Revista Medica Clinica Las Condes最新文献

英文中文

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

Granulomatosis with polyangiitis and neuroendocrine intestinal tumor: a unique and challenging combination in a case report 肉芽肿病合并多血管炎和神经内分泌肠肿瘤：一个独特而具有挑战性的病例报告

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01 DOI: 10.1016/j.rmclc.2025.01.003

Carolina Abreu MD, Marta Ferreira MD, Pedro Moules MD, Carla Noronha MD, Ana Isabel Reis MD

We report the case of a 43-year-old male smoker who presented to the emergency department with skin lesions resembling pyoderma on the lower extremities, punctate and necrotic digital ulcers, fever, malaise, polyarthralgia and elevated inflammatory markers. He later developed bilateral, asymptomatic cavitary pulmonary nodules, diffuse alveolar hemorrhage, pansinusitis, and positive PR3-ANCA, establishing the diagnosis of GPA. An excellent initial response was observed with pulse methylprednisolone, oral prednisolone, intravenous pulse cyclophosphamide, and hyperbaric oxygen therapy (HOT).

Three months later, however, he was diagnosed with a NET of the small intestine. It was polypoid and multifocal, with high catecholamine production but low Ki-67, leading to a reduction in immunosuppressive therapy. Two new flares occurred, with skin, renal, ocular, intestinal, and joint involvement, along with elevated c-ANCA levels, prompting a reinduction strategy with rituximab, plasmapheresis, corticosteroids, and HOT, resulting in significant improvement.

In addition to the complex and challenging clinical management of this case, this unique combination – GPA and NET – is highlighted.

我们报告一例43岁男性吸烟者谁提出了以皮肤病变类似脓皮病的下肢，点状和坏死的数字溃疡，发烧，不适，多关节痛和炎症标志物升高急诊科。他后来出现双侧无症状的空洞性肺结节、弥漫性肺泡出血、全鼻窦炎和PR3-ANCA阳性，确定了GPA的诊断。采用脉冲甲基强的松龙、口服强的松龙、静脉脉冲环磷酰胺和高压氧治疗（HOT）观察到良好的初始反应。然而，三个月后，他被诊断出患有小肠NET。它是息肉样和多灶性的，儿茶酚胺含量高，但Ki-67含量低，导致免疫抑制治疗减少。出现两个新的急性发作，累及皮肤、肾脏、眼部、肠道和关节，同时伴有c-ANCA水平升高，促使采用利妥昔单抗、血浆置换、皮质类固醇和HOT的再诱导策略，结果显著改善。除了该病例的复杂和具有挑战性的临床管理外，还强调了这种独特的组合- GPA和NET。

{"title":"Granulomatosis with polyangiitis and neuroendocrine intestinal tumor: a unique and challenging combination in a case report","authors":"Carolina Abreu MD, Marta Ferreira MD, Pedro Moules MD, Carla Noronha MD, Ana Isabel Reis MD","doi":"10.1016/j.rmclc.2025.01.003","DOIUrl":"10.1016/j.rmclc.2025.01.003","url":null,"abstract":"<div><div>We report the case of a 43-year-old male smoker who presented to the emergency department with skin lesions resembling pyoderma on the lower extremities, punctate and necrotic digital ulcers, fever, malaise, polyarthralgia and elevated inflammatory markers. He later developed bilateral, asymptomatic cavitary pulmonary nodules, diffuse alveolar hemorrhage, pansinusitis, and positive PR3-ANCA, establishing the diagnosis of GPA. An excellent initial response was observed with pulse methylprednisolone, oral prednisolone, intravenous pulse cyclophosphamide, and hyperbaric oxygen therapy (HOT).</div><div>Three months later, however, he was diagnosed with a NET of the small intestine. It was polypoid and multifocal, with high catecholamine production but low Ki-67, leading to a reduction in immunosuppressive therapy. Two new flares occurred, with skin, renal, ocular, intestinal, and joint involvement, along with elevated c-ANCA levels, prompting a reinduction strategy with rituximab, plasmapheresis, corticosteroids, and HOT, resulting in significant improvement.</div><div>In addition to the complex and challenging clinical management of this case, this unique combination – GPA and NET – is highlighted.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 1","pages":"Pages 25-30"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Revisión de artrodesis subtalar por no unión: a propósito de un caso 非结节下关节病复查：以案例为目的

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01 DOI: 10.1016/j.rmclc.2025.01.002

Gregorio Verschae MD , Valentín Val MD , Vicente Alba MD , Andrés Cáceres MD , Sebastián Pavez MD , Nicolás Cid MD

Introduction

Subtalar arthrodesis is a surgical procedure aimed at fusing the subtalar joint. One of the most common complications of this procedure is non-union. This article aims to analyze the study and management of non-union in general, as well as its specific approach in the context of subtalar arthrodesis. Given that this is a common complication, it is crucial to enhance knowledge on this topic.

Case Report

42-year-old healthy male patient with a background of post-traumatic osteoarthritis of the left ankle, initially treated with tibiotalar arthrodesis in 2022 with subsequent revisions due to poor outcomes, presenting osteoarthritis of the subtalar joint that required management with a subtalar arthrodesis. The latter evolved with symptomatic non-union and it was decided to perform a revision subtalar arthrodesis in July 2024.

Result

The patient showed a favourable postoperative clinical evolution, with adequate alignment and position of the osteosynthesis elements, with no signs of infection. At the last check-up (one month postoperatively), protected loading with an orthopaedic boot was started, showing a good recovery.

Conclusions

Non-unions in joint fusions, particularly in subtalar arthrodesis, represent a significant challenge in traumatology, with high complication rates. Evaluation of non-unions should include a thorough clinical examination, laboratory testing and imaging techniques. Identification of risk factors, both systemic and local, along with proper surgical planning, are essential in preventing complications. Treatment strategies should address the underlying causes; surgical options and their success should have a multidimensional approach that addresses both technical and biological aspects of the procedure. Finally, the implementation of well-structured diagnostic and therapeutic algorithms is crucial to improve functional outcomes and ensure successful bone fusion.

距下关节融合术是一种旨在融合距下关节的外科手术。该手术最常见的并发症之一是骨不愈合。本文旨在分析距下关节融合术中骨不连的一般研究和处理，以及骨不连的具体方法。鉴于这是一种常见的并发症，加强对这一主题的了解至关重要。42岁健康男性患者，创伤后左踝关节骨性关节炎，最初于2022年接受胫距关节融合术治疗，由于预后不佳，随后进行了翻修，表现为距下关节骨性关节炎，需要进行距下关节融合术治疗。后者发展为症状性不愈合，并决定在2024年7月进行距下关节融合术翻修。结果患者术后临床进展良好，植骨元件排列和位置良好，无感染迹象。在最后一次检查时（术后一个月），开始使用矫形靴进行保护加载，显示恢复良好。结论关节融合术不愈合，特别是距下关节融合术，是创伤学中的一个重大挑战，其并发症发生率很高。对骨不连的评估应包括全面的临床检查、实验室检查和影像学检查。识别全身和局部的危险因素，以及适当的手术计划，对于预防并发症至关重要。治疗策略应解决根本原因；外科手术的选择和他们的成功应该有一个多维的方法，解决技术和生物方面的程序。最后，实施结构良好的诊断和治疗算法对于改善功能结果和确保成功的骨融合至关重要。

{"title":"Revisión de artrodesis subtalar por no unión: a propósito de un caso","authors":"Gregorio Verschae MD , Valentín Val MD , Vicente Alba MD , Andrés Cáceres MD , Sebastián Pavez MD , Nicolás Cid MD","doi":"10.1016/j.rmclc.2025.01.002","DOIUrl":"10.1016/j.rmclc.2025.01.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Subtalar arthrodesis is a surgical procedure aimed at fusing the subtalar joint. One of the most common complications of this procedure is non-union. This article aims to analyze the study and management of non-union in general, as well as its specific approach in the context of subtalar arthrodesis. Given that this is a common complication, it is crucial to enhance knowledge on this topic.</div></div><div><h3>Case Report</h3><div>42-year-old healthy male patient with a background of post-traumatic osteoarthritis of the left ankle, initially treated with tibiotalar arthrodesis in 2022 with subsequent revisions due to poor outcomes, presenting osteoarthritis of the subtalar joint that required management with a subtalar arthrodesis. The latter evolved with symptomatic non-union and it was decided to perform a revision subtalar arthrodesis in July 2024.</div></div><div><h3>Result</h3><div>The patient showed a favourable postoperative clinical evolution, with adequate alignment and position of the osteosynthesis elements, with no signs of infection. At the last check-up (one month postoperatively), protected loading with an orthopaedic boot was started, showing a good recovery.</div></div><div><h3>Conclusions</h3><div>Non-unions in joint fusions, particularly in subtalar arthrodesis, represent a significant challenge in traumatology, with high complication rates. Evaluation of non-unions should include a thorough clinical examination, laboratory testing and imaging techniques. Identification of risk factors, both systemic and local, along with proper surgical planning, are essential in preventing complications. Treatment strategies should address the underlying causes; surgical options and their success should have a multidimensional approach that addresses both technical and biological aspects of the procedure. Finally, the implementation of well-structured diagnostic and therapeutic algorithms is crucial to improve functional outcomes and ensure successful bone fusion.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 1","pages":"Pages 13-20"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hipertensión pulmonar y enfermedad del tejido conectivo, una grave presentación 肺动脉高压和结缔组织疾病，病情严重

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01 DOI: 10.1016/j.rmclc.2025.01.004

Neguith Marrugo MD , Elián Giordanino MD , Gerardo Palma MD , Juan Carlos Venegas MD

Introduction

Pulmonary arterial hypertension (PAH) is a rare condition characterized by elevated pulmonary artery pressure (>20 mmHg) and increased vascular resistance. It affects 5 to 15 adults per million, causing dyspnea, chest pain, risk of right heart failure and death. Below, we describe a case of severe pulmonary arterial hypertension whose diagnosis was established after a recovered cardiac arrest.

Clinical Case

A 48-year-old man presented with edema, presyncope, and progressive dyspnea over 6 months. He suffered a cardiorespiratory arrest due to pulseless electrical activity and subsequent asystole, requiring resuscitation, norepinephrine, and mechanical ventilation. Echocardiography revealed severe pulmonary hypertension (pulmonary artery systolic pressure of 59 mmHg), preserved left ventricular function, and severe right ventricular dilation. Computed tomography angiography ruled out pulmonary embolism. Treatment with dobutamine and negative fluid balance improved his hemodynamics. Right heart catheterization confirmed precapillary pulmonary hypertension. Sildenafil, nitric oxide, and later, ambrisentan were initiated. Rheumatologic studies identified rheumatoid arthritis with overlapping Sjögren syndrome as the likely etiology of his pulmonary hypertension. The patient improved with targeted pulmonary hypertension therapy and prednisone, was successfully weaned off mechanical ventilation and was discharged, remaining stable at the one-month follow-up.

Discussion

PAH associated with connective tissue diseases, such as Sjögren syndrome and rheumatoid arthritis is rare. Treatments include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostanoids, and drug combinations. Appropriate immunological treatment for underlying rheumatologic diseases, like rheumatoid arthritis, may improve PAH. In this case, an integral approach, including pulmonary vasodilators and preload control, was key to the patient's recovery.

肺动脉高压（PAH）是一种罕见的疾病，其特征是肺动脉压升高（20mmhg）和血管阻力增加。每百万人中就有5到15人受其影响，导致呼吸困难、胸痛、右心衰和死亡的风险。下面，我们描述一个严重肺动脉高压的病例，其诊断是在心脏骤停恢复后确定的。临床病例：男性，48岁，水肿，晕厥前，进行性呼吸困难超过6个月。由于无脉电活动导致心肺骤停，随后出现心脏骤停，需要复苏、去甲肾上腺素和机械通气。超声心动图显示严重肺动脉高压（肺动脉收缩压59 mmHg），左心室功能保留，右心室严重扩张。计算机断层血管造影排除肺栓塞。多巴酚丁胺治疗和负体液平衡改善了他的血流动力学。右心导管检查证实毛细血管前肺动脉高压。西地那非，一氧化氮，后来，安布里森坦开始使用。风湿病学研究确定类风湿关节炎合并重叠Sjögren综合征可能是他肺动脉高压的病因。患者经针对性肺动脉高压治疗和强的松治疗后病情好转，成功脱离机械通气出院，随访1个月病情稳定。多环芳烃与结缔组织疾病相关，如Sjögren综合征和类风湿关节炎是罕见的。治疗包括内皮素受体拮抗剂、磷酸二酯酶-5抑制剂、前列腺素和联合用药。适当的免疫治疗潜在的风湿病，如类风湿关节炎，可能改善PAH。在这种情况下，包括肺血管扩张剂和预负荷控制在内的整体入路是患者康复的关键。

{"title":"Hipertensión pulmonar y enfermedad del tejido conectivo, una grave presentación","authors":"Neguith Marrugo MD , Elián Giordanino MD , Gerardo Palma MD , Juan Carlos Venegas MD","doi":"10.1016/j.rmclc.2025.01.004","DOIUrl":"10.1016/j.rmclc.2025.01.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Pulmonary arterial hypertension (PAH) is a rare condition characterized by elevated pulmonary artery pressure (>20mmHg) and increased vascular resistance. It affects 5 to 15 adults per million, causing dyspnea, chest pain, risk of right heart failure and death. Below, we describe a case of severe pulmonary arterial hypertension whose diagnosis was established after a recovered cardiac arrest.</div></div><div><h3>Clinical Case</h3><div>A 48-year-old man presented with edema, presyncope, and progressive dyspnea over 6 months. He suffered a cardiorespiratory arrest due to pulseless electrical activity and subsequent asystole, requiring resuscitation, norepinephrine, and mechanical ventilation. Echocardiography revealed severe pulmonary hypertension (pulmonary artery systolic pressure of 59mmHg), preserved left ventricular function, and severe right ventricular dilation. Computed tomography angiography ruled out pulmonary embolism. Treatment with dobutamine and negative fluid balance improved his hemodynamics. Right heart catheterization confirmed precapillary pulmonary hypertension. Sildenafil, nitric oxide, and later, ambrisentan were initiated. Rheumatologic studies identified rheumatoid arthritis with overlapping Sjögren syndrome as the likely etiology of his pulmonary hypertension. The patient improved with targeted pulmonary hypertension therapy and prednisone, was successfully weaned off mechanical ventilation and was discharged, remaining stable at the one-month follow-up.</div></div><div><h3>Discussion</h3><div>PAH associated with connective tissue diseases, such as Sjögren syndrome and rheumatoid arthritis is rare. Treatments include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostanoids, and drug combinations. Appropriate immunological treatment for underlying rheumatologic diseases, like rheumatoid arthritis, may improve PAH. In this case, an integral approach, including pulmonary vasodilators and preload control, was key to the patient's recovery.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 1","pages":"Pages 31-35"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-01-01

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Revista Medica Clinica Las Condes

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀