RESUMO
El síndrome de Tolosa-Hunt es una entidad poco frecuente cuya etiopatogenia y mecanismos fi- siopatológicos son controversiales, se caracteri- za por cefalea asociada a parálisis de uno o más nervios craneales, diplopía, estrabismo y ptosis palpebral, ocasionados por el compromiso del seno cavernoso o la fisura orbitaria superior. Su diagnóstico es un reto y se aborda dentro de los diagnósticos diferenciales de las oftalmoplejías dolorosas. Con el objetivo de describir y actua- lizar el conocimiento sobre esta enfermedad se presenta el caso de una paciente de 14 años que acudió a consulta por cefalea intensa, dolor ocu- lar y afección de nervios craneales. Los hallazgos clínicos y la resonancia magnética confirmaron el diagnóstico del síndrome de Tolosa Hunt...(AU)
Assuntos
Humanos , Feminino , Adolescente , Seio Cavernoso , Síndrome de Tolosa-Hunt/diagnóstico , Oftalmologia , Diplopia/complicações , Dor OcularRESUMO
A body of evidence supports a relevant role of brain-derived neurotrophic factor (BDNF) in temporal lobe epilepsy (TLE). Magnetic resonance data reveal that the cerebral atrophy extends to regions that are functionally and anatomically connected with the hippocampus, especially the temporal cortex. We previously reported an increased expression of BDNF messenger for the exon VI in the hippocampus of temporal lobe epilepsy patients compared to an autopsy control group. Altered levels of this particular transcript were also associated with pre-surgical use of certain psychotropic. We extended here our analysis of transcripts I, II, IV, and VI to the temporal cortex since this cerebral region holds intrinsic communication with the hippocampus and is structurally affected in patients with TLE. We also assayed the cyclic adenosine monophosphate response element-binding (CREB) and glucocorticoid receptor (GR) genes as there is experimental evidence of changes in their expression associated with BDNF and epilepsy. TLE and pre-surgical pharmacological treatment were considered as the primary clinical independent variables. Transcripts BDNF I and BDNF VI increased in the temporal cortex of patients with pharmacoresistant TLE. The expression of CREB and GR expression follow the same direction. Pre-surgical use of selective serotonin reuptake inhibitors, carbamazepine (CBZ) and valproate (VPA), was associated with the differential expression of specific BDNF transcripts and CREB and GR genes. These changes could have functional implication in the plasticity mechanisms related to temporal lobe epilepsy.
Assuntos
Fator Neurotrófico Derivado do Encéfalo/metabolismo , Córtex Cerebral/metabolismo , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/metabolismo , Epilepsia do Lobo Temporal/metabolismo , Receptores de Glucocorticoides/metabolismo , Adolescente , Idoso , Fator Neurotrófico Derivado do Encéfalo/genética , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/genética , Epilepsia do Lobo Temporal/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Glucocorticoides/genética , Adulto JovemRESUMO
The survival of several genera of fungi was determined in the ensiled solid fraction of swine faeces after 0, 7, 14, 28 and 56 days of ensiling. The experiment had two treatments, un-ensiled and ensiled manure, in a split-plot design. The manure was distributed into 50 containers; samples, taken at the specified times, were cultured in agar potato dextrose medium, incubated, and colony forming units (CFU/g) were counted and log-transformed. The ensiling process decreased the number of CFU after 56 days. Five fungal genera were identified (Absidia spp., Aspergillus spp., Penicillium spp., Rhizopus spp. and non-fructiferous fungi), and their vulnerability to the ensiling conditions varied, although most of them slowed their growth or disappeared after 14 days of ensiling.
Assuntos
Fezes/microbiologia , Fungos/citologia , Viabilidade Microbiana , Suínos/microbiologia , Animais , Contagem de Colônia Microbiana , Concentração de Íons de Hidrogênio , Esterco , TemperaturaRESUMO
La erupción polimorfa lumínica (EPL) es la fotodermatosis idiopática más común. Suele presentarse en primavera y se caracteriza por la aparición de lesiones pruriginosas de diferente morfología en las zonas expuestas al sol. Aunque existen distintos tratamientos, se considera que la mejor medida consiste en restringir la exposición y utilizar fotoprotectores del factor alto. En este estudio epidemiológico se han evaluado las características clínicas y la revolución de la EPL con medidas de fotoprotección con categoría ULTRA (FPS 90) durante tres meses es una muestra de 26 pacientes. La gravedad de los síntomas y la intensidad de prurito disminuyeron significativamente en tan sólo 15 días hasta niveles irrelevantes y siguió disminuyendo hasta el final del estudio. Los resultados sugieren que la utilización del fotoprotector FPS 90 ayuda a la resolución de las lesiones del brote agudi del EPL.
Assuntos
Masculino , Feminino , Adulto , Humanos , Protetores Solares/uso terapêutico , Transtornos de Fotossensibilidade/epidemiologia , Transtornos de Fotossensibilidade/tratamento farmacológico , Chile , Evolução Clínica , Dermatite Fotoalérgica , Relação Dose-Resposta a Droga , Epidemiologia Descritiva , Seguimentos , Índice de Gravidade de Doença , Transtornos de Fotossensibilidade/patologiaRESUMO
The survival and viability of eggs from Ascaris suum and Oesophagostomum dentatum and of infective larvae (L3) from O. dentatum were determined in the ensiled solid fraction of swine faeces after 0, 7, 14, 28 and 56 days of ensiling. The experiment had two treatments, un-ensiled and ensiled manure, in a split-plot design. Each of 50 containers was inoculated with 40,000 eggs of both A. suum and O. dentatum, and another 50 containers were inoculated with 32,747 L3 of O. dentatum each. A. suum eggs were not destroyed by the ensiling process, although their viability was diminished. O. dentatum eggs and larvae were destroyed during the first 7-14 days of the ensiling process.
Assuntos
Ascaris suum/fisiologia , Bactérias Anaeróbias/metabolismo , Fezes/parasitologia , Oesophagostomum/fisiologia , Suínos/parasitologia , Animais , Fezes/microbiologia , Concentração de Íons de Hidrogênio , Análise de Sobrevida , Temperatura , Fatores de TempoRESUMO
Objetivo: Mostrar la experiencia en la Fundacion Santa Fé de Bogotá con el abordaje extraseroso con resección de la duodécima costilla para el drenaje de los abscesos subfrénicos. Métodos: Se realiza una revision retrospectiva de las historias clínicas de los pacientes sometidos a drenaje de abscesos subfrénicos por la técnica de Ochsner en el periodo comprendido entre enero de 1995 y diciembre de 2001. Se revisaron datos demográficos, la causa del absceso, métodos díagnósticos, procedimientos quirúrgicos y/o radiológicos, el grado de severidad de la enfermedad calculado por el indice APACHE II en el momento de la cirugía, complicaciones de la cirugía, gérmenes detectados en los cultivos, complicaciones no relacionadas con el procedimiento y los días de hospitalización antes y después de la cirugía. Resultados: Cinco pacientes fueron sometidos a 6 procedimientos de Ochsner por 4 abscesos subfrénicos izquierdos y uno bilateral. Dos pacientes presentaron abscesos por pancreatitis aguda y tres por fístulas gástricas. Todos los díagnósticos se realizaron por TAC. El indice APACHE se pudo calcular en 4 pacientes y la medíana fué de 3,5. A todos se les habia practicado por lo menos un procedimiento abdominal previo y en 3 un drenaje percutáneo fallido. Solo hubo una complicación por el procedimiento y fue la apertura accidental del díafragma. Escherichia coli y Pseudomona sp fueron los principales gérmenes identificados. En todos los pacientes el tratamiento fue efectivo para el drenaje del absceso y la medíana de la hospitalización antes de la cirugía fue de 47 días y de 21 días de postoperatorio. Conclusiones: El drenaje posterior de los abscesos subfrénicos por la tecnica de Ochsner es un procedimiento seguro en quienes el drenaje percutáneo fue fallido y se ofrece como altemativa en aquellos casos en los que el drenaje percutáneo no este indicado.
Assuntos
Humanos , Masculino , Feminino , Abscesso Subfrênico/cirurgia , Drenagem , Fístula Gástrica/complicações , PancreatiteRESUMO
BACKGROUND: CA 19-9 is used for diagnosis of gastrointestinal neoplasia, mainly pancreatic and biliary cancer. False positive results have been described in cholestasis. OBJECTIVE: To establish the clinical value of CA 19-9 in the diagnosis of pancreatic and biliary cancer in patients with and without cholestasis. METHODS: Five hundred forty-eight medical records of patients with serum CA 19-9 determination performed from May-1996 to June-1998 were reviewed. Cases were grouped by final diagnosis; malignancy was established by histology or clinical and radiological characteristics. ROC curves were used to calculate ideal cut-off values (ICV) for the test. Cholestasis was defined as bilirrubinemia above 3 mg/dL. RESULTS: Thirty percent of serum determinations were done in patients with non-pancreatic and non-hepatobiliary benign diseases (only 1.3% with values > or = 100 U/mL). CA 19-9 levels were higher in pancreatic and hepatobiliary malignancy compared to benign diseases of the same origin, as well as in pancreatic cancer when compared with hepatobiliary cancer. ICV for differentiation of malignant hepatobiliary diseases was set around 100 U/mL, with increased specificity when compared with the usual cut-off value (37 U/mL). Cholestasis increased the values of the antigen in malignant and benign diseases and modified the efficacy of the test by increasing sensitivity while decreasing specificity. The ICV for determining resectability in pancreatic tumors was 224 U/mL. CONCLUSIONS: CA 19-9 is a valuable test for diagnosis of malignant pancreato-hepatobiliary disease. Given that cholestasis modifies the operational characteristics of the test, a cut-off value has to be tailored for each patient depending on the clinical setting, so to maintain the usefulness of the marker.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico , Biomarcadores Tumorais/análise , Antígeno CA-19-9/análise , Colestase/complicações , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a 41 years old man admitted with a tender goiter, fever, thyrotoxic manifestations and atrial fibrillation. Laboratory confirmed the diagnosis of subacute thyroiditis and treatment with aspirin and propranolol was started, obtaining a rapid relief of symptoms and normalization of heart rate. On the tenth day after admission, severe dysphagia, dysphonia, irritative cough and further enlargement of the neck mass developed. Fine needle aspiration of the mass and thyroid ultrasound lead to the diagnosis of a thyroidal abscess, which was surgically excised, draining 250 ml of purulent material. Cultures were positive for Staphylococcus aureus. Patient was treated during 21 with cloxacilyn and discharged with normal thyroid function. Long term follow up has been uneventful.