Enseñar a ser médico / Teaching to be a doctor

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Tratamiento de la orbitopatía de Graves / Treatment of Graves ophthalmopathy

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Fibronectina como marcador diagnóstico de determinadas enfermedades neurológicas / Fibronectine as diagnostic market in some neurologis illness

Objetivo: Dilucidar si la fibronectina en LCE puede ser un parámetro de utilidad en el diagnóstico de algunas enfermedades neurológicas. Material y métodos: Se estudiaron un total de 30 pacientes, subdivididos en 4 grupos según el tipo de enfermedad neurológica, y, como control, un grupo de 10 pacientes que llegaron al servicio de urgencias con el diagnóstico de sospecha de enfermedad neurológica y que fue descartada. En todos ellos se practicó punción lumbar, realizándose citología, sistemático, bioquímica, cultivo, determinación de inmunoglobulinas y cuantificación de fibronectina por ELISA. Resultados: Es de destacar el incremento significativo de los niveles de fibronectina, en el LCE, tanto en el grupo de pacientes con meningoencefalitis bacteriana como en el grupo de pacientes con enfermedad no esclerosis múltiple con respecto al grupo control. Conclusión: Por todo ello, la determinación de los niveles de fibronectina en LCE, pudiera ser un parámetro de utilidad en el diagnóstico de determinadas enfermedades neurológicas (AU)

[Fibronectin as a diagnostic marker in several determined neurological diseases]. / Fibronectina como marcador diagnóstico de determinadas enfermedades neurológicas.

OBJECTIVE: To determinate if fibronectin in CSF can be a useful parameter in the diagnosis of some neurologic illnesses. MATERIAL AND METHODS: We have studied 30 patients, subdivided in four groups, depending on the type of neurologic illness. We have chosen as control a 10-patient group, which came to the Emergency Service and were diagnosed as a suspicious of neurologic illness, but after this it was discarded. In the whole group we practiced a lumbar puncture, with cytology, systematic, biochemistry, cultures, immunoglobulins determination and fibronectin quantification by ELISA. RESULTS: We want to emphasize the increase in fibronectin levels in CSF in both the patients with bacterial meningitis and the multiple sclerosis groups, when it's compared with the control group. CONCLUSION: For this, the determination of fibronectin levels in CSF might be a useful parameter in the diagnosis of some neurologic illnesses.

Fibromyalgia syndrome: overnight falls in arterial oxygen saturation.

PURPOSE: Sleep alterations and muscular changes suggesting hypoxia have been reported in fibromyalgia syndrome (FS) pathophysiology. We tested the hypothesis that patients with FS show falls in the oxygen saturation of hemoglobin in arterial blood (SaO2%) during sleep. PATIENTS AND METHODS: Overnight SaO2% was measured by digital pulse oximetry in 28 randomly selected women who met 1990 American College of Rheumatology criteria for the diagnosis of FS and 15 similar controls. Considering the results of pulse oximetry and in order to evaluate the possible presence of a sleep apnea syndrome (SAS) as the reason for the nocturnal desaturations, the Epworth Sleepiness Scale (ESS) was mailed to the patients and controls. Patients and controls who had a score higher than 10 on the ESS underwent a polysomnographic study. RESULTS: Patients with FS showed lower overnight minimum SaO2% (86.8 +/- 1.3 versus 90.7 +/- 0.9 in controls, P < 0.05), greater number of desaturations (8.3 +/- 1.8 versus 2.7 +/- 0.8 in controls, P < 0.05) and more desaturations/hour (1.3 +/- versus 0.4 +/- 0.1 in controls, P < 0.05), more night minutes in SaO2% < 92% (56.3 +/- 12.9 versus 9.1 +/- 3.8 in controls, P < 0.01) and more minutes in SaO2% < 90% (14.7 +/- 3.7 versus 2.4 +/- 1.0 in controls, P < 0.05). There were no differences between patients with FS and controls in ESS scores. Five patients (19.2%) in the FS group and 2 (15.4%) in the control group had ESS scores higher than 10. One patient had 1 control subject showed on apnea-plus-hypopnea index higher than 5 (13 and 9, respectively) in polysomnographic study. CONCLUSIONS: Patients with FS showed small overnight falls in SaO2% and spent more time during the night in SaO2% below 92% and 90% than did the control group. These alterations that, as a whole, are not due to the presence of an associated SAS could be important in FS musculoskeletal pathophysiology.

[Fahr's disease and hypocalcemic syndromes. Presentation of a clinical case]. / Enfermedad de Fahr y síndromes hipocalcémicos. A propósito de un caso clínico.

A clinical case of a man with calcification of basal ganglions (CBG) is presented. The first manifestations of this syndrome were loss of consciousness and convulsions. The potential causes of his hypocalcemia, Fahr's syndrome, myocardiopathy of hypoparathyroidism and hypocalcemia are reviewed and a study oriented to autoimmune polyendocrinopathy is performed.

[Previous dissociative psychiatric disorder and status epilepticus in a case of acute HIV infection]. / Trastorno disociativo psiquiátrico previo y status epiléptico en un caso de infección aguda por VIH.

We described an 18 old homosexual man who after 5 days developed a neurologic picture associated with Human Immunodeficiency Viruses (HIV) seroconversion. The patient had developed a dissociative psychiatric disorder 6 months before, and after resolution of the acute neurologic disease a mild neuro-psychiatric disorder remained. After mononucleosis-like syndrome of three weeks, the patient developed a meningo-encephalitic process 48 h post admission. He evolved with tonic seizures and twilight state and was admitted into Intensive Care Unit because of epileptic status and deep coma. Evolution was favourable after 72 h of treatment with acyclovir and antiepileptic drugs. Laboratory data showed an inverted T4/T8 ratio and seroconversion to HIV-antibodies and p24-antigen both in serum and CSF. These observations confirm the existence of psychiatric as well neurological alterations in acute HIV infection, and also the significance of p24-antigen and Western-Blot in serum and CSF in showing the seroconversion profile.

[Intracranial calcifications in the differential diagnosis of epileptic disease]. / Calcificaciones intracraneales en el diagnóstico diferencial de la enfermedad epiléptica.

We report the case of a patient with a history of goiter operation 26 years before who present recurrent convulsive episodes diagnosed of epilepsy. Our study shows that this clinical setting is a Fahr's Syndrome (intracranial calcifications and chronic Hypoparathyroidism). We compare our case with others of the medical literature and analyze the neurological findings in regard to the type of intracranial calcifications and the severity and duration of hypocalcemia.

[Insulin-dependent diabetes mellitus and arterial hypertension]. / Diabetes mellitus insulinodependiente y tensión arterial.

Blood pressure variations of 30 insulin-dependent diabetic patients free of complications, and aged between 14-35 years have been studies, comparing their results to those from a control group formed by healthy person of the same age and physical features. Median systolic pressure of diabetic population was 120 +/- 11.07, compared to 112.90 +/- 11.31 from control group. The median diastolic pressure of diabetic population was 76.76 +/- 10.12 and 67.40 +/- 7.94 of the control group. A significant difference on systolic (p less than 0.05) and diastolic (p less than 0.001) pressures were observed in insulin-dependent diabetic patient comparing their results to those from the control group.

[A case of DIDMOAD syndrome with urologic symptoms]. / Un caso de síndrome de DIDMOAD con afectación urológica.

A new case of DIDMOAD syndrome is reported on. A complete description is given and the sequential associations are detailed; highlighting the fact that the frequently associated urinary alterations should be considered as part of the same disease.

[Acute pleuropericarditis and cardiac tamponade as extraintestinal complications of ulcerative colitis]. / Pleuropericarditis aguda y taponamiento cardíaco como complicaciones extraintestinales de la colitis ulcerosa.

Pericarditis and cardiac tamponade are very rare complications of inflammatory disease of the bowel. A case of a patient with ulcerative colitis, who subsequently developed pericarditis, cardiac tamponade and pleural effusion during a latent phase of the baseline disease, is presented. At the same time, the papers published on this subject are reviewed. The presence of dyspnea, tachypnea, of pleuritic pain in patients with ulcerative colitis must be taken into consideration, and all the tests necessary to study a pleuropericardial pathology should be performed.

[Thyroid function study in patients with diabetes mellitus]. / Estudio de la función tiroidea en pacientes afectos de diabetes mellitus.

We study 48 compensated diabetic patients, 41.6% of whom were male, 68.75% had diabetic neuropathy and/or vascular complications (macro-microangiopathy). In 60.4% of the patients the study began at ten years of disease evolution. We selected 14 healthy adults as a control group, 50% being male. Plasma levels of T3, T4 and TSH were measured by RIA and the antimicrosomal antibody (AMT) and antithyroglobulin antibody (ATG), detected by passive hemagglutination. A significant decrease in T3 level (p less than 0.05) was found in controlled diabetic patients, compared to T3 levels of the control group; there was a significant reduction in T3 level (p less than 0.05) in diabetic patients with vascular disease and in female diabetics (p less than 0.05), compared to the control group. There were no statistically significant differences in the other groups, including other parameters measured. We concluded that there is a decrease of T3 in all diabetic patients, this being more noticeable in diabetic females and diabetic patients with vascular disease.