Anales De Medicina Interna最新文献

Vocal cord dysfunction (VCD), is characterized by a paradoxical adduction of the vocal cords during inspiration, and occurs predominantly in young women. Common symptoms are cough, wheezing, episodic dyspnea, and inspiratory stridor. The true incidence and course of the disease are unknown, and it is usually self limited. It can coexist with, or mimic refractory asthma. Psychological disorders were thought to be the principal cause, subsequently multiple organic diseases have also been reported, like gastroesophageal reflux disease (GERD). Diagnosis is made by clinical suspicion and direct observation. The Gold standard for diagnosis is laryngoscopy with visualization of the paradoxical motion of the vocal cords when the patient is symptomatic. Speech therapy and psychotherapy have been used extensively without any prospective study. We report two cases of VCD associated with GERD, both with excellent respond to treatment.

The Optic Neuromyelitis is an inflammatory and autoimmune illness of the central nervous system. Presently work is carried out a revision of the different mechanisms involved in the pathogenesis of the Optic Neuromyelitis, the paper of the eosinophils is analyzed, of the antibodies against own antigens and of the regulatory T cells in the illness. In the Optic Neuromyelitis is very important the humoral response, the illness exists it is characterized by the immunocomplex deposit, activation of the complement, production of antibodies against proteins of the myelin and eosinophils recruitment in the lesions. It also exists an increase of the expression of chemokines receptors like the CCR3, specific of TH2 cells; the illness is associate predominantly to a TH2 response.

Background: The elderly patients are characterized by the high degree of polymedication. This factor is the most important in the appearance of adverse effects (EAD). The study of the medicaments helps to establish which are inappropriate and therefore they must move back, diminishing of this form EAD's possibility.

Patients and method: Prospective and observacional Study. Criterion of incorporation: patients of > 64 years old, hospitalized in an Internal Medicine Service. There were defined as inappropriate medicament the medicines of low therapeutic utility, them not indicated, and the inadequate ones for the elder. By means of the SPSS 11.5 program the possible variables related with the consumption were analyzed.

Results: 172 elders were included in the study. The average of medicines for person and day belonged to 5.34 (0-15). 52.5% was consuming an inappropriate medicament (36.6% inadequate for the elder, 15% not indicated, and 12% UTBs). The analysis multivariant associates the consumption of these medicaments with a major number of diseases (p < 0.012), to a major consumption of medicines (p < 0.001) and to the origin of the nursing residences (p < 0.001). Only the consumption of medicaments not adapted for the elder is associated with increase of EAD.

Conclusion: The half of the elders takes at least a medicament of unnecessary form, and the majority of these medicaments favors appearance of EAD.

Introduction: Postsurgical patients with head and neck cancer could have a high rate of ambulatory complications. The aim of our study was to investigate whether oral ambulatory nutrition of post surgical head and neck cancer patients with recent weight loss, using an omega 3 fatty acids and arginine diet could improve nutritional status and complications.

Design: A population of 30 ambulatory post surgical patients with oral and laryngeal cancer and recent weight loss was enrolled. At Hospital discharge post surgical head and neck cancer patients were asked to consume two cans per day of a specially designed omega 3 fatty acid and arginine enhanced supplement during 12 weeks.

Results: The average age was 62.7 + 11.1 years (3 females/27 males). The average days of dietary suplementation was 90.8 + 22 days. Blood albumin, prealbumin, transferring and lymphocites concentrations improved. C reactive protein decreased. Neither weight improvement nor other anthropometric parameters improved. A positive correlation between ratio w3/w6and kg of fat mass (r = 0.69; p < 0.05) and with midarm circumference (r = 0.62; p < 0.05) were detected. Patients were divided in two groups; group I (ratio dietary intake w3/w6 < 0,51) and group II (ratio dietary intake w3/w6 > 0,51). Group II had more final fat mass than group I (17.52 + 6.3 kg vs. 13.9 + 5.1 kg; p < 0.05).

Conclusion: At dose taken, inmuno-enhanced formula increased blood proteins (albumin, prealbumin and transferrin) concentrations and decresed CRP. The increase of fat mass was higher in patients with better w3/w6 ratios.

The risk of suffering opportunistics infections in the immunoincompetent patient is a fact perfectly established. An uncommon situation constitutes the bronchopaties, pathologies with a high prevalence among the general population that they require habitually, among other, steroid treatment. The immunosupression confers to the clinical evolution of the infections, as a consequence of the inadequate response to the physical stress, due to the inhibition of the hypothalamus-hypophysis axis being able to in particularly serious cases, to develop the denominated macrophage activation syndrome, a serious and uncommon syndrome that darkens the clinical prognosis in these patients. In presence of a feverish syndrome of uncertain origin in a patient in immunosuppressor treatment, although it is to low dose, it is necessary to carry out a exhaustive differential diagnosis, should consider, among them, the infection for Leishmania, a parasitosis whose incidence is increasing notably in the last years in the immunosuppressed population. We present the clinical case of a 63 year-old patient, immunoincompetent as a consequence of secondary chronic steroid therapy to asthmatic bronchopaty that experiences an uncommon form of visceral leishmaniasis in our area, consistent in multiorganic failure in the context of the development of a macrophage activation syndrome.