Hipoglucemia por hiperinsulinismo. A propósito de un caso / Hypoglycemia by hyperinsulinism. To purpose of a case

Se presenta un recién nacido con hipoglucemia refractaria al tratamiento, secundario e hiperinsulinismo. Se describen los hallazgos clínicos, de laboratorio, los diagnósticos diferenciales y el tratamiento con el propósito de analizar esta patología infrecuente. (AU)

Hipoglucemia por hiperinsulinismo. A propósito de un caso / Hypoglycemia by hyperinsulinism. To purpose of a case

Se presenta un recién nacido con hipoglucemia refractaria al tratamiento, secundario e hiperinsulinismo. Se describen los hallazgos clínicos, de laboratorio, los diagnósticos diferenciales y el tratamiento con el propósito de analizar esta patología infrecuente.

[Diagnosis and treatment of spinal epidural abscess]. / Diagnóstico y tratamiento del absceso epidural espinal.

Spinal epidural I abscess is an uncommon disease. The medical literature emphasizes the importance of its timely recognition and treatment. Three patients admitted in our hospital are presented. None of them was diagnosed on ambulatory bases. All of them were admitted because of spinal ache and two of them also had fever. Magnetic resonance imaging yielded the correct diagnosis in all cases and was very effective in delineating the extent of the lesion. We used antimicrobial therapy directed against the bacteria identified by cultures as well as surgical drainage in all cases. The three patients had a good outcome and no neurologic sequela. Early recognition, proper microbiologic diagnosis and surgical drainage are the main criteria for the current management of spinal epidural abscess.

Diagnóstico y tratamiento del absceso epidural espinal. / [Diagnosis and treatment of spinal epidural abscess]

Spinal epidural I abscess is an uncommon disease. The medical literature emphasizes the importance of its timely recognition and treatment. Three patients admitted in our hospital are presented. None of them was diagnosed on ambulatory bases. All of them were admitted because of spinal ache and two of them also had fever. Magnetic resonance imaging yielded the correct diagnosis in all cases and was very effective in delineating the extent of the lesion. We used antimicrobial therapy directed against the bacteria identified by cultures as well as surgical drainage in all cases. The three patients had a good outcome and no neurologic sequela. Early recognition, proper microbiologic diagnosis and surgical drainage are the main criteria for the current management of spinal epidural abscess.

[Acute meningitis caused by Streptococcus agalactiae in adult patient with a spinal fluid fistula]. / Meningitis aguda por Streptococcus agalactiae en una paciente adulta con fístula de líquido cefalorraquídeo.

Acute meningitis in adults caused by Streptococcus agalactiae is a rare entity. To our knowledge, there are only two cases associated with a central spinal fluid fistula published in the English literature from 1942 to the present. We report the third case. It was diagnosed in a 60-year-old woman with a twelve-year history of cerebrospinal rhinorrhea after a blunt head trauma. A CT scan of the base of the skull with administration of intrathecal contrast showed a disruption of the posterior and superior aspect of the sphenoid sinus with central spinal fluid leakage.

[Rapidly progressive dementia caused by tumor microembolism in the central nervous system]. / Demencia de evolución rapidamente progresiva producida por microembolias tumorales en el sistema nervioso central.

Brain tumoral microembolism is a very unusual etiology of cerebral vascular disease in patients with cancer. The clinical course is characterized by diffuse encefalopathy with associated neurologic deficits. We report a 72-year-old male patient, who developed rapidly progressive dementia associated with diffuse myoclonic jerks, without neurologic deficit, whose brain biopsy showed microscopic emboli of adenocarcinoma of unknown origin in capillary vessels. We did not find metastasis in other organs. We suggest that this entity should be included in the differential diagnoses of the subacute dementias.

Pronóstico a corto plazo en pacientes con insuficiencia cardíaca congestiva y función sistólica del ventrículo izquierdo normal / Short term prognosis in patients with congestive heart failure and normal left ventricular systolic function

Existem pocos estudios que describem el prognóstico de los pacientes con insuficiencia cardíaca congestiva (ICC) y función sistólica (FS) del ventrículo izquierdo (VI) intacta. El objetivo de este estudio prospectivo es describir a un grupo de 70 pacientes consecutivos internados en un servicio de medicina interna con ICC, identificar con ecocardiografía el estado contráctil del VI y establecer el pronóstico a corto plazo. Fueron 39 hombres y 31 mujeres con una edad media de 76,4 años. En 38 (54,3 por ciento) se encontró alteración de la FS del VI (Grupo I ) y en 32(45,7 por ciento) se encontraba intacta (Grupo II). El estudio con Doppler cardíaco mostró que 14 del Grupo II tenían alteración de la función diastólica (FD) del VI como único mecanismo responsable de su ICC. Se realizó un seguimiento de 8 meses en promedio, donde 20(28 por ciento) fallecieron. No hubo diferencias significativas en la mortalidad entre los Grupos I y II. Se realizó un análisis multivariado para determinar el riesgo relativo sobre la mortalidad de las variables edad, sexo, FS y diámetros del VI. Ninguna de éstas alcanzó una diferencia estadísticamente significativa. El nuestra serie de pacientes con ICC, 45,7 por ciento tenían FS del VI normal. El pronóstico a corto plazo fue similar al de los pacientes con FS del VI alterada (AU)

Pronóstico a corto plazo en pacientes con insuficiencia cardíaca congestiva y función sistólica del ventrículo izquierdo normal / Short term prognosis in patients with congestive heart failure and normal left ventricular systolic function

Existem pocos estudios que describem el prognóstico de los pacientes con insuficiencia cardíaca congestiva (ICC) y función sistólica (FS) del ventrículo izquierdo (VI) intacta. El objetivo de este estudio prospectivo es describir a un grupo de 70 pacientes consecutivos internados en un servicio de medicina interna con ICC, identificar con ecocardiografía el estado contráctil del VI y establecer el pronóstico a corto plazo. Fueron 39 hombres y 31 mujeres con una edad media de 76,4 años. En 38 (54,3 por ciento) se encontró alteración de la FS del VI (Grupo I ) y en 32(45,7 por ciento) se encontraba intacta (Grupo II). El estudio con Doppler cardíaco mostró que 14 del Grupo II tenían alteración de la función diastólica (FD) del VI como único mecanismo responsable de su ICC. Se realizó un seguimiento de 8 meses en promedio, donde 20(28 por ciento) fallecieron. No hubo diferencias significativas en la mortalidad entre los Grupos I y II. Se realizó un análisis multivariado para determinar el riesgo relativo sobre la mortalidad de las variables edad, sexo, FS y diámetros del VI. Ninguna de éstas alcanzó una diferencia estadísticamente significativa. El nuestra serie de pacientes con ICC, 45,7 por ciento tenían FS del VI normal. El pronóstico a corto plazo fue similar al de los pacientes con FS del VI alterada

[Short-term prognosis in patients with congestive heart failure and normal left ventricular systolic function]. / Pronóstico a corto plazo en pacientes con insuficiencia cardíaca congestiva y función sistólica del ventrículo izquierdo normal.

Congestive heart failure (CHF) has been traditionally associated with impairment of the left ventricular systolic function (LVSF). There are few clinical assays that describe the prognosis of patients with CHF and intact LVSF. The aims of this prospective assay are: to describe a group of 70 patients admitted to an internal medicine department with the clinical syndrome of CHF, to determine the contractile state of the left ventricle with echocardiography and to establish the short term prognosis. There were 39 males and 31 females with a mean age of 76.4. The LVSF was impaired in 38 (54.3%) [Group I] and preserved in 32 (45.7%) [Group II] (Table 1). Sex distribution was different between both groups with women predominating in group II (Figure 1). Fourteen patients belonging to Group II had diastolic function impairment according to cardiac Doppler. There was no other evidence of cardiac abnormality that could justify CHF. During an average of 8 months follow-up 20 (28%) patients died. There were no differences in overall mortality between Groups I and II (Figure 2). Multivariate analysis was used to determine the relative risk in prognosis of the covariates age, gender, systolic function and diameters of the LV. None of these were statistically significant (Table 2). In our series 45.7% of the patients with CHF had normal LVSF. The short term prognosis proved to be the same in patients with and without impaired LVSF.

Pronóstico a corto plazo en pacientes con insuficiencia cardíaca congestiva y función sistólica del ventrículo izquierdo normal. / [Short-term prognosis in patients with congestive heart failure and normal left ventricular systolic function]

Congestive heart failure (CHF) has been traditionally associated with impairment of the left ventricular systolic function (LVSF). There are few clinical assays that describe the prognosis of patients with CHF and intact LVSF. The aims of this prospective assay are: to describe a group of 70 patients admitted to an internal medicine department with the clinical syndrome of CHF, to determine the contractile state of the left ventricle with echocardiography and to establish the short term prognosis. There were 39 males and 31 females with a mean age of 76.4. The LVSF was impaired in 38 (54.3

) [Group I] and preserved in 32 (45.7

) [Group II] (Table 1). Sex distribution was different between both groups with women predominating in group II (Figure 1). Fourteen patients belonging to Group II had diastolic function impairment according to cardiac Doppler. There was no other evidence of cardiac abnormality that could justify CHF. During an average of 8 months follow-up 20 (28

) patients died. There were no differences in overall mortality between Groups I and II (Figure 2). Multivariate analysis was used to determine the relative risk in prognosis of the covariates age, gender, systolic function and diameters of the LV. None of these were statistically significant (Table 2). In our series 45.7

of the patients with CHF had normal LVSF. The short term prognosis proved to be the same in patients with and without impaired LVSF.