RESUMO
Introducción: La parasitosis intestinal por Geohelmintiasis es una de las Enfermedades Infecciosas Desatendidas (OMS), que afecta a poblaciones vulnerables. Existen factores predisponentes como: condiciones precarias de vivienda, bajos ingresos económicos y nivel educativo deficiente. De los helmintos, el Ascaris lumbricoides es el más grande nematodo intestinal en humanos -alcanza hasta 40 centímetros-. La presentación clínica depende del grado de infestación variando desde anemia, astenia, pérdida de peso, hasta invasión interna de órganos blancos como hígado, pulmones, cerebro y corazón en casos extremos. Caso Clínico: Niña de 16 meses de edad, con historia de fiebre prolongada y expulsión espontánea de parásitos por orificio naturales, que llega al servicio de urgencias con síntomas de shock cardiorrespiratorio. Se realiza Ecocardiográfía visualizándose imágenes de cuerpos extraños en forma de cintas y con movimientos espontáneos, compatibles con parásitos de localización cardíaca (2 en aurícula y ventrículo derecho y 1 cabalgando las arterias pulmonares); en el seguimiento ecocardiográfico se constatan múltiples trombos a lo largo del parásito localizado en aurícula derecha y, que dada la gravedad del cuadro se determinó su extracción quirúrgica de urgencia. Se extrajeron 4 parásitos adultos,y, coágulos adherido a uno de ellos. Discusión: El estudio parasitológico y anatomopatológico concluyó que correspondían a hembras adultas de Ascaris lumbricoides. Alta al 8° día post-operatorio en buenas condiciones. Aunque este caso fue exitoso, las complicaciones cardiacas e infecciones sistémicas graves, son de alta morbi-mortalidad, que pueden evitarse con programas de desparasitación y reducción de carga parasitaria mediante mejoras en el saneamiento ambiental y educación sanitaria. A nuestro conocimiento este es el primer caso reportado en el mundo, de extracción de Ascaris Lumbricoides formas adultas del Corazón humano.
Introduction: Geohelminthiasis intestinal parasitosis is one of the neglected Infectious Diseases (WHO) that affects vulnerable populations. Predisposing factors are: poor housing conditions, low economic income and poor educational level. Of the helminths, Ascaris lumbricoides is the largest intestinal nematode in humans - it reaches up to 40 centimeters. The clinical presentation depends on the degree of infestation, which varies from anemia, asthenia, weight loss to internal invasion of organs such as liver, lungs, brain and the heart in severe cases. Case Report: A 16-month-old girl with a history of prolonged fever and spontaneous expulsion of parasites through a natural orifice, arrived at the emergency department with symptoms of cardiorespiratory shock. Echocardiography showed foreign bodies in the form of tapes and with spontaneous movements, compatible with cardiac parasites (2 in the atrium and right ventricle and 1 riding the pulmonary arteries); at echocardiographic follow-up, multiple thrombi were found along the parasite located in the right atrium and, given the severity of the condition, emergency surgical removal was performed 4 adult parasites were removed, with clots adhered to one of them. Discussion: The parasitological and pathological study concluded that the parasites were adult Ascaris lumbricoides females. The patient was discharged on the 8th post-operative day in good condition. Although this case was successful, the cardiac complications and serious systemic infections have a high morbidity and mortality, which can be avoided with deworming programs and reduction of parasite load through improvements in environmental sanitation and health education. To our knowledge, this is the first reported case of Ascaris Lumbricoides adult form extraction from the human heart in the world.
RESUMO
Introducción: El conducto arterioso permeable puede provocar hipertensión arterial pulmonar; éste ocupa el primer lugar de las cardiopatías congénitas quirúrgicas en la ciudad de Toluca, México. Métodos: En el periodo comprendido entre enero del 2006 y diciembre del 2011 se operaron 51 pacientes con conducto arterioso permeable: 34 (66.7%) del sexo femenino. Se estudia la reversibilidad de la presión arterial pulmonar y de la dilatación de cavidades izquierdas posterior al cierre quirúrgico del conducto arterioso permeable y se describen las complicaciones posquirúrgicas en la población de la ciudad de Toluca, localizada a una altitud de 2680 metros sobre el nivel del mar (msnm). Resultados: La reversibilidad de la presión pulmonar ocurrió en el 88% de los casos. También se observó una disminución de los diámetros de las cavidades izquierdas, manifestado por una relación de aurícula izquierda/anillo aórtico prequirúrgica de 2.0±0.41 y posquirúrgica de 1.36±0.25 (p<0.001). El cierre exitoso del conducto arterioso permeable inmediato fue del 94.1% y mediato del 98.0%. Se presentaron complicaciones posquirúrgicas en el 13.8% de los pacientes, todas fueron menores, siendo las principales: infección y hematoma de la herida quirúrgica (5.9%), neumotórax (3.9%), neumonía (2.0%) y derrame pleural (2.0%). Conclusiones: La hipertensión arterial pulmonar secundaria a conducto arterioso permeable es reversible en la mayoría de los casos después del cierre quirúrgico, incluso en habitantes de localidades por arriba de los 2500 msnm.
Introduction: Patent ductus arteriosus in Toluca can cause pulmonary hypertension and ranks first surgery of congenital heart disease in Toluca, Mexico. Methods: In the period between January 2006 and December 51 patients with patent ductus arteriosus went to surgery: 34 (66.7%) were female. We study the reversibility of pulmonary arterial pressure and the left cavities dilatation after surgical closure of the ductus arteriosus and postoperative complications are described in a population of Toluca, located at an altitude of 2680 meters over the sea. Results: The reversibility of pulmonary pressure ocurred in 88% of cases. We also observed a decrease in the diameters of the left chambers manifested by a ratio of left atrium/aortic annulus before surgery of 2.0 ± 0.41 SD and after surgery of 1.36 ± 0.25 SD, (p<0.001). The successful closure of the ductus arteriosus was 94.1% immediately and mediate 98.0%. Postoperative complications ocurred in 13.8%, being the main infection and surgical wound hematoma (5.9%), pneumothorax (3.9%), pneumonia (2.0%) and pleural efusion (2.0%). Conclusions: Pulmonary arterial hypertension secundary to patent ductus arteriosus is reversible in the mayority of cases after surgical closure, including residents of village above 2500 meters over the sea.
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Altitude , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/cirurgia , Hipertensão Pulmonar/complicações , México , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
INTRODUCTION: Patent ductus arteriosus in Toluca can cause pulmonary hypertension and ranks first surgery of congenital heart disease in Toluca, Mexico. METHODS: In the period between January 2006 and December 51 patients with patent ductus arteriosus went to surgery: 34 (66.7%) were female. We study the reversibility of pulmonary arterial pressure and the left cavities dilatation after surgical closure of the ductus arteriosus and postoperative complications are described in a population of Toluca, located at an altitude of 2680 meters over the sea. RESULTS: The reversibility of pulmonary pressure ocurred in 88% of cases. We also observed a decrease in the diameters of the left chambers manifested by a ratio of left atrium/aortic annulus before surgery of 2.0 ± 0.41 SD and after surgery of 1.36 ± 0.25 SD, (p<0.001). The successful closure of the ductus arteriosus was 94.1% immediately and mediate 98.0%. Postoperative complications ocurred in 13.8%, being the main infection and surgical wound hematoma (5.9%), pneumothorax (3.9%), pneumonia (2.0%) and pleural efusion (2.0%). CONCLUSIONS: Pulmonary arterial hypertension secundary to patent ductus arteriosus is reversible in the mayority of cases after surgical closure, including residents of village above 2500 meters over the sea.
Assuntos
Altitude , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/cirurgia , Hipertensão Pulmonar/complicações , Pré-Escolar , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
Rhabdomyoma is the most common cardiac tumor detected during fetal life and childhood; nevertheless its incidence is very low. This is a histologically benign tumor, but in some cases may cause hemodynamic repercussion with date of low cardiac output, arrhythmias and exceptionally intrauterine death as occurred in our case, which was detected by obstetric ultrasound and fetal echocardiogram and corroborated by histological study.
Assuntos
Morte Fetal , Neoplasias Cardíacas/diagnóstico por imagem , Rabdomioma/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Morte Fetal/etiologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Humanos , Gravidez , Rabdomioma/complicações , Rabdomioma/patologiaRESUMO
OBJECTIVE: to describe the type of presentation, the clinical manifestations, the response to treatment and the coronary artery abnormalities in eleven cases of children with Kawasaki disease. METHODS: Eleven patients who fulfill diagnostic criteria for Kawasaki disease were studied in a six years period. RESULTS: the mean age was 26 months, 80 % of patients were less than 5 years old, the male-female ratio was 1:1.2; no differences between typic and atypic presentation were found. The most frequent clinical manifestation (80 %) was non-exudative conjunctive injection, followed by polymorphic exanthema and mucosal involvement in the mouth. Nine of 11 patients (82 %) received treatment with intravenous immunoglobulin during the first 10 days of fever; seven of these patients showed coronary artery ectasia; they showed in the echocardiogram a complete resolution in the first year of follow-up. Two patients (18 %) without intravenous immunoglobulin developed coronary aneurysms. CONCLUSIONS: the Kawasaki disease is the main cause of acquired cardiopathy in the pediatric age in our hospital, an early diagnosis and treatment within 10 days of the beginning of the fever allowed a reduction of coronary artery alterations in these patients.
Assuntos
Doenças Cardiovasculares/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Pré-Escolar , Feminino , Humanos , Lactente , MasculinoRESUMO
El Lupus Eritematoso Sistémico Bulloso (LESB) es un trastorno poco frecuente, caracterizado por la formación de ampollas sub-epidérmicas que aparece en personas que padecen lupus eritematoso sistémico, siendo muy rara en niños.Presentamos el caso de una niña de 10 años de edad, cuya primera manifestación del LES fue la erupción ampollosa.
Assuntos
Humanos , Lúpus Eritematoso Sistêmico , PediatriaRESUMO
Intrapericardial teratomas in fetal and neonatal stages are rare. They invade the mediastinum compromising the venous return to the heart and leading to hydrops. We report a case of a neonate with fetal hydrops who required ventilatory support at birth and urgent surgical treatment due to severe respiratory failure. During surgery, a multicyst mass was resected in the anterior mediastinum, corresponding to an immature teratoma.
Assuntos
Neoplasias Cardíacas/diagnóstico , Pericárdio , Teratoma/diagnóstico , Feminino , Humanos , Recém-NascidoRESUMO
Mantle cell lymphoma (MCL) is a B-cell lymphoid tumor that expresses CD20 and is associated with a poor prognosis. Central nervous system involvement has been associated with particularly dismal outcome. We report a 62-year-old male with MCL and meningeal lymphomatosis. The patient was treated with intrathecal rituximab (IT-R) 25 mg every third day for five doses with clearance of tumor after the third dose. Systemic therapy consisted of R-HyperCVAD alternating with rituximab, high-dose methotrexate, and cytarabine every 21 days, with IT-R on day 1 of each chemotherapy cycle. The patient was consolidated with an autologous stem cell transplant and remains in remission 23 months later. The use of IT-R and conventional intrathecal chemotherapy in MCLs is discussed here.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Linfoma de Célula do Manto/tratamento farmacológico , Neoplasias Meníngeas/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Injeções Espinhais , Linfoma de Célula do Manto/patologia , Masculino , Pessoa de Meia-Idade , RituximabAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Neoplasias Cutâneas/patologia , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Osso Frontal/patologia , Humanos , Injeções Espinhais , Linfoma de Células B/complicações , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Osso Occipital/patologia , Prednisona/administração & dosagem , Rituximab , Couro Cabeludo/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico , Osso Temporal/patologia , Vincristina/administração & dosagemRESUMO
BACKGROUND: Ocular lymphomas and ocular adnexae lymphomas (OL and OAL) constitute 7-8% of all extranodal lymphomas. OBJECTIVE: Describe the clinical, morphologic and immunophenotypic characteristics of OAL seen in our hospital. MATERIAL AND METHODS: Retrospective analysis of patient records with OL and OAL between July 1994 and July 2005. The following data was analyzed: Clinical presentation, therapy, treatment response, overall survival and disease free survival. RESULTS: Ten patients with OL and OAL were identified. Of these, 8 were women and 2 men. Median age was 50. Eight of 10 patients achieved complete remission, 6 of the 6 presenting MALT Lymphoma. Two patients with stage IV had refractory disease. CONCLUSIONS: In our series 0.02% of lymphomas were OL and OAL of a total 498 LNH. MALT lymphomas appear at a more advanced age, sixty percent of the cases were MALT lymphomas and were diagnosed during their early stages. Patients were followed during 21 months, global survival was 100%, free illness survival had a mean of 868 days and a survival median of 442 days.
Assuntos
Neoplasias Oculares/patologia , Linfoma não Hodgkin/patologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Neoplasias Oculares/tratamento farmacológico , Neoplasias Oculares/radioterapia , Feminino , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/radioterapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
Antecedentes. Los linfomas oculares (LO) y de los anexos oculares (LAO) tienen una incidencia de 7- 8% de todos los tumores extraganglionares. Objetivo. Describir las características clínicas, morfológicas e inmunofenotípicas de los LO y LAO atendidos en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Material y métodos. Se revisaron los expedientes de los pacientes con diagnóstico de LO y LAO de julio de 1994 a julio del 2005. Se analizaron los siguientes datos: presentación clínica, tratamiento, respuesta al tratamiento, supervivencia global, y supervivencia libre de enfermedad (SVLE). Resultados. Se analizaron 10 pacientes, 8 mujeres y 2 hombres. La media de edad fue de 50 años. La remisión completa (RC) se presentó en 8 de 10 pacientes y en los 6 pacientes con linfoma de tejido linfoide asociado a mucosas (MALT). Se encontraron dos con enfermedad refractaria, los cuales estaban en estadio IV. Conclusiones. En este estudio los LO y LAO correspondieron a 0.02% de todos los linfomas no Hodgkin (LNH) estudiados (498 casos). Los linfomas tipo MALT se presentan a edad más avanzada, se encontraron en estadios más tempranos y en todos hubo RC, con una SVLE promedio de 868 días y una media de supervivencia de 442 días.
BACKGROUND: Ocular lymphomas and ocular adnexae lymphomas (OL and OAL) constitute 7-8% of all extranodal lymphomas. OBJECTIVE: Describe the clinical, morphologic and immunophenotypic characteristics of OAL seen in our hospital. MATERIAL AND METHODS: Retrospective analysis of patient records with OL and OAL between July 1994 and July 2005. The following data was analyzed: Clinical presentation, therapy, treatment response, overall survival and disease free survival. RESULTS: Ten patients with OL and OAL were identified. Of these, 8 were women and 2 men. Median age was 50. Eight of 10 patients achieved complete remission, 6 of the 6 presenting MALT Lymphoma. Two patients with stage IV had refractory disease. CONCLUSIONS: In our series 0.02% of lymphomas were OL and OAL of a total 498 LNH. MALT lymphomas appear at a more advanced age, sixty percent of the cases were MALT lymphomas and were diagnosed during their early stages. Patients were followed during 21 months, global survival was 100%, free illness survival had a mean of 868 days and a survival median of 442 days.