Revista medica de Panama最新文献

End stage renal disease patients is a serious problem all around the world. The number of patients and the cost of treatment are increasing. Kidney transplantation is the only alternative to solve the problem. In Panama, kidney transplantation is performed since 1990. At the present time 55 living related donors transplantations have been performed. It is necessary to increase the number of transplantations and to begin the cadaveric donor transplant program.

This is an admission thesis to the Panamenian Academy of Medicine and Surgery. We reviewed the use of the pulmonary surfactant in neonatology, the history, biochemical and biophysical properties; the metabolism and commercially available preparations were also analyzed. We presented the international clinical experience and our own in Panama.

Megalourethra was described originally by Nesbitt as a rare congenital abnormally characterized by dilation of the peneal urethra. This defect has been classified as scaphoid or fusiform deformity. Because of its rarity we present this case diagnosed in the Neonatology Service of the Caja de Seguro Social of Panama. A male neonate with a 40 week gestation period arrived from the delivery room and we found a 5.5 cm long macropenia which had an 8 cm circumference and 2.5 cm width. It had a positive transillumination and was oozing urine. The ultrasonography showed dilation of the peneal urethra and two corpora cavernosa. Renal ultrasound showed bilateral hydronephrosis. The functional renogram with DTPA 99 Tc revealed normal bilateral renal function, dilated ureters which were redundant and proximal urethral obstruction. On cistourethrography, vesicoureteral bilateral reflux was observed, as well as stenosis of the proximal urethra. When he was a month old the infant underwent a vesicostomy and we decided to perform a urethroplasty when he is between 18 and 24 months old. Since the diagnosis was a type scaphoid megalourethra the prognosis is good. We hope that the postoperative results will enable our patient to have a normal sex life.

We reviewed 239 charts of adolescents and young adults, who visited our clinic. The purpose was to know the incidence of the Human Papiloma Virus infection (HPVI), diagnosed by Pap's smears, and the relationship to a population with some gynecological and sociodemographic characteristics. The women age population was between 14-24 years old with a mean age of 19.9 years. Seventy (29.3%) were PIV positive and 169 (70.7%) negatives. About 75% among both groups (PIV + and -) began active sexual life between 15-19 years old. Among the women with 4 or more sexual partners, 55.6% were HPVI positive. About 60% of all women had never used any method before being admitted to the clinic. In this study there is no correlation between IVSA and HPVI. We do demonstrate that the greater the number of sexual partners, the highest the risk of a sexual acquired disease.

The acute pregnancy liver fat (APLF) is an illness that occurs exclusively during pregnancy. Its cause is unknown and it only appears during the second half of pregnancy, specially between 32 and 36 weeks. Usually the APLF symptoms starts one to two weeks before hospitalization with nausea, emesis, general uneasiness, jaundice, epigastric pain and other symptoms. As to the laboratories: white cells count, bilirubin, transaminase, coagulation period and amonio increases; on the other hand, the platelets, hemoglobin, glycemia, fybrinogen and antitrombin III decreases. The hepatic biopsy should be left for those atypical cases. The ultrasonogram and the CAT scan does not evidences precision in the diagnoses, yet still they are useful to disregard any other hepatic pathologies. The maternal outcome has improved enormously during the last decade, since recent studies performed in developed and underdeveloped countries have coincided in not finding maternal death. Fetal prognosis has also improved, nevertheless there is a mortality rate of 20%. Early diagnosis, pregnancy interuption and handling in special care or treating complications has lead to good materno-fetal results.

A patient with vascular ectasia of the gastric antrum is presented. This abnormality caused him anemia, treated with packed red cells. He received hormonal treatment during two weeks, but he did not improve. Therefore, an antrectomy with vagectomy, and a gastroduodenal anastomosis Billroth type I were performed.

Two patients with Barret's esophagus developed severe dysplasia diagnosed during endoscopic surveillance. Both patients underwent esophagectomy. The surgical specimen revealed adenocarcinoma in situ in the first patient and invasive adenocarcinoma to the submucosa in the second one. The life expectancy in these patients is at least 75% at 5 years, much better than the 5% five year survival of the patients diagnosed when they present with dysphagia. The natural history, pathogenesis, diagnosis, treatment and prevention are discussed.

Eosinophilic fasciitis is a disorder characterised by induration of the skin due to chronic inflammation and fibrosis of the subcutaneous septa and muscular fascia. It is different from sclerodermia. This is a clinical entity that presents as swelling, tenderness and stiffness of the extremities associated with peripheral eosinophilia. We described a patient with this disorder with 18 month of evolution who had a bilateral carpal tunnel syndrome. Her disease appeared after steroid treatment. A review of medical literature demonstrated that similar clinical pictures are originated by different causes. Some authors propose to encompass this group of disorder under the designation of "fasciitis-panniculitis syndrome" instead of "eosinophilic fasciitis" although the well-known eosinophilic fasciitis is clearly recognized and demonstrated.

We have discussed the surgical options to save the anorectal sphincter in lesions within the lower 2/3 of the rectum. We presented four clinical cases: two villous adenomas, one adenocarcinoma and one benign tumor, probably of embryonic origin. We discussed the surgical options in order to avoid a permanent colostomy. There is not a single surgical procedure that we can count on to preserve the anal sphincter, either in benign or malignant lesions. The surgeons treating this pathology should consider all options and be able to select the most adequate, the less complicated and yet be able to preserve continence. The surgeons should remember that in treating malignant lesions "a curative resection is worth a colostomy".

During the year 1994, 318 women suffered from hip fractures in the Republic of Panama. Of these, 310 fractures occurred in post-menopausal women (97.5%). The rate of hip fractures in post-menopausal women is 191.76 by 100,000 women of fifty or more years of age. Both public health and other civic entities should organize a nationwide campaign to prevent osteoporosis and fractures in general.