Temblor y ataxia en COVID-19 / Tremor and ataxia in COVID-19

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Tuberculosis - sarcoidosis, un desafío diagnóstico: reporte de un caso / Tuberculosis - sarcoidosis, a challenge diagnosis: case report

Introducción: La tuberculosis (TBC) y la sarcoidosis presentan similitudes en cuanto a su manifestación clínica, radiología e histología. El término tuberculosis-sarcoidosis, hace referencia a una entidad con diferentes manifestaciones, en donde la TBC puede preceder, seguir o coexistir con el curso de la sarcoidosis. Presentación del caso: Mujer de 47 años, con antecedentes de miomectomía y colecistectomía, con historia de cuatro meses de dolor abdominal tipo cólico, de localización difusa asociado a hiporexia y baja de peso de 15 kilogramos. Paciente consultó por empeoramiento de cuadro inicial, acompañado de cefalea frontal intensa, quedando hospitalizada para estudio por especialistas. Evolucionó el primer día con paresia facial periférica derecha, compromiso del trigémino izquierdo V1-V2, hipoestesia abdominal izquierda T10 a L1, síntomas deglutorios del nervio gloso-cutáneo lateral izquierdo. Se decidió continuar estudio con punción lumbar, informándose: proteínas: 0,81 mg/dl, glucosa: 62 mg/dl, 100% mononucleares, tinción Ziehl Nielsen y Gram negativa. Tomografía de tórax identificó adenopatías mediastínicas. Se realizó biopsia ganglionar mediastínica que informó focos de necrosis caseosa con tinción Ziehl Nielsen (+). Se decidió inicio de tratamiento antituberculoso y corticoidal, evolucionando al mes en malas condiciones: con dolor neuropático costal y uveítis bilateral, por ello se decidió agregar metrotrexato (MTX). Por nula respuesta al tratamiento y por tratarse de una enfermedad resistente a corticoides y MTX, se decidió manejo con infliximab, con buena respuesta clínica. Discusión: Estas entidades pueden ser confundidas con una serie de condiciones neurológicas, músculo-esqueléticas o vasculares, requiere de un manejo multidisciplinario precoz, aunque por lo general, la respuesta a tratamiento clásico es escasa.

Introduction: Tuberculosis (TBC) and sarcoidosis have many similarities in their clinical manifestation, radiology and histology. The concept tuberculosis-sarcoidosis, refers to a clinical entity with different kinds of presentations, where TBC may precede, follow or coexist with the course of Sarcoidosis. Case report: 47 year old woman with a history of myomectomy and cholecystectomy, with a history of 4 months of difuse crampy abdominal pain, with hyporexia and 15 kilogram weight loss. Worsening of the pain made her go to the emergency unit, also presented frontal intense headache. In that moment she is admitted in the hospital to be studied for specialists. The symptoms evolved the next day with peripheral right facial paresis, left trigeminal commitment V1-V2, left abdominal hypoesthesia T10 to L1, swallowing symptoms of left lateral cutaneous nerve gloso. It was decided to continue study with lumbar puncture informing: protein: 0.81 mg / dl, glucose 62 mg / dl, 100% mono-nuclear Ziehl Nielsen and Gram negative. Chest CT identified mediastinal lymph nodes. In their biopsy, cheesy foci of necrosis, Ziehl Nielsen (+) was reported. She started corticoidaland antituberculosis treatment but she evolved in poor conditions; adding neuropathic costal pain and bilateral uveitis, so methotrexate (MTX) was added. Because of the none responding symptoms and dealing with a corticoid- and resistent disease it was decided to start with Infliximab, with great clinical response. Discussion: These entities can be confused with several neurological, muscle, or vascular conditions, it requires a multidisciplinary approach early, although generally, the classic response to treatment is low.

Cirugía menor en un centro de salud familiar y concordancia clínico patológica / Minor surgery in a family health center and clinicopathological concordance

INTRODUCCIÓN: Los servicios de Atención Primaria de Salud(APS) realizan Cirugía Menor(CM), evidenciándose beneficios como optimización de recursos y promoción de la actividad preventiva, diagnóstica y terapéutica. OBJETIVO: Describir la actividad de CM en un centro de APS y analizar la concordancia clínica-patológica de las lesiones...

INTRODUCTION: Primary Health Care (PHM) services perform minor surgery (MS), displaying benefits such as resource optimization and the promotion of preventive, diagnostic and therapeutic activities. OBJECTIVE: Describe the MS activity from a PHM center and analyse the clinicopathological concordance of the lesions…

Streptococcus anginosus (Streptococcus milleri Group) Pyomyositis in a 50-Year-Old Man with Acquired Immunodeficiency Syndrome: Case Report and Review of Literature.

We describe the first reported case of bacterial pyomyositis of the right thigh caused by Streptococcus anginosus (S. milleri group) in an HIV-infected patient. The clinical presentation was complicated by multiple ring-enhancing lesions detected on magnetic resonance imaging of the brain. Evaluation for central nervous system toxoplasmosis,syphilis, and cryptococcal infection was negative. Aggressive antibiotic therapy directed against S. anginosus and surgical debridement were limb salvaging. Clinicians should considerS. anginosus as a causative pathogen in HIV-associated pyomyositis, particularly in complex presentations. Prompt surgical drainage may minimize complications due to S. anginosus, a pathogen associated with significant sequelae due to its invasive nature.

Immunolocalization of metallothioneins in different tissues of turbot (Scophthalmus maximus) exposed to Cd.

Metallothioneins (MT) were localized by immunochemistry in different organs and cell compartments of turbot exposed to sublethal concentrations (100 ppb) of Cd for 7 days. The polyclonal rabbit anti-cod MT antibody (NIVA, Norway) applied herein exhibited positive cross-reactivity with turbot MTs. Immunoreactive MTs were localized in the branchial epithelium, in the liver and in the kidney of turbot. In Cd exposed fishes MTs were demonstrated mainly in branchial chloride cells (CC) and to a lesser extend in the area where progenitor cells are located and in the cells of the respiratory epithelium (secondary lamellae). A higher staining intensity for MTs was observed in CC of the interlamellar space of the main branchial epithelium in comparison with control CC. MT-staining was also observed in the chondroblasts of the cartilage and in the erythrocytes within blood vessels both in control and Cd-exposed specimens. MT immunoreaction was high in the liver hepatocytes and weak in the epithelium of the proximal portion of the kidney in exposed turbot. The tegument, spleen and muscle were devoid of any immunolabelling in both treatments. Ultrastructural studies at the transmission electron microscope revealed that Cd-induced MTs were mainly located in the cytoplasm of gill CC, the lysosomes and the cytoplasm of hepatocytes and in the basal labyrinth of kidney proximal nephrocytes. The differential localization/induction of MTs in different cell types described hereby suggests that the quantification of the specific expression of MT may be used in biomonitoring programs as a biomarker of Cd exposure in aquatic environments.

Autometallography and metallothionein immunohistochemistry in hepatocytes of turbot (Scophthalmus maximus L.) after exposure to cadmium and depuration treatment.

In this study, autometallography and immunohistochemistry were used to localize and quantify cadmium and metallothionein (MT) levels, respectively, in cellular compartments of turbot liver on exposure to cadmium for 7 days and further depuration treatment for 14 days. Metals weakly bound to proteins (i.e. MTs) in hepatocyte lysosomes were visualized as black silver deposits (BSDs) using a light microscope. With the aid of a newly developed immunohistochemical procedure, MTs were localized and semi-quantified in both the cytosolic and the lysosomal compartments of hepatocytes. The BSD extent in the lysosomes of hepatocytes increased significantly as a result of cadmium exposure. This response was evidenced after 1 h. Further, a progressive increase in the volume density of BSDs occurred up to the seventh day. Total MT immunohistochemical levels increased at a lower rate, starting after 1 day of cadmium exposure. BSD extent values recovered after depuration, whilst MT levels remain unchanged. It is possible that the detoxification rate of metals via lysosomes was diminished, whilst MT levels remained unchanged, at least after 14 days of depuration. It can be concluded that autometallography and MT immunohistochemistry are good tools for clarifying metal and metal-MT trafficking routes in hepatocytes, and also that BSD extent and MT immunohistochemical levels in the lysosomes and cytosol of fish hepatocytes can be considered to be useful biomarkers of metal exposure.

Influencia de la tiroidectomía sobre la pérdida de masa ósea en relación con el déficit de calcitonina y el tratamiento con tiroxina / Influence of thyroidectomy and thyroxin treatment on bone mass loss and calcitonin deficit

Introducción. Durante las últimas décadas se ha intentado valorar si la tiroidectomía y el tratamiento con tiroxina tienen un efecto negativo sobre la masa ósea. Los resultados publicados presentan discrepancias, faltan, además, estudios en pacientes con tratamiento sustitutivo. Material y métodos. Se realiza un estudio de casos y controles, comparando a mujeres tiroidectomizadas (n = 60) con mujeres sin enfermedad tiroidea, de la misma situación estrogénica y edad, peso y talla similares. Se determinan T3, T4, TSH, PTH, vitamina D, calcitonina basal e inducida, densitometría ósea lumbar y femoral (AXD) y marcadores de la actividad ósea (osteocalcina, FATR, hidroxiprolina y deoxipiridinolina), así como las dosis de tiroxina y el tiempo de tratamiento en cada paciente. Resultados. La comparación entre casos y controles no presentó diferencias en edad, peso, talla, PTH y vitamina D. No se hallaron diferencias densitométricas globales ni aumento de pérdida de densidad ósea en los subgrupos estrogénicos de las tiroidectomizadas. Tampoco se apreciaron diferencias en la osteocalcina y en la deoxipiridinolina. La calcitonina basal fue de 6,9 ñ 4,4 pg/ml en los controles y de 4,6 ñ 1,9 pg/ml en los casos (p < 0,01). No hubo respuesta al estímulo en las tiroidectomías totales, que presentó un incremento mínimo a los 5 minutos en las subtotales. Conclusiones. No existe aumento de pérdida de mineral óseo en mujeres tiroidectomizadas por enfermedad benigna no hipertiroidea tratadas con tiroxina. Éstas presentan valores de calcitonina inferiores a los controles con incapacidad de respuesta al estímulo con calcio (AU)

Hipertiroidismo y cáncer de tiroides concurrente / Concurrent hyperthyroidism and thyroid carcinoma

Introducción. Se han llevado a cabo varios estudios para evaluar la incidencia y la relevancia clínica de la asociación entre hipertiroidismo y cáncer de tiroides, demostrando que dicha asociación no constituye un hallazgo infrecuente. Pacientes y métodos. Revisamos retrospectivamente las historias clínicas de 245 tiroidectomías realizadas en pacientes hipertiroideos. Se encontró cáncer de tiroides en 9 pacientes (3,7 por ciento).Resultados. Se demostró cáncer de tiroides en 5 de 163 pacientes con enfermedad de Graves (3 por ciento), en 3 de 21 pacientes con adenomas tóxicos (14,3 por ciento), y en uno de 61 pacientes con bocio multinodular hipertiroideo (1,6 por ciento). Todos los tumores se correspondían microscópicamente con cánceres papilares. Cuatro de ellos tenían un diámetro inferior a 1 cm (cánceres ocultos). Todos los pacientes fueron tratados mediante tiroidectomía total y 131I en los casos en los que se consideró oportuno. Durante un seguimiento entre 12 y 120 meses no se constató ninguna muerte ni recidiva de la enfermedad. Conclusiones. La prevalencia de cáncer de tiroides en el contexto del hipertiroidismo debe ser tenida en cuenta, especialmente en aquellos pacientes con adenomas tóxicos, con el fin de adecuar los métodos diagnósticos y considerar mejor las opciones de tratamiento quirúrgico (AU)

Metástasis en tiroides / Metastases to thyroid gland

Introducción. El cáncer secundario de la glándula tiroides es una enfermedad muy poco frecuente y poco conocida en la clínica, y por ello en ocasiones condiciona problemas de manejo diagnóstico y terapéutico. Pacientes y métodos. Se estudian de forma retrospectiva los 210 pacientes intervenidos por cáncer de la glándula tiroides intervenidos entre 1981 y 1998. Presentamos 3 casos clínicos de cánceres metastásicos en glándula tiroides, con origen en recto, ovario y mediastino. Conclusiones. A pesar de la escasa frecuencia con la que se presentan las metástasis en la glándula tiroides, esta posibilidad deberá ser considerada como primera ante un paciente con nódulo tiroideo e historia previa más o menos remota de neoplasia maligna. Un diagnóstico precoz y un tratamiento quirúrgico agresivo contribuyen probablemente a prolongar la supervivencia y mejorar la calidad de vida de algunos pacientes (AU)

[Cancer of the operated stomach: a descriptive study on the experience of the last 12 years]. / Cáncer de estómago operado: estudio descriptivo sobre la experiencia de los últimos doce años.

BACKGROUND: The incidence of gastric remnant carcinoma ranges between 1% and 9%. We report here our experience in a sanitary area in which, on account of different social and working reasons, the surgical indication for treatment of peptic disease was very common in previous decades. PATIENTS AND METHODS: An analysis was made of the 52 cases of patients operated over the last 12 years, which represents 7.13% of 729 gastric cancers operated over the same time period. RESULTS: In 67% of cases the carcinoma sat on a type-II stump, in 25% on a B-I type stump, and in the remaining 8% on stomachs with vagotomy and pyloroplasty. Seventy-five percent of patients had two characteristics: to be older than 60 years and to have undergone primary surgery at least 15 years before. Over half of patients were admitted on an emergency basis with no diagnosis and had received prolonged symptomatic therapies without previous examinations. The carcinoma involved the anastomotic mouth in 56% of cases and the histologic intestinal type predominated. Twenty-seven percent of patients had stages I and II, whereas almost half of patients had stage IV. Surgical resection was feasible in 42 cases (81%), with a surgical mortality rate of 21% for resections. The overall survival rate estimated at 5 years was 23%. CONCLUSIONS: The possibility of performing surgery with a curative aim is the main prognostic factor for the gastric remnant carcinoma. The endoscopic study of patients at risk allows for diagnosis in earlier stages and therefore and improvement in results.

[Solitary rectal ulcer syndrome: report of 7 cases at the Salvador +Zubirán National Institute of Nutrition, from 1980 to 1992]. / Síndrome de úlcera rectal solitaria: informe de 7 casos en el Instituto Nacional de la Nutrición "Salvador Zubirán", de 1980 a 1992.

Solitary rectal ulcer syndrome (SRUS) is an unusual disorder which is seldom seen in our hospital. Considerable uncertainly remains concerning the cause, natural history, and management of this condition. During 1980-1992 period, 7 patients were seen at the Instituto Nacional de la Nutrición and the diagnosis was established on histological, sigmoidoscopic and clinical grounds. Most of the patients suffered rectal bleeding, abdominal pain, straining at defecation, tenemus and rectal mucus discharge. Laboratory results were non specific. Eighty-five percent has macroscopic ulcerations and these were found within 5.2 cm of the anal margin and usually situated anteriorly. Neither medical nor local surgical treatment consistently achieved relief of symptoms or healing of the lesion.