Vasculitis de vaso pequeño asociada a un producto oral usado para la caída del pelo / Small vessels vasculitis associated with a oral medication for loss hair

Se presenta el caso de una mujer de 36 años que consultó por lesiones vasculíticas en extremidades inferiores que aparecieron con relación al uso de un producto oral comercializado para la caída del pelo que contiene prosilium, vitaminas B6, B5, B8, hierro, zinc y vitamina E. Algunos elementos evolucionaron hacia la necrosis, especialmente en la pierna derecha. Los análisis de laboratorio permitieron excluir otras patologías asociadas con vasculitis, diagnosticándose una vasculitis cutánea de vaso pequeño posiblemente asociado a alguno de los componentes de dicho producto.

A 36 year old woman went for a consultation because of vasculitic lesions in her lower extremities that appeared after the use of a commercial oral product for hair loss which contains prosilium, vitamin B6, B5, B8, E, iron, and zinc. Some elements evolved towards necrosis, especially in the right leg. Laboratory analysis excluded other causes of vasculitis. The final diagnosis was a cutaneous vasculitis possible associated with some of the components of the hair loss product.

Reacciones adversas a los anticoagulantes: a propósito de un caso clínico / Adverse effects of anticoagulants: a clinical case report

Paciente de 71 años, de sexo femenino, en tratamiento anticoagulante oral durante cuatro años por enfermedad cardiaca. Presentó en relación a acenocumarol lesiones palpebrales pigmentadas. Se revisan los efectos adversos de los anticoagulantes.

We present a case of a 71 year old woman in anticoagulant treatment for four years because of heart disease. She presented a reaction to acenocumarol, with pigmented eyelid lesions. A review of adverse reactions to anticoagulants is presented.

Dermatosis acantolíticas: a propósito de un caso / Acantholytic dermatosis: a case report

Se presenta el caso de una paciente de 64 años que ha tenido episodios recurrentes de lesiones vesiculosas en su extremidad inferior derecha, diagnosticándose una dermatosis acantolítica. Existe un espectro de enfermedades acantolíticas que histopatológicamente presentan acantolisis, pero que no comparten factores genéticos. El diagnóstico clínico puede ser extremadamente difícil y es la suma de herencia, clínica, histopatología y evolución, la que permite llegar a un diagnóstico. Se realiza una reseña de todas estas enfermedades.

We present the case of 64-year-old female patient with recurrent episodes of vesicles in her lower right limb. Histopathological study revealed acantholytic dermatosis. There is a large spectrum of acantholytic dermatosis that histopathologically presents acantholysis but does not share genetic factors. Clinical diagnosis may be extremely difficult and results in the sum of genetics, clinical findings, histopathological studies and evolution. We also present a review of these diseases.

Necrosis de escroto en adolescente / Necrosis of the scrotum in an adolescent

Paciente de 19 años, sin antecedentes mórbidos de importancia, que presentó necrosis y úlceras genitales sensibles durante un período de cuatro meses y medio, en relación a cuadros infecciosos amigdalianos y respiratorios.

We present the case of a 19-year-old patient, lacking significant morbid antecedents, who presented necrosis and sensitive genital ulcers during a period of four and a half moths, related with tonsillitis and respiratory infections.

[Pharmacokinetics and clearance of ciprofloxacin and amikacin in continuous hemodialysis]. / Farmacocinética y aclaramiento de ciprofloxacina y amikacina en hemodiálisis continua.

We studied the pharmacokinetic and clearance of a 200 mg ciprofloxacin and a 500 mg amikacin intravenous dose during 5 continuous hemodialysis procedures in 5 patients with acute oliguric renal failure. Hourly blood and ultrafiltrate drug concentrations were measured during 8 hours. Dialysate flux (Qd) was 16.6 ml/min during the first hours and 33.2 ml/min thereafter. For each Qd, total ciprofloxacin clearance was 1.13 +/- 0.99 and 2.8 +/- 1.71 ml/min (p < 0.001), diffusive clearance was 0.96 +/- 0.87 and 2.47 +/- 1.56 ml/min (p < 0.005) and convective clearance was 0.16 +/- 0.17 and 0.33 +/- 0.2 ml/min (p < 0.05). Likewise, total amikacin clearance was 3.47 +/- 1.31 and 4.18 +/- 0.53 ml/min (p < 0.001), diffusive clearance was 2.97 +/- 1.24 and 3.86 +/- 0.52 ml/min and convective clearance was 0.50 +/- 0.47 and 0.32 +/- 0.29 ml/min (p = NS). Protein binding was 84% for ciprofloxacin and 77% for amikacin. It is concluded that during continuous hemodialysis with cuprofan membrane, the main transport mechanism of ciprofloxacin and amikacin is diffusive. Very low amounts of ciprofloxacin are depurated by the dialyser. Likewise, the shortening of amikacin half life suggests the presence of other elimination pathway and the need to use supplementary doses every 24 hours.

[Chronic hemodialysis: program for evaluating the quality of life of patients over 60 years old]. / Hemodiálisis crónica: programa de evaluación de calidad de vida en pacientes mayores de 60 años.

The aim of this work was to assess the quality of life of 87 patients older than 60 years, out of 200 undergoing chronic hemodialysis in 9 centers at Santiago. A visual analog scale, with scores ranging from 0 (bad) to 100 (optimal) and a specific questionnaire about the impact of hemodialysis in daily activities, with scores ranging from -10 (severe limitation) to +10 (no limitation) were applied to patients and their attending nurses. Using the visual analog scale, patients assessed their quality of life in 51.7%, and health personnel in 61.3%. Patients had a questionnaire score of 2.3. Quality of life scores were inversely correlated with the condition of being diabetic and the number of hospital admissions.

[Continuous hemodialysis with cuprophan membranes in critical patients]. / Hemodiálisis continua con membrana de cuprofán en pacientes críticos.

The aim of this work was to evaluate the use of 1 m2 Cuprophan hollow fiber filters for continuous arteriovenous hemodialysis procedures. Thirty one critically ill patients (18 male) aged between 20 and 80 years old, subjected to 35 hemodialysis procedures were studied. Sixteen patients had acute renal failure (10 of these had multiorgan failures) and 15 terminal chronic renal failure. Femoral vessels were used for vascular access and isotonic peritoneal dialysis solution flowing at 16.6 ml/seg as dialyzing solution. No extracorporeal pump assistance was used. Mean procedure time was 76 +/- 69.7 h, filter consumption was 2.8 +/- 2.1 filters/procedure, ultrafiltration rate was 168 ml/min and urea clearance was 19.9 +/- 4.4 ml/min. No replacement solutions were required and good electrolyte and circulating volume control was achieved with excellent hemodynamic stability. Blood urea fell from 116.9 +/- 49.1 to 64 +/- 27.2 mg/dl after the procedure (p < 0.001). Hyperglycemia was observed in eight procedures, six patients developed non infectious vascular access complications and two patients catheter related sepsis. We conclude that continuous arteriovenous hemodialysis using cuprophan membranes is a good renal substitution technique for critically ill patients.

[Continuous hemodialysis in the treatment of chronic renal insufficiency in emergencies]. / Hemodiálisis continua en el tratamiento de la insuficiencia renal crónica en emergencia.

Continuous hemodialysis is advantageous for the treatment of renal failure in critically ill patients. This study reports our experience in the treatment of emergencies during chronic renal failure with continuous hemodialysis using a Cuprofane membrane. Eighteen patients with acute decompensations of chronic renal failure were treated with continuous hemodialysis (14 arteriovenous and 4 veno-venous). Procedures lasted a mean of 44.2 h, blood urea nitrogen decreased from 150.3 +/- 49.8 to 60.6 +/- 30.7 mg/dl, metabolic acidosis was corrected raising serum bicarbonate from 10.1 +/- 44 to 17.8 +/- 3.3 mEq/L and hyperkalemia was corrected. Mean ultrafiltration was 239.6 +/- 124.6 ml/h which allowed to withdraw a mean 10.590 ml of ultrafiltrate. Two patients were complicated with femoral artery pseudoaneurysms and one patient with a catheter related sepsis. Global mortality was 16.7%, which compared favorably with the 32.1% predicted mortality according to the Simplified Acute Physiology Score. It is concluded that continuous hemodialysis, a readily available procedure, is suitable for the treatment of emergencies during chronic renal failure.

Hernia de Bochdalek en un preescolar. / Bochdalek hernia in a preschool child

Se relata el caso de un nino de 4 anos de edad con Hernia de Bochdalek. Se senala la frecuencia de esta patologia, el cuadro clinico, diagnostico y tratamiento. El caso reviste especial interes por sus caracteres miscelaneos y sin precedentes