RESUMO
Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico , Heparina/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Rivaroxabana/uso terapêutico , Anticoagulantes/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controleRESUMO
Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.
Assuntos
Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Heparina/efeitos adversos , Rivaroxabana/uso terapêutico , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controleRESUMO
Introducción: La hernia de Amyand es la presencia del apéndice cecal en el interior de una hernia inguinal, observándose en el 0,5-1% del total de hernioplastías en los adultos. Presentación del caso: Mujer de 81 años ingresó al servicio de urgencias por dolor en fosa iliaca derecha de una semana de evolución, de intensidad progresiva, asociado a aumento de volumen inguinal derecho, redondo de 10 centímetros de diámetro, sensible a la palpación, no reductible y sin signos de irritación peritoneal. Se decidió realizar intervención quirúrgica por sospecha de hernia inguinal derecha complicada, evidenciándose contenido purulento entre asas intestinales, el cual se drenó, descubriéndose el apéndice cecal en el interior del saco herniario, de aspecto necrótico y perforado, procediéndose a realizar apendicectomía más hernioplastia. La paciente evoluciona en el postoperatorio con cuadro bronquial obstructivo, el cual se trató con antibioticoterapia, respondiendo favorablemente, otorgándose el alta 13 días después de la cirugía. Discusión: El 6,7% de las causas de abdomen agudo en adultos mayores se deben a cuadros apendiculares, mientras que un 13,3% se deben a hernias complicadas. Sin embargo es extremadamente infrecuente encontrar el apéndice cecal inflamado intraherniano, lo que ocurre aproximadamente en el 0,1% de todas las apendicectomías. El cuadro clínico consiste en síntomas inespecíficos con confirmación usualmente intraoperatoria. Se ha descrito el diagnóstico pre-quirúrgico imagenologico con tomografía computarizada (TC). El tratamiento consiste en dos procedimientos: apendicectomía con aseo de la cavidad y la reparación del defecto herniario.
Introduction: Amyand's hernia is the presence of cecal appendix within an inguinal hernia, observed in 0.5-1% of total hernioplasties in adults. Case Report: 81 year old woman admitted to the emergency room for pain in the right iliac fossa, one week of evolution, progressive in intensity associated with an increase in right round inguinal volume, 10 centimeters (cm) in diameter, sensitive to palpation, non reducible without signs Peritoneal irritation. It was decided to undergo surgery for suspicion of complicated right inguinal hernia, showing purulent contents between the intestinal loops, which managed to drain, discovering the cecal appendix in the sack of necrotic and perforated inguinal hernia, proceeding to the subsequent appendectomy of hernioplasty. Postoperatively, the patient developed bronchial obstruction, which was treated with antibiotics, responding favorably, granting discharge 13 days after surgery. Discussion: 6.7% of the causes of acute abdominal pain in older adults are due to appendiceal pictures, while 13.3% are due to complicated hernias. However it is extremely rare to find the intraherniano inflamed cecal appendix, which occurs in approximately 0.1% of all appendectomies. The clinical picture is nonspecific symptoms usually intraoperative confirmation. It described the pre-surgical diagnosis imaging with computed tomography (CT). Treatment consists of two procedures: appendectomy with toilet cavity and repair of the hernia defect
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Apendicite/cirurgia , Apendicite/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Apendicectomia , Apendicite/diagnóstico por imagem , Hérnia Inguinal/diagnóstico por imagemRESUMO
The complex behavior that occurs when traffic lights are synchronized is studied for a row of interacting cars. The system is modeled through a cellular automaton. Two strategies are considered: all lights in phase and a "green wave" with a propagating green signal. It is found that the mean velocity near the resonant condition follows a critical scaling law. For the green wave, it is shown that the mean velocity scaling law holds even for random separation between traffic lights and is not dependent on the density. This independence on car density is broken when random perturbations are considered in the car velocity. Random velocity perturbations also have the effect of leading the system to an emergent state, where cars move in clusters, but with an average velocity which is independent of traffic light switching for large injection rates.
Assuntos
Biofísica/métodos , Algoritmos , Automação , Automóveis , Análise por Conglomerados , Humanos , Modelos Estatísticos , Modelos Teóricos , Meios de TransporteRESUMO
Intestinal parasitism was studied in children of Trujillo (Peru) to create a prevention and control program. Fecal samples of 489 children were examined. The general prevalence of intestinal parasitosis was found to be 68%. The most frequent pathogenic enteroparasites were Giardia lamblia (26.4%), Cyclospora cayetanensis (13%), Hymenolepis nana (2%), Hymenolepis diminuta (1.6%), and Cryptosporidium spp. (1%). All these parasites appeared both in diarrheic and nondiarrheic children, except Cryptosporidium, which invariably caused diarrhea. Multiple parasitism was frequent, 45.6% of the children presenting two, three, or four intestinal parasites. Cryptosporidium was the only parasite that was not associated with the others. Only five children were affected of cryptosporidiosis, presenting explosive diarrhea, nausea, and vomiting. Cryptosporidium species and genotypes involved in the infantile cryptosporidiosis were determined by polymerase chain reaction-restriction fragment length polymorphism. Four children were parasitized by Cryptosporidium hominis and only one by Cryptosporidium parvum. Our results confirm that anthroponotic transmission of Cryptosporidium is predominant in Peru.
Assuntos
Criptosporidiose/epidemiologia , Cryptosporidium/classificação , Cryptosporidium/genética , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , Parasitos/classificação , Animais , Criança , Criptosporidiose/parasitologia , Cryptosporidium/isolamento & purificação , Impressões Digitais de DNA , DNA de Protozoário/genética , Diarreia/parasitologia , Fezes/parasitologia , Genótipo , Humanos , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/fisiopatologia , Parasitos/isolamento & purificação , Peru/epidemiologia , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , PrevalênciaRESUMO
PURPOSE: Since 1998 we have been conducting a prospective study of nonpenetrating deep trabeculectomy with chronic open-angle glaucoma to evaluate the efficiency of the technique. MATERIAL AND METHODS: The study was carried out in 55 eyes of 41 patients who suffered from open-angle glaucoma. After performing a superior scleral flap, mitomycin diluted to 0.01% was applied for 3 minutes, then the 4 x 4-mm superficial scleral flap was dissected at two-thirds deepness until reaching the cornea. The Schlemm canal and the external trabecula were surgically removed and the two points of the Schlemm canal were catheterized with a trabeculotome to ensure that the ablation was well done. If it was not, it was completed by using a trabeculotome as a guide. Postoperatively, if the filtering bleb tended to decrease or ocular pressure began to increase, the operated trabecular region was reopened with Yag laser. The filtering bleb characteristics were correlated with the normalization of intraocular pressure in the first 30 cases. RESULTS: Preoperative pressure without treatment was 32 mmHg. Postoperative intraocular pressure without treatment was 20 mmHg or less in 79% of the eyes after 4 months, 77.5% after 6 months, 75% after 8 months and 61% after 12 months. By adding a local hypotension treatment in monotherapy, a pressure of 20 mmHg or less was obtained in 79% of the cases after 12 months. No severe complications were observed. The presence of a filtering bleb is an important factor in the normalization of postoperative pressure (p=0.0048). CONCLUSIONS: This surgical technique provides a substantial decrease in intraocular pressure and very few complications after 12 months of follow-up.
Assuntos
Antimetabólitos/uso terapêutico , Mitomicina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Trabeculectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Trabeculectomia/efeitos adversos , Trabeculectomia/métodosRESUMO
Presentamos nuestra experiencia en 17 procedimientos de cirugía laparoscópica sin neumoperitoneo. La aplicación de esta técnica ha implicado fabricar elementos de tracción de la pared abdominal como alambres y tractor regulable. Se han realizado 11 colecistectomías, 2 procedimientos urológicos y 4 ginecológicos. El análisis de este procedimiento ha demostrado tener una morbilidad menor que la técnica con neumoperitoneo, y una disminución considerable en los otros
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Procedimentos Cirúrgicos do Sistema Biliar , Laparoscopia , Pneumoperitônio Artificial , Redução de Custos , Instrumentos Cirúrgicos , Músculos Abdominais/cirurgia , Prognóstico , Estudos Prospectivos , Tração/instrumentaçãoRESUMO
The presence of hepatitis C virus antibodies was studied in 64 patients with non alcoholic liver disease and found in 11 (17%). The greater frequency of positive antibodies was found among patients with cryptogenetic liver disease, specially those without serum auto-antibodies (32%). The antibody was unusually found (0 to 11%) in non alcoholic liver diseases of other etiologies. It is concluded that hepatitis C virus chronic infections may be the etiology of an important number of non alcoholic chronic liver diseases.
Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatopatias/imunologia , Adulto , Idoso , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Feminino , Anticorpos Anti-Hepatite C , Humanos , Hepatopatias/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
Se establecen los valores de referencia para las fracciones electroforeticas de proteinas sericas en recien nacidos sanos.Se detecta una diferencia estadisticamente significativa entre ambos sexos para los valores de proteinas totales, albumina y globulinas alfa 1 y alfa 2. Las medianas para las proteinas totales fueron 6.26g% y 5.67g% para ninos y ninas respectivamente (P<0.001). Las medianas de los porcentajes relativos de las fracciones electroforeticas de ninos y ninas fueron albumina: 61.16 y 67.04 (P<0.001), globulinas alfa 1: 3.30 y 1.89 (P<0.001), globulinas alfa 2: 7.30 y 4.76 (P<0.005), globulinas beta: 8.41 y 7.06 y globulinas gamma 19.90 y 17.30 respectivamente. No se detecto difencia estadisticamente significativa para las fracciones beta y gamma globulinas entre ambos sexos
Assuntos
Humanos , Masculino , Feminino , Eletroforese das Proteínas Sanguíneas , Recém-NascidoAssuntos
Obesidade , Antropometria/métodos , Peso Corporal , Dobras Cutâneas , Adolescente , EstaturaAssuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Sequestro Broncopulmonar , BroncografiaRESUMO
Se estudian las caracteristicas de una muestra representativa (265 pacientes) de los asmaticos en control en nuestros servicios, demostrandose que entre nuestros enfermos existe una alta proporcion de las formas mas severas de asma, lo que se traduce en que estos ninos, a su ingreso a tratamiento y control, presentaban un importante numero de hospitalizaciones y consultas al Servicio de Urgencia, asi como ausentismo escolar,intolerancia al ejercicio y alteraciones en el sueno. Una nueva evaluacion hecha luego de un minimo de dos anos de terapia demuestra una gran mejoria en todos los indices de gravedad del asma y en la condicion de vida de estos pacientes