RESUMEN

Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.

Asunto(s)

RESUMEN

Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.

Asunto(s)

RESUMEN

La función de barrera intestinal se encuentra alterada en los pacientes quemados; supone una probable fuente de traslocación bacteriana que puede tener como resultado un fallo orgánico múltiple en estos pacientes. No sabemos cuánto tarda esta función en recuperarse hasta valores normales y no conocemos cómo se encuentra la función de barrera gástrica en los pacientes quemados. El propósito de este estudio es intentar responder a estas cuestiones, observando el ritmo de normalización de la función de barrera intestinal y lo que ocurre con la permeabilidad gástrica en este tipo de pacientes. Estudiamos un total de 15 pacientes (10 varones y 5 mujeres), grandes quemados, con un promedio de superficie corporal quemada (SCQ) de un 18% (+/-7,4), con quemaduras de 2° y 3° grados de Converse Smith, ingresados hasta 24 horas después de producirse la quemadura, a los que se les realizó test de permeabilidad gastrointestinal a las 24 horas y los días 3, 7,14 y 21 postquemadura; elaboramos curvas de permeabilidad gástrica e intestinal y, posteriormente, se compararon con las permeabilidades obtenidas de 18 individuos sanos control. .Observamos que la excreción de sacarosa al ingreso fue de 94,6 (44,7-198,3 mg.), 5 veces mayor que la de los individuos sanos; aunque hubo disminución progresiva de estos niveles de excreción , a las 3 semanas todavía no se habían alcanzado los valores de los individuos sanos. En cuanto a la relación de lactulosa/manitol , en los pacientes quemados fue de 0,080 (0,042-0,153 %), 4,4 veces mayor que la de los individuos sanos; sólo se alcanzaron los niveles de éstos 2 semanas después de la quemadura. No se observó correlación entre la SCQ y los valores de sacarosa y lactulosa/manitol. Existe por tanto una fuerte alteración de la permeabilidad gástrica e intestinal en pacientes quemados, que comienza a normalizarse alrededor de la segunda semana postquemadura para la permeabilidad intestinal, mientras que la permeabilidad gástrica tarda más en normalizarse, no alcanzando los valores normales durante las 3 semanas que duró este estudio (AU)

Gut barrier function is impaired in burn patients, leading to increased odds of bacterial penetration and resulting in multiple organic failure. It is unknown how long does it take to the normalization of the gut barrier, nor the gastric barrier. The purpose of our study is trying to answer those questions, analyzing the rate of gastric permeability and gut barrier normalization in this kind of patients We studied 15 burn patients, 10 males and 5 females, with medium burn total body surface of 18%(+/- 7,4) , with 2nd and 3rd degree burn injuries according to the Converse Smith classification, hospitalized within the first 24 hours of injury. Gastric and intestinal permeability were measured in 24h, and days 3rd, 7th, 14th and 21st after injury and compared with 18 normal patients as controls. Sacarose excretion on admission was 94,6 (44,7-198,3 mg), 5 times higher than controls; these levels decreased within the 3 weeks of the study, but never reached the levels of the controls subjects. In contrast, the rate lactulose/manitol, 0,080 (0,042-0,153%) was 4 times higher than controls on day 1st, but reached normal levels after 2 weeks. The levels of sacarose and lactulose/manitol were not related to burn total body surface. There is a strong correlation between gastric and gut permeability in burn patients. The intestinal permeability takes about 2 weeks to begin to normalize, and the gastric permeability improves but did not normalize during the 3 week duration of this study (AU)

Asunto(s)

RESUMEN

El tema central es el de establecer las bases de un programa de compatibilización del ruido en la vecindad de los aeropuertos argentinos acorde con los requerimientos del mundo actual. Se realiza un desarrollo didáctico que se origina en una encomienda dedicada a evaluar el impacto sonoro producido por aeronaves de 57 aeropuertos del Sistema Nacional. Los 7 capítulos abarcan desde el enunciado de los conceptos básicos y definiciones hasta la propuesta de un marco legal de referencia. Comprende normas, reglamentos y procedimientos actualizados para la mitigación y control del impacto ambiental en las cercanías de aeropuertos, y datos concretos y específicos obtenidos en grandes aeropuertos de países desarrollados. Se incluye, como muestra patrón, la información obtenida en el caso del aeroparque Jorge Newbery de la Ciudad de Buenos Aires

RESUMEN

El tema central es el de establecer las bases de un programa de compatibilización del ruido en la vecindad de los aeropuertos argentinos acorde con los requerimientos del mundo actual. Se realiza un desarrollo didáctico que se origina en una encomienda dedicada a evaluar el impacto sonoro producido por aeronaves de 57 aeropuertos del Sistema Nacional. Los 7 capítulos abarcan desde el enunciado de los conceptos básicos y definiciones hasta la propuesta de un marco legal de referencia. Comprende normas, reglamentos y procedimientos actualizados para la mitigación y control del impacto ambiental en las cercanías de aeropuertos, y datos concretos y específicos obtenidos en grandes aeropuertos de países desarrollados. Se incluye, como muestra patrón, la información obtenida en el caso del aeroparque Jorge Newbery de la Ciudad de Buenos Aires

RESUMEN

Common chimpanzees (Pan troglodytes) and 2-year-old human children (Homo sapiens) were presented with a rakelike tool and a desirable but out-of-reach object. One group of subjects observed a human demonstrator use the tool in one way, and another group observed a demonstrator use the tool in another way. Children in both cases did what the model did. Chimpanzee subjects, however, behaved identically in the 2 model conditions. Both groups performed better than subjects who saw no demonstration. This pattern of results suggest that the chimpanzees were paying attention to the general functional relations in the task and to the results obtained by the demonstrator but not to the actual methods of tool use demonstrated. Human children were focused on the demonstrator's actual methods of tool use (her behavior). The different social learning processes used by the 2 species have implications for their different forms of social organization.

Asunto(s)

RESUMEN

El distiroidismo espontáneo autoinmune (DE) tiene agregación familiar positiva. Se ha identificado distiroidismo en pacientes que reciben amiodarona (DIA). Hemos observado que este grupo muestra predisposición genética y ahora se analizó en forma prospoectiva, la presencia de autoanticuerpos y la historia familiar para identificar factores de riesgo en 140 enfermos que reciben amiodarona (A), 40 de estos con DIA y 30 sujetos con DE. Se estudió tambíen un grupo testigo formado por personas sanas, y sin historia familiar de distiroidismo. En todos se investigaron los antecedentes de distiroidismo en familiares de primer grado y se buscaron anticuerpos anti-tiroglobulina, músculo liso mucosa gástrica, miocardio, mitocondrias, sustancia intercelular del epitelio y membrana basal epitelial, así como anticuerpos antinucleo y factores reumatoides. Los anticuerpos anti-tiroglobulina, mucosa gastríca y miocardio se encontraron con mayor frecuencia en los tres grupos de enfermos que entre los testigos (P < 0.05). Los Ac anti tiroglobulina fueron iguales en frecuencia en los individuos que reciben A, tengan o no distiroidismo. La estratificación pronóstica de las dos poblaciones con A indicó que la presencia de este antoanticuerpo es independiente del sexo, edad, dosis o tiempo de tratamiento con la droga. La expresión clínica del padecimiento tiroideo, depende de la predisposición genética individual, los antecedentes familiares de distiroidismo se encontraron con mayor frecuencia en las familias de los pacientes con DE y DIA que en ls sujetos que reciben la droga y no alteraron la función (P < 0.005). El análisis de asociación entre antecedentes familiares y la manifestación clínica de distiroidismo secundario al tratamiento con A indicó riesgo mayor en los pacientes con uno o más familiares distiroideos (riesgo relativo 7.6)

Asunto(s)

RESUMEN

Spontaneous autoimmune thyroid disease (SATD) shows familial aggregation. Some patients receiving amiodarone treatment have been found to develop thyroid dysfunction. Previously, we reported genetic predisposition among this group of patients, now we inform a prospective study which includes the search for autoantibodies and family history to identify risk factors in amiodarone treated patients, 40 of them with amiodarone related thyroid disfunction, and 100 without it; for comparison, 30 patients with SATD and a control group of healthy subjects were also studied. We looked for the presence of autoantibodies against thyroglobulin, smooth muscle, gastric mucosa, myocardium, mitochondria, epithelial intercellular substance, and basal membrane as well as antinuclear antibodies and rheumatoid factors; in addition the history of thyroid disease in first degree relatives was investigated. Organ-specific antibodies anti-thyroglobulin, gastric mucosa and myocardium were found with increased frequency in the three groups of patients compared with controls (p less than 0.05). The frequency of antihydroglobulin antibodies was similar in patients receiving amiodarone with or without thyroid dysfunction. Prognostic stratification revealed that this finding is independent of sex, age, dosage or duration of treatment. A family history of thyroid dysfunction was found more frequently among patients with SATD and amiodarone related dysthyroidism in comparison with patients receiving amiodarone without altered thyroid function (p less than 0.005). The appearance of clinical thyroid disease depends on individual genetical predisposition. In patients with a positive family history, the risk of developing clinical, thyroid disease is 7.6 when treated with amiodarone.

Asunto(s)

RESUMEN

The hyperglycemia usually observed in patients undergoing heart surgery with extracorporeal circulation (EC) represents a difficult therapeutic problem. We studied the effects of several regimens of insulin therapy on serum glucose (SG) in 24 noninsulin dependent diabetic patients (NIDDs). The patients were randomly divided in five groups; group A received on IV bolus of 10.0-50.0 U/h according to glycosuria; groups B, C, D and E were given a continuous iv insulin infusion of 2.5, 5.0, 7.5 and 10.0 U/h respectively. In 10 non-diabetic patients (NDP) SG levels were also measured, but insulin was not given. A mean of 5.0 l/m2 of body surface of fluids containing 300 g of glucose were administered to all patients during surgery. At the operations SG levels rose progressively soon after the anesthesia was started, reached the highest values during the period of EC, and decreased slowly in blood samples taken after the EC phase and by 24h. This patterns was shown by all groups studied statistically significant lower SG levels, however, were observed in patients of group C, whose values were similar to those seen in the NDP group. Groups D and E had slightly higher SG levels than those of group C. An additional NIDDM patient with advanced chronic renal failure (CRF), had a tendency to hypoglycemia even during the EC period in response to relatively low doses of insulin (2.5 U/h), given by a continuous iv infusion and, although the insulin administration was stopped, his SG levels remained well below the mean values of the other patients for the rest of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

RESUMEN

Amiodarone (2-n-butyl-3,4-diethylaminoethoxy-3',-diiodobenzoyl-benzofurone ) is a drug widely used for the treatment of cardiac arrhythmias. Due to its high iodine content and structural similarity to thyroxine it produces abnormalities in thyroid hormone metabolism and, in some cases, clinical thyroid dysfunction as well. We report 18 patients, 11 females and 7 males, whose thyroid disease developed during treatment with amiodarone (A). Age ranged from 13 to 64 years. A history of thyroid disease in a first-degree relative was present in five, and three patients had goiter prior to A therapy. Fifteen patients had atrial arrhythmias, and 3 had ventricular arrhythmias. Amiodarone was being given in doses of 200 to 800 mg daily. Thyroid function abnormalities appeared between 1 and 29 months after starting A therapy. Nine patients became clinically and chemically thyrotoxic; three patients developed diffuse thyroid enlargement and had total T4 concentration and FI4I increased with normal T3 and no signs of hyperthyroidism; and the six remaining patients became clinically hypothyroid with low values of total T4 and FTI and raised basal TSH. No relationship between dosages of A or duration of treatment and the appearance or severity of thyroid dysfunction was found. Regression of symptoms occurred in all but two patients with simple goiter between 1 and 8 months after amiodarone was discontinued and appropriate treatment was given. Our observations confirm the potential of A to induce thyroid abnormalities in patients with and without preexistent thyroid disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

RESUMEN

We report the laboratory findings from studies carried out on 37 pheochromocytoma patients; (20 males and 17 females whose age ranged from 11 to 55 years). Among the parameters measured, fasting hyperglycemia was one of the alterations most frequently encountered (59%), the difference with the normal values was highly significant (p less than 0.001). The levels found for the other parameters measured were also elevated in some cases and the difference between them and the normal values was statistically significant, the assays included were serum cholesterol and creatinine, haemoglobin, hematocrit and white blood cell and platelet counts. The response to the oral glucose load was normal in 9 patients, 6 showed a diabetic curve and 2 had a glucose intolerance response. Data from our observations and from the literature shows that these alterations may be a source of erroneous diagnosis, mainly in cases where symptoms are atypical or infrequent such as fever of unknown etiology, shock and others. Therefore recognizing these abnormalities as a sign of pheochromocytoma is very important both from the diagnostic and therapeutic points of view.

Asunto(s)

RESUMEN

We present 38 acromegalyc patients who were studied by non invasive methods to assess the frequency of cardiovascular complications. Seventy one percent of the cases presented some type of cardiovascular alteration. In 68% we observed left ventricular hypertrophy by echocardiography which was the most sensitive method to detect it. In 71% we obtained abnormal electrocardiograms, mainly because of conduction disturbances, being right bundle branch block the most frequent. Half of the cases had pulmonary fibrosis and chronic bronchitis. Arterial hypertension was present in 32%. Diabetes mellitus in 21%. Only 2 cases had coronary heart disease. In 37% of the patients who underwent hypophisectomy we observed regression up to 90% of the cardiac complications except for left ventricular hypertrophy and pulmonary fibrosis. None of the patients has died.

Asunto(s)

Asunto(s)

Asunto(s)