Revista medica de Panama最新文献

Background: Although the neurological manifestations of HIV infection occur at any age, children with perinatal AIDS are affected earlier and with greater impact. There are no published data about a potential association between HIV encephalopathy and viral load in THE CSF OF the pediatric population.

Design: Twenty-three children, aged 7 months to 10 years, were studied as part of a multicenter international study that evaluated double versus triple antiretroviral therapy. Samples of CSF and plasma were collected for HIV RNA measurements on day 0 and on follow-up weeks 8, 16, and 48. Neurological assessments, psychological evaluations, and CT scans were done on admission and at study end. Viral isolates were processed for genotypic resistance.

Results: No correlation between viral load in CSF and plasma was detected at study onset. Eighty percent of children had >2 log HIV RNA in CSF at day 0 but only 30% at week 16. Eight subjects responded favorably to therapy and their CSF had undetectable viral load during follow-up determinations. On day 0, 72% of children had identical patterns of genotypic resistance in CSF and plasma samples. At week 48, however, only 11% of these subjects had identical patterns. On day 0, 83% of children had abnormal neurological findings but these alterations declined to 35% at week 48 (p = 0.004). Most children with neurological abnormalities had detectable CSF viral loads (65% vs 17%, p = 0.04).

Conclusions: The data generated in this study suggest that CSF and plasma behave as two different body compartments in terms of HIV dynamics and resistance mutants. Presence of neurological abnormalities correlate with detection of HIV in CSF and these alterations improve as therapy decreases CSF viral load. These results underscore the importance of using ARV drugs with good CNS penetration for optimal management of HIV-infected young children.

From 1972 to 2000 we managed 27 patients with vertebral and spinal cord trauma. The purpose of this presentation is to analyze the clinical and functional manifestations, the mechanism and treatment of this condition.

Euthanasia has always constituted a controversial subject, but has recently been revived by a good number of well meaning intellectuals, many of whom, by and large, are not physicians. The present resurgence of this matter is due, primarily, to the prevalence of modern medical technology that makes it possible to maintain a futile life, often vegetative in nature, for an extended and even indefinite period of time. This is a complex situation that must be focused from different angles, one of which can be attributed to the conflict often experienced by physicians who have to deal with the management of catastrophic illness and realize how impotent they may be to achieve such difficult task. Another important aspect is the prospect of the greater degree of dehumanization that can arise from the management of patients with a devastating and incurable sickness. We feel that the ethical and healthy answer to this issue lies on the norm that advises health-care takers to convey optimal palliative care and constant emotional support to the sick persons and their families.

Osler-Weber-Rendu disease, also known as hereditary hemorrhagic telangiectasia is an arteriovenous malformation of different organs and systems, due to fibrovascular displasia. The knowledge of its molecular genetic basis has developed in the last few years. Generally, these patients are evaluated each time they have hemorrhagic manifestations as isolated events, rather than integrating these events into a single disorder. This is the case of a patient who had several skin and visceral manifestations years before the diagnosis was made.

Objective: [corrected] We evaluated the prognostic factors in patients with breast cancer EC-I-II treated in the Instituto Nacional de Cancerología in Mexico and compared patients with or without local or/and systemic recurrence.

Method: This is a retrospective study in patients treated with conservative surgery between 1983 and 1993 with a diagnosis of invasive breast cancer and tumors <4 cm All pathological variables were analyzed and we performed studies on c-erb.B2, P53, estrogene and progesterone receivers, cellular ploidy and cellular percentage on face "S" of the cellular cycle. All these variables were compared in two groups, one with recurrences and the other without recurrences, with the same symptoms and demographics characteristics.

Results: From 1270 patients with breast cancer EC I-II, 139 patients were submitted to conservative surgery, 14 patients of this group recurred and were compared with 32 patients that did not, out of a total of 46 patients. We found that SBR greater than five (P = 0.046), poor differentiated tumors (P = 0.04), tumors with vascular permeability (P = 0.020) and with intraductal characteristics of a comedocarcinoma (P = 0.004) had a worse prognosis and increased the risk of local recurrences.

Conclusions: In patients with breast cancer the pathological variants are more important than the so called secondary prognostic variables. Besides the pathological variants, it is acceptable only the use of hormonal receptors and the presence of c-erb-b2.

We present a comparative trial between Sandimmun, the original cyclosporine presentation, and a modified one, called Neoral, in microemulsion, to increase the blood absortion and stability of the product. We built for each product, an absorption kinetic curve and we applied it to three patients with stable renal function, using the same dosage that was used for ciclosporine. We observed a greater absorption and stability in the blood levels of Neoral. We analyzed hundred blood samples in 25 patients and we found a higher level of this product; this lead us to make possible that in 72% of the patients we could diminish the daily dosis in 5 to 10%. The patient's renal function was stable and no complications or secondary effects were present with Neoral.

This is a report of our initial experience with laparoscopic splenectomy in children. From August 1997 to March 1999, 19 patients underwent laparoscopic splenectomy for various hematologic disorders. The ages ranged from 3 to 13 years. A four port technique was used to perform the procedure. All 19 procedures were completed successfully laparoscopically. The average surgical blood loss was 60 cc. The average operative time was 138 min and the length of stay in the hospital 2.5 days. One patient required a reintervention because of postoperative bleeding. We discuss the learning curve in our laparoscopic splenectomy cases.

The gastric pathogen Helicobacter pylori has been recognized as the major aetiologic agent of chronic gastritis and peptic ulcers and also a risk factor for gastric cancer; eradication of H pylori prevents peptic ulcer recurrence and may also decrease the prevalence of gastric cancer in high risk populations around the world. Currently the only accepted indication for treatment is ulcer disease and maltosa, infected with Helicobacter pilory. However treatment is difficult and easily develops resistance. The elaboration of an antibiotic profile is recommended after a treatment failure. There is a lack of information in developing countries so the aim of this work was to determine the antibiotic profile of 51 strains isolated from patients gastric biopsies attended at Hospital San Juan de Dios in Costa Rica, using egg yolk broth and finding a resistance of 63.0% to metronidazole with a breakpoint of 8.0 microg/ml and 20.0% resistance to tetracycline (MIC1.0 microg/ml), 6.0% to clarithromicyn with a MIC of 0.125 microg/ml. There was no resistance to amoxicilin (MIC 0.015 microg/ml). The microdilution technique is very laborious, but highly reproducible with results accordingly to previous work, and we recommended it for the designing of therapeutical scheme.

Mycotoxins are fungal metabolites that may contaminate foods and feeds, resulting at times in important disease in humans and animals. Thirty-six samples of nine varieties of newly harvested corn (4 samples each variety) were analyzed in search of aflatoxins by thin layer chromatography and high pressure liquid chromatography, and also cultured for the presence of Aspergillus flavus. Of the 36 samples studied, one was contaminated with 1290 ppb aflatoxin B1, which is 258x the concentration suggested by WHO, placed at 5 ppb in food for human consumption. Culture of the 36 samples of corn resulted in growth of 55 colonies of A. flavus from all but two (1 and 6) of the 9 varieties. Of the 55 colonies of A. flavus obtained, 15 (27.3%) were toxigenic. Comments are made on the public health implications of these findings.

Trombosis of the vascular access is the most frecuent complication among patients with chronic renal disease. From 1995 on we performed the percutaneous recanalization of the access and considered the procedure as the best option. We analized the results in the two groups of patients treated at different periods and emphasized the importance of the early diagnosis of the thrombosis in the last group. The importance of the information given by the radiologist to the surgeon pre and postoperatively is also stressed.