Cardiomiopatía de Takotsubo en el contexto de sepsis por Staphylococcus aureus / Takotsubo cardiomyopathy in the context of Staphylococcus aureus sepsis

La cardiopatía de Takotsubo consiste en una disfunción transitoria del ventrículo izquierdo. Se caracteriza por una alteración de la contractilidad segmentaria, sin lesiones coronarias significativas en la coronariografía. Se suele manifestar tras un episodio de estrés físico o emocional. Presentamos el caso de una mujer de 70 años que en el postoperatorio de una osteosíntesis de tobillo desarrolló una cardiomiopatía de Takotsubo en el contexto de una sepsis por Staphylococcus aureus. Presentó edema agudo de pulmón y un cuadro clínico de bajo gasto cardíaco. El ecocardiograma evidenció acinesia medioapical del ventrículo izquierdo. La coronariografía fue normal. Fue tratada con medidas de soporte, con buena evolución. A los 33 días del ingreso pudo darse el alta domiciliaria, con función sistólica normal en la ecocardiografía (AU)

Takotsubo cardiopathy consists of a transient dysfunction of the left ventricle. It is characterized by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually ocurrs after an episode of physical or emotional stress. We present the case of a 70-year-old woman, who, in the postoperatory period of ankle osteosynthesis developed Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed a left ventricular medioapical akinesia. Coronari angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged form to hospital to home with normal systolic function on echocardiography (AU)

[Takotsubo cardiomyopathy in the context of Staphylococcus aureus sepsis]. / Cardiomiopatía de Takotsubo en el contexto de sepsis por Staphylococcus aureus.

Takotsubo cardiomyopathy consists of a transient dysfunction of the left ventricle. It is characterised by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually occurs after an episode of physical or emotional stress. We present the case of a 70 year-old woman, who, in the postoperative period of an ankle osteosynthesis, developed a Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed left ventricular medioapical akinesia. Coronary angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged from hospital to home with normal systolic function on echocardiography.

[Fat embolism syndrome after surgery to replace the femoral stem of a hip prosthesis]. / Síndrome de embolia grasa tras recambio de vástago femoral de prótesis de cadera.

A 66-year-old woman developed hemodynamic instability, oliguria, prostration, fever, and coagulopathy 4 hours after surgery to replace the femoral stem component of a hip prosthesis under a combined subarachnoid-epidural block. Dyspnea and tachypnea developed, and a petechial rash appeared 24 hours later. The diagnosis was fat embolism after other possible causes were ruled out. Supplementary oxygen, fluid replacement therapy, and inotropic support were started. The patient's condition improved and she was discharged from the postoperative recovery unit 5 days after admission. Although fat embolism usually appears in young men after large bone fractures, it should be considered when symptoms consistent with this diagnosis arise in patients who have undergone orthopedic surgery so that appropriate treatment can be started early.

[Wilson disease. Report of a case of autopsy with copper tissue quantification and electronic microscopy]. / Enfermedad de Wilson. Informe de un caso de autopsia con cuantificación tisular de cobre y microscopia electrónica.

UNLABELLED: Wilson's disease is a rare autosomal recessive disorder of copper metabolism. Kinnear Wilson described the entity in 1912 and considered it to be a degenerative disorder of the central nervous system associated with asymptomatic cirrhosis. Gene linkage analysis has localized the genetic defect on chromosome 13. CLINICAL CASE: Woman of 15 years of age. She began with amenorrhea at 8 months of evolution, and acholia and hepatomegaly 1 month before her death. The viral serology panel was negative. She evolved with severe hepatic insufficiency and died. The quantitation of copper dose postmortem in hepatic tissue by atomic absorption spectrophotometry resulted in 250.57 micrograms/g. Electronic microscopy showed dense bodies in the mitochondria. Young adolescents frequently develop hepatic insufficiency as a first manifestation of Wilson's disease. Histologically, some morphology data such as the glucogenized naked nuclei, microvesticular fatty change, Mallory bodies, and hepatic regeneration, but the definitive diagnosis was decreased serum ceruloplasmin level, quantitation of copper in tissue, electron microscopy, and more recently, the molecular biology or genetic alterations.

[Neonatal hemochromatosis. Report of 3 autopsy cases]. / Hemocromatosis neonatal. Informe de tres casos de autopsia.

INTRODUCTION: Neonatal hemochromatosis is a disease that starts in utero, characterized by severe fibrosis or cirrhosis and siderosis of the liver and other organs without affecting the mononuclear fagocytic system. The most important clinical features are severe hepatic failure at birth and hypoglycemia. The diagnosis is made excluding other diseases more frequently seen in the neonatal period and with at least two of the clinicopathologic criteria delineated by Knisely. METHODS: A retrospective analysis of the autopsies of newborn done at the Department of Pathology of the Hospital de Pediatría, C.M.N. SXXI, IMSS, a tertiary care facility in the period 1989 from 1997. Those cases with primarily hepatic disease as the main diagnosis were chosen. The degree of siderosis was determined cualitatively. The amount of Fe and copper in the liver and spleen in samples fixed in formalin was obtained using X ray fluorescence in the Instituto Nacional de Investigaciones Nucleares, two control cases were also tested. RESULTS: Only four out of 210 autopsies of newborn babies were found to have hepatic disease as a main diagnosis but without an etiology determined. In three of such cases the diagnosis of neonatal hemochromatosis was made. All patients were male with ages six, 29 and 36 days, one with Down's syndrome. The ratio of iron deposits in liver/spleen in hemochromatosis' cases was higher to 1.5 in the liver in contrast to the two control cases. CONCLUSIONS: These cases showed the utility of the autopsy in establishing the adequate diagnosis in three cases of neonatal hemochromatosis. The importance of establishing an accurate diagnosis is to recognize it as an entity with a lethal course, that can be potentially managed with liver transplant as well as genetic counseling to the family. A remarkable finding in the study of these cases was the ratio of iron concentration in the liver and spleen that allowed to discard other causes of siderosis. To our knowledge this finding has never been recorded.

[Calcified aortic stenosis due to healed experimental bacterial endocarditis]. / Estenosis aórtica calcificada por endocarditis bacteriana experimental curada.

We studied the role of bacterial endocarditis in the development of aortic valve stenosis. A femoral arterio venous shunt was performed in nine dogs with the method previously proposed by Lillehei. We induced bacteremic infection with the administration of streptococcus mitis (1 x 10(10)) 10 ml once a day for 15 days these bacterium were sensible to penicillin. All dogs were treated with 1,000,000 U of benzatinic penicillin and sacrificed between 28-102 days after the bacterial inoculation ended. In one dog we observed bacterial endocarditis in the mitral and aortic valves and in other three dogs there was an aortic valve stenosis with calcium deposits in the body and in the free edges of the aortic valve with evident irregular stenosis as seen in man.

[Pathology of the papillary muscles]. / Patología de los músculos papilares.

Anatomoclinical findings in 21 cases of papillary muscle (PM) damage found in 4,000 consecutive autopsies are reviewed. Mitral PM muscles were involved in 17 cases, the posteromedial muscle in 11 patients, in 8 of these with necrosis (N) in 3 with fibrosis (F), in 2 with rupture. The mitral antero-lateral (MAL) was involved in 4 cases, by myocardial infarction (MI), fibrosis, hemorrhage and infectious endocarditis (IE). Both mitral PM were involved in two patients (MI and endomyocardial fibrosis). Tricuspid PM involvement was found in 4 cases. In two because of MI and the two remaining with fibrosis. In the 12 cases with MI microscopic examination showed, PM necrosis of variable magnitude: in the 7 cases with F, there was increased interstitial tissue by connective tissue; in the case with IE there was severe inflammatory reaction with microabscess formation and in one case, a small central longitudinal artery was damaged, a finding not previously described. Mitral PM infarction caused regurgitant murmurs, increase in heart size, heart failure and death from acute pulmonary edema or serious arrhythmias. There was no radiological evidence of left atrial enlargement. ECG findings were not useful in the diagnosis. Based on this anatomoclinical experience considerations are made about other diagnostic and surgical methods.

Craneofaringioma. Estudio anatomoclinico de 10 casos. / Craniopharyngioma: Anatomoclinical study of 10 cases

Se informan 10 casos de craneofaringioma, uno con necropsia, que constituyen el 9.6 por ciento de las biosias y el 2.7 por ciento de las necropsias de los tumores intracraneanos. La neoplasia es mas frecuente en varones (7:3), en la segunda decada de la vida. Clinicamente se manifesto en orden de frecuencia por: hipertension intracraneana, compresion de vias opticas, hipofuncion hipofisaria e hipotalamica y sindrome piramidal. La radiografia simple lateral de craneo fue valiosa al mostrar aumento de la silla turca y erosion de las apofisis clinoides. La tomografia axial computada demuestra localizacion, tamano y aun estructura solida o quistica del tumor. Se hizo extirpacion total o subtotal en ocho casos, con buen exito y solo una recidiva. Los tumores fueron irregulares, lobulados, de 4.5 cm. de diametro, predominantemente solidos y microscopicamente se observaron mas escamosos que adamantinosos. En cuatro casos se observaron calcificaciones microscopicas, en uno de ellos visible radiograficamente. Se discute la ventaja del tratamiento combinado de cirugia y radioterapia por la dificil extirpacion total debido a la localizacion