RESUMO

Los tumores gástricos benignos son poco frecuentes siendo los más reportados los leiomiomas y lipomas. En los últimos años, se ha descubierto una nueva entidad patológica denominada Tumores Estromales del Tracto Gastrointestinal (GIST), que derivan de las células de Cajal. El tratamiento es quirúrgico y son sensibles a quimioterapia. La manifestación clínica es variada y generalmente se presenta con plenitud, sangramiento o dispepsia. Los métodos diagnósticos son múltiples, la ecoendoscopia es de gran importancia para la susceptibilidad de resección endoscópica o quirúrgica. Se consultó paciente femenino de 18 años, sin patología previa, quien presentó malestar general, adinamia, palidez cutánea mucosa, mareos y cefalea. Se automedicó con analgésicos tipo AINES. Posteriormente hematemesis y melena. Al examen físico: palidez, taquicardia, llenado capilar lento, abdomen distendido, doloroso. Laboratorio: anemia, resto sin alteraciones. Ultrasonido abdominal: Loe epigástrico. Gastroscopia: tumor submucoso con sangrado activo, se aplicó ablación con Argón Plasma. Eco endoscópico concluye leiomioma gigante. Reporte de inmunohistoquímica positivo a vimentina y CD117 (CKIT). Compatible con tumor del estroma gastrointestinal, variedad epitelioide. Se realiza gastrectomía subtotal. Los GIST pueden tener un comportamiento benigno o potencialmente maligno con recidiva o metástasis.

Benign gastric tumors are infrequent, being leiomiomas and lipomas the more common among them. Recently a new pathological entity has been described denominated Gastro Intestinal Stromal Tumors (GIST) which originates from the Cajal cells. Treatment is mostly surgical and they are sensible to chemotherapy. Clinical manifestation varies, appearing generally with fullness, bleeding or dyspepsia. Diagnostic methods are multiple; ecoendoscopy is of great importance to determine treatment, whether endoscopic or surgical resection. We present a 18 years old female patient, without previous pathology, who presented with general malaise, adynamia, mucous cutaneous pallor, dizziness and migraine. Self-medicated with NSAID`s, presenting later hematemesis and melena. At physical examination: pallor, tachycardia, slow capillary filling, abdomen distended and painful. Laboratory: anemia, the rest without alterations. Abdominal ultrasound: Epigastric tumor. Gastroscopy: submucosal tumor with active bleeding, argon plasma coagulation was applied. Eco Endoscopy concluded a giant leiomioma. The immunohistochemistry report was positive for vimentine and CD117 (CKIT), compatible with a gastrointestinal stromal tumor of the epithelioid kind. A subtotal gastrectomy was performed. GIST can have a benign or potentially malignant behavior with relapse or metastasis.

Assuntos

RESUMO

INTRODUCTION: Multiple sclerosis (MS) is an inflammatory disease in its early stages whose primary or secondary immunological mechanisms produce reversible or irreversible lesions in the myelin and axons in the central nervous system. The first case of MS in Cuba was reported in 1965. Current prevalence of MS is considered to be 10 cases/100,000 inhabitants. AIMS: The aim of this study was to characterise MS in Western Cuba from a clinical point of view and in comparison with other similar studies carried out in two other regions in the country. PATIENTS AND METHODS: 50 patients living in the western region were clinically assessed. Statistical tests were carried out to compare this survey with two similar studies conducted in the central and eastern regions. RESULTS: 80% of our patients were females, predominantly white skinned, the main events in their family histories were neurological diseases and psychiatric diseases, essentially schizophrenia, the chief triggering event being psychic tension, the most frequent form of progression was the remittent recurring form, followed by secondary progressive form, and then the primary progressive; the main symptoms at onset were visual, followed by pyramidal and sensory; the most strongly affected functional system was the pyramidal and then the sensory system; the functional systems are more affected in the primary progressive form, except the visual and the brainstem; the largest group of patients corresponded to those that had a history of over 10 years with the disorder. By far the majority of results compared with the series from the central region and from Santiago de Cuba were similar, but some significant differences did appear on comparing these two series. CONCLUSIONS: The study shows the characteristics of the disease in the Western region valuated using distinct parameters and several differences between the three series can be observed fundamentally with regard to skin colour, triggering events, symptoms at onset and functional involvement in the forms of progression.

Assuntos

RESUMO

INTRODUCTION: Multiple sclerosis (MS) was first described by Charcot in 1868 and the first case in Cuba was reported in 1965. Prevalence rate is now considered to be about 10 cases/100,000 inhabitants. Cuba is an island that can be divided into three different geographical regions and a comparison of these areas is interesting because it is known that geographical features exert an influence on MS. Demographic differences are also present. AIMS: The purpose of this study was to evaluate a sample of cases from the Western part of the country as regards their results on two important scales and the results of evoked potentials (EP), and to compare them with two samples of patients from the other two regions. PATIENTS AND METHODS: The first sample was made up of 50 patients living in the western region; their diagnosis was confirmed, the scales were applied and the EP test was performed because of its high degree of sensitivity, objectivity and reproducibility. Results were then compared with the other two studies that had already been reported. RESULTS: Most cases had a score of between 0.5 and 5.5 points on the EDSS and only 6% scored above 7.0 points. Patients with PP type MS obtained higher scores. More than half the cases had more than 80 points on the Scripps scale and the second largest group had between 61 and 80 points; the two progressive forms behaved in a similar manner. The most sensitive EP are visual, followed by somatosensory and, lastly, by brain stem auditory EP (BAEP). The vast majority of the results compared with the series from the central region and from Santiago de Cuba were similar, yet some significant differences were found: progression time is longer in the West, EDSS scores were higher in the primary progressive form in the East and the BAEP were less sensitive in the West. CONCLUSIONS: Our findings correspond to those available from other countries around the world and it can be seen that some of the parameters differ between the three regions.

Assuntos

RESUMO

The AV junction ablation was useful to treat patients with drug-refractory supraventricular arrhythmias. The purpose of this study was to determine short and long-term success and complications of the atrioventricular nodal catheter ablation and to compare direct current and radiofrequency energy. Forty patients underwent AV nodal ablation with direct current energy (Group I) and forty patients with radiofrequency (Group II). They were followed up for a mean of 76 +/- 49 and 28 +/- 20 months, respectively. Persistent complete AV block was successfully induced during the first ablation session in 45% of 40 patients who underwent DC energy, while in 50% it was modulated. All patients in the radiofrequency group had complete AV block. The rate of recurrence of AV conduction was 7.5% and 2.5% respectively. Immediate complications did not occur after either procedure. One patient died suddenly in each group during follow-up. AV nodal ablation with radiofrequency energy appears to be as efficacious and safe as direct current energy.

Assuntos

RESUMO

We studied the structure and ultrastructure of three chagasic aneurysms, the excision of which abolished malignant arrhythmias. Chronic recurrent ventricular tachycardia often occurs in patients with chagasic aneurysms, and ventricular mapping indicates that these arrhythmias originate in regions adjacent to those aneurysms. In our patients, ventricular tachycardia had been refractory to medical treatment. During surgery, epicardial and endocardial mapping showed abnormal potentials. Sutures were placed in the areas of resection, their sizes approximating those of earliest activation so that these sites could be identified. The myocardium showed chronic inflammatory reaction, myocytolysis and fibrosis. The presence of "islets" was common (normal, "early" damaged or "established" necrotic myocytes surrounded by fibrous tissue). The "early" lesions were predominant at the previously identified areas of arrhythmogenic activity. The ultrastructural studies showed hypertrophy of myocytes and partial or complete loss of myofibrils, swelling of mitochondria and disruption of mitochondrial cristae, accumulation of lipofuscin granules, and intracellular oedema. A most striking alteration was the thickening of the basement membranes of myocytes and vascular endothelial and smooth muscle cells. The interlaced fronts of respectively healthy (fast conducting) and "early" damaged (slow conducting) myocytes seen in serial sectioning produced an ideal configuration for reentry circuits. The final proof that the arrhythmias originated in these endocardial regions was their abolition by resection of the aneurysm.

Assuntos

RESUMO

Laser beam constitutes a potential therapy in modern cardiology. Although its myocardial effects are known, they have been insufficiently evaluated at the surviving myocytes zone surrounding the evaporated crater. In order to assess myocyte cellular and organelar damage, we studied 8 isolated canine hearts radiated with different intensities by a CO2He laser beam 2.4, 3.5, 5, 15, 25, 30 and 40 Watts, varying the exposition time from 1 to 6 sec. Color photographs from the post-radiated lesions on front and depth were obtained. Their volumes were measured applying the cylinder and the cut out-conus formulas according to the shape of the lesions and then the involved tissues were embedded in paraffin for histological studies. Previously, samples of the lesions were fixed in glutaraldehyde for ultrastructural studies. Volumes of the craters were from 0.0004 to 19.57 mm3. Three layers were observed: a) a carbonized internal lining which measured x 15 microns in thickness; b) a coagulation necrotic zone ("gruyere cheese-like"), 70 microns thickness; c) finally more peripherally, a layer consisting of myocytes with patchy homogeneous cytoplasm, and scare positivity for the Barbeito López Trichome Stain (a positive technique in cases of myocardial damage). Ultrastructurally, crater peripherical cells showed cytosol and mitochondrial edema without membrane disruptions. These findings suggest that myocytes surrounding the laser beam crater, show reversible lesions. Therefore laser beam apperrs a safe procedure to be used in myocardium.

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos