated with extensive skin loss.

Necrotizing skin and soft-tissue infections associated with septicemia: 7 cases report and review.

The authors report seven cases of necrotizing skin and soft-tissue infections, with clinical presenting as hemorrhagic bullae, gangrenous cellulitis or necrotizing fasciitis, in association with septicemia, between January 2003 and January 2007 in Hat Yai Hospital. Six were male and the majority of the lesions, six cases, occurred in the lower extremities. The average age of the patients was 50.0 +/- 11.019 years old. All patients presented with watery diarrhea, severe abdominal pain, high fever and sepsis. The skin lesions were begun with erythema, tender and swelling with formation of hemorrhagic bullae, gangrene and necrosis within 24-48 hours. Three of them were caused by Streptococcus spp., another three by Halophilic Vibrios, and only one by Aeromonas hydrophila. Furthermore, the literatures related with clinical manifestations of necrotizing skin and soft-tissue infections, etiologic pathogens, histological finding, management in setting of sepsis, comorbid conditions, complications and patients' outcome were reviewed.

Factores de riesgo poblacioal en cancer de vesicula biliar: evaluación basada en ele analisis de haplotipo B de DNA mt / Population risk factor in gallblader cancer: evaluation based in the analysis of the haplotype B of DNA mt

Pregunta de investigación ¿Estará relacionado al cáncer de vesícula biliar con el haplotipo B mitocondrial como factor poblacional, en sujetos de ambos sexos, habitantes de la ciudad de La Paz?. Objetivos Determinar si e factor poblacional, es un factor genético de riesgo relacionado con cáncer de vesícula bibliar (CAVB). Evaluar el comportamiento del haplotipo B en relación con el CAVB. Diseño. Casos y controles. Lugar. Instituto de Genética. Facultad de Medicina-UMSA. Población. 52 pacientes en toral, divididos en dos grupos, de ambos sexos: casos 17 y controles 35, en ambos sexos y grupos etáreo diverso, siendo los caos pacientes con CAVB y controles pacientes con CCL. Métodos. Se realizó la evaluación clínica, ecográfica y de anatomía patológica. Se analizó el DNA mt de linfocitos de sangre periférica mediante la técnica de la PCR. Se utilizó estadística descriptiva.

Manobra de descolamento subseroso da vesícula na videolaparoscopia / Maneuver of subserous detachment of gallbladder in videolaparoscopy

Trata-se de comunicaçäo inicial sobre uma manobra para facilitar o descolamento da vesícula na colecistectomia videolaparoscópica. Pela terceira porta de acesso (trocarte de 5mm) introduz-se uma agulha, que punciona a subserosa da vesícula. Injeta-se, sob pressäo, soro fisiológico, iniciando-se o descolamento da serosa vesicular ou esta do leito hepático. Há menor sangramento, usa-se menos o cautério e a mobilizaçäo da vesícula fica mais fácil e rápida

Penfigóide benígno de mucosa: caso clínico / Benign mucous membrane pemphigoid: clinical case

Os autores relatam um caso pouco comum de Penfigóide Benigno de Mucosa (PBM), em paciente do sexo masculino. Discutem os aspectos clínicos da doença, a terapêutica preconizada e o quadro clínico evolutivo

Colecistectomia laparoscopica indicaciones y contraindicaciones / Laparoscopic cholecystectomy; ibdication and conbtraindications

La tecnica video laparoscopica constituye una forma novedosa y en apariencia mas ventajosa para los pacientes, de extirpar las vesiculas biliares enfermas, por lo tanto constituye otra forma de operar, no es una operacion nueva,