ABSTRACT
Presentamos el caso de una mujer de 65 años con fiebre, alteraciones del comportamiento y mutismo. En el diagnóstico diferencial del síndrome febril con alteraciones neuropsiquiátricas es fundamental realizar un estudio sistemático para llegar a un conocimiento temprano de la etiología del cuadro, que nos permita realizar un correcto tratamiento. En este caso, el diagnóstico temprano de catatonia maligna permitió aplicar tratamiento específico con terapia electroconvulsiva, con una pronta y favorable evolución. En este artículo, proponemos una conducta diagnóstica que se debe seguir que creemos puede resultar de utilidad en la práctica médica diaria (AU)
We present a case of a 65-year-old woman with fever, behaviour disorder and mutism. The differential diagnosis of fever and neuropsychiatric disorders requires a systematic study to get an early understanding of the aetiology, allowing us to provide the correct treatment. In our case, the early diagnosis of malignant catatonia enabled us to give our patient electroconvulsive therapy, achieving a spectacular improvement. In this article, we suggest an algorithm that could be useful in daily medical practice (AU)
Subject(s)
Humans , Female , Middle Aged , Mental Disorders/complications , Fever/complications , Mutism/diagnosis , Mutism/rehabilitation , Catatonia/complications , Catatonia/diagnosis , Electroconvulsive Therapy/methods , Fever/etiology , Fever/therapy , Electroconvulsive Therapy/trends , Electroconvulsive Therapy , Diagnosis, DifferentialABSTRACT
Relapsing polychondritis is an episodic systemic disorder, characterized by recurrent inflammation that affects cartilaginous structures, the cardiovascular system, eyes and ears. Although the etiology is unknown, experimental evidence strongly suggest that immunologically mediated mechanisms are implicated. Auricular, articular and nasal manifestations are the most frequent disturbances. In about 30% of cases, relapsing polychondritis is associated with other connective tissue diseases and vasculitis. Actually, the diagnosis is based on the criteria proposed by McAdam, and modified by Damiani. We present a case, whose first manifestations of relapsing polychondritis were an intermittent fever and transient arthralgias. Eight months later, auricular chondritis appeared, and gave us the key to diagnosis.
Subject(s)
Polychondritis, Relapsing/diagnosis , Aged , Diagnosis, Differential , Ear, External , Female , HumansABSTRACT
Cardiac function is studied with regular hemodynamic determinations and 2D-doppler echocardiography, in 22 patients with massive ascites. Patients were divided in two groups: 1. Hepatic cirrhosis (n = 12) and 2. Peritoneal carcinomatosis (n = 10). Patients with carcinomatosis showed lowered heart-beat volume, cardiac output, ventricular work and ejection fraction in comparison with cirrhotic patients. In cirrhotic patients the hemodynamic study was done before and after an evacuatory paracentesis, following which an improvement in cardiac function was shown, with significant increments in heart-beat volume, cardiac output, ventricular work, and ejection fraction. 42% of the cirrhotic patients showed an hyperdynamic circulatory status in the baseline study, but after paracentesis this hyperkinetic status was present in 100% of the patients. It is suggested that tension ascites influences negatively in cardiac function because it difficult the venous return. This depression in the ventricular function is more obvious in patients with carcinomas that in cirrhotic patients due to the fact that the former do not have a previous circulatory status.
Subject(s)
Ascites/physiopathology , Heart/physiopathology , Punctures , Aged , Ascites/therapy , Echocardiography, Doppler , Female , Hemodynamics/physiology , Humans , Liver Cirrhosis, Alcoholic/physiopathology , Male , Middle Aged , Peritoneal Neoplasms/physiopathology , Prospective StudiesABSTRACT
The acute suppurative thyroiditis is a rare infection. It affects specially patients with preexisting thyroid gland pathology and its frequency is higher in women. In childhood it's linked to local anatomic defects. The infection used to be located in left thyroid lobe and it's much less usual in right lobe, in both or in isthmus. The most important causal microorganisms are staphylococci (Staphylococcus aureus overcoat) and streptococci (usually Streptococcus pyogenes and Streptococcus pneumoniae), with frequent isolation of mixed flora and anaerobes in the last reported cases. We present the case of a male patient, without previous thyroid disease, who suffered an acute suppurative thyroiditis and Sepsis due to Klebsiella pneumoniae, with right lobe abscess and secondary septic focus formation (kidneys, spleen, lungs), with fatal course despite of medical treatment, favoured or precipitated by the development of serious alcoholic abstinence.
Subject(s)
Abscess/pathology , Klebsiella Infections/pathology , Klebsiella pneumoniae , Thyroiditis, Suppurative/pathology , Abscess/microbiology , Acute Disease , Humans , Klebsiella Infections/microbiology , Klebsiella pneumoniae/isolation & purification , Male , Middle Aged , Thyroid Gland/pathology , Thyroiditis, Suppurative/microbiologyABSTRACT
BACKGROUND: The features of the diseases caused by Yersinia have not been properly evaluated in the Basque Country. The present study was performed to assess the incidence and consequences of this infection. METHODS: 51 cases of Yersinia infection in a general hospital during the period 1984-1989 were reviewed. Clinical, epidemiological, microbiological, and therapeutic data and the hospital stay were evaluated. RESULTS: 62% of patients were males with a mean age of 16 +/- 19.4 years. Most came from urban areas. 40% of cases developed in winter and 32% in summer. The presenting features were: acute gastroenteritis (66%), pseudoappendicitis (10%), sepsis (4%), lymphadenopathy (2%) and others (18%). 40% of the patients had significant underlying diseases, and 16% had complications attributable to the infection. The microbiological diagnosis was made by stool culture in 88%. 96% corresponded to Yersinia enterocolitica (biotype 4), serogroup 0: 3 (93%). Yersinia pseudotuberculosis was isolated from the culture of a cervical lymph node in one patient. In the Yersinia enterocolitica strains the most common antibiotic resistances were to ampicillin (87%), cephalotin (81%), ticarcillin (75%), mezlocillin (43%) and piperacillin (43%). The mean hospital stay was 6.1 +/- 12.2 days and it was significantly shorter in children (3.3 +/- 6.1%) than in the adult population (10.9 +/- 17.4) (p less than 0.05). It was longer in patients with underlying diseases (13.3 +/- 17.8 vs 3.3 +/- 5.6) (p less than 0.005). CONCLUSIONS: Our patient population had male and urban predominance. Most infections were caused by Yersinia enterocolitica and presented as acute gastroenteritis, without differences between winter and summer. We point out to the relationship between Yersinia infection, abnormalities in iron metabolism and immunosuppression. There were few complications of the infection. The mean hospital stay was directly correlated with age and underlying diseases.
Subject(s)
Yersinia Infections/epidemiology , Yersinia enterocolitica , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Hospitals, General , Humans , Infant , Male , Middle Aged , Retrospective Studies , Spain/epidemiology , Yersinia Infections/diagnosisABSTRACT
Several immunologic changes, both humoral and cellular, have been described in patients with post-alcoholic cirrhosis. One of these changes was a polyclonal hypergammaglobulinemia which can be produced by a failure in the immunoregulation dynamics. The number of leukocytes, as well as lymphocytic population and subpopulation, did not prove significant differences between healthy people and patients. The seric immunoglobulin showed an increase of IgG in cirrhotics. The synthesis of immunoglobulins "in vitro" showed increased productions in cirrhotics; this being spontaneous in IgA and induced by pokeweed in the case of IgG and IgA.
Subject(s)
Hypergammaglobulinemia/immunology , Liver Cirrhosis, Alcoholic/immunology , Adult , Aged , Female , Humans , Immunoglobulin A/metabolism , Immunoglobulin G/metabolism , Immunoglobulin M/metabolism , Leukocyte Count , Lymphocyte Subsets , Male , Middle AgedABSTRACT
Left ventricular function is studied in cirrhotic patients and in patients with alcoholic hepatitis by means of isotopic ventriculography (Tc99m) both in basal conditions and after the i.v. injection of a somatostatin bolus (250 mcg). The results obtained are compared to those of conventional hemodynamics. Basal ventricular function is normal in both groups and somatostatin induces a significant decrease (p less than 0.001) in heart rate (74 + 12 vs 67 + 11 bpm), ejection fraction (60 + 6 vs 57 + 65) and maximal ejection rate (-3.3 + 0.4 vs -2.0 + 0.3) in patients and normal controls respectively. The hormone induces a significant increase (p less than 0.01) in telediastolic pressure of the left ventricle (8.1 + 4 vs 21 + 7 mmHg) with no change in systemic resistance. The results suggest that somatostatin has a negative inotropic effect on the heart as well as causing bradycardia.
Subject(s)
Blood Pressure/drug effects , Heart Rate/drug effects , Liver Cirrhosis/physiopathology , Somatostatin/pharmacology , Stroke Volume/drug effects , Adult , Cardiac Output/drug effects , Heart Ventricles , Humans , Liver Cirrhosis/drug therapy , Middle Aged , Somatostatin/therapeutic useABSTRACT
Malignant schwannomas represent 2% of the tumors of the nervous sheath and they are localized, in frequency order, at the limbs, paravertebral areas and head, few cases being described at retroperitoneum. The initial clinical data might be a painful mass and/or several sensitive-motor symptoms. A case of an epithelioid malignant schwannoma, observed during the study of a patient suffering from dorso-lumbar pain and adrenal insufficiency because due to tumoral affection, which is a non-frequent manifestation, is presented. It has not been described before in national medical literature.
