[Eosinophilic meningoencephalitis in Villa Clara (Cuba). A study of 17 patients]. / Meningoencefalitis eosinofílica en Villa Clara (Cuba). Estudio de 17 pacientes.

INTRODUCTION: Infection by Angiostrongylus cantonensis is caused by eating snails and slugs or contaminated vegetables, and is the commonest cause of eosinophilic meningoencephalitis throughout the world. OBJECTIVES: To make a further study of this condition, analyze the clinical behaviour and evaluate the cerebrospinal fluid findings and response to treatment. PATIENTS AND METHODS: We made a retrospective, descriptive study by reviewing the clinical histories of a series of 17 adult patients attended in two university hospitals in the province of Villa Clara (Cuba), between December 1991 and January 2000. We recorded the characteristics of the clinical picture, results of the complementary investigations, treatment given and clinical course and the necropsy findings of the three patients who died. The data was collected from questionnaires. RESULTS: Headache was a constant symptom. Twelve patients had high temperatures and seven had stiff necks. Motor deficit and coma were seen in the three patients who died. In two patients the cranial nerves were involved. Spinal fluid pleocytosis varied between 48 and 2570 cells/mm3. Initially there was lymphocyte predominance in 10 patients and subsequently eosinophil conversion. The peripheral eosinophilia, seen in all patients, varied between 7% and 61%. Of the 14 patients cured, eight received symptomatic treatment and six antihelminth drugs. Steroids were given to only one patient. Of the three patients who died, two had received antihelminth drugs. CONCLUSIONS: Motor deficit and coma worsen the prognosis, which is generally good. There is no relation between cerebrospinal fluid pleocytosis and raised protein levels in the cerebrospinal fluid, nor between blood eosinophilia and prognosis. The most difficult differential diagnosis in our patients was with leptospirosis. No differences were seen in clinical evolution in relation to the treatment given.

Meningoencefalitis eosinofílica en villa clara (cuba). Estudio de 17 pacientes / Eosinophilic meningoencephalitis in villa clara (cuba). A study of 17 patients

Introducción. La infestación por Angiostrongylus cantonensis se produce por la ingestión de caracoles y babosas, o vegetales contaminados, y es la causa más frecuente de meningoencefalitis eosinofílica en todo el mundo. Objetivos. Profundizar en el conocimiento de esta entidad, analizar su comportamiento clínico y evaluar los resultados del líquido cefalorraquídeo, así como la respuesta al tratamiento. Pacientes y métodos. Se realizó un estudio retrospectivo, descriptivo, a través de la revisión de las historias clínicas de una serie de 17 pacientes adultos, atendidos en dos hospitales universitarios de la provincia de Villa Clara (Cuba), entre diciembre de 1991 y enero de 2000. Se tuvieron en cuenta las características del cuadro clínico, resultados de los exámenes complementarios, tratamiento utilizado y evolución clínica, así como el informe de necropsia de los tres pacientes fallecidos; los datos se almacenaron mediante encuestas. Resultados. La cefalea fue un síntoma constante. Doce pacientes presentaron hipertermia y siete rigidez nucal. El déficit motor y el coma aparecieron en los tres fallecidos. En dos enfermos se afectaron los pares craneales. La pleocitosis raquídea varió entre 48 y 2.570 cél/mm3.En un inicio, hubo predominio linfocítico en 10 enfermos y posteriormente conversión eosinofílica. La eosinofilia periférica, que no faltó en ningún paciente, varió entre el 7 y el 61 por ciento. De los 14 pacientes curados, ocho siguieron tratamiento sintomático y seis antihelmínticos; sólo en un paciente se emplearon esteroides. De los tres enfermos fallecidos, dos seguían tratamiento antiparasitario. Conclusiones. El déficit motor y el coma ensombrecen al pronóstico, que generalmente es bueno. No existió relación entre pleocitosis raquídea y proteinorraquia en el curso de la enfermedad; tampoco entre eosinofilia sanguínea y su pronóstico. El diagnóstico diferencial más difícil en nuestro medio fue la leptospirosis. No encontramos diferencias en la evolución clínica de acuerdo con el tratamiento usado (AU)

Poliarteritis nudosa con hemorragia retropertoneal espontanea, bilateral. Presentación de un caso

La Poliarteritis nudosa (PAN) es una vasculitis necrotizante sistémica de pequeñas y medianas arterias musculares carente de signos y síntomas patógnomonicos, aunque con posibilidad potencial de afectación de todos los organos parenquimatosos. (AU)

Polipectomía endoscópica de colon / Endoscopic polypectomy of the colon

Se realizaron 80 polipectomías en 63 pacientes (14,7 porciento de las colonoscopias realizadas) en el Servicio de Gastroenterología del Hospital Docente Clinicoquirúrgico "Joaquín Albarrán" en pacientes mayores de 15 años. Se obtuvieron 76 pólipos para su estudio histopatológico. El 37,5 porciento de los pólipos se encontraban por encima del rectosigmoide. El adenocarcinoma in situ se encontró en el 4,8 porciento de los pólipos resecados. Los pólipos se asociaron a adenocarcinoma del colon en el 38,5 porciento. No se presentaron complicaciones en los pacientes a los cuales se les aplicó esta técnica. Los pacientes que presentaron carcinoma in situ 2 años después, no presentaron recidiva de pólipos una vez realizada nuevamente la colonoscopia(AU)

[Prevalence of malignant oral neoplasms in the Celia Sanchez Clinicosurgical Hospital from 1982 to 1985]. / Prevalencia de neoplasia maligna de la cavidad bucal en el Hospital Clinicoquirurgico "Celia Sanchez" años 1982 a 1985.

Malignant tumors of the oral cavity rebound on the organism of the affected patients, because it is the open door of the digestive apparatus and any alteration of it, involves nutritional status. Besides oral cavity is easy to approach for its examination, importance of early detection of such neoplasias for the patient moves us to review 13,267 reports of biopsies from the Department of Pathologic Anatomy, "Celia S++ánchez" Clinicosurgical Hospital; 50 of such biopsies present diagnosis of malignant neoplasia of the oral cavity and are selected in order to know prevalence (0.37%), the most frequent locations (tongue, 50%), most affected age (sixth to seventh decades of life), sex (prevalence of male sex, 80%), and also to contribute to the widest knowledge and to the development of the plan for the early detection of oral cancer carried out by the Ministry of Public Health.

[The value of the Pi system phenotype in alpha 1-antitrypsin deficiency]. / Valor del fenotipo del sistema Pi en la deficiencia de alfa-i-antitripsina.

One-hundred-and-ten children between the ages of two months and 14 years with the following liver diseases were studied: 16 with acute viral hepatitis, 8 with persistent chronic hepatitis, 31 with active chronic hepatitis, 5 with hepatic steatosis, 11 with cirrhosis of the liver, 24 with newborn cholestasis, 3 with Wilson's disease, 2 with congenital hepatic fibrosis, 5 with metabolic diseases and 5 due to other causes. These children presented Pi system phenotypes in isoelectric focus using ultrafine polyacrylamide gels according to Kuepper's method, with modifications incorporated to determine Alpha-1-antitrypsin (A1-AT) serum level deficiencies in those presenting the Pi ZZ phenotype, a liver biopsy with P.A.S. coloration on digestion of diastase and a family history of the phenotype. Four (3.6%) of the children with Pi ZZ phenotypes showed a decrease of serum A1-AT and the presence of positive P.A.S. inclusions resistant to diastase in the cytoplasm of hepatocytes. Three had a history of postnatal icterus and the fourth presented hepatomegaly. The phenotypic study of the parents showed their being heterozygous (MZ), while siblings were normal (MM). The importance of the diagnosis of A1-AT deficiency and the diagnostic value of detecting Pi system phenotypes in every case of liver disease in children and adolescents is stressed.

Valor del fenotipo del sistema Pi en la deficiencia de alfa-i-antitripsina. / [The value of the Pi system phenotype in alpha 1-antitrypsin deficiency]

One-hundred-and-ten children between the ages of two months and 14 years with the following liver diseases were studied: 16 with acute viral hepatitis, 8 with persistent chronic hepatitis, 31 with active chronic hepatitis, 5 with hepatic steatosis, 11 with cirrhosis of the liver, 24 with newborn cholestasis, 3 with Wilsons disease, 2 with congenital hepatic fibrosis, 5 with metabolic diseases and 5 due to other causes. These children presented Pi system phenotypes in isoelectric focus using ultrafine polyacrylamide gels according to Kueppers method, with modifications incorporated to determine Alpha-1-antitrypsin (A1-AT) serum level deficiencies in those presenting the Pi ZZ phenotype, a liver biopsy with P.A.S. coloration on digestion of diastase and a family history of the phenotype. Four (3.6

) of the children with Pi ZZ phenotypes showed a decrease of serum A1-AT and the presence of positive P.A.S. inclusions resistant to diastase in the cytoplasm of hepatocytes. Three had a history of postnatal icterus and the fourth presented hepatomegaly. The phenotypic study of the parents showed their being heterozygous (MZ), while siblings were normal (MM). The importance of the diagnosis of A1-AT deficiency and the diagnostic value of detecting Pi system phenotypes in every case of liver disease in children and adolescents is stressed.