Masas múltiples como presentación de enfermedad de Wegener / No disponible

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Claudicació nmandibular, ¿pensar en enfermedad de Wegener? / No disponible

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Hipokalemia, acidosis tubular distal y tiroiditis de Hashimoto / No disponible

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Histoplasmosis diseminada en un paciente trasplantado renal / No disponible

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Disfunción de cuerdas vocales secundaria a reflujo gastroesofágico / Gastroesophageal reflux as a cause of vocal cord dysfunction

La disfunción de cuerdas vocales se caracteriza por la aducción paradójica de las mismas durante la inspiración, y ocurre con mayor frecuencia en mujeres jóvenes. Es un síndrome caracterizado por crisis habitualmente autolimitadas de tos, sibilancias, disnea y estridor inspiratorio, presentados en forma brusca. Su incidencia e historia natural son desconocidas. Puede coexistir o asemejar a un asma refractario. Originalmente los trastornos psicológicos eran la única causa conocida, aunque luego se describieron múltiples factores desencadenantes orgánicos como el reflujo gastroesofágico, ejercicio, sinusitis, distonía, tiroidectomía, irritantes respiratorios e infecciones de vías aéreas superiores. Para el diagnóstico se requiere una alta sospecha, y la realización de una laringoscopia directa objetivando la aducción de las cuerdas vocales durante la inspiración en el paciente sintomático. La terapia fonoudiológica y la psicoterapia han sido extensamente utilizadas, sin una evaluación prospectiva. Uno de los ejes centrales del manejo, es el tratamiento de la causa subyacente si esta se identifica. Reportamos dos casos de disfunción de las cuerdas vocales secundaria a reflujo gastroesofágico que evolucionaron en forma favorable con tratamiento específico

Vocal cord dysfunction (VCD), is characterized by a paradoxical adduction of the vocal cords during inspiration, and occurs predominantly in young women. Common symptoms are cough, wheezing, episodic dyspnea, and inspiratory stridor. The true incidence and course of the disease are unknown, and it is usually self limited. It can coexist with, or mimic refractory asthma. Psychological disorders were thought to be the principal cause, subsequently multiple organic diseases have also been reported, like gastroesophageal reflux disease (GERD). Diagnosisis made by clinical suspicion and direct observation. The Gold standard for diagnosis is laryngoscopy with visualization of the paradoxical motion of the vocal cords when the patient is symptomatic. Speech therapy and psychotherapy have been used extensively without any prospective study. We report two cases of VCD associated with GERD, both with excellent respond to treatment

[Serotonin syndrome: four report cases and review of the literature]. / Síndrome serotoninérgico: Presentación de cuatro casos y revisión de la literatura.

The serotonin syndrome is a clinical condition associated with serotonin agonists. Is due to an overstimulation of central and peripheral serotonin receptors that leads to mental, autonomic and neuromuscular changes. Usually the disorder resolves within the first 24 hours after the medications are discontinued, however some patients progress to a multiple organ failure and die. We describe four elderly patients that presented with the classic triad. They presented the symptoms in average at the third day after the initiation or variation of the treatment with serotonin reuptake inhibitors. All had a favorable response with the suspension of medications and, in three cases, with the treatment with chlorpromazine. We believe it is a potentially fatal but reversible condition, probably underdiagnosed that requires a high index of suspicion.

[Gastroesophageal reflux as a cause of vocal dysfunction]. / Disfunción de cuerdas vocales secundaria a reflujo gastroesofágico.

Vocal cord dysfunction (VCD), is characterized by a paradoxical adduction of the vocal cords during inspiration, and occurs predominantly in young women. Common symptoms are cough, wheezing, episodic dyspnea, and inspiratory stridor. The true incidence and course of the disease are unknown, and it is usually self limited. It can coexist with, or mimic refractory asthma. Psychological disorders were thought to be the principal cause, subsequently multiple organic diseases have also been reported, like gastroesophageal reflux disease (GERD). Diagnosis is made by clinical suspicion and direct observation. The Gold standard for diagnosis is laryngoscopy with visualization of the paradoxical motion of the vocal cords when the patient is symptomatic. Speech therapy and psychotherapy have been used extensively without any prospective study. We report two cases of VCD associated with GERD, both with excellent respond to treatment.

[Gastroesophageal reflux as a cause of night sweating]. / Sudoración nocturna secundaria a reflujo gastroesofágico.

Night sweats has been defined as drenching sweats that require the patient to change bed clothes. In current studies night sweats appear in 30% of non-obstetric patients and affects approximately 60% of pregnant women. Differential diagnoses include infections, malignancy, medications, hot flashes and panic attacks, making of each patient a challenge. We present two patients with night sweating. After excluding systemic diseases the diagnosis of gastroesophageal reflux was made, with excellent response to anti-reflux treatment. The presentation of our two patients coupled with a deep literature review, underscores the importance of gastroesophageal reflux as a cause of night sweating.

Sudoración nocturna secundaria a reflujo gastroesofágico / Gastroesofhageal reflux as a cause of night sweating

La sudoración nocturna ha sido definida como la presencia reiterada de sudoración durante el sueño que obliga a cambiar la ropa de cama. En estudios dirigidos este signo es muy variable, presentándose en un 30 % de los pacientes no obstétricos y hasta en un 60 % de las mujeres embarazadas. Las causas son diversas: infecciones, tumores, medicamentos, alteraciones endocrinológicas, ataques de pánico y misceláneas, por lo que cada paciente con sudoración nocturna se convierte en un desafío diagnóstico. Presentamos dos pacientes con sudoración nocturna y a quienes luego de numerosos estudios, se les diagnóstica reflujo gastroesofágico, presentando excelente respuesta y desaparición de la sudoración con el tratamiento anti reflujo. Esta presentación, junto con una revisión de la literatura pretende resaltar la importancia de considerar el reflujo gastroesófagico en el algoritmo diagnóstico de los pacientes con sudoración nocturna, una vez excluidos los procesos potencialmente graves

Night sweats has been defined as drenching sweats that require the patient to change bedclothes. In current studies night sweats appear in 30% of non-obstetric patients and affects approximately 60% of pregnant women. Differential diagnoses include infections, malignancy, medications, hot flashes and panic attacks, making of each patient a challenge. We present two patients with night sweating. After excluding systemic diseases the diagnosis of gastroesophageal reflux was made, with excellent response to anti-reflux treatment. The presentation of our two patients coupled with a deep literature review, underscores the importance of gastroesophageal reflux as a cause of night sweating

[Graves disease, sign and symptoms]. / La enfermedad de Graves, signos y síntomas.

Graves disease is by far the most common cause of hyperthyroidism. Is an immunologic disorder and it is distinguished clinically from other forms of hyperthyroidism by the presence of diffuse thyroid enlargement, ophthalmopathy, and occasionally pretibial myxedema. In this paper we summarize the prolific life of Robert Graves and we also describe the signs and symptoms of hyperthyroidism. In today s medicine, were technology plays a very important role, we would like to remark the value of anamnesis and physical exam as some of the most useful tools.

[Einstein's sign and other signs of aortic aneurysm]. / El signo de Einstein y otros signos de aneurisma de aorta.

Einstein's sign is a syndrome similar to an acute cholecystitis caused by the rupture of an abdominal aortic aneurysm. In this paper we describe the evolution of the disease that the physicist suffered till it led him to death. We also revise other signs which could be found in some patients with ruptured or dissected abdominal aortic aneurysm.

El signo de Einstein y otros signos de aneurisma de aorta / Einstein´s sign and other signs of aortic aneurysm

Se conoce como signo de Einstein a un cuadro similar a la colecistitis aguda causado por la ruptura de un aneurisma de aorta abdominal. En este artículo describimos la evolución de la enfermedad que padeció el renombrado físico hasta llevarlo a la muerte, realizando posteriormente una revisión de otros signos que pueden hallarse en algunos pacientes con aneurisma de aorta, ruptura o disección

Einstein’s sign is a syndrome similar to an acute cholecystitis caused by the rupture of an abdominal aortic aneurysm. In this paper we describe the evolution of the disease that the physicist suffered till it led him to death. We also revise other signs which could be found in some patients with ruptured or dissected abdominal aortic aneurysm

Takotsubo, discinesia apical transitoria: presentación de 4 casos y revisión de la literatura / Takotsubo, reversible apical ballooning of the left ventricle: report of 4 cases

A syndrome of apical ballooning, with ECG mimicking acute myocardial infarctation, mild or no enzymatic changes, and normal coronary angiogram was described in 1990. It presents mainly in middle aged and elderly women and it is preceded by stress triggering circumstances. Several mechanisms have been proposed although the precise cause remains unclear. The most accepted theory proposes the interaction of catecholamines and an inadequate inotropic response. We report four cases that presented with chest pain and sudden onset of heart failure, all patients had physical or emotional stress as a triggering factor. On ECG, ST segment elevation and inverted T waves were observed in the acute phase. All patients had typical echocardiogram image and normal coronary angiogram. Both ECG and echocardiogram returned to normal within two weeks.

En 1990 se describió un síndrome caracterizado por discinesia apical transitoria, cambios en el electrocardiograma(ECG), mínima elevación de enzimas cardíacas y arterias coronarias normales. Sepresenta con mayor frecuencia en mujeres añosas y es precedido por un evento de estrés, ya sea físico opsíquico. La fisiopatología aún no está aclarada y se proponen diversas teorías. La de mayor peso es la quepostula una afección secundaria a la descarga de catecolaminas desencadenada por el estrés, sobre un corazón incapaz de mantener una respuesta inotrópica adecuada. Se presentan cuatro casos de pacientes atendidos en nuestro hospital que se manifestaron con síntomas sugerentes de infarto agudo de miocardio asociadosa insuficiencia cardiaca, en el contexto de un episodio estresante. Los síntomas preponderantes fueron dolor precordial opresivo y disnea. En el ECG se evidenciaron tanto supradesnivel del segmento ST, como inversiónde la onda T. Todos los pacientes presentaron la imagen ecocardiográfica típica de discinesia apical, y todos tuvieron en la cinecoronariografía coronarias normales. Cabe destacar que tanto el ECG, como el ecocardiograma volvieron a la normalidad a partir de las dos semanas.

Takotsubo, discinesia apical transitoria: presentación de 4 casos y revisión de la literatura / Takotsubo, reversible apical ballooning of the left ventricle: report of 4 cases

A syndrome of apical ballooning, with ECG mimicking acute myocardial infarctation, mild or no enzymatic changes, and normal coronary angiogram was described in 1990. It presents mainly in middle aged and elderly women and it is preceded by stress triggering circumstances. Several mechanisms have been proposed although the precise cause remains unclear. The most accepted theory proposes the interaction of catecholamines and an inadequate inotropic response. We report four cases that presented with chest pain and sudden onset of heart failure, all patients had physical or emotional stress as a triggering factor. On ECG, ST segment elevation and inverted T waves were observed in the acute phase. All patients had typical echocardiogram image and normal coronary angiogram. Both ECG and echocardiogram returned to normal within two weeks.(AU)

En 1990 se describió un síndrome caracterizado por discinesia apical transitoria, cambios en el electrocardiograma(ECG), mínima elevación de enzimas cardíacas y arterias coronarias normales. Sepresenta con mayor frecuencia en mujeres añosas y es precedido por un evento de estrés, ya sea físico opsíquico. La fisiopatología aún no está aclarada y se proponen diversas teorías. La de mayor peso es la quepostula una afección secundaria a la descarga de catecolaminas desencadenada por el estrés, sobre un corazón incapaz de mantener una respuesta inotrópica adecuada. Se presentan cuatro casos de pacientes atendidos en nuestro hospital que se manifestaron con síntomas sugerentes de infarto agudo de miocardio asociadosa insuficiencia cardiaca, en el contexto de un episodio estresante. Los síntomas preponderantes fueron dolor precordial opresivo y disnea. En el ECG se evidenciaron tanto supradesnivel del segmento ST, como inversiónde la onda T. Todos los pacientes presentaron la imagen ecocardiográfica típica de discinesia apical, y todos tuvieron en la cinecoronariografía coronarias normales. Cabe destacar que tanto el ECG, como el ecocardiograma volvieron a la normalidad a partir de las dos semanas.(AU)