Revista medica de Panama最新文献

The author reviewed the clinical records of 40 patients with the diagnosis of penetrating cardiac trauma operated on in a period of 38 months in order to confirm the prognostic value of trauma indexes: Physiologic Index, Revised Trauma Scale and Index of Penetrating Cardiac Trauma. Thirty-eight patients were men and two were women with an average age of 26.8 years. Thirty-one patients suffered knife wounds and nine were wounded by bullets. The 15 unstable patients (systolic Blood Pressure 80 mmHg after infusion of crystalloid solutions) were submitted to thoracotomy. The 25 stable patients underwent the performance of a pericardial (subxiphoid) window for diagnosis, followed by sternotomy if the result was positive. There were 5 deaths all of which occurred in the operating room due to exsanguination. In all these cases Revised Trauma Scale was less than 3 and the Physiologic Index was grade III in four and grade II in one patient. Our results indicate that the Revised Trauma Scale and the Physiologic Index are good prognostic indicators of survival and that patients with Physiologic Index grade I and II have good probabilities for survival if they are operated on promptly.

The clinical records and follow up of two patients with jaundice in the third trimester of pregnancy and final diagnosis of acute fatty liver of pregnancy (AFLP) are reported. The purpose of this paper is to orient clinicians on the appropriate diagnostic approach in every woman with jaundice in the third trimester of pregnancy.

Pseudosarcoma botryoides is an infrequent vaginal tumor with benign evolution. Its importance lies in to distinguish of sarcoma botryoides, what is usually fatal. A case of vaginal polyp during pregnancy is presented. After cesarean section, polyp was excised and diagnosis of sarcoma botryoides was made. Patient was referred to ION for treatment and her diagnosis was changed to pseudosarcoma by revision of histologic plates. Patient doesn't need further treatment but previous excision, and she is asymptomatic twelve months later. Histologic findings of both tumors are described and confusion between them are noted.

Reviewing the records of 60 patients admitted with clinical diagnosis of common duct stone, we demonstrated that the symptoms and the biochemical liver tests were predictive of choledocholithiasis only 50% of the time. The sensitivity for the ultrasound was 42%. The ERCP diagnosed pancreatic or biliary pathology in over 90% of the patients. Through endoscopic sphincterotomy, the ERCP prevented the surgical exploration of the common bile duct in 93% of the patients, and did not aggravate the clinical picture in the group with acute pancreatitis. The sequence of ERCP--laparoscopic cholecystectomy decreased the hospital days and has emerged as the treatment of choice for the patients with cholelithiasis and suspected common duct stone.

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling. The nitrocellulose strips were evaluated considering the incubation time (1 and 16 hours), two conjugates (human anti IgG with Peroxidase and human anti IgG Biotin plus Streptatividine with Peroxidase) and two dilutions of the patients' sera (1/50 and 1/100). Based on their results the Authors conclude that, in the first place, the optimal conditions for the test include a dilution of 1/100 of the patients serum, incubation of the serum for 16 hours and the use of the conjugate of anti human IgG with Biotin and Streptavidine with Peroxidase; secondary, that the immunologic reactivity against proteins p24 and gp 160/120 is the most important diagnostic criterion for the confirmation of infection with HIV-1 and that they obtained a diagnostic correlation of 100% at a cost which was 5 to 7 times less than that of the commercial system.

The purpose of this study was to show that the nonionic contrast media of low osmolarity are better tolerated than ionic media of high osmolarity, which to date are most frequently used in the authors hospital. We found that adverse reaction occurred in 80% of the group in which nonionic contrast medium was used. The authors conclude that nonionic, low osmolarity contrast media significantly reduce the frequency of adverse reactions and increase their safe use.

The authors report the results of mini-cholecystectomy performed through a 3 to 4 cm long subcostal incision in 29 patients with the diagnosis of acute or chronic cholecystitis, from February 1991 to November 1922. Some of the patients were obese, diabetics or presented as emergency cases. The patients were operated on in the morning, as in laparoscopic cholecystectomy, began oral intake in the afternoon and were discharged on the day after surgery. Dissection of the gallbladder was facilitated by the use of a modified gynecologic valve and long thin instruments. Duration of surgery varied from 40 to 140 minutes. Patients could return to work on the third day after surgery. Notably, the costs/benefits were on the third more favorable than those of laparoscopic cholecystectomy.

The authors present the clinical history of four children under two years of age who were hospitalized in the Arnulfo Arias Madrid Medical Complex with the diagnosis of herpes zoster. The mothers of these children had varicella when in the third, sixth, eight and fifth month of pregnancy respectively and the children were 3, 24, 14 and 8 months old when they had herpes zoster. The first child (whose mother had varicella when she was three months pregnant) was born underweight, dysphagic and premature. The fourth (whose mother had varicella in the 5th. month of gestation) was only underweight. The other two (mothers had varicella in the 6th and 8th month of pregnancy, respectively) were born without apparent abnormality. The authors, based on their findings, believe that there is risk for the child to have a congenital malformation when the mother develops varicella in the first months of pregnancy.

The authors reviewed the clinical records of 31 patients with carcinoma of the breast diagnosed at the Dr. Rafael Hernández Hospital in Chiriquí from January 1988 to December 1990. All the patients were women and the average age was 51.9 years. 41.9% of the patients were classified Stage 1; 29%, Stage 2; 16.1%, Stage IIIA; and 12.8%, Stage IIIB. 74% of the patients were treated with a modified radical mastectomy, radiation and hormonal therapies. Systemic cytotoxic therapy was given to 77% of the patients. Total survival 48 months after diagnosis was 83.3% in patients at Stage I; 66%, at Stage II; 40%, at Stage IIIA; and 0%, in patients at Stage IIIB.