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Resumen: La arteria de Percherón es una variante vascular que se caracteriza por una arteria tálamo-perforante dominante originada en el segmento P1 de la arteria cerebral posterior y se bifurca para irrigar a ambos tálamos en su porción paramedial. Su obstrucción se traduce en infartos talámicos bilaterales en el sitio paramedial. Se comunica el caso de un paciente de 85 años de edad con alteraciones en el estado de conciencia, con poca interacción con el medio y parálisis vertical de la mirada, al que se le realizó una resonancia magnética que evidenció infartos talámicos bilaterales. Las lesiones talámicas bilaterales son poco frecuentes. Los infartos talámicos representan 11% de los eventos vasculares y los bilaterales de 22 a 35% de los eventos vasculares talámicos; generalmente son de origen embólico y en raras ocasiones se asocian con hipoperfusión. La tríada típica incluye alteraciones del estado de conciencia, alteraciones de la memoria y parálisis vertical de la mirada. Aunque es una enfermedad infrecuente, es importante considerar la realización de estudios de imagen en pacientes con alteraciones del estado de conciencia que permitan descartar infartos talámicos como parte del diagnóstico diferencial.
Abstract: The Percheron's artery is a vascular variant characterized by the presence of a dominant thalamic-perforating artery originated in the P1 segment of the posterior cerebral artery; it forks to irrigate both thalamus in its paramedial portion. Its obstruction results in bilateral thalamic infarcts in the paramedial site. This paper reports the case of an 85-year-old man evaluated for alterations in the state of consciousness, associated with little interaction with the environment and vertical paralysis of the gaze. MRI evidenced bilateral thalamic stroke. The presentation of bilateral thalamic lesions is rare. The thalamic infarcts represent 11% of the vascular events, and the bilateral events 22 to 35% of the thalamic vascular events; they usually have an embolic origin and they are rarely associated with hypoperfusion. The typical triad includes alterations of the state of consciousness, alterations of the memory and vertical paralysis of the gaze. Although this is an infrequent disease, it is important to consider the performance of imaging studies in patients with alterations of the state of consciousness that allow to discard thalamic infarctions as part of the differential diagnosis.
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Resumen: Las fiebres recurrentes corresponden a una proporción significativa pero menospreciada (18-42%) de las fiebres de origen desconocido. Un grupo de fiebres recurrentes, conocidas como enfermedades autoinflamatorias o síndromes hereditarios de fiebre periódica ocurren debido a una respuesta disregulada de la inmunidad innata, en donde ocurre una reacción autoinflamatoria que causa daño tisular. A diferencia de las enfermedades autoinmunitarias, las enfermedades autoinflamatorias no se asocian con autoanticuerpos específicos o complejos mayores de histocompatibilidad (CMHs), pero ocurren debido a la activación aberrante de las células de la inmunidad innata, como macrófagos y neutrófilos. Aunque la mayoría de los casos inicia durante la infancia, varios suelen ser diagnosticados años después de su inicio o comienzan durante la edad adulta, lo que justifica la necesidad de que el internista esté familiarizado con estas afecciones. En esta revisión discutimos la epidemiología, fisiopatología, manifestación clínica, diagnóstico y tratamiento de las principales enfermedades autoinflamatorias.
Abstract: Recurrent fevers make up a significant yet underappreciated proportion (18-42%) of fevers of unknown origin. A group of recurrent fevers, known as autoinflammatory diseases or hereditary periodic fever syndromes occur due to a deregulated response of innate immunity, whereby an autoinflammatory reaction occurs resulting in tissue damage. Unlike autoimmune diseases, the autoinflammatory diseases are not associated to specific autoantibodies or major histocompatibility complexes (MHCs), but rather result from an aberrant activation of innate immune cells such as macrophages and neutrophils. Although the majority of cases begin during childhood, several are often diagnosed years after their debut or begin during adult life, justifying the need for internists to be familiar with these diseases. In this review we discuss the epidemiology, pathophysiology, clinical presentation, diagnosis and management of the main autoinflammatory diseases.
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SETTING: It is generally accepted that antibodies do not protect against Mycobacterium tuberculosis infection, as this role relies upon T-cell reactivity. Hence, most studies on antimycobacterial antibodies have been aimed at developing serologic tests, and few explore their role in disease pathogenesis. OBJECTIVE: To determine the IgG antimycobacterial antibody response of 55 Mexican Totonaca Indians with pulmonary tuberculosis and its correlation with some features of the disease. DESIGN: Study of the profile of antigen recognition by immunoblot and ELISA with isolated antigen 85 complex (Ag85) and whole culture filtrate proteins. Correlation of immunoblot and ELISA results with BCG vaccination, tuberculin reactivity, extent of the disease, clinical setting, and response to treatment. RESULTS: On immunoblot, band reactivity was very poor and the most frequently recognized antigen was the 30-32 kDa, antigen 85 complex (45.8% of serum samples). ELISA with this antigen showed a sensitivity of 72% and a specificity of 100%. Positive antibody titers to Ag85 were observed in 79.4% of patients with non-cavitary tuberculosis (P = 0.012) and in 95.8% of patients who were cured with anti-tuberculosis chemotherapy (P = 0.0001). By contrast, an antibody response to whole culture filtrate antigens had no correlation with the presence of cavitations or with prognosis. CONCLUSIONS: Our data show that an antibody response to Ag85, aside from having great potential to develop a serologic test for tuberculosis, was associated with a positive outcome in a cohort of tuberculous Mexican Indians.
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Aciltransferasas/inmunología , Antígenos Bacterianos/inmunología , Inmunoglobulina G/inmunología , Indígenas Norteamericanos , Mycobacterium tuberculosis/inmunología , Tuberculosis Pulmonar/inmunología , Adulto , Formación de Anticuerpos , Vacuna BCG , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Immunoblotting , Masculino , México , Estudios Prospectivos , Tuberculosis Pulmonar/etnologíaRESUMEN
BACKGROUND: The use of protease inhibitors has revolutionized the treatment of HIV infection. These agents are well tolerated, although the Federal Drug Administration (FDA) has warned U.S. doctors that protease inhibitors may precipitate hyperglycemia and diabetes (DM), based on isolated reports from physicians. METHODS: Sixty-one patients with HIV infection with criterion of non-DM from the onset of the protease inhibitor therapy participated in the study. Plasma glucose levels were obtained every month during a 6-month period, with a basal determination prior to protease inhibitor therapy. RESULTS: All Mexican patients enrolled in this study had the same Hispanic-American ethnic origin. Four patients (6.55%) developed hyperglycemia related with saquinavir. One had family history of DM type II. These patients were controlled with diet. CONCLUSIONS: Based on present data, we believe the benefits of these drugs to patients suffering from HIV infection outweigh the various risks of taking protease inhibitors. However, physicians who use these drugs have to be on the alert for hyperglycemia in the Mexican population, while patients should know the warning symptoms of hyperglycemia and diabetes.
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Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Hiperglucemia/inducido químicamente , Adulto , Femenino , Humanos , Masculino , MéxicoRESUMEN
Information sources are the books, journals and electronic systems which support the academic work of physicians. Doctors have not taken enough advantage of these sources for their clinical decisions because they trend to rely on a routine undue confidence in experience, and because they do not have the skills for so-called health documentation. Many patients, consequently, have access to the best alternatives for solving their medical problems. The proper use of these sources implies some skills such as reflexive practice, the ability for recovering information, and critical reading and enough determination to apply the results of scientific research to individual patients, taking into consideration the patient's circumstances and the evaluation of outcomes. In this way, there is real integration of medical care, research, and continuing medical education.
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Medicina Clínica , Documentación , Medicina Basada en la Evidencia , Servicios de Información , InvestigaciónRESUMEN
Cutaneous larva migrans (CLM) is a ubiquitous self-limited skin eruption, most frequently caused by the larvae of dog and cat hookworms. Although CLM is most frequent in tropical climates, the infection is becoming more common in urban areas. CLM has been frequently misdiagnosed and/or treated inappropriately, and mimics rheumatic, infectious, vascular, or dermatologic diseases. We here in report the clinical presentation and management of 18 cases of CLM.
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Eritema/parasitología , Larva Migrans/complicaciones , Adolescente , Adulto , Anciano , Eritema/tratamiento farmacológico , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Población UrbanaRESUMEN
POEMS syndrome is a multisystem disorder with signs such as peripheral neuropathy, organomegaly, endocrinopathy, monoclonal protein, skin lesions, papilledema, and increased cerebrospinal fluid proteins, which can also evolve with renal and cardiac affection. It is considered a result of a plasma cell cyscrasia with the production of a monoclonal protein. A 46-year old man was seen as an outpatient referring progressive weakness of legs and arms, fever, impotence, inguinal and cervical lymphadenopathies, peripheral edema, hepatomegaly and skin hyperpigmentation. In laboratory test, platelet count was between 528 x 10(9)/L and 599 x 10(9)/L, creatinine clearance 27.2 ml/min, proteinuria 0.8 g/dl, IgA 455 mg/dl, T3 30 ng/100 ml, T4 2.6 vg/dl, T4F 0.5 ng/dl, TSH 12.4 vU/ml; testosterone 1.56 ng/ml. The electromyography showed a mixed sensitive-motor pattern. On the pelvis radiography, an osteosclerotic lesion on the left sacroiliac joint was identified. Bone biopsy of the site of the sclerotic lesion revealed plasma cell dyscrasia. The patient was treated with diuretics, digitalis and prednisone. Diagnosis of this disorder is difficult because of the multipathology it is necessary to establish differential diagnosis.
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Síndrome POEMS/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This paper evaluates the usefulness of ASA physical status classification and the multifactorial index of cardiac risk in the preoperative assessment, without considering arterial blood gases. With the results of this study we propose to add the ASA physical status classification, the radiologic diagnosis of chronic obstructive pulmonary disease and the multifactorial index of cardiac risk. This strategy increases the diagnostic certainty of Goldman's index of cardiac risk, is practical, not expensive and favors a better establishment of the risk of perioperative cardiovascular morbidity.
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Anestesiología/normas , Enfermedades Cardiovasculares/etiología , Estado de Salud , Complicaciones Intraoperatorias/etiología , Enfermedades Pulmonares Obstructivas/complicaciones , Radiografía Torácica , Procedimientos Quirúrgicos Operativos , Anciano , Enfermedades Cardiovasculares/complicaciones , Humanos , Enfermedades Pulmonares Obstructivas/diagnóstico por imagen , Persona de Mediana Edad , Factores de RiesgoRESUMEN
We report the clinical case of a man who survived a massive attack of Africanized bees (>2000 bee stings). The man experienced anaphylactic shock and multisystem organ failure (neurologic, hepatic, renal, and hematologic failure). He was treated with administration of dopamine hydrochloride, antihistaminic agents, corticosteroids, fluid and electrolyte replenishment, peritoneal dialysis, and plasmapheresis. No sequelae have been observed during follow-up.
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Anafilaxia/etiología , Abejas , Mordeduras y Picaduras de Insectos/complicaciones , Insuficiencia Multiorgánica/etiología , Adulto , Animales , Humanos , Masculino , SobrevivientesRESUMEN
Pyoderma gangrenosum is a rare cutaneous disorder frequently associated with systemic diseases. The authors report the case of a 28-year-old man with pyoderma gangrenosum and inferior cava vein syndrome due to thrombosis. The search for pyoderma gangrenosum-associated conditions (gastrointestinal, rheumatic, neoplasic, and infectious diseases) was negative. A prolonged partial thromboplastin time and a positive test for circulating anticardiolipin antibodies strongly suggested the diagnosis of the antiphospholipid syndrome. There are reports of at least three other cases of pyoderma gangrenosum associated with the antiphospholipid syndrome. This clinical case adds further evidence to the possible link between these disorders and warrants a search for anticardiolipin antibodies in patients with pyoderma gangrenosum.
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Síndrome Antifosfolípido/complicaciones , Vena Ilíaca , Piodermia Gangrenosa/complicaciones , Trombosis/complicaciones , Vena Cava Inferior , Adulto , Anticuerpos Antifosfolípidos/análisis , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/inmunología , Humanos , Masculino , Flebografía , Piodermia Gangrenosa/diagnóstico , Trombosis/diagnóstico , Trombosis/cirugíaRESUMEN
Gastric carcinoid tumors arise from enterochromaffin-like (ECL) cells, these tumors represent 2-41% of all neuroendocrine tumors and 0.3% of malignant gastric neoplasias, being more common in men than in women, and commonly affecting people over 60 years old. These tumors arise from accelerated proliferation of the ECL cells as a consequence of the hypersecretion of gastrin, situation that can be present in atrophic gastritis and the Zollinger-Ellison syndrome. We report the case of a 51 year old hispanic female who presented with a 3 month history of abdominal pain, meteorism and constipation; she was treated with ranitidine and metoclopramide without clinical improvement, thus she underwent upper gastrointestinal endoscopy which showed an atrophic gastritis and gastric polyps. Histopathologic examination revealed a neuroendocrine gastric tumor which was positive to serotonine and gastrin stainings. Hormonal screening showed normal serum levels of LH, FSH, estradiol, ACTH, progesterone, calcitonin and cortisol. The serum level of gastrin was elevated with 500 pg/mL. Gammagraphic scanning with octreotide was negative for metastasis.
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Tumores Neuroendocrinos , Neoplasias Gástricas , Adulto , Anciano , Anciano de 80 o más Años , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/patología , Diagnóstico Diferencial , Femenino , Gastrinas/sangre , Humanos , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Estómago/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologíaRESUMEN
INTRODUCTION: Tuberculosis is frequently the form of presentation of HIV infection, even in patients who have not developed AIDS. Nevertheless, pancreatic affection is rare, and focal pancreatic affection is even rarer. CASE REPORT: We present the case of a 49 years old man with antecedents of 25 heterosexual partners and exploratory laparotomy three years before because of an hepatic lesion during which he was multitransfunded. He had a one year history of fever, diaphoresis and abdominal pain, in whom ultrasonography detected an image compatible with pancreatic abscess, so he went through laparotomy for drainage; biopsy reported tuberculosis. He persisted with fever and abdominal pain, and a computed tomography scan demonstrated persistent pancreatic abscess. The determination of HIV antibodies was positive, and the CD4 count in 110/mm3. Antituberculous therapy was started and eight weeks later, the computed tomography showed improvement; also, he had clinical improvement. After a two-years follow up, he remains asymptomatic, only with antiretroviral therapy. DISCUSSION: Pancreatic tuberculosis is an infrequent complication of this infection. It is considered the result of the dissemination of the infection from near lymphatic nodes. When needle aspiration of a pancreatic abscess is made, it is necessary to effect a culture in order to diagnose tuberculosis. The recommended treatment comprises a four antifimic scheme for 72 doses followed by a triple intermittent scheme for 60 more doses.
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Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Absceso Abdominal/etiología , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Enfermedades Pancreáticas/etiología , Tuberculosis/etiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Absceso Abdominal/diagnóstico , Absceso Abdominal/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Antituberculosos/uso terapéutico , Estudios de Seguimiento , Humanos , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/diagnóstico , Enfermedades Pancreáticas/tratamiento farmacológico , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Zidovudina/uso terapéuticoRESUMEN
The authors present the case of a twenty-one-year-old woman with familial Mediterranean fever who during her first pregnancy developed a primary antiphospholipid syndrome. This is an association not reported previously.
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Síndrome Antifosfolípido/diagnóstico , Fiebre Mediterránea Familiar/diagnóstico , Adulto , Síndrome Antifosfolípido/etnología , Fiebre Mediterránea Familiar/etnología , Femenino , Humanos , Judíos , México , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/etnología , Siria/etnologíaRESUMEN
UNLABELLED: The scope of this work is to analyze the usefulness and indications of preoperative evaluation. PATIENTS AND METHODS: 791 consecutive patients candidate for surgical treatment, were studied prospectively under the next inclusion criteria: 40 years old or less than 40 years old. Blood count cell, glucose, urea, creatinine, sodium, potassium, prothrombin time, partial thromboplastin time, platelets count, liver function tests, chest x-ray and electrocardiograph made before entry. In the the post liver, lung, bleeding, infectious or metabolic complications was done, while visiting the patients every day until discharge. Relative risk (RR) was calculated for every variable, analyzing differences with X2 and Fisher's Test. Those variables with statistical significance value were analyzed with logistic regression. Only 751 patients were studied, there were 335 male (44%) and 416 female (56%), with mean age of 63.9 years. Metabolic disorders (16.9%) and postoperative infections (7.0%) were the more frequent complications. Hemorrhage during of after surgery occurred in 2.2% of the patients. There were seventeen deaths (2.2%) related directly with surgery, with systemic illness or with postoperative complications. Selection of auxiliary tests for preoperative evaluation must be agree with clinical evaluation. The major objective of clinical evaluation is to estimate risk factors for surgery.
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Diagnóstico , Cuidados Preoperatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Pruebas Diagnósticas de Rutina , Exudados y Transudados/microbiología , Faringe/microbiología , Costos y Análisis de Costo , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Humanos , México/epidemiología , Faringitis/diagnóstico , Faringitis/economía , Faringitis/epidemiología , Estudios Retrospectivos , Tonsilitis/diagnóstico , Tonsilitis/economía , Tonsilitis/epidemiologíaRESUMEN
Thyroid function in the elderly has been a matter of discussion. The universe of the present study includes males and females 36 hospitalized with an average age of 72.97 +/- 8.70 years (group I) and 36 ambulatory asymptomatic elderly with 69.81 +/- 8.55 years of age (group II). Serum levels of T3, T4, T4L and TSH were measured in both groups. Mean values of T3 were significantly lower in the hospitalized patients than in the control group. The difference persisted on both, males and females, analyzed separately. Mean values of T4L were significantly lower in women of group II, while mean values of T3 were significantly lower in men of group I. The comparison of thyroid function tests in male and female showed that serum values of T3 and T4 were significantly lower in men of group I. By dividing results in age categories, serum levels of T4L in group II were significantly lower in the age group of 70 to 79 and 80 to 89. Thyroid function tests in asymptomatic ambulatory elderly tend to be normal, whereas the hospitalized patients showed a high proportion of alterations.