Relationship between sex hormones, myocardial infarction, and occlusive coronary disease.

An alteration in sex hormones has been considered a risk factor for myocardial infarction. In this study, estradiol (E2) and testosterone (T) levels were evaluated in healthy firefighters, patients with myocardial infarction acutely and during their convalescence, patients with no evidence of occlusive coronary artery disease on arteriography, and patients with chronic angina pectoris in whom there was at least one vessel that indicated 50% occlusive coronary artery disease. Although T levels were similar in all groups, E2 levels were substantially higher in patients with myocardial infarction and in patients with chronic angina pectoris. These results support the hypothesis that elevated estrogen levels may be a risk factor for myocardial infarction and coronary artery disease, possibly by promoting clotting or coronary spasm.

Isolated progressive muscle weakness with tubular aggregates.

We report 2 isolated cases of slowly progressive muscle weakness in which tubular aggregates in muscle biopsy were found as the major pathological feature. Tubular aggregates were present in both types of fibers. Electron microscopy revealed the accumulation of double-walled tubular structures in dense subsarcolemmal locations or in smaller amounts within the myofibrils, close to cytoplasmic organelles. Myopathy with tubular aggregates is believed to form a distinct clinico-pathological entity with 3 well-distinguished clinical groups. The cases reported herein would fall into the group of sporadic isolated progressive muscle weakness of which only 3 other cases have been previously described.

Left subclavian vein puncture for insertion of Swan-Ganz catheters.

A rapid, safe, and reliable method for insertion of Swan-Ganz flow-directed, balloon-tipped catheters using the left subclavian vein is described. Experience with this method in 24 consecutive patients indicates a distinct advantage over the antecubital fossa approach: A venous cutdown is not necessary, the pulmonary artery is readily entered, fluoroscopy is not required, the patient is free to move both arms, and thrombophlebitis and infection occur infrequently. With proper attention to landmarks such as the clavicular tubercle, the procedure may be performed with facility. The major complication, pneumothorax, is minimized if mechanical ventilators are briefly disconnected during the subclavian puncture.

[Muscular biopsy in ceroid lipofuscinosis: 3 case reports of juvenile form]. / Biopsia muscular en la ceroidolipofuscinosis: estudio de tres casos de la forma juvenil.

Ceroid lipofuscinosis (CLF) is a progressive hereditary neurodegenerative disease characterised by deposits in the central nervous system and other tissues of ceroid lipopigment. Symptomatology and clinical course of the disease are heterogeneous and up to ten types have been distinguished, although the most frequent and best known are the Santavuori-Haltia infantile form, the Jansky-Bielschowsky late infantile form, the Spielmeyer-Vogt juvenile form and the Kufs adult form. We present here three cases diagnosed as having juvenile ceroid lipofuscinosis by means of muscular biopsy. Although morphological and ultrastructural findings in CLF have already been described in literature, the use of muscular biopsy as a means of diagnosis is not usual and its usefulness is not very well known. For this reason, we especially recommend this method for its simplicity and diagnostic specificity.

[Eight cases of extracranial vertebral artery dissection]. / Disección de la arteria vertebral extracraneal: ocho casos.

We present eight cases of extracranial vertebral artery dissection. One of these had traumatic antecedents at the neck level while undergoing massage treatment. Of the rest, in four cases there was only a history of commonplace traumatism at neck level, consisting of twisting or stretching. Most presented pain at this level both before and during symptoms. Five had symptoms compatible with lateral bulbar infarct, two with cerebral infarct and one at the protuberance level. Angiography showed irregular stenosis of the spine on the affected side in five cases, occlusion in three cases. Nuclear magnetic resonance (NMR) was performed on five, with findings compatible with dissection. Six received anticoagulant treatment and two received platelet antiagregants with good recovery except in one patient who died twelve months later without any indication of the existence of dissection. We also carried out a review of the literature with special emphasis on the etiology of spontaneous cases, on clinical and neuroimaging findings and on treatment.

[Spontaneous hemorrhage of the quadrigeminal plate: description of two cases]. / Hemorragia espontánea en la lámina cuadrigémina: presentación de dos casos.

INTRODUCTION: Spontaneous mesencephalic hemorrhages are very unusual, specially those located in the tectal region. Hypertension is a less important factor that in other classical locations. Other etiologies reported are arteriovenous malformations, coagulation disorder and trauma. We describe two patients with spontaneous hemorrhage of the quadrigeminal plate. CLINICAL CASE: Case 1: a non-hypertensive 30 year-old man who suddenly presented headache, nausea, diplopia and left hemisensory deficit. Twenty-four hours later he lost consciousness but was again alert within five hours. Examination revealed upward and downward gaze palsy and limited convergence. The patient recovered completely within six weeks. Case 2: a 38 year-old man without hypertension, who suddenly developed dizziness, occipital headache, nausea and diplopia. On examination, there was impaired upward and downward gaze, limitation of convergence and right arm hyposthesia. After eight weeks examination showed a mild limitation of upward voluntary gaze. CT and MR imaging studies revealed a small quadrigeminal hemorrhage in both cases. CONCLUSIONS: Hemorrhages located at mesencephalic tectal region are infrequent. They have a typical clinical presentation and outcome is usually favourable. Hypertension is less common than in hemorrhages of other locations. A significant proportion of cases can be attributed to occult vascular malformations.

[Meningitis due to Salmonella in the neonatal period]. / Meningitis por Salmonella en período neonatal.

INTRODUCTION: Meningitis due to Salmonella is an unusual sign of salmonellosis. Usually Salmonella causes clinical disorders of the digestive tract, but on occasions, especially in babies, may cause focalized infections such as meningitis. Although meningitis due to Salmonella is unusual, it should be remembered because of its gravity, since it has a high morbimortality. It mainly affects neonatal babies and those under 4 months of age. It usually precedes or is accompanied by gastroenteritis and has a rapid clinical course. CLINICAL CASE: We present the case of a neonatal baby girl, 17 days old, who was very irritable, had liquid or semi-liquid faeces and high fever of unknown origin with poor response to antipyretic drugs. On lumbar puncture a cloudy liquid, compatible with bacterial meningitis was obtained. Treatment was therefore started immediately with intravenous ampicillin and cefotaxima. CSF culture grew Salmonella which was resistant to ampicillin but sensitive to cefotaxima. Antibiotic treatment was given for 21 days. There was excellent clinical recovery. After eight months of follow-up no sequelae have been seen and her development, both psychomotor, in height and in weight is normal for her age. CONCLUSION: Meningitis due to Salmonella is an unusual condition. Immediate, suitable treatment is essential to obtain satisfactory recovery.

[Endovascular treatment of dural arteriovenous fistulas with medullary venous drainage. Experience with 18 patients]. / Tratamiento endovascular de fístulas arteriovenosas durales con drenaje venoso medular. Experiencia en 18 pacientes.

INTRODUCTION AND OBJECTIVE: The authors report a series of 18 patients with myelopathy who were diagnosed of dural arteriovenous fistulas with venous medullary drainage (DFVMd). Purpose was to assess the effectiveness, initial and long term, of embolization, as the initial treatment, using polyvinyl alcohol particles (PVA) and liquid adhesives. N-butyl-cyanoacrylate (NBCA). MATERIAL AND METHODS: Magnetic resonance images were obtained in all patients showing spinal cord tissue changes consistent with an isquemic process secondary to venous hypertension. All 18 patients showed initially an improvement in clinical symptoms, demonstrating previous MR images resolution. RESULTS: The neurological status of 8 patients subsequently deteriorated with angiographically proven recurrences of their DFVMd. These patients underwent a second successful embolization procedure using NBVA. PVA embolization is long term ineffective and is not without risk. Endovascular treatment is less invasive than surgery, its morbidity is less, and it ensures earlier recovery for the patients. If embolization has failed, surgery can still be done. CONCLUSIONS: We recommend that NBVA embolization be the initial treatment of choice for DFVMd if referring the patient to an experienced interventional Neuroradiology unit is available. Careful clinical and neurologic examination is necessary to establish the diagnosis of DFVMd. Finally, we strongly recommend that patients be followed closely and aggressively. Periodic clinical and radiologic assessments, including MR and spinal angiography, are essential to achieve complete cure.

[Health care reform in Mexico and the dynamics and politicization of interests: an approach]. / La reforma de los servicios de salud en México y la dinamización y politización de los intereses: una aproximación.

The article discusses the health care reforms that have been underway in Mexico since 1982. The process is examined as a socio-political phenomenon whose dynamics and nature are the products of past and present conflicts regarding technical and social-work projects, which constitute reflections of certain views of the future. The text first looks at the government-engendered power structure that has dominated the health care sector and that has benefited certain social groups, encouraged their development, and incorporated them into its power structures while simultaneously marginalizing or repressing others. The article next offers an empirical reconstruction of the "social history" of this reform, that is, of the dynamics of interests and conflicts surrounding the question of how the health care sector might best be shaped.

[Social participation in health: a case study in Brazil]. / Participación social en salud: un estudio de caso en Brasil.

OBJECTIVE: To study the complex relationships between government power and health care utilization in Brazil, through the analysis of local initiatives of social participation fostered by decentralization of health services. MATERIAL AND METHODS: A qualitative study was carried out among the local executive groups (LEG), particularly the one located in the peripheral area of Rio de Janeiro, known as AP.3.1. Group activities were followed during 1986. Data were collected by means of open interviews to community leaders, health service managers and university faculty. One of the main information sources was the LEG proceedings book. RESULTS: Data analysis disclosed the dynamics of the relationship between social mobilization and healthcare responses, underscoring the limits and potential of governmental initiatives regarding the inclusion of social groups as active interlocutors and actors in the definition of demands, as well as the limits of institutionalization of popular participation in settings socially and politically deprived. CONCLUSIONS: Contraposition between health policymakers and healthcare users is evidenced by the implementation of social participation strategies that do not take into account the organizational figures of social groups.