RESUMO
Syncope is a medical emergency, which is more or less frequent. Its prevalence increases with age. It is defined as the loss of consciousness and postural tone resulting from a transient alteration of cerebral flow. It appears suddenly, but it does not leave behind any sequela or after-effects. Out of two groups, the neutrally mediated (or neuromediated) syncope, especially the one called carotid sinus hypersensitivity, is related to the carotid sinus paraganglioma. It is triggered by sinus pressure, which results in sudden death by overstimulation. In the next article, we show the case of a sexagenarian female patient with a disabling syncope and a 7 cm carotid body paraganglioma, which did not allow her the minimum movement of lateral dorsiflexion or extension of the neck. For this reason, the patient had to remain hospitalized, in a dorsal decubitus position with semiflexion of the neck. Before the surgery was practiced, a temporary pacemaker was used, and after the resection of the carotid body paraganglioma, in accordance to the patient's studies of cardiac electrophysiology, she was discharged without electrical nerve stimulation.
El síncope es una urgencia médica que es más o menos frecuente. Su prevalencia aumenta con la edad. Se define como la pérdida de la conciencia y el tono postural por una alteración transitoria del flujo cerebral. Suele aparecer de manera brusca y no deja secuelas neurológicas. De los dos tipos de síncope, el neuromediado, en especial el llamado síndrome de hipersensibilidad del seno carotídeo, está relacionado con el paraganglioma del seno carotídeo. Se desencadena por presión del seno y puede llegar a ocasionar muerte súbita debido a sobreestimulación. En el presente artículo mostramos el caso de una sexagenaria con síncope incapacitante y un paraganglioma carotídeo de 7 cm, el cual no le permitía ni el mínimo movimiento de dorsiflexión lateral o extensión del cuello. Por esta razón, la paciente tuvo que permanecer hospitalizada en decúbito dorsal con semiflexión del cuello. Se le colocó un marcapasos temporal en el preoperatorio y después de la resección del paraganglioma carotídeo, de acuerdo con los estudios de electrofisiología cardiaca, se le dio de alta de manera definitiva, sin necesidad de emplear electroestimulación definitiva.
Assuntos
Seio Carotídeo , Paraganglioma/diagnóstico , Síncope/etiologia , Neoplasias Vasculares/diagnóstico , Idoso , Feminino , Humanos , Paraganglioma/complicações , Neoplasias Vasculares/complicaçõesRESUMO
The prevalence of Streptococcus pneumoniae (S. pneumoniae) resistant to penicillin is an increasing problem with variable prevalence across the world. In Mexico, some reports inform prevalence as high as 50% of the isolations. S. penumoniae is a germ that produces a wide variety of diseases, although the most serious infections are in respiratory tract and meningitis. Most patients with the infection caused by this microorganism have a good response to the treatment. The cases with bad prognosis and those which are eventually lethal are related to host factors and microbiologic characteristics such as resistance to beta-lactam antibiotics. The aim of this paper is to inform on three cases of fulminant meningitis due to S. pneumoniae resistant to penicillin, which presented neurological focalization, acute loss of consciousness, coma, and death within the first week, in spite of treatment with cephalosporin of third and fourth generation. In all these cases, S. pneumoniae was isolated from cerebrospinal fluid. The presence of similar cases should alert the clinician to consider an early diagnosis of penicillin resistant meningitis in order to establish an appropriate antibiotic therapy, and consequently, modify the prognosis of the patients.
Assuntos
Meningite Pneumocócica/tratamento farmacológico , Adolescente , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resistência às PenicilinasRESUMO
BACKGROUND: This article is an update of a similar study published in 1984 in which the frequency of cesarean sections practiced in four Mexico City hospitals from 1976 to 1983 was analyzed. OBJECTIVE: To assess the frequency of cesarean sections practiced in four Mexico City hospitals from 1995 to 2002. MATERIAL AND METHOD: Data from these same hospitals corresponding to the 1995-2002 period was again collected. RESULTS: The frequency of cesarean sections in those four health care centers exceeded by far the internationally accepted standards; this frequency shows an increase, and it now accounts for twice as many operations as the number of interventions originally recorded. In 1976, 10 out of every 68 pregnancies came to end vaginally. By 2002, the same ratio was 10 out of 27. CONCLUSIONS: It is urgent to reduce the frequency of such a practice, as well as to reorganize the obstetric services; furthermore, the corresponding modifications in the training of such medical specialists must be done.