RESUMEN
Un hombre de 72 años, es hospitalizado por falla cardiaca aguda. Tiene historia de hipertensión arterial en manejo con enalapril e hidroclorotiazida. Desde su ingreso, se inició trom-boprofilaxis con enoxaparina 40 mg diarios por vía subcutánea en abdomen. Tres días después aparecen lesiones cutáneas ampollosas, tensas, de contenido hemático y diámetro entre 5-15 mm. Las lesiones se localizan en miembro superior derecho (Figura 1) y pie izquierdo (Figura 2), tienen haloeritematoso y no son dolorosas. Las pruebas de coagulación, proteína C reactiva, VSG y hemograma son normales. Se realizó biopsia de piel que mostró lesión subepidérmica con material hemorrágico en dermis papilar y reticular con neutrófilos escasos, sin vasculitis o trombosis. Estos hallazgos, confirman el diagnóstico de dermatosis ampo-llosa hemorrágica a distancia asociada a enoxaparina. Este constituye un efecto adverso infrecuente y autorresolutivo de las heparinas, no relacionado con la dosificación y en sitios distantes a su aplicación. Este paciente se trató con el retiro del medicamento, resolviendo las lesiones a los sietedías y sin recurrencia de las mismas luego de tres meses de seguimiento
A 72-year-old man was hospitalized for acute heart failure. He had a history of arterial hypertension being treated with enalapril and hydrochlorothiazide. Thromboprophylaxis was begun at admission with 40 mg of subcutaneous enoxaparin daily, in the abdomen. Three days later, tense, blood-filled bullous skin lesions with a 5-15 mm diameter appeared. The lesions were on the right arm (Figure 1) and the left foot (Fig-ure 2); they had an erythematous halo and were not painful Clotting, C-reactive protein, ESR and complete blood count were normal. A skin biopsy was performed, which showed a subepidermal lesion with hemorrhagic material in the papillary and reticular dermis with scant neutrophils and no vasculitis or thrombosis. These findings confirm the diagnosis of bullous hemorrhagic dermatosis at distant sites related to enoxaparin. This is an uncommon and self-resolving adverse effect of heparins, unrelated to the dose and at sites distant from their application. This patient was treated by discontinu-ing the medication, and the lesions resolved seven days later with no recurrence after three months of follow-up.
Asunto(s)
Humanos , Masculino , Anciano , Enfermedades de la Piel , Vasculitis , Pacientes , Piel , Trombosis , Heridas y Lesiones , Coagulación Sanguínea , DermisRESUMEN
The objective of the present study was to evaluate the annual ovulatory activity of hair sheep at 15° N. Nineteen Creole ewes with body weight of 40.8 ± 0.3 kg were used. The ovulatory activity was monitored for a year by quantifying progesterone concentrations in blood samples obtained from all the ewes every 7 days. The differences in monthly proportions of ewes with ovulatory activity were analyzed by the chi-square test. Ovulatory activity decreased from May to July and in September, and 42% of ewes ovulated year round. It is concluded that at 15° N, a high proportion of ewes is capable of ovulating throughout the year in the tropical southeastern region of Mexico.