RESUMEN

BACKGROUND: Asthma has a global prevalence of 18%. In work-related asthma, there is an association between asthma and the exposure to dust, vapors, or fumes only at the workplace, in patients with or without a previous asthma diagnosis; it represents approximately 5-25% of the cases of adult onset asthma. In Mexico, the information about this topic is scarce. CASE REPORT: A series of 17 patients with an asthma diagnosis and occupational exposure to dust, vapors, or fumes is reported; occupational asthma was determined by the Allergy and Clinical Immunology Service at Centro Médico Nacional Siglo XXI. CONCLUSION: Occupational health is essential for the proper performance of the staff, the optimal performance of the work unit, and for avoiding health damages, economic losses, and social implications. The role of the physician in charge of occupational health in terms of prevention, diagnosis, and timely management of frequent pathologies according to the work sector, represents a great area of opportunity that is important to fulfill in many work centers.

Antecedentes: El asma tiene una prevalencia mundial de 18 %. En el asma relacionada con el trabajo existe asociación entre asma y exposición a polvo, vapores o humos exclusivamente en el ambiente laboral, en pacientes con o sin diagnóstico previo de asma; representa aproximadamente de 5 a 25 % de los casos de asma de inicio en edad adulta. En México existe escasa información al respecto. Casos clínicos: Se reporta una serie de 17 pacientes con diagnóstico de asma y exposición laboral a polvo, vapores o humos; se determinó asma ocupacional por parte del Servicio del Alergia e Inmunología Clínica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI. Conclusiones: La salud en el trabajo es primordial para el adecuado desempeño del personal, el funcionamiento óptimo de la unidad laboral y para evitar daños a la salud, pérdidas económicas y repercusiones sociales. La función del médico a cargo de la salud ocupacional en cuanto a la prevención, diagnóstico y manejo oportuno de patologías frecuentes de acuerdo con el sector laboral representa una gran área de oportunidad en centros de trabajo que es importante atender.

Asunto(s)

RESUMEN

BACKGROUND: Trauma, osteomyelitis, bone tumour resections and congenital deformities are the main causes of bone deficiency in which autologous graft is the preferred treatment, but usually the bone supplies are limited. METHODS: An experimental model of heterotopic bone formation in the subcutaneous abdominal area of dogs was developed. This model consists in omentum wrapped implants constituted by collagen type 1 sponges embedded with demineralized bone powder, calcium cloride, thrombin and platelet rich plasma; the implant is totally converted in trabecular bone after four months of implantation. This model was improved by accelerating bone production, after the isolation of the most conspicuous histological constituents (inflammatory, bone and adipose tissues) by laser microdisection and purified from them RNA that was used to determine by RT-PCR the gene expression kinetics of the most important growth bone factors. Then, the most abundant and rapidly synthesized factors were produced by genetic engineering in tobacco plants. RESULTS: Bone morphogenetic proteins 2 and 7 and transforming growth factor-ß1were the most rapidly and highly synthesized factors, and they were efficiently produced in a genetic engineering plant based system in tobacco leaves. Their incorporation as recombinant proteins in the scaffold collagen sponge induced in just one month mature heterotopic bone. CONCLUSION: This study demonstrates for the first time that this plant system is able to produce recombinant bone growth factors in high amount and at low cost, and they were highly efficient to rapidly induce bone formation in abdominal implants potentially useful for autotransplantation.

RESUMEN

UNLABELLED: Bile duct injuries occur with a frequency of 1 to 5 per 1000 cases as a result of an increase in the number of procedures performed. Elderly patients have more severe lithiasis- related diseases than the younger population. This fact increases the likelihood of conversion from laparoscopic to open surgery, and the probability of injury. We report the results of bile duct reconstruction after injury in these patients. SETTING: A tertiary care academic university hospital. METHODS: The files of patients over 65 years of age who had biliary tract reconstruction after iatrogenic injury were retrospectively reviewed. Post operative results, quality of life and failures from the repair were analyzed. RESULTS: 20 patients over the age of 65 were referred for biliary tract reconstructive surgery over a ten year period. Mean age was 71 (65 - 83). Nineteen cases were referred from other hospitals. Fourteen cases (60%) had comorbidities (type 2 diabetes mellitus, systemic hypertension). All patients were treated by means of Roux en Y hepatojejunostomy. No operative morbility was recorded and only one major complication (abdominal collection) was found. Two long term mortalities unrelated to surgery were found. Treatment success (as defined by the Johns Hopkins criteria) was obtained in 17 cases (85%) and only one patient (5%) required reoperation two years after the initial attempt. CONCLUSIONS: Elderly patients that survive biliary injury and are reconstructed have long-term results comparable to the younger population; Roux en Y hepatojejunostomy offers the best surgical choice.

Asunto(s)

Asunto(s)

RESUMEN

Introducción. El síndrome de Guillain-Barré es la causa más común de parálisis generalizada aguda. La enfermedad usualmente es benigna y tiende a autolimitarse, pero en casos severos puede causar la muerte por insuficiencia respiratoria. Objetivo: Describir la experiencia obtenida en un centro de referencia (Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán) para pacientes con síndrome de Guillain- Barré (SGB). Material y métodos: Se realizó una análisis retrospectivo de 28 pacientes con el diagnóstico de GB.Resultados: Se analizaron 28 pacientes durante un período de 10 años. La edad promedio del grupo fue 37.6 años + 17.2. 13 pacientes eran del sexo masculino (46 por ciento) y 15 (54 por ciento) eran mujeres. 9 pacientes (32 por ciento) tuvieron una infección de vías respiratorias superiores y 5 (18 por ciento) tuvieron un cuadro de gastroenteritis previo a los síntomas y 14 (50 por ciento) no tuvieron un factor precipitante. El tiempo de evolución tuvo una mediana de 7 días (2-15). 26 pacientes (93 por ciento) tuvieron una presentación clínica típica con una debilidad ascendente de extremidades y 18 (64 por ciento) tuvieron disestesias o parestesias. 18 pacientes (64 por ciento) correspondieron a la variante clínica clásica PDIA (Polirradiculopatía desmielinizante inflamatoria aguda), 5 (18 por ciento) correspondieron a la variante NASMA (Neuropatía axonal sensitivo-motora aguda), 3 (11 por ciento) NAMA (Neuropatía axonal motora aguda), y 2 (7 por ciento) presentaron el síndrome de Fisher-Miller. 24 pacientes (86 por ciento) tuvieron hiperproteinorraquia en el líquido cefalorraquídeo. 15 pacientes (54 por ciento) requirieron ventilación mecánica. 20 pacientes (71 por ciento) tuvieron una recuperación total, 6 (21 por ciento) tuvieron recuperación parcial y 2 (7 por ciento) pacientes no tuvieron ninguna respuesta.Discusión: Aunque la enfermedad tiende a autolimitarse en la mayoría de los casos, los cuadros más severos son frecuentes en las unidades de tercer nivel como se muestra en nuestro estudio donde el 54 por ciento requirieron ventilación mecánica, sin embargo la mayoría de estos casos tuvieron una buena respuesta (71 por ciento).

Asunto(s)