[Perforation of Meckel's diverticulum by a fishbone]. / Perforatsiya divertikula Mekkelya ryb'ei kost'yu.

Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.

Necrólisis epidérmica tóxica por nevirapine Una patología poco frecuente en un servicio de terapia intensiva / Toxic epidermal necrolysis by nevirapine A rare pathology in an intensive care service

La Necrólisis epidérmica tóxica (N.E.T), es un desorden poco frecuente, caracterizado por una muerte epidérmica extensa, producido por una reacción idiosincrática por drogas. Es una enfermedad grave que puede eventualmente ocasionar la muerte por complicaciones sépticas o fallo multiorgánico, en alrededor del 30 % de los pacientes. El caso clínico que se describe, se asocia con el uso de Nevirapine que es un fármaco antirretroviral inhibidor de la Transcriptasa inversa, no análogo de nucleosidos, esta droga se vincula a la aparición de N.E.T en el 1% de los tratamientos(AU)

Toxic epidermal necrolysis (TEN) is a very uncommon disorder, characterized by extensive epidermal death, produced by an idiosyncratic drug reaction. Is a severe disease that eventually can be lethal. Death may be caused by septic complications or multiorgan failure, in about 30% of patients. In this case report the disease is related to the use of Nevirapine. This antiretroviral drug is a nonnucleoside reverse transcriptase inhibitor that is supposed to cause TEN in 1% of the patients.(AU)

Long-term effects of transdermal estradiol with and without medroxyprogesterone acetate.

OBJECTIVE: To study the long-term biological and metabolical effects of estradiol (E2) administered by transdermal therapeutic systems with and without the addition of medroxyprogesterone acetate (MPA). DESIGN: Open, randomized, comparative trial. SETTING: The reproductive endocrine unit of a tertiary care university-affiliated hospital. PATIENTS: Fifty-seven postmenopausal women were given E2 transdermally, whereas 28 were randomized to take MPA by mouth. Fifteen premenopausal women were studied for comparison. INTERVENTIONS: Estradiol, 0.1 mg, was administered by a transdermal therapeutic system for 24.5 of 28 days and was cycled for 96 weeks. Medroxyprogesterone acetate, 10 mg, was given for days 13 to 25 of each 28-day cycle (E+P group), whereas the remainder received E2 only. MAIN OUTCOME MEASURES: Serum E2, estrone (E1), luteinizing hormone, follicle-stimulating hormone, low-density, high-density, very low-density, and total cholesterol, triglycerides, blood pressure, renin substrate, plasma renin activity, and serum aldosterone levels were measured in all subjects at baseline and in the postmenopausal women every 24 weeks until the end of study. RESULTS: Mean +/- SE levels of E2 rose significantly from baseline at 24 weeks to 426 and 355 pmol/L for the E only and E+P groups, respectively. Smaller increases of estrone (E1) were observed to 263 and 244 pmol/L for the same respective groups. As expected, baseline levels of both gonadotropins were elevated, fell significantly with E2 administration, but remained increased in comparison with values observed in younger women. Decreases of total and low-density lipoprotein (LDL) cholesterol were observed in both groups that reached statistical significance at 48 weeks or later with the exception of LDL cholesterol in the E only group. No significant change of high-density lipoprotein or very low-density lipoprotein cholesterol or triglycerides was observed. There were reductions of mean systolic and diastolic blood pressures in both groups that reached significance at 72 weeks. Mean baseline plasma renin substrate, plasma renin activity, and serum aldosterone levels were within the ranges observed in younger, healthy women and did not change significantly with E2 administration in either group. CONCLUSION: These data support the long-term efficacy and safety of this form of replacement therapy, particularly in combination with MPA, in women with a uterus.

Comparison of continuous versus sequential estrogen and progestin therapy in postmenopausal women.

A pilot study was performed comparing the efficacy and safety of continuous versus sequential schedules of the two most commonly prescribed medications for ovarian hormone replacement, conjugated equine estrogens and medroxyprogesterone acetate. Bleeding patterns, endometrial histology, and metabolic parameters were studied in 48 postmenopausal women prospectively randomized to a continuous schedule (daily estrogen and progestin) or a sequential schedule (conjugated estrogen on days 1-25, medroxyprogesterone acetate on days 16-25). Doses studied were 0.625 and 1.25 mg of conjugated estrogens and 10 mg of medroxyprogesterone acetate. Significantly greater bleeding was observed with the 1.25-mg dosage of conjugated estrogens. Bleeding patterns were similar between schedules, with the exception that amenorrhea was more prevalent in the women using the 1.25-mg dosage of estrogen and the continuous progestin schedule. More frequent endometrial atrophy was observed with the continuous schedule, supporting the concept that prolonged use of this schedule may promote amenorrhea in most patients. Both doses and schedules were associated with modest and insignificant increases in high-density lipoprotein cholesterol. Sequential therapy did not prevent the estrogen-induced decrease of low-density lipoprotein cholesterol, whereas the continuous schedule did, particularly with 0.625-mg dosage of conjugated estrogens. Significant increases of triglycerides were also seen with the continuous but not with the sequential schedule. Because of reports that the continuous schedule using the 2.5-mg dosage of medroxyprogesterone acetate does not elicit these actions on circulating lipids, attention should be directed toward examining the long-term effects of this lower dosage given continuously.