Leptina y hueso / Leptin and bone

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Addison disease after appendicitis.

A 14-year-old boy manifested acute abdominal pain, vomiting, high temperature and diarrhea. He also underwent increasing hyponatremia and hyperkalemia after appendectomy. Further testing confirmed Addison disease. The serum adrenal antibody test was positive, and other autoimmune diseases were excluded.

The validity of classic symptoms and chest radiographic configuration in predicting pulmonary tuberculosis.

OBJECTIVE: Patients admitted to the pulmonary isolation service to rule out tuberculosis (TB) were prospectively studied to identify predictors of smear-positive TB. METHODS: History of symptoms--cough, sputum production, fever, weight loss, night sweats, hemoptysis, anorexia, and dyspnea; medical history--TB, tuberculin skin test (TST) status, TB contact; and social factors--crowding index, history of incarceration or living in a shelter, and employment status were obtained in face-to-face interviews. Chest x-rays (CXRs) were scored as typical, atypical, or negative. Serial morning sputa were collected. RESULTS: Complete data were collected on 101 patients; 44 had pulmonary TB; 33 patients were smear positive and considered infectious; 11 patients were smear negative but culture positive. There was no difference between TB and non-TB patients with respect to HIV status and social risk factors. Significant differences were found between patients who were smear positive for TB and smear negative with respect to cough, sputum, and typical CXR (79%, 76%, and 79% sensitivity, respectively). Eleven patients without TB had an atypical CXR and denied cough, sputum, and weight loss. Only one patient with TB presented this way. CONCLUSION: Even in high-risk populations, symptoms of cough, sputum, weight loss for less than 2 weeks, and the absence of a typical CXR are strong negative predictors for TB.

Tularemia from a cat bite: case report and review of feline-associated tularemia.

We report the case of a 63-year-old man who developed ulceroglandular tularemia complicated by pneumonia following a cat bite. A review of the literature revealed 51 cases of cat-related tularemia reported since 1928. Details of 15 cases (including the present case) were available and analyzed. If, following feline contact, patients develop pneumonia or if patients with skin and soft-tissue infection fail to respond to therapy with penicillin, physicians should be alerted to the possibility of tularemia. A greater awareness of this complication following a cat bite or cat scratch is important for recognizing this uncommon infection.

Infection of arterio-venous fistulas created for chronic haemodialysis.

One of the complications of chronic haemodialysis is infection at the venous access site. A retrospective chart review (1985-1990) was done on patients requiring venoaccess for haemodialysis. 197 patients had 254 arterio-venous (A-V) fistulas created. 40 patients had 71 prosthetic implants and 157 patients had 183 autogenous fistulas created. 16 (22%) prosthetic grafts were infected versus 8 (4.3%) autogenous fistulas (p < 0.0001). Bacteraemia was present in 9/16 (56%) infected prosthetic grafts and 4/8 (50%) infected autogenous fistulas. Seven (43.8%) of the prosthetic grafts required removal; 6 (37.5%) were cured with drainage, irrigation and antibiotics, and 3 (18.8%) with antibiotics alone. One (12.5%) of the autogenous fistulas was removed, 4 (50%) required revision and 3 (37.5%) were treated with antibiotics alone. Whenever possible, A-V fistulas should be created in the arms with an autogenous graft as infections are less and easier to treat.

Elective treatment of bleeding varices with the Sugiura operation over 10 years.

A 10-year experience with the devascularization operation described by Sugiura is reported here. The operation was performed electively in 100 patients in whom it was not possible to place a shunt, all of whom had different kinds of hepatopathies (63 Child's A, 32 Child's B, and 5 Child's C). In 15 patients, the procedure was done in one stage (6% operative mortality, 1 patient), and, in 51, it was performed in two stages. Eight deaths were recorded in the 63 patients of the Child's A group, with a total of 111 operations. The operative mortality rate for this group was 12% and, as related to the number of operative procedures, 7% (8 of 111 operations). Seventeen patients were not considered for a second stage. Rebleeding in the early postoperative period was 4% and at long-term 6%. Incapacitating encephalopathy was found in 2 of the 71 surviving patients (3%). Survival (as determined by Kaplan-Meier tests) was 75% (1 year), 70% (5 years), and 69.2% (10 years). Six esophageal fistulas were observed secondary to transection. The Sugiura operation is an excellent complement to the therapeutic armamentarium used to treat portal hypertension, with low rebleeding and encephalopathy rates.

Intrasellar mass with hypopituitarism as a manifestation of sarcoidosis. Case report.

A 45-year-old woman was admitted suffering from headache, weight loss, asthenia, pedal edema, and amenorrhea. Morphological and functional studies revealed an intrasellar mass causing hypopituitarism without diabetes insipidus. Histological examination of the tissue obtained at transsphenoidal surgery was compatible with a diagnosis of sarcoidosis. The clinical and histological features, together with the presence of cutaneous anergy and ocular lesions, led to the diagnosis of sarcoidosis. The presentation of sarcoidosis in this patient was very unusual because it was not accompanied by characteristic intrathoracic findings or by diabetes insipidus.

Tuberoinfundibular dopaminergic tonus in common migraine.

Changes in dopaminergic tonus have been hypothesized in patients with common migraine, suggesting that prolactin may play a role in the pathogenesis of the migraine. We investigated the prolactin response to domperidone, a dopamine receptor blocker. We tested 22 patients with common migraine (8 men, 7 women in the follicular phase of the menstrual cycle, and 7 women in the luteal phase), and 22 normal subjects adjusted for age, sex and phase of the menstrual cycle. Domperidone produced a significant rise of serum prolactin (p less than 0.01) in migrainous patients (7.77 +/- 3.09 vs 71.06 +/- 9.97 in men, 7.05 +/- 2.3 vs 129.58 +/- 14.15 in women in the follicular phase of the menstrual cycle, and 14.28 +/- 3.51 vs 169.71 +/- 16.63 in women in the luteal phase) and control subjects. The response did not show significant differences between migrainous patients and normal subjects. These data do not suggest changes in the tuberoinfundibular dopaminergic tonus in migrainous patients, in contrast to reports of other authors.