RESUMO
Introduction: Glaucoma is a leading cause of irreversible blindness. It is a prevalent disease worldwide, affecting â¼70 million people and expected to reach up to 112 million by 2040. Purpose: The aim of this study is to describe the implementation and initial experience of a telemedicine program to monitor glaucoma and glaucoma suspect patients in a large, integrated health care system during the COVID-19 pandemic. Methods: A retrospective chart review of established glaucoma or glaucoma suspect patients who participated in a telemedicine evaluation at the ophthalmic center of a large, Colombian health care system between June 2020 and April 2023 was conducted. Clinical and sociodemographic variables were analyzed. Generated clinical orders for additional testing, surgical procedures, follow-ups, and referrals, as well as changes in medical treatment, were evaluated. Results: A total of 11,034 telemedicine consults were included. The mean ± standard deviation age of this group was 63 ± 17.2 years and 67% were female. Of the patients who attended teleconsults, 49% were glaucoma suspects and 38.5% were followed with a diagnosis of open-angle glaucoma. After the consult, 25% of patients were referred to a glaucoma specialist, 40% had additional testing ordered, and 8% had a surgical procedure ordered, mainly laser iridotomy (409 cases). Almost a third of patients returned for subsequent telemedicine visits after the initial encounter. Despite some technical difficulties, 99.8% of patients attended and completed their scheduled telemedicine appointments. Conclusions: A telemedicine program aimed to monitor established glaucoma patients can be successfully implemented. Established patients within an integrated health care system have high adherence to the virtual model. Further research by health care institutions and government agencies will be key to expand coverage to additional populations. Clinical Trial Registration Number: CEIFUS 1026-24.
Assuntos
COVID-19 , Glaucoma , Telemedicina , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , COVID-19/epidemiologia , Estudos Retrospectivos , Telemedicina/organização & administração , Glaucoma/diagnóstico , Glaucoma/terapia , Colômbia , Idoso , Adulto , SARS-CoV-2 , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Programas de Rastreamento/organização & administração , Programas de Rastreamento/métodos , Idoso de 80 Anos ou maisRESUMO
The study of the Heteroptera (Hemiptera) fauna of the El Impenetrable National Park, resulted in an inventory composed of: Alydidae (2 spp.), Aradidae (1 sp.), Belostomatidae (5 spp.), Berytidae (1 sp.), Blissidae (1 sp.), Coreidae (11 spp.), Corixidae (2 spp.), Geocoridae (1 sp.), Gerridae (1 sp.), Hebridae (1 sp.), Largidae (4 spp.), Lygaeidae (5 spp.), Miridae (17 spp.), Nabidae (1 sp.), Notonectidae (1 sp.), Oxycarenidae (1 sp.), Pachygronthidae (1 sp.), Pachynomidae (2 spp.), Pentatomidae (16 spp.), Pleidae (1 sp.), Pyrrhocoridae (1 sp.), Reduviidae (30 spp.), Rhopalidae (5 spp.), Rhyparochromidae (12 spp.), Saldidae (1 sp.), Scutelleridae (2 spp.), Tingidae (1 sp.), and Veliidae (1 sp.). These findings include six new records for the Argentinean fauna: Prytanes foedus (Stl), Saldula pallipes (Fabricius), Camirus brevilinea (Walker), Atopozelus opsimus Elkins, Doldina bicarinata Stl, Rocconota sextuberculata St and 39 new records for Chaco Province.
Assuntos
Hemípteros , Heterópteros , Reduviidae , Animais , Argentina , Parques RecreativosRESUMO
resumen está disponible en el texto completo
Abstract: Introduction: Among the patients infected with SARS-CoV-2, 14.6% were admitted to intensive care unit. this 29 to 75% required invasive mechanical ventilation with an associated mortality of 12 to 81%. Acute respiratory distress syndrome (ARDS) is the most serious form of presentation. The pathophysiology of ARDS secondary to SARS-CoV-2 differs from conventional causes. It presents dysregulation in hypoxic pulmonary vasoconstriction, secondary acute pulmonary hypertension and microthrombotic phenomena. The development of refractory severe hypoxemia (PaO2 < 60 mmHg or PaO2/FiO2 < 100 mmHg, with FiO2 80 to 100%, with PEEP > 10 to 20 cmH2O for at least 10 to 12 hours) constitutes the scenario of maximum severity with an associated mortality of 71 to 94%. The use of rescue strategies that impact on the specific pathophysiology of this entity such as the use of inhaled nitric oxide, neuromuscular blockade and prone ventilation have emerged as therapeutic targets of interest. Protective mechanical ventilation (plateau pressure [Pplat] < 27 cmH2O and driving pressure [DP] < 15 cmH2O) continues to be the cornerstone of the management. Objectives: To determine whether there is an association between the use of inhaled nitric oxide and prone ventilation with ventilatory mechanics in patients with severe refractory hypoxemia secondary to SARS-CoV-2 infection. Material and methods: A historical, retrospective, descriptive, comparative and retrolective cohort study was carried out. Data from the records of patients admitted to the Respiratory ICU of the ABC Medical Center with a diagnosis of ARDS secondary to SARS-CoV-2 infection who required iNO and mechanical ventilation in prone from April 1 to December 31, 2020 were analyzed. A univariate analysis was performed, the statistical analysis was performed in SPSS v 21, measures of trend, dispersion were analyzed as well as the analysis of risk factors with Student's t test and χ2. Results: A total of 108 patients were analyzed, of which 54 received iNO, neuromuscular blockade and prone and 54 only neuromuscular blockade and prone ventilation. 81.5% (n = 88) were men. The most common comorbidity was diabetes mellitus in 51.9% (n = 56). The increase in oxygenation (delta PaO2/FiO2) was with a median of 31.9 ± 15.2 mmHg in the iNO group and 52.9 ± 16.74 mmHg in the control group (p = 0.001). The postintervention Pplat in the iNO group was 26.3 ± 3 and 34.5 ± 1.9 cmH2O in the control group (p = 0.792). The preintervention DP in the iNO group was 17.2 ± 3.9 and 13.4 ± 2.8 cmH2O in control group vs 13.1 ± 1.29 and 12 ± 1.92 cmH2O after the intervention (p = 0.001). Conclusions: The use of iNO in patients with severe hypoxemia refractory to prone ventilation and neuromuscular blockade did not produce a statistically significant improvement in oxygenation, however it allowed to reprogram the ventilatory support to keep the patient in goals of alveolar protection.
Resumo: Introdução: 14.6% dos pacientes infectados com SARS-CoV-2 são internados em terapia intensiva. Destes, 29 a 75% necessitam de ventilação mecânica invasiva com mortalidade associada de 12 a 81%. A síndrome do desconforto respiratório agudo (SDRA) é a forma mais grave de apresentação. A fisiopatologia da SDRA secundária ao SARS-CoV-2 difere das causas convencionais. Apresenta desregulação na vasoconstrição pulmonar hipóxica, hipertensão pulmonar aguda secundária e fenômenos microtrombóticos. O desenvolvimento de hipoxemia grave refratária (PaO2 < 60 mmHg ou PaO2/FiO2 < 100 mmHg, com FiO2 de 80 a 100%, PEEP > 10 a 20 cmH2O por pelo menos 10 a 12 horas) constitui o cenário mais grave com mortalidade associada de 71 a 94%. O uso de estratégias de resgate que impactam na fisiopatologia específica dessa entidade, como o uso de óxido nítrico inalatório (NOi), bloqueio neuromuscular e ventilação prona, surgiram como alvos terapêuticos de interesse. A ventilação mecânica protetora (Pressão de Platô [PPLAT] < 27 cmH2O e Pressão de Condução [CP] < 15 cmH2O) continua sendo a base de seu manejo. Objetivo: Determinar se existe associação entre o uso de óxido nítrico inalatório e ventilação prona prolongada com mecânica ventilatória em pacientes com hipoxemia refratária grave secundária à infecção por SARS-CoV-2. Material e métodos: Realizou-se um estudo de coorte histórico, retrospectivo, descritivo, comparativo e retroletivo. Analisaram-se dados dos prontuários de pacientes internados na UTI Respiratória do Centro Médico ABC com diagnóstico de SDRA secundária à infecção por SARS-CoV-2 que necessitaram de óxido nítrico inalatório e ventilação mecânica prona no período de 1o de abril a 31 de dezembro de 2020. Realizou-se uma análise univariada , a análise estatística foi realizada no SPSS v 21, foram analisadas as medidas de tendência e dispersão, assim como a análise dos fatores de risco com teste t de Student e χ2. Resultados: Analisaram-se 108 pacientes, dos quais 54 receberam NOi, bloqueio neuromuscular e prono e 54 apenas bloqueio neuromuscular e ventilação prona. 81.5% (n = 88) eram homens. A comorbidade mais comum foi diabetes mellitus em 51.9% (n = 56). O aumento da oxigenação (Delta PaO2/FiO2) foi com mediana de 31.9 ± 15.2 mmHg no grupo NOi e 52.9 ± 16.74 mmHg no grupo controle (p = 0.001). A PPLAT após a intervenção no grupo NOi foi de 26.3 ± 3 e 34.5 ± 1.9 cmH2O no grupo controle (p = 0.792). A PC antes da intervenção no grupo NOi foi de 17.2 ± 3.9 e 13.4 ± 2.8 cmH2O no grupo controle vs 13.1 ± 1.29 e 12 ± 1.92 cmH2O após a intervenção (p = 0.001). Conclusões: O uso de NOi em pacientes com hipoxemia grave refratária à ventilação em pronação e bloqueio neuromuscular não produziu melhora estatisticamente significativa na oxigenação, porém permitiu que o suporte ventilatório fosse reprogramado para manter as metas de proteção alveolar do paciente.
RESUMO
Inflorescence movements in response to natural gradients of sunlight are frequently observed in the plant kingdom and are suggested to contribute to reproductive success. Although the physiological and molecular bases of light-mediated tropisms in vegetative organs have been thoroughly investigated, the mechanisms that control inflorescence orientation in response to light gradients under natural conditions are not well understood. In this work, we have used a combination of laboratory and field experiments to investigate light-mediated re-orientation of Arabidopsis thaliana inflorescences. We show that inflorescence phototropism is promoted by photons in the UV and blue spectral range (≤500 nm) and depends on multiple photoreceptor families. Experiments under controlled conditions show that UVR8 is the main photoreceptor mediating the phototropic response to narrowband UV-B radiation, and phototropins and cryptochromes control the response to narrowband blue light. Interestingly, whereas phototropins mediate bending in response to low irradiances of blue, cryptochromes are the principal photoreceptors acting at high irradiances. Moreover, phototropins negatively regulate the action of cryptochromes at high irradiances of blue light. Experiments under natural field conditions demonstrate that cryptochromes are the principal photoreceptors acting in the promotion of the heliotropic response of inflorescences under full sunlight.
Assuntos
Proteínas de Arabidopsis/genética , Arabidopsis/fisiologia , Proteínas Cromossômicas não Histona/genética , Citocromos/genética , Fotorreceptores de Plantas/genética , Fototropismo/genética , Arabidopsis/genética , Proteínas de Arabidopsis/metabolismo , Proteínas Cromossômicas não Histona/metabolismo , Citocromos/metabolismo , Fotorreceptores de Plantas/metabolismoRESUMO
Introducción: La vasculatura fetal persistente bilateral es una malformación ocular poco frecuente, generalmente unilateral, que suele presentarse como leucocoria. Objetivo: Presentar el caso de una paciente de 6 meses con leucocoria bilateral y diagnóstico de vasculatura fetal persistente bilateral. Resumen del caso: Reporte de caso por medio de recopilación de datos de la historia clínica, fotografías del segmento anterior de la paciente, ecografía ocular y resonancia magnética de cerebro. Conclusiones: La vasculatura fetal persistente bilateral es poco frecuente, pero hay que tenerla en cuenta en el momento del abordaje de un paciente con leucocoria bilateral, cuyo pronóstico visual depende de su reconocimiento y tratamiento tempranos.
Introduction: Bilateral persistent fetal vasculature is a rare developmental disorder of the eye, usually seen as leukocoria affecting only one eye. Objective: Report on a case of a 6 month old patient with bilateral leukocoria and diagnosis of bilateral persistent fetal vasculature. Case summary: Descriptive case report study with data from de medical history, anterior segment photographs, ocular ultrasonography and cerebral magnetic resonance imaging. Conclusions: Bilateral persistent fetal vasculature is an infrequent disease that has to be taken into account when approaching a patient with bilateral leukocoria, whose visual prognosis depends on the early detection and treatment
Assuntos
Humanos , Masculino , Lactente , Vasos Retinianos , Corpo VítreoRESUMO
Esta investigación constituye un estudio transver sal que tuvo como objeto de estudio a 1000 estudiantes de medicina de la ESPOCH de Riobamba, Ecuador, con el objetivo de determinar la existencia de algunos factores modificables de riesgo coronario, así como la coexistencia de los mismos en cada estudiante investigado, mediante una entrevista individual y la realización del examen físico. La dieta rica en grasas saturadas (69,6%), la tensión emocional mantenida (56,4%), la obesidad (42,1), y el sedentarismo (39,9%), fueron los factores con mayor prevalencia, seguidos por el hábito de fumar (14,3%). La hipertensión arterial y la ingestión frecuente de bebidas alcohólicas fueron los factores de riesgo con menor proporción. Cabe destacar que el 54,4% de las estudiantes utilizaba algún tipo de anticonceptivo de tipo hormonal.Fue elevada la proporción de estudiantes en quienes coexistían 2, 3, y 4 y más factores de riesgo. Se llega a la conclusión de que existe un alto riesgo de desarrollar en el futuro una enfermedad cardiaca coronaria entre los jóvenes estudiados, pero esta situación es factible de modificación.
This research is a cross-sectional study that aimed to study 1000 medical students from ESPOCH of Riobamba, Ecuador, with the objective of determining the existence of some modifiable factors of coronary risk, as well as the coexistence of the same in each student Investigated, through an individual interview and physical examination. The diet rich in saturated fat (69.6%), maintained emotional tension (56.4%), obesity (42.1), and sedentary lifestyle (39.9%) were the most prevalent factors followed By smoking (14.3%). High blood pressure and frequent ingestion of alcoholic beverages were the risk factors with the lowest proportion. It should be noted that 54.4% of the students used some form of hormonal contraceptive. The proportion of students in whom 2, 3, and 4 coexisted and the risk factors increased. It is concluded that there is a high risk of developing coronary heart disease in the future among the young people studied, but this situation is feasible for modification
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Alcoolismo , Comportamento Sedentário , Hipertensão , Obesidade , Exame Físico , Gorduras na Dieta , Fumar , Fatores de Risco , EquadorRESUMO
BACKGROUND: Delirium is a poorly recognized entity in surgical patients that may commonly be mistaken for dementia or cognitive dysfunction. It is of great importance to know the measures that can lower its incidence and insure early recognition in order to begin specific treatment. The main objective of this study was to prove that implementation of an educational program for health care professionals is an effective strategy to reduce delirium incidence and to help in early detection. METHODS: A preventive program was developed based on non-pharmacological measures and with support from patient relatives consisting of educational sessions, didactic material and questionnaires, as well as specific strategies for all patients above 65 years old admitted to the hospital and within inclusion criteria. Two evaluations were made by physician and nursing personnel before and after implementation of the program. RESULTS: We observed an improvement in ability to identify disease (initial 22% vs. 93%; p= 0.000). 200 patients were included in the study group in one year where only one case of delirium developed showing an important reduction compared to the previous incidence in our hospital (10% vs. 0.5% p= 0.000) whereas in the surgical patients group no patient developed delirium (4.8% vs. 0% p= 0.01, NNT= 21). CONCLUSIONS: Implementation of a delirium prevention program is feasible. Due to the satisfactory results in our study it should be considered as an effective strategy for reducing incidence of this condition that may cause greater postoperative morbidity and mortality.K.
Antecedentes: el delirium es un padecimiento poco reconocido en los pacientes quirúrgicos que frecuentemente se confunde con deterioro cognitivo o demencia. Es de vital importancia conocer las medidas que pueden disminuir su incidencia y reconocerlo de manera temprana para iniciar el tratamiento específico. Objetivo: implementar un programa educativo en delirium para el equipo de salud, con el propósito de disminuir su incidencia. Material y métodos: estudio observacional, longitudinal y analítico basado en medidas no farmacológicas y con apoyo de los familiares con quienes se tuvieron sesiones educativas, material didáctico, cuestionarios y estrategias específicas para todos los pacientes mayores de 65 años. Se realizaron dos evaluaciones al personal médico y de enfermería antes y después de implementar el programa.Resultados: se observó mejoría en la capacidad para dentificar el delirium (22% inicial vs 93%; p= 0.000). Se incluyeron 200 pacientes en el grupo de ensayo a un año y se encontró un solo caso de delirium que mostró reducción importante respecto a la incidencia previa en el hospital (10 vs 0.5% p= 0.000), mientras que en el subgrupo de 98 pacientes quirúrgicos no hubo ningún caso de delirium (4.8% inicial vs 0% p= 0.01, NNT= 21). Conclusiones: la implementación de un programa preventivo para el delirium es factible. Los resultados fueron satisfactorios, por lo que puede considerarse una estrategia efectiva para reducir la incidencia de esta afección que puede causar gran morbilidad y mortalidad postoperatoria.
Assuntos
Idoso/psicologia , Delírio/prevenção & controle , Educação Médica Continuada , Educação Continuada em Enfermagem , Corpo Clínico Hospitalar/educação , Recursos Humanos de Enfermagem/educação , Complicações Pós-Operatórias/prevenção & controle , Idoso de 80 Anos ou mais , Desidratação/complicações , Desidratação/prevenção & controle , Delírio/diagnóstico , Delírio/etiologia , Feminino , Humanos , Imobilização/efeitos adversos , Incidência , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Privação do Sono/prevenção & controle , Inquéritos e Questionários , Avaliação de SintomasRESUMO
Cervical carotid artery dissections (CCAD) are common in young adults with a mean age of 44 years and may account for as many as 20% of strokes in patients younger than 30 years. Trauma and primary diseases of the arterial wall such as fibromuscular dysplasia are the main predisposing factors. Some CCAD cases are diagnosed solely on clinical history and physical examination, and even imaging tools such as helical/multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) sometimes are not sufficient to reach a diagnosis. We describe the case of an 18-year-old male who presented to our emergency department due to loss of consciousness 18 hours after a car accident. Previously he had been in no acute distress, with fluent speech, and able to follow 3-step commands. Helical CT showed a hypodense lesion in the left-middle cerebral artery territory, as well as hyperdensity of the M1 segment of the middle cerebral artery. Cerebral angiography depicted the left carotid artery dissection in the C1 segment. Physicians should consider this entity in "asymptomatic" patients during their first hours after head injury, among patients who later develop focal neurological symptoms and clinical deficits. Clinical suspicion followed by radiological findings allows early neurovascular treatment, trying to save viable brain tissue in the first hours post injury.
Assuntos
Lesões das Artérias Carótidas/complicações , Dissecação da Artéria Carótida Interna/etiologia , Infarto da Artéria Cerebral Média/etiologia , Adolescente , Angiografia , Lesões das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
La disección de la arteria carótida interna (DACI) en su porción extracraneal es más común en adultos jóvenes, con edad de presentación promedio de 44 años y representa hasta 20% de los accidentes vasculares cerebrales en menores de 30. Algunos casos de DACI son de difícil diagnóstico, si se basan únicamente en la clínica y la exploración física; aunado a este hecho, los métodos de imagen como la tomografía computada (TC) helicoidal o multicorte así como la resonancia magnética (RM) pueden no ser suficientes para delinear la patología en cuestión. Presentamos el caso de un paciente masculino de 18 años, quien sufrió accidente automovilístico, sin pérdida del estado de alerta, 18 horas después del accidente presenta deterioro súbito del estado de conciencia, fue trasladado al hospital. La TC identificó una lesión hipodensa en el territorio de la arteria cerebral media izquierda, e hiperdensidad de esta arteria en la fase simple. Se realizó una angiografía cerebral diagnóstica, que mostró DACI izquierda en su segmento C1. Desde el punto de vista clínico-quirúrgico es importante sospechar esta patología en un paciente asintomático en las primeras horas postraumatismo y que posteriormente desarrolla déficit neurológico. La sospecha clínica y su comprobación radiológica permiten un tratamiento neuroquirúrgico-vascular para intentar el rescate del tejido cerebral viable en las primeras horas de establecido el daño.
Cervical carotid artery dissections (CCAD) are common in young adults with a mean age of 44 years and may account for as many as 20% of strokes in patients younger than 30 years. Trauma and primary diseases of the arterial wall such as fibromuscular dysplasia are the main predisposing factors. Some CCAD cases are diagnosed solely on clinical history and physical examination, and even imaging tools such as helical/multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) sometimes are not sufficient to reach a diagnosis. We describe the case of an 18-year-old male who presented to our emergency department due to loss of consciousness 18 hours after a car accident. Previously he had been in no acute distress, with fluent speech, and able to follow 3-step commands. Helical CT showed a hypodense lesion in the left-middle cerebral artery territory, as well as hyperdensity of the M1 segment of the middle cerebral artery. Cerebral angiography depicted the left carotid artery dissection in the C1 segment. Physicians should consider this entity in [quot ]asymptomatic[quot ] patients during their first hours after head injury, among patients who later develop focal neurological symptoms and clinical deficits. Clinical suspicion followed by radiological findings allows early neurovascular treatment, trying to save viable brain tissue in the first hours post injury.
Assuntos
Humanos , Masculino , Adolescente , Dissecação da Artéria Carótida Interna/etiologia , Infarto da Artéria Cerebral Média/etiologia , Lesões das Artérias Carótidas/complicações , Angiografia , Artéria Carótida Interna , Dissecação da Artéria Carótida Interna , Infarto da Artéria Cerebral Média , Lesões das Artérias Carótidas , Tomografia Computadorizada por Raios XRESUMO
Como ente asesor del Ministerio de la Protección Social para el control del cáncer, el Instituto Nacional de Cancerología presenta por primera vez cifras estimadas de incidencia de cáncer a nivel departamental, obtenidas mediante una metodología validada por la Agencia Internacional para el Control del Cáncer (IARC), en un trabajo de estrecha colaboración con ellos. Para un país en el que el cáncer se ha tornado un problema de salud pública, contar con información sobre la magnitud del mismo, de manera periódica y sistemática, es una prioridad en los distintos aspectos que conlleva la implementación de un programa de control del cáncer. En la celebración de sus setenta años, el Instituto Nacional de Cancerología publicó el Atlas de mortalidad por cáncer en Colombia, en el cual se trataron los datos de mortalidad de una manera novedosa, pero sin escapar a algunas limitaciones. En esta oportunidad se presentan datos sobre las defunciones por cáncer para un periodo más reciente y con una aproximación metodológica diferente en la que se corrigió la información sobre defunciones en el país y en los departamentos, con indicadores de subregistro, los que no se tuvieron en cuenta en la publicación previamente mencionada. De otro lado, en este caso no se hizo tratamiento de la información según su calidad. Las dos aproximaciones efectuadas en publicaciones subsiguientes brindan a nuestros lectores la posibilidad de comparar los resultados de métodos alternos que pueden utilizarse en el futuro de forma complementaria para brindarle al país herramientas para alcanzar una mayor calidad. Esperamos que esta publicación sea el inicio de un ejercicio de difusión periódica de información por parte del INC, que, además de servir a los tomadores de decisiones y a los planificadores en salud del país, motive en los profesionales de la salud un interés por el cáncer, por la población a riesgo y por la calidad de la información que aquéllos generan y que constituye la base de todo sistema de información.
Assuntos
Humanos , Masculino , Feminino , Colômbia , Sistemas de Informação Geográfica , Localização Geográfica de Risco , Neoplasias , Neoplasias da Mama , Neoplasias do Colo , Neoplasias Esofágicas , Neoplasias da Vesícula Biliar , Neoplasias Laríngeas , Leucemia , Neoplasias Hepáticas , Neoplasias Pulmonares , Linfoma não Hodgkin , Neoplasias Bucais , Neoplasias do Sistema Nervoso , Neoplasias Pancreáticas , Neoplasias Faríngeas , Neoplasias da Próstata , Neoplasias Retais , Neoplasias Gástricas , Neoplasias da Bexiga Urinária , Neoplasias do Colo do Útero , Neoplasias UterinasRESUMO
Se comunica el caso de dos pacientes con fascitis necrozante del escroto y pared abdominal, como los informados por Fournier en 1883, con la anatomía, fisiopatología, bacteriologíca y tratamiento del padecimiento con alto riesgo de mortalidad.