Revista medica de Panama最新文献

The records of 96 patients with sickle cell disease were studied in relation to various immunological parameters. Age, sex, levels of total and fractionated serum protein and immunoglobulins, serum complements, antierythrocytic antibodies, circulating immune complexes, antiviral antibodies and lymphoid populations were taken into account. No major alterations in humoral immunity were found in this group of panamanian sickle cell patient.

The authors studied the clinical histories of 17 patients with AIDS who were hospitalized with the diagnosis of Meningoencephalitis. Laboratory studies showed the causative agent to be Cryptococcus neoformans. All patients had fever and most had localized headache. Some patients had nausea and vomiting, nuchal rigidity and convulsions. One each had blurred vision, photophobia, periods of disorientation, ataxia, lumbar or cervical pain. Cell count, chemical analysis, India ink preparation and culture of the cerebrospinal fluid confirmed the diagnosis and the etiologic agent. Blood cultures were negative in the few patients on whom it was performed. The best results of therapy were obtained in the patients who received Amphotericin B and Fluocytosine (80%) in dosages of 0.3 to 1 mg/k/day and 150 mg/day respectively, for 21 days.

The involvement of the central nervous system by histoplasma is an infrequent complication. The clinical diagnosis is difficult because the microscopic examination and the culture of the spinal fluid are frequently negative. In this article we report two cases of meningitis by Histoplasma capsulatum in patients with acquired immunodeficiency syndrome. The first case is a meningitis without evidence of disseminated histoplasmosis in a patient who had been treated with amphotericin B. The histologic appearance was that of a granulomatous inflammation of the meninges and the underlying nervous tissue. The second case is a disseminated histoplasmosis with involvement of the central nervous system. This consists of macrophages filled with histoplasma invading the meninges and underlying nervous tissue without associated inflammation.

The authors examined material from the respiratory tract obtained from 55 patients, with silver Methenamine and Giemsa stains to detect Pneumocystis carinii. Twenty five patients were positive. All had fever and fatigue, 80% had dyspnea, 72% had productive cough, and significant weight loss occurred in 48%. None of the patients had signs of pulmonary consolidation. Chest X-Ray showed diffuse infiltrates in 55.2%. Nodular lesions in both lung fields were present in 6.9%. A local infiltrate was seen in 13.6% and no infiltrates were seen in 10.3%. LDH was elevated in all (ranging from 885 4500 UI), 84% of the patients had a PO2 of 70 mmHg or less. Most of the patients, 80%, responded to therapy with Trimethoprim-Sulfa.

The authors analyzed the mortality of patients admitted to the Surgical Intensive Care Unit of the Social Security Metropolitan Hospital Complex (SSMHC) in the city of Panama, from January to July 31, 1994. They determined that most of patients were males under 65 years of age and that the main cause of death was multiple trauma with shock. There was also a strong correlation between the syndrome of multiple organ failure, sepsis and death. The 17% mortality indicates an acceptable, good management of the patients admitted to the Surgical Intensive Care Unit of the SSMHC.

47 transesophageal echocardiograms (TEE) were performed on 43 patients (27 men and 20 women) in 30 months. The average age was 52.1 +/- 24.3 years. The most frequent indications for the procedure were: search for the source of emboli in 15 patients, suspected endocarditis and valvulopathies in 11. The main findings were intracavitary thrombi in 9 and vegetations in 8. The findings on TEE changed the medical management in 22 patients, confirmed suspected diagnosis in 15, and added nothing new in 10. Hypotension occurred in only one patient and resolved when the transducer was withdrawn. Comparing their results with those found in the literature the authors found that the indications were similar. TEE is an easy, safe and trustworthy study in selected patients.

The authors report the clinical history of a 15 years old young man with severe congenital pulmonary valvular stenosis who was treated, for the first time in Panama, with percutaneous balloon pulmonary valvuloplasty (PBPV). The patient presented with an episode of syncope at rest. The EKG showed right ventricular hypertrophy (RVH) and suggested the presence, with the echocardiogram, of pulmonary systolic pressures higher than the systolic systemic pressures. The diameter of the interior pulmonary ring was estimated to 20 mm. The chest X-ray suggested the presence of RVH. Multiple premature ventricular systoles were detected by the Holter monitoring. Cardiac catheterization showed pressures of 150/12 mm Hg in the right ventricle (RV) and 24/9 mm Hg in the pulmonary artery (PA) with a transvalvular gradient of 126 mm Hg. PBPV was successfully done on 19 june 1993. The pressures in the RV were then 38/5 mm Hg and in the PA 25/7 mm Hg with a residual gradient of 13 mm Hg. Twenty minutes after completion of the procedure the patient experienced a hypertensive crisis and pulmonary edema, a complication of PBPV not previously reported in the literature.

The authors review the penile ultrasound records of 47 patients referred from the Urology Service with a diagnosis of Erectile Dysfunction. The pear systolic and and diastolic pressures were measured every 5 minutes for 30 minutes after the intracavernous injection of 60 mg of Papaverine, as well as the diameter of the cavernous arteries before and after the injection which was made using a 25 gauge needle. A tourniquet was applied at the base of the penis while injecting and was kept in place for 2 minutes after the injection was completed. The results were normal in 16 (34.04%) and abnormal in 31 (65.95%) patients. Of these, 27 (87.1%) had an abnormal vascular response and in 4 (12.9%) it was of an undetermined type. The abnormal vascular response was due to arterial insufficiency in 12 (44%) and to venous insufficiency in 15 (56%). The authors also found that the diameter of the cavernous arteries increased 15% to 120% (-/+ = 68%) in the patients with normal studies, 17% to 100% (-/+ = 58.1%) in those with arterial insufficiency and 23% to 89% (-/+ = 52.3%) in those with signs of venous insufficiency.

The author discusses the etiology and pathophysiology of the Ovarian Hyperstimulation Syndrome (OHS) and its relationship with Polycystic Ovarian Disease, in which it occurs more frequently. He presents the clinical histories of five patients who, in a period of two years, developed this syndrome in three different degrees of severity, while undergoing therapy for ovulatory infertility. The clinical history of one patient, who developed the most severe manifestations of OHS, is discussed in detail. The author emphasizes the difficulties that can be faced in trying to prevent the OHS, particularly because of probably inherited characteristics which may explain why not all patients with the same risk factors develop the OHS.