Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados / Management of thoracic aorta traumatize in 5 multiple traumatized patients

El traumatismo de aorta torácica es una lesión asociada a una alta morbimortalidad en el lugar del accidente. En los años noventa se generalizó el tratamiento mediante la colocación de un stent endovascular con buenos resultados. En este trabajo presentamos una serie de cinco casos clínicos de pacientes ingresados en la Unidad de Cuidados Intensivos de nuestro hospital durante el año 2006. De un total de 619 pacientes ingresados en el mismo periodo, 121 (19,5%) fueron traumáticos y 5 (4,13%) sufrían traumatismos de aorta torácica. Todos los pacientes fueron diagnosticados por tomografía computarizada helicoidal torácica al ingreso. Cuatro pacientes tenían un pseudoaneurisma de aorta y fueron intervenidos. Tres recibieron tratamiento endovascular dentro de las 36 primeras horas y el otro al vigesimoctavo día del ingreso. El quinto paciente presentó una lesión de la íntima y no se intervino. La evolución posterior fue buena en todos los casos (AU)

Thoracic aorta traumatism is a lesion associated to high morbidity-mortality at the site of the accident. In the 90’s, treatment by placement of an endovascular stent was generalized with good results. In this work, we present a series of 5 clinical cases of patients admitted to the Intensive Care Unit of our hospital during the year 2006. Out of a total of 619 patients admitted in the same period, 121 (19.5%) were traumatic and 5 (4.13%) had thoracic aorta traumatisms. All of the patients were diagnosed by thoracic helical computed tomography on admission. Four patients had a pseudoaneurism of the aorta and underwent an operation. Three received endovascular treatment within the first 36 hours and the fourth on day 28 of admission. The fifth patient had a lesion of the intima and was not operated on. Posterior evolution was good in all the cases (AU)

[Management of thoracic aorta traumatism in 5 multiple traumatized patients]. / Manejo del traumatismo de aorta torácicaen cinco pacientes politraumatizados.

Thoracic aorta traumatism is a lesion associated to high morbidity-mortality at the site of the accident. In the 90's, treatment by placement of an endovascular stent was generalized with good results. In this work, we present a series of 5 clinical cases of patients admitted to the Intensive Care Unit of our hospital during the year 2006. Out of a total of 619 patients admitted in the same period, 121 (19.5%) were traumatic and 5 (4.13%) had thoracic aorta traumatisms. All of the patients were diagnosed by thoracic helical computed tomography on admission. Four patients had a pseudoaneurism of the aorta and underwent an operation. Three received endovascular treatment within the first 36 hours and the fourth on day 28 of admission. The fifth patient had a lesion of the intima and was not operated on. Posterior evolution was good in all the cases.

[Adverse cutaneous reactions to erlotinib]. / Efectos cutáneos adversos causados por erlotinib.

INTRODUCTION: Erlotinib is an inhibitor of human epidermal growth factor approved for treating non-small cell lung cancer. The aim of this prospective observational study was to determine the prevalence of adverse cutaneous reactions caused by erlotinib and assess the management of such effects. METHODS: Eleven patients with lung cancer and 1 with ovarian cancer received erlotinib at a dose of 150 mg/d. The prevalence, severity, and time course of the adverse cutaneous reactions were assessed. RESULTS: The most frequent cutaneous reaction was acneiform eruption (10 cases). The patients were treated with topical erythromycin and clindamycin, or with doxycycline. Also reported were seborrheic dermatitis (5), paronychia (4), xerosis (3), mouth blisters (3), blepharitis (2), cheilitis (1), and fissures on the hands and feet (1). The first reactions to appear were seborrheic dermatitis (9.8 days until onset) and acneiform eruption (11.8 days), whereas the paronychia presented latest (65.3 days). One patient with acneiform eruption and another with paronychia suspended treatment until the lesions improved. CONCLUSIONS: Erlotinib induces adverse effects in most patients treated. Acneiform eruption, seborrheic dermatitis, and paronychia are the most frequently reported reactions and can lead to temporary suspension of erlotinib administration.

Radius hypoplasia, radial palsy, and aplasia cutis due to amniotic band syndrome.

Amniotic band syndrome is one of the many causes of aplasia cutis congenita. It is usually seen as a constriction band surrounding a limb or as a membrane that adheres to some part of the body. This syndrome can be associated with various malformations. An infant with amniotic adhesions producing aplasia cutis, radial palsy, and hypoplasia of the radius is presented. Early treatment led to total functional recovery of the affected limb.

Leukocytoclastic vasculitis as a cutaneous manifestation of systemic infection caused by Brucella melitensis.

A 22-year-old man with leukocytoclastic vasculitis as a cutaneous manifestation of brucellosis is presented. Skin lesions resolved 48 hours after starting treatment with tetracycline and rifampicin. Although skin manifestations are rarely associated with infection due to Brucella and do not seem to worsen the prognosis, they may cause the patient to seek medical attention as well as contribute to the diagnosis.

Median raphe cysts of the penis: a report of five cases.

Cysts of the median raphe are embryologic developmental anomalies of the male genitalia. Although generally present since birth, these lesions tend to manifest in adult life. Histologically the cysts are characterized by a pseudostratified epithelium in the middle dermis. The early age at consultation is a common characteristic in four of the five patients reported herein and is probably due to the growing concern among the general population about skin problems.

Congenital lower lip pits (Van der Woude syndrome): presentation of 10 cases.

Congenital lower lip pits are a rare developmental malformation of the lower lip. Clinically they present as bilateral depressions in the vermilion zone of the lower lip. It is important to be aware of this disorder because lower lip pits have also been reported in a variety of other congenital disorders and are associated with other malformations. Ten cases of this entity are presented. Nine of the 10 patients are members of two related families. The clinical and pathologic picture as well as some of the genetic and therapeutic aspects of this peculiar condition are discussed.

Angiokeratoma corporis diffusum associated with beta-mannosidase deficiency.

BACKGROUND: Angiokeratoma corporis diffusum (ACD) was at one time thought to be synonymous with Anderson-Fabry disease. However, it is well known that widespread angiokeratomas may also be found in other lysosomal enzyme disorders, as well as in patients with normal enzyme activities. beta-Mannosidase deficiency was first described in humans in 1986; since then, only 11 cases of beta-mannosidase deficiency, which occurred in 8 families, have been reported. Although the clinical manifestations are varied, mental retardation and neurologic disorders are present in practically all patients. OBSERVATIONS: We describe a 22-year-old woman who, since the age of 12 years, presented with progressive ACD affecting the lower limbs and the buttocks. Enzymatic studies revealed beta-mannosidase deficiency in cultured fibroblasts and in samples of serum and leukocytes. The patients's parents in turn exhibited intermediate enzyme levels, thus confirming the recessive autosomal hereditary nature of the disease. With the exception of an introverted character, the patient demonstrated no other anomalies. CONCLUSIONS: This is the first case of beta-mannosidase deficiency diagnosed as a result of purely dermatologic findings, in the form of ACD. beta-Mannosidase deficiency should therefore be included when screening for enzyme abnormalities in patients with ACD, even in the absence of neurologic disorders or mental retardation.

[Ichthyosis X. Clinical review and rapid identification using lipid electrophoresis]. / Ictiosis X. Revisión clínica e identificación rápida por electroforesis de lípidos.

Ichthyoses X as a part of the steroid sulphatase deficiency syndrome are reviewed. The usefulness of lipid electrophoresis is emphasized.