Medicina-buenos Aires最新文献

Lipoma is the most common benign tumor in adults. Its intraoral location is extremely rare, close to 1%. Its clinical presentation is variable, from an asymptomatic mass to dyspnea and dysphagia. Computed tomography allows adequate tumor definition for planning surgical tactics, with surgery being the only effective treatment for the patient's complete restitution. Its timely diagnosis together with effective surgical treatment avoids sustained mechanical trauma that, if it persists, could lead to the subsequent malignant transformation of the tumor. Here we describe the case of a soft tissue tumor with an unusual topographic location, inside the oral cavity, linked with pain during chewing, being this association truly uncommon. A high index of clinical suspicion allows rapid recognition of the tumor, in order to provide timely treatment, and avoiding perhaps the most feared complication, its transformation into a malignant neoplasm.

We present the case of a 69-year-old male with no cardiovascular history, who was admitted to the emergency department due to acute coronary syndrome with ST elevation and cardiogenic shock. Immediately after the percutaneous coronary intervention, he developed a greater requirement of vasopressors, the addition of inotropes, and an increase in oxygen supply by mechanical respiratory assistance. An echocardiogram was performed, which showed acute ischemic mitral regurgitation due to complete rupture of the posteromedial papillary muscle. Under ventricular assistance with a counterpulsation balloon, a mitral valve replacement was decided, and he left the operating room with extracorporeal membrane for oxygenation (ECMO). During the postoperative period, the patient evolved adequately, achieving the retirement of the ECMO at 72 hours with good hemodynamic tolerance. Respiratory weaning was prolonged. Once pulmonary rehabilitation was completed, he was discharged from the hospital.

Introduction: Maternal cortisol undergoes variations in its levels secondary to physiological adaptations. Maternal cortisol secretion increases from the 25th week of pregnancy, estimated to reach twice the value of nonpregnant women in the third trimester. The objectives of this study were to demonstrate the increase in cortisol values in pregnancy and establish reference ranges of plasma cortisol trimester specific to our population of healthy pregnant women.

Materials and methods: Cortisol measurement was performed in 186 healthy pregnant women between 2020 and 2023, 62 women were analyzed for each trimester of pregnancy, including age, body mass index (BMI), previous pregnancies, glycemia and ionogram.

Results: The median age was 27 (18 - 47) years, previous pregnancies 1 (0-9), BMI 25.7 (16.6 - 46.2) kg/m2. In the first trimester, the median cortisol level was 14.1 (7.53 - 31.0) ug/dL; in the second trimester 20.5, (10.0 - 47.2) ug/dl and in the third trimester 23.2, (11.8 - 33.1) ug/dL. The increase in cortisol throughout the trimesters was statistically significant p < 0.001.

Discussion: In this study, cortisol values were identified by specific trimester, which could show an increase throughout pregnancy. Having reference values allows for proper interpretation and clinical diagnosis of endocrine diseases at this stage of life.

It has been observed that menopausal women have a greater sensitivity to sodium intake than women in fertile age. Furthermore, it is now known that the immune system activated by high sodium intake plays an essential role in the development of hypertension. Changes observed in components of the immune system in an animal model of menopause, show the key role of estrogens in the regulation of the immune response to a high salt load. Faced with the same challenge, intact rats have adequate renal sodium management, and the immune system is not activated, while hormone-deprived rats retain sodium and show a pro-inflammatory profile. Pharmacological treatment of hypertension reduces blood pressure, but the observed renal damage remains. Therefore, menopausal women should be especially advised to have an adequate sodium intake that does not pose a risk to their health.

Introduction: Falls in the elderly are a frequent phenomenon during hospitalization and are preventable adverse events. Falls could cause serious injuries in this vulnerable patient population and also lead to poor health outcomes such as increased morbidity, mortality and healthcare costs. The objective of this study is to characterize falls in hospitalized elderly people and analyze the implication of polypharmacy and inappropriate prescription of medications in a University Hospital in Argentina.

Materials and methods: Descriptive, observational, retrospective study.

Results: A sampling 226 patients was taken, the mean age was 74.7 SD: 12.9, range 69-91. The total number of falls was 237 (9 patients suffered more than one fall). Falls are associated with several factors including polypharmacy, cognitive status, advanced age, female sex, and inappropriate prescription of medications.

Discussion: Incidents of falls are frequent, preventable and multi-causal. Some factors such as polypharmacy, cognitive impairment, among others, would be associated with its occurrence; the published literature confirms these concepts.

"Mild autonomous cortisol secretion" is present in up to one-third of patients with adrenal incidentalomas and is characterized by excessive cortisol production without the typical clinical signs of Cushing's syndrome. Due to the lack of typical symptoms, biochemical evaluation is essential for diagnosis, as chronic cortisol secretion has been linked to multiple comorbidities (hypertension, diabetes, metabolic syndrome, dyslipidemia and osteoporosis) as well as increased mortality. While numerous studies address the comorbidities associated with autonomous cortisol secretion and its clinical impact, the indication for surgery remains uncertain and controversial; currently, no guidelines provide precise recommendations for surgical treatment in these patients. However, the few studies reported in the literature suggest an improvement in the cardiometabolic profile after adrenalectomy.

Spinal epidural abscess (SEA) is a classically monomicrobial infection most commonly caused by Staphylococcus aureus (∼65%), followed by Gram-negative bacilli (∼16%), and less frequently by Gram-positive diplococci such as Streptococcus pneumoniae (∼7%), which typically reach the epidural space hematogenously from another focus, mainly respiratory. SEA can originate from hematogenous seeding or direct inoculation, and in approximately one-third of cases, the source of infection cannot be identified. We present a clinical case of SEA associated with pneumococcal bacteremia. A 65-year-old woman with no relevant medical history presented with a 48-hour history of right-sided lower back pain, rendering her unable to sit or stand, with radiation to the thigh and associated fever. A contrast-enhanced magnetic resonance imaging of the spine revealed 5 and 6 mm collections in the posterior epidural space at the L4 and L5 levels. Blood cultures grew multi-sensitive S. pneumoniae, prompting initiation of antibiotic therapy with good clinical response. The traumatology team assessed the patient and obtained a sample from the larger collection, which also yielded the same pathogen. Isolated pneumococcal spinal infection is a rare but extremely serious condition, with a mortality rate exceeding 20%, and can lead to significant neurological consequences if not managed through a multidisciplinary approach involving broad-spectrum antibiotics and, in some cases, surgical intervention.