ABSTRACT
OBJECTIVE: We studied patients who had experienced a stroke in the postoperative period of cardiac surgery, aiming to analyse their progression and determine the factors that may influence prognosis and treatment. METHODS: We established a protocol for early detection of stroke after cardiac surgery and collected data on stroke onset and a number of clinical, surgical, and prognostic variables in order to perform a descriptive analysis. RESULTS: Over the 15-month study period we recorded 16 strokes, which represent 2.5% of the patients who underwent cardiac surgery. Mean age in our sample was 69 ± 8 years; 63% of patients were men. The incidence of stroke in patients aged 80 and older was 5.1%. Five patients (31%) underwent emergency surgery. By type of cardiac surgery, 7% of patients underwent mitral valve surgery, 6.5% combined surgery, 3% aortic valve surgery, and 2.24% coronary surgery. Most cases of stroke (44%) were due to embolism, followed by hypoperfusion (25%). Stroke occurred within 2 days of surgery in 69% of cases. The mean NIHSS score in our sample of stroke patients was 9; code stroke was activated in 10 cases (62%); one patient (14%) underwent thrombectomy. Most patients progressed favourably: 13 (80%) scored≤2 on the modified Rankin Scale at 3 months. None of the patients died during the postoperative hospital stay. CONCLUSION: In our setting, strokes occurring after cardiac surgery are usually small and have a good long-term prognosis. Most of them occur within 2 days, and they are mostly embolic in origin. The incidence of stroke in patients aged 80 and older and undergoing cardiac surgery is twice as high as that of the general population.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Stroke/etiology , Aged , Aged, 80 and over , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications , Postoperative Period , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Stroke/epidemiology , ThrombectomyABSTRACT
Introducción: El mixoma cardiaco es una causa poco frecuente pero importante de infarto cerebral en pacientes jóvenes. Existen pocas series de pacientes que analicen la frecuencia de las manifestaciones neurológicas en pacientes con mixoma y su presentación clínica. Objetivo: Conocer las complicaciones neurológicas del mixoma cardiaco en nuestro hospital durante los últimos 28 años. Pacientes y métodos: Revisión retrospectiva de las manifestaciones neurológicas de 36 pacientes operados de mixoma cardiaco con confirmación patológica en nuestro centro desde diciembre de 1983 hasta marzo del 2012. Resultados: Ocho de los 36 pacientes con mixomas cardiacos (22%) intervenidos en nuestro centro presentaron clínica neurológica. El 50% eran mujeres y la edad media ± desviación estándar de 52,4 ± 11,6 años. El síntoma neurológico más frecuente fue la hemiparesia de aparición brusca (63%). El ictus isquémico establecido fue la manifestación clínica más frecuente (75%), seguido del accidente isquémico transitorio. El territorio más afectado fue el de la arteria cerebral media. En todos los casos se alcanzó el diagnóstico del tumor mediante ecocardiografía. El tamaño medio del mixoma fue de 4,12 cm. La mayoría (63%) presentaba una superficie polipoide. Todos los tumores fueron resecados quirúrgicamente con éxito. No hubo muertes hospitalarias. Conclusiones: Los mixomas cardíacos comienzan frecuentemente con manifestaciones neurológicas, en particular como eventos isquémicos (AIT o ictus establecidos) en pacientes jóvenes y sin factores de riesgo cardiovascular. El territorio anterior, en especial la arteria cerebral media, suele estar más frecuentemente afectado. La ecocardiografía puede facilitar el diagnóstico y permitir un tratamiento precoz de la lesión (AU)
Introduction: Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma. Objective: To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years. Patients and methods: We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012. Results: Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1 cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths. Conclusions: Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion (AU)
Subject(s)
Humans , Myxoma/complications , Heart Neoplasms/complications , Stroke/epidemiology , Echocardiography , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma. OBJECTIVE: To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years. PATIENTS AND METHODS: We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012. RESULTS: Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths. CONCLUSIONS: Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion.
Subject(s)
Heart Neoplasms/complications , Myxoma/complications , Nervous System Diseases/etiology , Adult , Brain Ischemia/etiology , Electrocardiography , Female , Follow-Up Studies , Heart Neoplasms/pathology , Humans , Infarction, Middle Cerebral Artery/etiology , Male , Middle Aged , Myxoma/pathology , Nervous System Diseases/pathology , Neuroimaging , Paresis/etiology , Retrospective Studies , Stroke/etiology , Treatment OutcomeSubject(s)
Humans , Male , Middle Aged , Aortic Rupture/diagnosis , Aortic Rupture/surgery , /methods , Hypertension/complications , Hypertension/diagnosis , Hemorrhage/complications , Laparotomy/methods , Laparotomy , Splenic Artery/injuries , Splenic Artery/surgery , Aortic Rupture , Arthritis/complications , /instrumentation , Renal Colic/complications , Abdominal Pain/complications , Abdominal Pain/etiology , Retroperitoneal Space/pathology , Retroperitoneal Space , Splenic Artery/physiopathology , Splenic ArteryABSTRACT
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Subject(s)
Humans , Female , Aged , Embolization, Therapeutic , Aneurysm, False/diagnosis , Aneurysm, False/surgery , Subclavian Artery , Magnetic Resonance AngiographyABSTRACT
We present the case of a 4-day-old newborn with serious dehydration, polypnea, hypertonus and lethargy. Blood analysis showed severe metabolic acidosis with ketonemia, ketonuria and elevation of the GAP anion. Urine analysis revealed increased excretion of 2-methyl-3-hydroxybutyrate acid, tiglycine, and 2-methylacetoacetate acid. Neonatal onset of mitochondrial acetoacetyl-CoA thiolase (T2) deficiency is exceptional. Most patients have no clinical symptoms in the neonatal period. This entity should be considered in patients with acute metabolic acidosis and ketosis with normal glycemia and aciduria. The urine contains large amounts of 2-methylacetoacetate and its decarboxylation products. In the neonatal period, this inherited disorder of metabolism can produce severe hydroelectrolyte disorders in the form of a gradual process or acute episodes, which can occasionally be fatal.
Subject(s)
Acetyl-CoA C-Acetyltransferase/deficiency , Mitochondria, Muscle/metabolism , Humans , Infant, Newborn , Isoleucine/metabolism , Ketone Bodies/metabolism , MaleABSTRACT
Presentamos el caso de un recién nacido de cuatro días de vida con deshidratación grave, polipnea, hipertonía y letargia. Los exámenes complementarios revelaron una acidosis metabólica grave con cetonemia, cetonuria y aumento del anión GAP. El análisis de orina reveló una excreción aumentada de ácido 2-metil-3-hidroxibutirato, tiglicina y 2-metilacetoacetato. El inicio neonatal del déficit de acetoacetil-CoA tiolasa (T2) es muy infrecuente. En la mayoría de los casos, los pacientes no presentan clínica en el período neonatal. Debemos pensar en esta entidad cuando un paciente presente una acidosis metabólica aguda, cetosis con glucemia normal y aciduria. La orina presenta aumento de las concentraciones de 2-metilacetoacetato y sus productos de descarboxilación. Este error innato del metabolismo en período neonatal puede producir graves alteraciones hidroelectrolíticas en forma de un proceso gradual o agudo que ocasionalmente puede causar la muerte del paciente
We present the case of a 4-day-old newborn with serious dehydration, polypnea, hypertonus and lethargy. Blood analysis showed severe metabolic acidosis with ketonemia, ketonuria and elevation of the GAP anion. Urine analysis revealed increased excretion of 2-methyl-3-hydroxybutyrate acid, tiglycine, and 2-methylacetoacetate acid. Neonatal onset of mitochondrial acetoacetyl-CoA thiolase (T2) deficiency is exceptional. Most patients have no clinical symptoms in the neonatal period. This entity should be considered in patients with acute metabolic acidosis and ketosis with normal glycemia and aciduria. The urine contains large amounts of 2-methylacetoacetate and its decarboxylation products. In the neonatal period, this inherited disorder of metabolism can produce severe hydroelectrolyte disorders in the form of a gradual process or acute episodes, which can occasionally be fatal
Subject(s)
Infant, Newborn , Humans , Coenzyme A-Transferases/deficiency , Coenzyme A-Transferases/genetics , Hypoglycemia/genetics , Metabolism, Inborn Errors/enzymology , Blood Glucose/metabolism , Ketone Bodies/blood , Infusions, Intravenous , Hypoglycemia/enzymology , Severity of Illness IndexABSTRACT
Group A beta-hemolytic streptococcus (GAS) causes almost 10% of acute hematogenous osteomyelitis (AHOM). These entities are frequently located in long bones (femur, tibia and humerus), and only 6-8% of all AHOM are located in the pelvis. This uncommon localization delays diagnosis and can lead to inappropriate management, with negative effects on outcomes. We present the case of a 6-year-old boy with high fever, pain in the right hip and difficulty in walking due to pelvic AHOM and septic shock caused by GAS. We also provide a review of the literature.
Subject(s)
Hip Joint , Osteomyelitis/microbiology , Streptococcal Infections , Streptococcus pyogenes , Child , Humans , MaleABSTRACT
El estreptococo betahemolítico del grupo A (SGA) es causante de aproximadamente un 10 % de las osteomielitis de diseminación hematógena (OMDH). Dentro de éstas son frecuentes las localizaciones en huesos largos (fémur, tibia y húmero), siendo las situadas en pelvis inusuales, sólo entre el 6-8% del total de OMDH. Esta rara localización conlleva un diagnóstico tardío y en ocasiones un tratamiento inicial erróneo con una peor evolución clínica y pronóstico final. Presentamos a continuación un paciente varón de 6 años con un cuadro de fiebre elevada, dolor en cadera derecha y dificultad para caminar, que fue una osteomielitis pélvica por SGA asociada a shock séptico y revisamos la literatura especializada
Group A Beta-hemolytic streptococcus (GAS) causes almost 10 % of acute hematogenous osteomyelitis (AHOM). These entities are frequently located in long bones (femur, tibia and humerus), and only 6-8% of all AHOM are located in the pelvis. This uncommon localization delays diagnosis and can lead to inappropriate management, with negative effects on outcomes. We present the case of a 6-year-old boy with high fever, pain in the right hip and difficulty in walking due to pelvic AHOM and septic shock caused by GAS. We also provide a review of the literature
Subject(s)
Male , Child , Humans , Osteomyelitis/diagnosis , Osteomyelitis/microbiology , Pelvic Infection/diagnosis , Pelvic Infection/microbiology , Streptococcal Infections/diagnosisABSTRACT
En el diagnóstico diferencial de la urticaria aguda hay que tener en cuenta el síndrome de Baboon, una dermatosis sistémica por inyección, ingestión o inhalación de diferentes sustancias, siendo la más frecuente la inhalación de vapores de mercurio. Aportamos un caso clínico de síndrome de Baboon por inhalación de vapores de mercurio (AU)
In the differential diagnosis of acute urticaria we must keep in mind the Baboon Syndrome, la systemic dermatosis caused by injection (inoculation), ingestion or inhalation of different substances, being the most usual the mercury vapors inhalation. We report a case of Baboon Syndrome by mercury vapors inhalation (AU)
Subject(s)
Humans , Female , Child , Urticaria/diagnosis , Urticaria/therapy , Diagnosis, Differential , Mercury/adverse effects , Hydroxyzine/therapeutic use , Prednisone/therapeutic use , Skin Diseases/complications , Skin Diseases/drug therapy , Exanthema/complications , Exanthema/diagnosis , Exanthema/drug therapy , Pruritus/complications , Pruritus/diagnosis , Adrenal Cortex Hormones/therapeutic useABSTRACT
No disponible
Subject(s)
Child, Preschool , Child , Female , Humans , Male , Calcinosis , Intervertebral Disc , Thoracic VertebraeABSTRACT
El osteosarcoma vertebral representa el 0,85-2% de todos los osteosarcomas, siendo la localización más frecuente la columna lumbar. El 95% de los pacientes presentan dolor y e 80%, alteraciones neurológicas. Presentamos a un niña de 15 años con un ostrosarcoma vertebral (AU)
Vertebral osteosarcoma accounts for 0,85-2% of all osteosacomas. Lumbar spine in the most common location of this tumor. Pain and neurologic deficits were the most frequent clinica findings appearing in 95% and 85% of patients, respectively. We present a fifteen-year-old girl with vertebral osteosarcoma (AU)
Subject(s)
Humans , Female , Adolescent , Osteosarcoma/diagnosis , Spinal Neoplasms/diagnosis , Central Nervous System Diseases/epidemiologyABSTRACT
Introducción. La PCR es una técnica sensible (un 20 por ciento superior al cultivo), específica y rápida en la identificación de enterovirus. La detección de enterovirus en heces en casos de meningitis aséptica puede ser considerada una evidencia a favor del diagnóstico de infección enteroviral del SNC. Objetivo. Comparar los resultados de la detección de enterovirus por PCR en LCR con los resultados del cultivo viral en heces de pacientes pediátricos de 2 a 14 años diagnosticados de meningitis aséptica. Pacientes y métodos. Se valoraron prospectivamente todos los niños de esta edad que fueron sometidos a punción lumbar por sospecha de infección del SNC. Se excluyeron aquellos niños con meningitis bacteriana, alteración neurológica en el curso de infección sistémica o convulsión febril. Las muestras de LCR se estudiaron mediante técnicas de PCR para detección de enterovirus y herpesvirus. Las muestras de heces se inocularon en cuatro líneas celulares. Se aplicaron las pruebas de la x2 y la t de Student para' la comparación de variables cuali y cuantitativas respectivamente. Se calcularon la sensibilidad y especificidad de las técnicas y se correlacionaron ambas técnicas. Resultados. Entre el 1 de enero y el 31 de diciembre de 2000, 28 niños fueron sometidos a punción lumbar por sospecha de meningitis aséptica. De ellos, 6 pacientes fueron excluidos. 22 casos fueron evaluables. De acuerdo con los criterios establecidos, 16 de los 22 casos (73 por ciento) fueron diagnosticados de meningitis por enterovirus. Las heces fueron positivas en 16/21 casos (76 por ciento). La PCR en LCR fue positiva en 9/15 casos (60 por ciento). De acuerdo con la definición clínica establecida la sensibilidad de la PCR en LCR fue del 81 por ciento y las del cultivo viral fecal del 100 por ciento: Ambas técnicas se correlacionaron en un 86,6 por ciento. Conclusión. La técnica de PCR en LCR tiene una elevada sensibilidad. El cultivo viral fecal, aun con sus limitaciones de interpretación, tiene una sensibilidad mayor (AU)
Subject(s)
Adolescent , Female , Child, Preschool , Male , Child , Humans , Enterovirus/isolation & purification , Meningitis, Aseptic/microbiology , Prospective Studies , Meningitis, Aseptic/cerebrospinal fluid , Feces/microbiology , Enterovirus/pathogenicity , Polymerase Chain Reaction/methodsABSTRACT
Non-Hodgkin's lymphomas are the most common cancers in children with human immunodeficiency virus (HIV) infection. Extranodal disease is the most common form of clinical presentation. Treatment with aggressive chemotherapy and highly active antiretroviral therapy has improved the prognosis of these children. We present a 10-year-old severely immunocompromised girl with HIV infection and non-Hodgkin's lymphoma manifested by a muscle mass.
Subject(s)
HIV Seropositivity/complications , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Muscle, Skeletal/pathology , Antineoplastic Agents/therapeutic use , Biopsy , Child , Female , Humans , Lymphoma, Non-Hodgkin/drug therapy , Muscle, Skeletal/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Los linfomas no hodgkinianos constituyen la primera neoplasia en frecuencia en los niños con infección por virus de la inmunodeficiencia humana (VIH). Su presentación clínica es extranodal en la mayoría de los casos. El tratamiento actual con protocolos de quimioterapia asociados a tratamiento antirretroviral ha mejorado el pronóstico de estos niños. Se presenta el caso de una niña de 10 años con infección por VIH e inmunodepresión grave que presentó un linfoma de Hodgkin cuya manifestación clínica inicial fue una tumoración muscular (AU)
Subject(s)
Child , Female , Humans , Tomography, X-Ray Computed , Muscle, Skeletal , Biopsy , Antineoplastic Agents , HIV Seropositivity , Lymphoma, Non-HodgkinABSTRACT
An anaplastic large cell lymphoma which fulfills all the criteria required for its inclusion among the soft tissue forms is reported. We point out in this case, in addition to its low frequency in adults, the severe systemic involvement of the disorder with out generalization, the lack of expression of the ALK1 protein, frequently positive in the generalized forms and the absence of response to polichiomiotherapy. We think that this case emphasizes the heterogenicity if the disorder on the clinical pathologycal relation ship of this kind of lymphomas.
Subject(s)
Lymphoma, Large-Cell, Anaplastic/pathology , Soft Tissue Neoplasms/pathology , Aged , Humans , Ki-1 Antigen/analysis , Lymphoma, Large-Cell, Anaplastic/metabolism , Magnetic Resonance Imaging , Male , Soft Tissue Neoplasms/metabolismABSTRACT
Se describe un linfoma anaplásico de células grandes que reune todas las condiciones exigidas para incluirlo dentro de las formas descritas como "de tejido blando". Son llamativos en este caso, aparte de su escasa frecuencia en adultos, la grave repercusión sistémica del proceso, pese a no demostrarse la generalización del mismo, la ausencia de expresión de la proteína ALK1, frecuentemente positiva en las formas generalizadas, y la falta de respuesta a la poliquimioterapia. Creemos que este caso subraya la heterogenicidad del proceso en lo que se refiere a la relación clínico-patológica de este tipo de linfomas. (AU)
