Derrame pericárdico neoplásico infectado por Salmonella enteritidis / Pericardial overflow infected by Salmonell enteritidis

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Fiebre de origen desconocidoy disección aórtica / Fever of unknown origin and aortic dissection

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Endocarditis y abscesos esplénicos / Endocarditis and splenic abscesses

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[Typical absence epilepsy in a patient with serious cranio-encephalic trauma]. / Ausencias típicas en un paciente con trauma craneoencefálico grave.

INTRODUCTION: Head injury is the commonest cause of symptomatic or secondary epilepsy and one of its most serious sequelas. Typical absence seizures are well defined clinically and electroencephalographically and are seen in age-related idiopathic epilepsies. There are very few descriptions of seizures of typical absences that were symptomatic of tumors or other structural lesions. CLINICAL CASE: We describe the case of a nine year old boy who had had a severe head injury at the age of four years. When he was seven years old he started to have seizures with all the clinical and electroencephalographic features of typical absences. CONCLUSIONS: In this case, taking the age of the patient into account, the APF, APP, electroclinical characteristics of the seizures, neurological and clinical condition, the problem was to decide whether the seizures were idiopathic or symptomatic of a cerebral lesion. This was important for treatment and prognosis. The answer could only be obtained by follow-up and assessment of the response to specific treatment for petit mal.

[Memory disorders in the epidemic neuropathy]. / Trastornos de la memoria en la neuropatía epidémica.

INTRODUCTION: The epidemic neuropathy that occurred in Cuba between 1992-1993 had three clinical forms: optic, peripheral and mixed. Epidemic neuropathy patients often complained of disorders in the recent memory. PATIENTS AND METHODS: We studied 120 patients: 68 with peripheral form, 26 with the optic form and 26 of the mixed form and 70 healthy subjects as control group. The short term memory was evaluated with the paradigm of Brown and Petersen, task of free recall for verbal nonsense material, during several intervals of retention (0, 15, 30, 45 seconds). Also, we applied tests for general capacity, depression and a subjective questionnaire about neuropathic symptoms intensity. RESULTS: Significant differences were observed in the severity of the forgetfulness and depression level between the peripheral form patients and the others groups. The correlation between severity of visual symptoms and the forgetfulness were not significant (S = -0.05; t (176) = -0.7; NS), whereas there was a significant correlation between severity of neuropathic peripheral symptoms and the forgetfulness (S = 0.2; t (184) = 2.7; p < 0.008). This effect on the mediate memory was not observed in the group of visual neuropathy and only occurred, of attenuated form, in the mixed group. CONCLUSION: An explanation for this dissociation is suggested based on the physiopathogenic mechanisms invoked in the illness.

[The evaluation of patients with ischemic cerebral lesions by CT, SPECT and qEEG in acute, subacute and chronic phases]. / Evalución mediante TC, SPECT y qEEG de pacientes con lesiones isquémicas cerebrales durante las fases aguda, subaguda y crónica.

INTRODUCTION: SPECT, EEG AND CT scan offer information with several pathophysiologic meanings. Their results vary with time and according to the vascular affected territory. OBJECTIVE: We wanted to study how the sensibility varies and the relationship with the clinic of SPECT, qEEG and CT scan in the acute, subacute and chronic stages and according to the vascular affected territory. We also wanted to analyze the several pathophysiologic aspects of the cerebral ischemia. METHODS: Thirty-six patients with symptoms of hemispheric stroke were evaluated with CT scan, qEEG, SPECT99mTc-HMPAO during the acute (0-5 days), subacute (0-15 days) and chronic (16 days to 1 year) stages. RESULTS: The decrease of ipsilateral CBF depend on the time (p = 0.0061), being not very frequent during the two first weeks. The qEEG was the most sensitive study in the first phase, its sensibility did not depend on the vascular affected territory and was dependent on the time (p = 0.0011), diminishing in the chronic phase. The slow activity was habitually ipsilateral. The CT scan was the less sensitive study. CONCLUSION: After 24 hours and until the second week, there is habitually an increase of the ipsilateral rCBF. The luxury perfusion could explain the fogging effect in the CT scan. The slow activity of the qEEG represents the alteration of the oxygen metabolism. The interpretation of the variation of the CBF and the qEEG allow us to define oligemia of the ischemia and between reactive hyperemia and the increase of CBF due to the necrotic tissue.

Thromboangiitis obliterans (Buerger's disease) with intestinal involvement--a case report.

Thromboangiitis obliterans (TAO) or Buerger's disease is a nonatherosclerotic vascular disease of unknown etiology that occurs almost exclusively in young male tobacco users. The involvement of the medium-sized and small arteries and veins leads to ischemic complaints and trophic changes in the limbs. The authors report a case of Buerger's disease in a 29-year-old man, a heavy smoker, affecting the lower limbs and mesenteric vessels.

[Jugular thrombosis and adenocarcinoma of the prostate: a state of hypercoagulability?]. / Trombosis yugular y adenocarcinoma de próstata: estado de hipercoagulabilidad?

The association between cancer and hypercoagulability states is well known. It usually presents as a complication of gastrointestinal tract adenocarcinomas. We present the case of patient diagnosed of prostatic adenocarcinoma who was admitted because of pain and inflammation in the left side of the neck. The ultrasound study showed a jugular vein thrombosis. In the bibliographic review (MEDLINE 1990-1995), we have not found any similar reports Jugular vein thrombosis is a rare complication and usually is secondary to central vein catheter insertion, although it has been also described with ovarian hyperstimulation syndrome, infections, head and neck tumors and rarely in other neoplastic diseases. The physiopathologic process is not well known, although it is known that neoplastic cells interact with the thrombin and plasmin generating systems and that there is also a decrease in coagulation inhibitors, all of which leads to prothrombin activation in the absence of the corresponding increases in thrombin inhibitor complexes.

Evaluación mediante TC, SPECT y qEEG de pacientes con lesiones isquémicas cerebrales durante las fases aguda, subaguda y crónica / Evaluation of patients with ischemic cerebral lesions using TC, SPECT and qEEG during acute, subacute and chronic phases

Introducci›n. La SPECT, el EEG y la TC brindan informaci›n con diferente significado fisiopatol›gico; sus resultados var­an en el tiempo y segœn el territorio vascular afectado. Objetivos. En este estudio nos propusimos estudiar c›mo var­a la sensibilidad y la relaci›n con la cl­nica de la SPECT, el qEEG y la TC en las etapas aguda, subaguda y cr›nica, segœn el territorio vascular afectado. Asimismo, analizamos diferentes aspectos fisiopatol›gicos de las ECV isqu micas. M todos. Se realiz› un estudio con TC, qEEG, SPECT 99mTc-HMPAO durante las etapas aguda (0-5 d­as), subaguda (6-15 d­as) y cr›nica (de 16 d­as a 1 a o) a 36 pacientes. Resultados. La disminuci›n ipsilaeral del FSC dependi› del tiempo (p=0,0061), siendo poco frecuente durante las dos primeras semanas. El qEEG fue el estudio mÿs sensible en la primera fase, su sensibilidad no estuvo relacionada con el territorio vascular afectado y si dependi› del tiempo (p=0,0011), disminuyendo en la fase cr›nica. La actividad lenta habitualmente fu ipsilateral. La TC de crÿneo result› ser el estudio menos sensible. Conclusiones. Despu s de las 24 horas y hasta la segunda semana, habitualmente se produce un aumento del FSCr ipsilateral. la perfusi›n de lujo podr­a explicar el efecto fogging en la TC simple de crÿneo. La actividad lenta del qEEG representa la alteraci›n del metabolismo de ox­geno. La interpretaci›n de la variaci›n del FSC y del qEEG permite delimitar entre la perfusi›n de miseria de tipo oligo mica de la isqu mica, as­ como la hiperemia reactiva del aumento del FSC debido a la necrosis tisular

Evaluaci›n mediante TC, SPECT y qEEG de pacientes con lesiones isqu micas cerebrales durante las fases aguda, subaguda y cr›nica / Evaluation of patients with ischemic cerebral lesions using TC, SPECT and qEEG during acute, subacute and chronic phases

Introducci›n. La SPECT, el EEG y la TC brindan informaci›n con diferente significado fisiopatol›gico; sus resultados var­an en el tiempo y segœn el territorio vascular afectado. Objetivos. En este estudio nos propusimos estudiar c›mo var­a la sensibilidad y la relaci›n con la cl­nica de la SPECT, el qEEG y la TC en las etapas aguda, subaguda y cr›nica, segœn el territorio vascular afectado. Asimismo, analizamos diferentes aspectos fisiopatol›gicos de las ECV isqu micas. M todos. Se realiz› un estudio con TC, qEEG, SPECT 99mTc-HMPAO durante las etapas aguda (0-5 d­as), subaguda (6-15 d­as) y cr›nica (de 16 d­as a 1 a o) a 36 pacientes. Resultados. La disminuci›n ipsilaeral del FSC dependi› del tiempo (p=0,0061), siendo poco frecuente durante las dos primeras semanas. El qEEG fue el estudio mÿs sensible en la primera fase, su sensibilidad no estuvo relacionada con el territorio vascular afectado y si dependi› del tiempo (p=0,0011), disminuyendo en la fase cr›nica. La actividad lenta habitualmente fu ipsilateral. La TC de crÿneo result› ser el estudio menos sensible. Conclusiones. Despu s de las 24 horas y hasta la segunda semana, habitualmente se produce un aumento del FSCr ipsilateral. la perfusi›n de lujo podr­a explicar el efecto fogging en la TC simple de crÿneo. La actividad lenta del qEEG representa la alteraci›n del metabolismo de ox­geno. La interpretaci›n de la variaci›n del FSC y del qEEG permite delimitar entre la perfusi›n de miseria de tipo oligo mica de la isqu mica, as­ como la hiperemia reactiva del aumento del FSC debido a la necrosis tisular

Ausencias típicas en un paciente con trauma craneoencefálico grave / Typical absences in a patient with serious head injury

Introducción. El traumatismo craneoencefálico (TCE) es la causa más frecuente de epilepsia sintomática o secundaria, que, a su vez, constituye una de las secuelas más serias del TCE. Las crisis de ausencia típica están bien definidas clínica y electroencefalográficamente, y se observan en las epilepsias idiopáticas relacionadas con la edad; muy raramente se han descrito crisis de ausencia típica sintomáticas a tumores u otras lesiones estructurales. Caso clínico. Describimos el caso de un niño de 9 años de cada con antecedentes de TCE grave sufrido a los 4 años. A los 7 comienza a presentar crisis con todas las características clínicas y electroencefalográficas de las crisis de ausencia típicas. Conclusiones. En el caso que nos ocupa, y teniendo en cuenta la edad del paciente, los APF, los APP, las características electroclínicas de las crisis y el cuadro clínico neurológico, la problemática reside en precisar si estas crisis son idiopáticas o sintomáticas a la lesión cerebral, con la importancia que tiene esta precisión desde el punto de vista terapéutico-pronóstico. La respuesta sólo la puede dar el seguimiento evolutivo del paciente y la respuesta al tratamiento anti "petit mal" específico(AU)

Clinical significance of splenic tuberculosis in patients infected with human immunodeficiency virus.

To assess the clinical significance of splenic tuberculosis in patients infected with human immunodeficiency virus (HIV) type 1, we compared 20 patients who had splenic tuberculosis with 20 randomly selected, HIV-infected patients with culture-proven tuberculosis for whom splenic involvement had been ruled out by ultrasonography. All of the patients were male prison inmates and intravenous drug users. Statistically significant differences (P < .05) were detected between patients with splenic involvement (median CD4+ cell count, 54/mm3) and those without splenic involvement (median CD4+ cell count, 92/mm3). No specific symptoms suggesting splenic involvement were detected in the patients with splenic tuberculosis. All patients received antituberculous drugs, and none of these patients required splenectomy. The median survival was similar in both groups. Splenic tuberculosis occurs in more-severely immunocompromised HIV-infected patients, the prognosis is generally good, the clinical response to therapy is usually favorable, and splenectomy is rarely necessary.

A longitudinal study of transmission of tuberculosis in a large prison population.

The purpose of this study was to determine the extent of transmission of tuberculosis in a large prison population over an 18-mo period. Restriction-fragment-length polymorphism (RFLP) analysis of isolates of Mycobacterium tuberculosis was performed, using the insertion sequence IS6110 and the plasmid pTBN12. Patients infected with strains having the same fingerprint were grouped in clusters. Medical records were reviewed and movement of inmates among prisons was examined for selected patients. Tuberculosis was diagnosed in 216 inmates (case rate = 2,283 per 100,000 per year). Isolates from 210 (97%) patients were fingerprinted, 155 (74%) were grouped in 25 clusters, and 55 (26%) showed a unique fingerprint. Recent infection was inferred in 62% of these patients. Eighty-four percent (161 of 192) of patients tested were human immunodeficiency virus (HIV)-positive, of whom 121 were in clusters and 40 were not (p = 0.74). Patients in clusters were less adherent with tuberculosis treatment than those not in clusters (p < 0.05), and prison transmission of resistant strains was observed. It is crucial that infection control guidelines be fully implemented in the prison setting to prevent tuberculosis transmission.