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INTRODUCTION: Central nervous system tuberculosis is a common chronic infection in developing countries, being the most frequent forms: tuberculous meningitis and intracranial tuberculosis. Extramedullary intradural tuberculosis is a rare entity with few cases described in the world literature, and is usually associated with a history of tuberculous meningitis or during antituberculosis treatment. CASE REPORT: A 17 years-old male patient, without history of tuberculosis, with subacute onset and progressive course of compressive myelopathy. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion between the C4 and T8 spinal levels. Surgical resection of tuberculoma was realized, followed by chemotherapy. The histopathological study confirmed the diagnostic. CONCLUSIONS: Tuberculosis of the central nervous system is an entity of high incidence in developing countries, and intradural extramedullary tuberculoma should be included in the differential diagnosis of expansive spinal cord injuries, especially if the patient is young and there is a history of pulmonary tuberculosis or tuberculous meningitis. It is also important to take it into account as part of a paradoxical reaction after the initiation of specific treatment. Although surgical resection improves compressive medullary symptoms, medical therapy remains the mainstay in the treatment of tuberculomas.
TITLE: Tuberculoma intradural extramedular: descripcion de un caso clinico y revision de la bibliografia.Introduccion. La tuberculosis del sistema nervioso central es una infeccion cronica comun en paises en vias de desarrollo, y la meningitis tuberculosa y los tuberculomas intracraneales son las formas mas frecuentes. El tuberculoma intradural extramedular es una entidad poco frecuente, con pocos casos descritos en la bibliografia mundial, y por lo general se asocia a un antecedente de meningitis tuberculosa o durante el tratamiento antituberculoso. Caso clinico. Varon de 17 años, sin antecedente de tuberculosis, con cuadro clinico de una mielopatia compresiva de aparicion subaguda y curso progresivo, cuya neuroimagen evidencio una lesion extensa intradural extramedular. Se le realizo cura quirurgica mas laminectomia descompresiva en D4-D8 seguido de quimioterapia. El estudio histopatologico confirmo el diagnostico. Conclusiones. La tuberculosis del sistema nervioso central es una entidad de alta incidencia en nuestro medio, y el tuberculoma intradural extramedular deberia incluirse en el diagnostico diferencial de lesiones expansivas de la medula espinal, mas aun si el paciente es joven y existe el antecedente de tuberculosis pulmonar o meningitis tuberculosa. Asimismo, es importante tenerla en cuenta como parte de una reaccion paradojica despues del inicio del tratamiento especifico. Aunque la reseccion quirurgica mejora los sintomas compresivos medulares, la terapia medica continua siendo el pilar en el tratamiento de los tuberculomas.
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Tuberculoma , Tuberculose Meníngea , Adolescente , Humanos , Masculino , Tuberculoma/diagnóstico , Tuberculoma/terapia , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/terapiaRESUMO
Chikungunya en la mujer embarazada constituye un estado nosológico que pone en peligro la vida materno-infantil durante el periodo perinatal. Con el objetivo de determinar el perfil clínico epidemiológico de embarazadas con Chikungunya bajo vigilancia epidemiológica, se realizo un estudio descriptivo y epidemiológico retrospectivo con una muestra de fichas epidemiológicas de 100 embarazadas con Chikungunya durante el segundo semestre del año 2014.Los datos obtenidos fueron procesados y analizados utilizando medidas de tendencia central, porcentajes e intervalos de confianza. Los resultados indican un promedio de 27 años de edad, siendo el eje Metropolitano de la ciudad de Maracay el de mayor incidencia con 86% de los casos de la entidad federal. El promedio del tiempo de embarazo fue entre las semanas 36 y 40 en 30% de ellas. La red pública representó 53% de las referencias. Las manifestaciones clínicas incluyen fiebre 94%, artralgias 84%, cefalea 75%, erupción cutánea 64%, náuseas y vómitos 45% y 43% respectivamente y disminución sustancial del hematocrito. En la evolución de las gestantes con Chikungunya no se encontró un comportamiento distinto al de la triada clínica de la enfermedad. Se evidenció un buen control prenatal con un estándar normal de 6 controles prenatales. Un bajo porcentaje de las embarazadas ingresó a la unidad de cuidados intensivos. Las complicaciones más frecuentes fueron la preeclamsia grave y la amenaza de parto pretérmino. El mal llenado de las fichas e historias clínicas impidió conocer con detalle los avances significativos en la toma de decisiones con respecto a la enfermedad.
Chikungunya in pregnant women is a nosological state that endangers life maternal and child during the perinatal period. In order to determine the clinical and epidemiological profile of pregnant women with Chikungunya under epidemiological surveillance, descriptive and retrospective epidemiological study with a sample of 100 pregnant epidemiological chips with Chikungunya was conducted during the second half of the year 2014.Los data were processed and analyzed using measures of central tendency, percentages and confidence intervals. The results indicate an average of 27 years of age, being the Metropolitan axis of the city of Maracay the highest incidence with 86% of cases the federal entity. The average length of pregnancy was between weeks 36 and 40 in 30% of them. The public network represented 53% of the references. Clinical manifestations include fever 94%, arthralgia 84%, headache 75%, 64% rash, nausea and vomiting 45% and 43% respectively and substantially decreased hematocrit. In the evolution of pregnant women with Chikungunya a different triad clinical behavior of the disease was found. good prenatal care with a normal standard 6 prenatal visits was evident. A low percentage of pregnant entered the intensive care unit. The most frequent complications were severe preeclampsia and preterm labor. The poor completion of clinical histories and files kept detailed knowledge significant advances in making decisions regarding the disease.
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BACKGROUND: Giardia duodenalis is among the commonest protozoan parasites in the intestinal tract of humans and may cause significant morbidity worldwide. Although there are several antigiardial agents, treatment failures have been commonly reported. OBJECTIVE: To compare the efficacy and safety of chloroquine (CQ) versus metronidazole (MTZ) in the treatment of children with confirmed G duodenalis mono-infection. METHODS: A randomized, controlled, open-label trial was carried out at the Cuban Institute of Gastroenterology. One hundred and twenty-two children were randomly assigned to receive either CQ (10 mg/Kg bodyweight twice a day for five days) or MTZ [15 mg/Kg bodyweight divided in three daily does for five days]. All children were asked to provide three faecal samples on days 3, 5 and 7 after treatment completion. Children were considered to be cured, if no Giardia trophozoites or cysts were found in any of the three post-treatment faecal specimens evaluated by direct wet mounts and/or after Ritchie concentration techniques. RESULTS: The frequency of cure was a little higher for CQ than for MTZ but the difference was not statistically significant. Headache was more common in patients treated with CQ as was bitter taste. Yellowish colouration of the urine was more frequent in the MTZ treated group. CONCLUSION: Chloroquine, for five days, is as efficacious as the recommended treatment with MTZ in children infected with G duodenalis.
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Amebicidas/uso terapêutico , Cloroquina/uso terapêutico , Giardíase/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Cuba , Fezes/parasitologia , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
Introducción: La incontinencia pigmenti (IP) es una genodermatosis rara, de herencia dominante ligada al cromosoma X. Afecta principalmente a mujeres, si bien se ha descripto en algunos pacientes de sexo masculino. Se caracteriza por comprometer distintos órganos de origen neuroectodérmico como la piel, el sistema nervioso central y los ojos. Las manifestaciones dermatológicas son las más frecuentes. Las lesiones cutáneas evolucionan en cuatro estadios y característicamente se distribuyen a lo largo de las líneas de Blaschko. El objetivo de este trabajo es describir las características clínicas de los pacientes con IP diagnosticados en la sección Dermatología Pediátrica de nuestro hospital, haciendo hincapié en los hallazgos en varones. Materiales y métodos: Estudio retrospectivo descriptivo, basado en la revisión de las historias clínicas de 23 pacientes con diagnóstico de IP evaluados entre los años 1998 y 20008. Resultados: De los 23 casos, 19 eran mujeres y 4 varones. El 48% presentó lesiones cutáneas congénitas. El 100% tuvo lesiones correspondientes al estadio I, 74% al estadio II, 84% al estadio III y 47% al estadio IV. Casi el 40% presentó recurrencias del estadio inflamatorio. Veinte casos tuvieron confirmación histológica. Las manifestaciones extra-cutáneas fueron: alteraciones dentarias en 3 casos, esqueléticas en 2, neurológicas en 4 y oftalmológicas en 2 pacientes. Tres de los 4 varones tuvieron cariotipo normal, del caso restante no obtuvimos el resultado. Tres de ellos tuvieron enfermedad limitada a piel y 1 compromiso neurológico severo y dentario.
Introduction: Incontinentia pigmenti (IP) is a rare X linked genodermatosis. Although some male patients have been described, it classically affects female patients. It is characterized for affecting organs of ectodermal origin such as skin, central nervous system and eyes. Cutaneous findings are the most frequent manifestation and lesions appear in four different stages, all distributed along lines of Blaschko. Our objective was to describe the clinical characteristics of patients with diagnosis of IP in the Pediatric Dermatology Section of our hospital with especial emphasis on male patients. Materials and methods: Retrospective and descriptive study, based on the review of clinical records of 23 patients with diagnosis of IP evaluated between 1998 and 2008. Results: Of the 23 patients, 19 were females and 4 males. Forty-eight percent showed lesions at birth. All patients developed stage I, 74% stage II, 84% stage II and 47% stage IV lesions. Around 40% of patients showed recurrence of stage I. In 20 cases diagnosis was confirmed by skin biopsy. Extra cutaneous lesions were: 3 cases of dental anomalies, skeletal anomalies in 2 patients, ophthalmological alterations in 2 cases and neurologic involvement in 4. Three out of 4 boys had a normal karyotype, the result of the last one was not available. Three of these patients had their disease limited to skin while one had severe neurologic symptoms and dental alterations. Discussion: We hereby report findings in 23 patients with IP, highlighting: 1) all patients showed cutaneous manifestations and developed lesions of stage I. This may be explained by the disease high index of suspicious even at early ages and in males; 2) 40% of patients undergone stage I recurrences later in their lives; 3) a small percentage of patients with dental abnormalities was found, probably due to the low age of the population studied; and 4) the diagnosis in 4 males, including one with a severe phenotype.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Incontinência Pigmentar , Incontinência Pigmentar/diagnóstico , Dermatoses Faciais , Cromossomo XRESUMO
The effectiveness and complications of the treatment of detrusor-external sphincter dyssynergia (DESD) and voiding pressure > 60 mm H2O using an endoluminal urethral sphincter prosthesis (Urolume) were compared with those of conventional external sphincterotomy in 46 men with spinal cord injury (SCI) (mean age 34 years; range 18-58 years). Twenty-six patients elected the Urolume, and 20 chose sphincterotomy. The age and level and duration of SCI were similar in the two groups. Follow-up ranged from 6 to 20 months. After prosthesis placement, voiding pressure dropped from 88 +/- 29 cm H2O to 38 +/- 22 cm H2O at 6 months (n = 23) and 35 +/- 16 cm H2O at 12 months (n = 18) (P < 0.001). The residual urine volume fell from 180 +/- 145 mL preoperatively to 85 +/- 125 mL at 12 months (P < 0.001), while the maximum cystometric capacity remained constant (P = 0.75). External sphincterotomy achieved similar statistically significant decreases in voiding pressure and residual urine volume, and bladder capacity was maintained. The preoperative and follow-up urodynamic measures were similar in the two groups. Prosthesis placement was associated with a significantly shorter operation (P = 0.001) and length of hospitalization (P = 0.01), a lower hospitalization cost (P = 0.01), and less bleeding (change in hemoglobin concentration) (P = 0.01) than external sphincterotomy. The complications of stent insertion were device migration (n = 4) and secondary bladder neck obstruction (n = 2). One patient with continuing reflux required bilateral ureteral implantation. The complications of sphincterotomy were bleeding necessitating transfusion (n = 2), recurrent obstruction (n = 2), and erectile dysfunction (n = 1). The sphincter prosthesis is as effective as sphincterotomy in the treatment of DESD, while being technically easier, less morbid, and less expensive.
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Traumatismos da Medula Espinal/cirurgia , Uretra/cirurgia , Esfíncter Urinário Artificial , Adulto , Humanos , Rim/fisiopatologia , Masculino , Ereção Peniana , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Prospectivos , Radiografia , Traumatismos da Medula Espinal/fisiopatologia , Stents , Ultrassonografia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagemRESUMO
The purpose of our investigation was to compare external sphincterotomy, the traditional method of treatment of detrusor-external sphincter dyssynergia (DESD), with two newer methods, balloon dilatation or internal stenting of the external sphincter. Sixty-one spinal cord injured (SCI) men were prospectively evaluated. The indications for treatment were DESD and voiding pressure greater than 60 cmH2O demonstrated during video-urodynamic study. Twenty patients were treated with balloon dilatation of the external sphincter, 26 with an internal stent prosthesis, and 15 with traditional external sphincterotomy. Age and duration of SCI were similar among the three treatment groups. A significant decrease in both voiding pressure and residual urine from presurgery levels persisted during the follow-up period of 3 to 26 months (mean, 15 months) in all three groups. Bladder capacity remained constant, renal function improved or stabilized, and autonomic dysreflexia (AD) improved in all three groups. Balloon dilatation and prosthesis placement are associated with a significantly shorter length of surgery (p = 0.045), length of hospitalization (p = 0.005), decrease in hospitalization cost (p = 0.01), and decrease in hemoglobin postoperatively (p = 0.046) when compared to external sphincterotomy. Complications of stent insertion included device migration (three patients) and secondary bladder neck obstruction (two patients). In the balloon dilatation group, three recurrent sphincter obstructions, one case of bleeding requiring transfusion, and one case of bulbous urethral stricture occurred. After external sphincterotomy, two patients developed recurrent obstruction, two required blood transfusion, and 1 patient noted erectile dysfunction. Balloon dilatation and prosthesis placement both proved to be as effective as external sphincterotomy in the treatment of DESD.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cateterismo/métodos , Próteses e Implantes , Traumatismos da Medula Espinal/complicações , Stents , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia , Adulto , Análise de Variância , Cateterismo/efeitos adversos , Cateterismo/economia , Análise Custo-Benefício , Seguimentos , Hospitalização/economia , Humanos , Testes de Função Renal , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos , Próteses e Implantes/efeitos adversos , Próteses e Implantes/economia , Stents/efeitos adversos , Stents/economia , Resultado do Tratamento , Bexiga Urinaria Neurogênica/diagnóstico por imagem , Bexiga Urinaria Neurogênica/fisiopatologia , Urodinâmica , UrografiaRESUMO
Eighty-one consecutive flexible cystoscopic examinations were performed on 69 patients with spinal cord injury (SCI) at the time of their urodynamic study. The indications for cystoscopy included hematuria, recurrent urinary tract infections, symptoms of bladder outlet obstruction, the presence of an intraurethral sphincter stent requiring evaluation, neurogenic vesical dysfunction requiring endourodynamic study (cystometrogram through the working port of the flexible cystoscope), or bladder calculi. Flexible cystoscopy was accomplished in all patients, whether lying supine or seated in a wheelchair (N = 16). Only 6 of 39 patients with previous episodes of autonomic dysreflexia became hypertensive during cystoscopy. When a urodynamic catheter could not be inserted, the flexible cystoscope was particularly useful in defining the urethral anatomy or obstruction and in performing endourodynamic evaluation. The only complication was the development of febrile urinary tract infection in four patients. The flexible cystoscope is a valuable tool in the urodynamic laboratory caring for patients with SCI and is effective for use in endourodynamics, especially when patient positioning or catheter placement is difficult. The procedure is well tolerated, causes minimal stimulation leading to the development of autonomic dysreflexia, and provides accurate cystometric data.
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Cistoscópios , Traumatismos da Medula Espinal/fisiopatologia , Urodinâmica , Adolescente , Adulto , Idoso , Pressão Sanguínea , Cistoscopia/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/etiologiaRESUMO
One hundred twenty-eight nonmalnourished male patients between 3 and 36 months of age were randomly assigned to receive one of four lactose-free dietary treatments to determine the effect of dietary therapy on the severity and nutritional outcome of diarrheal illness. Group 1 received a formula diet composed of casein, sucrose, dextrin with maltose (Dextri-Maltose), and vegetable oil to provide 110 kcal/kg body weight/d (CSO-110). Group 2 received CSO to provide 55 kcal/kg/d (CSO-55) for 2 days and then CSO-110. Group 3 received only oral glucose-electrolyte solution (GES) for 2 days, CSO-55 for the next 2 days, and then CSO-110. Group 4 received the same diets as Group 3 except that only intravenous GES was used for the first 2 days. The GES maintenance solutions provided 24 to 30 kcal/kg/d. Therapeutic success rates were similar among dietary groups, ranging from 90% to 97%. Fecal excretion was initially lower in group 4 (P less than 0.05) but was similar initially among groups treated orally and among all four groups beginning on day 3. Net apparent absorption of nitrogen, fat, carbohydrate, and total energy; retention of nitrogen; and increments in body weight, arm circumference, and skin-fold thickness were positively related to the amounts of dietary energy consumed. Thus continued oral feeding with the CSO diets during the early phase of therapy yielded improved nutritional results.
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Diarreia/dietoterapia , Fenômenos Fisiológicos da Nutrição , Absorção , Doença Aguda , Pré-Escolar , Diarreia/fisiopatologia , Estudos de Avaliação como Assunto , Hidratação , Alimentos Formulados , Humanos , Lactente , Masculino , Nitrogênio/farmacocinética , Estado Nutricional , Distribuição AleatóriaRESUMO
Se estudiaron 44 ojos en 22 pacientes glaucomatososs y 52 ojos en 26 pacientes normales, todos con medios claros usando el medidor de la agudeza visual potencial (PAM), aparato diseñado para evaluar agudeza retinal en pacientes con medios opacos y se encontró una buena correlación entre la agudeza visual tomada con tablas de Snellen y la tomada con el PAM, en pacientes glaucomatosos y el grupo de control, demostrando su utilidad en la evaluación de Función Retinal en pacientes en los que opacidades parciales de los medios dificulte la observación y evaluación directa de la retina