Recuperación de la inmunoglobulina total y sus subclases en el síndrome nefrótico: deflazacort vs metilprednisona / No disponible

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Tratamiento del síndrome nefrótico con tacrolimus (FK 506) / Management of nephrotic syndrome with tacrolimus (FK 506)

No disponible

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[The additive antiproteinuric effect of Enalapril and Losartan to normotensive patients with pathology proteinuria]. / Efecto antiproteinúrico del uso aditivo de Enalapril y Losartán en pacientes pediátricos normotensos con proteinuria.

UNLABELLED: The proteinuria is frequently the initial insult to the kidney and it usually followed by a progressive decline in the glomerular filtration rate. The angiotensin II mediate by glomerular permeselective function via the opening of large pores after elevations in transmembrane pressure and by acting on the glomerular pressure, too. There is evidence that angiotensin-converting enzyme inhibitors alone or with the angiotensin receptor-blockade may improve the glomerular size-selective function and the hemodynamic intrarenal accounted output of plasma proteins. We evaluated the Enalapril action only in two progressive doses (stage 1: 0.2 mg/kg/day and stage 2: 0.4 mg/kg/per day, respectively) and then we evaluated the combinated treatment (stage 3) with Enalapril (0.2 mg/kg/per day) + Losartan (0.8 mg/kg/day) in thirteen patients (2 female/ 11 male, mean age 12 yrs, r: 10y-16y) normotensive with middle or heavy proteinuria and normal glomerular filtration rate. The study lasted six months. In the three stages occurred decrease of the urinary protein, but only the stage 2 and 3 was significant (p < 0.05). And the three stages had significant reduction of the mean blood pressure, too (p < 0.05). On the other hand there has a good correlation between the less proteinuria and the descent of the mean blood pressure in the stage I (r: 0.75, p < 0.05) and the stage 2 (r: 0.70, p < 0.05), but this did not occur in the stage 3 (r: 0.37, p < 0.1). No patient had raise serum potassium; neither did they have decrease glomerular filtration rate or anaemia. CONCLUSION: The coadministration of Enalapril and Losartan was the most efficient treatment antiproteinuric effect. It was not only by the drug related reduction in systemic blood pressure. There weren't any adverse side effects in any patient dependent of the medication.

Taponamiento cardíaco por pseudoaneurisma aórtico fistulizado a ventrículo derecho / Cardiac tamponade due to aortic pseudoaneurysm with right ventricular fistula

Una mujer de 69 años, portadora de una prótesis valvular aórtica por insuficiencia aórtica de origen reumático, presentó un taponamiento cardíaco súbito provocado por la rotura de un pseudoaneurisma de aorta ascendente originada en la sutura de aortotomía realizada 10 años atrás. El taponamiento cursó con síncope, ausencia de pulso central acompañado de parada ventilatoria. El episodio fue presenciado permitiendo iniciar con rapidez las maniobras de reanimación cardiopulmonar hasta la recuperación hemodinámica. Tras la reposición de volumen intravascular y la perfusión de catecolaminas se realizó una ecocardiografía transesofágica que demostró el derrame pericárdico y la existencia de flujo entre la aorta y el ventrículo derecho. La actuación quirúrgica, mediante esternotomía exploradora urgente, reparó la cavidad aneurismática y una rara fístula al ventrículo derecho. La evolución cardiovascular fue satisfactoria, si bien las complicaciones respiratorias prolongaron la estancia hospitalaria por la presencia de hipoxemia grave, derrame pleural y neumonía con cultivos positivos para Pseudomona aeruginosa, Acinetobacter spp y Aspergillus flavus en aspirado traqueal y lavado broncoalveolar. Resaltamos que la inmediata aplicación de las maniobras de reanimación evitó la instauración de fracasos orgánicos y permitió una recuperación global satisfactoria tras la cirugía, a pesar de la presencia inicial de factores pronósticos de elevada mortalidad (AU)

[Cardiac tamponade caused by aortic pseudoaneurysm with fistula in the right ventricle]. / Taponamiento cardíaco por pseudoaneurisma aórtico fistulizado a ventrículo derecho.

A 69-year-old woman, with an aortic replacement valve for rheumatic aortic insufficiency suffered a sudden cardiac tamponade caused by a ruptured pseudoaneurysm of the ascending aorta which had its origin in the suture of the aorta performed 10 years earlier. The cardiac tamponade presented as syncope, absent central pulse, and respiratory failure. Hemodynamic variables recovered with early detection and start of cardiopulmonary resuscitation maneuvers. After fluids were replaced and following catecholamine treatment, a transesophageal echocardiogram revealed a pseudoaneurysm and continuous flow between the aorta and the right ventricle. The aneurysm and an unusual right ventricular fistula were repaired surgically through an emergency exploratory sternotomy. Cardiovascular recovery was satisfactory although hospital discharge was delayed because of pulmonary complications leading to severe hypoxia, pleural effusion, and pneumonia, with tracheal aspirate and bronchoalveolar lavage cultures positive for Pseudomonas aeruginosa, Acinetobacter spp, and Aspergillus flavus. We stress that immediate start of cardiopulmonary resuscitation prevented multiorgan failure and allowed for satisfactory recovery from surgery in spite of the presence of risk factors for mortality.

[Presentation of Burkitt's lymphoma in nasal sinus]. / Presentación nasosinusal del linfoma de Burkitt.

Burkitt' lymphoma is a malignant, non-Hodgkin's lymphoma of high grade that present two clinical from the african or endemic form affects near the middle of children of central africa and the american or sporadic form, that was first described in North American and the clinical setting was similar to endemic form. In our geographic area is an unusual entity. We present a clinical case of marrocan child that the first symptom was nasosinusal.

[Unusual manifestations of squamous carcinoma of the lip]. / Manifestaciones inusuales del carcinoma escamoso de labio.

We present a case of squamous cell carcinoma of the lip with metástasis to the mandible and meningeal involvement causing multiple cranial nerve palsies. Biopsy proven metástasis to the mandible was demonstrated. Studies of CT scan of the head were negative. Extension through perineural space have been speculated.

[Nasosinusal inverted papilloma]. / Papilomas invertidos nasosinusales.

Inverted papilloma is a papillar lesion of the nasal cavity and paranasal sinuses that arise from the Schneiderian membrane. This tumor has a high rate of local recurrence. We present a review of 10 cases of inverted papilloma of the nose and paranasal sinuses. A review of the literature is done.

[Cranioencephalic traumatism. Audiovestibular sequelae]. / Traumatismos craneoencefálicos. Secuelas audiovestibulares.

A group of 80 patients with blunt head injury were examined. Long-term clinical neurologic and otologic sequelae of traumatic head injury are well recognized. The authors studied the vestibular disorders using ENG, EEG and high resolution CT.

[Primary malignant melanoma of the nasal cavity]. / Melanoma maligno primario de cavidad nasal.

This refers to a case of a malign melanoma in the nasal cavity. Melanomas of the mucosal origin differed from the melanomas cutaneous in that size of the primary lesion did not influence prognosis. Regional lymph node metastases are rare and did not influence prognosis. Local recurrence at the primary site is frequent. Surgical treatment offers long-term cure to only a limited number of patients.

[Review of 156 myringoplasties]. / Revisión de 156 miringoplastias.

We report the anatomical and functional results of 156 myringoplasty; 134 with onlay surgical technique and 22 with underlay technique. We comment the climatologic of our area and its relation with the surgical failures.