Revista medica de Panama最新文献

The incidence of low-birth weight babies in the Santo Tomás maternity ward was 9% between the first of August of 1992 and the 31 of July of 1993. We found a higher risk of having low birth weight babies if the mother was toxemic, without prenatal care of low socioeconomic status and if she was single. We did not find an association with adolescence, short mother's height, low educational status and primi- or multiparity of 5 or more.

The authors present the clinical history of a 70-year-old male with arterial hypertension who sought medical advice because of dyspnea on exertion, orthopnea and episodes of paroxysmal nocturnal dyspnea. The electrocardiogram showed left arterial hemiblock and abnormalities of ventricular repolarization compatible with a left lateral endocardiac lesion. Echocardiography revealed a hypertrophied left ventricle with a small ventricular cavity, compatible with an infiltrative-restrictive myopathy. Blood chemistry showed creatinine 4.9 mg/dl, BUN 133 mg/dl and alkaline phosphatase 204 i.v. The patient expired because of intractable heart failure. The histopathological examination of a piece of myocardium (authorized by the family) stained with Congo red confirmed the presence of abundant, diffuse deposits of amyloid, as had been suspected because of the echocardiographic findings.

Duplex ultrasonography (DUS) has shown high sensitivity and specificity in the diagnosis of proximal deep vein thrombosis (DVT). It is now considered the initial procedure of choice for the evaluation of this entity because of its advantages (low cost, non invasiveness, no need for contrast media, no ionizing radiation) and because of the possibility of making other diagnoses, v.g. Baker's cyst. With the development of color Doppler, this study has become easier and now includes the calf and iliac vessels. Nevertheless, it has not improved the sensitivity and specificity of DUS. Phlebography, until now the "golden standard", has become a "second choice" procedure for proximal DVT but it continues to be of value in the evaluation of calf veins, which are more difficult to evaluate with DUS, and other venous pathology.

60 vasovasostomies were performed between june 1990 and january 1994, following the modified one layer technique, under microscopic magnification. All the patients who requested the surgical procedure were included in the present study despite their age or time after vasectomy, in order to have a non selected group. Follow up was given with sperm counts processed under similar standards and performed at 2, 4 and 6 months after the surgical procedure. Our overall experience seems to confirm that strong correlation does not exist between the surgical technique used (one layer vs two layer), but the lapse of time passed between the vasectomy and the reversal is critical. In our series a pregnancy rate of 56.6% was achieved, with a patency rate of 86.7%.

The oat-cell carcinoma is more frequently found in the lungs, but has been described in other organs. It is a rare but aggressive tumor and its prognosis is dismal. The longest survival time reported is 22 months. In our patient was 15 months. We treated at the National Cancer Institute of Panama a 52-year-old patient with oat-cell carcinoma of the esophagus and described his symptoms, pathology, treatment and results.

The author describes the clinical, radiographic and histological characteristics of three tumors diagnosed as maxillary myxomas at the National Oncological Institute. In the first two patients the tumor was completely excised and 74 and 67 months after surgery, respectively, both patients are well. The third patient underwent curettage of the lesion and, at the time of this report, 3 months after surgery, he has had no recurrence of the tumor and is also well.

The authors present the clinical history and physical findings in a 16-month baby girl with the diagnosis of Poland's syndrome associated with another congenital anomaly: unilateral peripheral facial palsy, on the opposite side. The authors believe this is the first report of such an association.

The author highlights the role of the physician opposite the technological revolution and the importance of clinical judgement as a balancing factor as well as the imperative need for a close collaboration between the physician and health institutions, insurance companies and patients, so as to better utilize resources in the face of rising living expenses, in order to achieve excellent care through accurate diagnosis and effective and timely therapy.

The authors report the results of the epidemiological surveillance of AIDS in Panama and they detail the incidence according to sex, place of residence, the mode of contagion and mortality. They point out that in children less than four years of age the infection occurred more frequently in girls, while it affected boys and men, predominantly, in all other age groups. Furthermore, since 1991 there was an increase in the number of affected women and men and the pattern of mainly homosexual mode of transmission changed to a heterosexual one. Since the majority of patients were between 20 and 40 years of age and the incubation period of the disease ranges from 5 to 10 years, it is assumed that infection occurred in adolescence in many patients. Infection occurred by sexual exposure (homo-hetero-or bisexual) in the majority of patients and less frequently by blood products (hemophiliacs, i.v. drug users) and or perinatally.

We report the experience at Gorgas Army Hospital with myocardial perfusion studies by single-photon emission tomography. We describe the technique, the specificity and sensitivity, and its use in the diagnosis, evaluation of extension and prognosis of coronary artery disease.