[Hypokalemic rhabdomyolisis and schizophrenia]. / Rabdomiólisis hipokalémica y esquizofrenia.

The purpose of this report is to emphasize the necessity to periodically explore internal environment variables, as certain metabolic alterations often go unnoticed during antipsychotic treatment. Early detection of such alterations may prevent catastrophic syndromes. We will also stress the clinical relevance of cognitive perseverations in schizophrenic patients, as these often condition habits of consumption which can alter the internal environment. In this clinical case of a schizophrenic patient, a chain of events led to a catastrophic syndrome: a trivial home accident (fall from own height) developed into a condition characterized by oligoanuria, hypokalemia, creatine phosphokinase (CPK) elevation (125,000 IU / L) and acute renal failure with dialysis requirement. This episode was non lethal due to the early implementation of support measures. We performed a revision of the available literature in order to discern the cause of the elevation of CPK. Here we aim to highlight the importance of 1) careful clinical and laboratory monitoring of psychopharmacological treatment, 2) interactions resulting from consumption habits capable of generating unforeseen consequences, 3) the role of the psychiatrist in the context of multidisciplinary work.

[Impact of thoracic and abdominopelvic surgery on the functional status in the elderly]. / Repercusión de la cirugía torácica y abdómino-pélvica en el estado funcional del anciano.

The quality of life of older people is determined by their functional capacity, rather than by the number or type of disease suffered. We analyzed 43 patients over 65 years undergoing major surgery. Longitudinally continued evolution of functional status by analyzing six variables, activities of daily living (ADLs), instrumental activities of daily living (IADL), the get up and walk test, functional reach test of arm, strength of handgrip and walking speed, measured before surgery (baseline measurement) and at 1, 2, 3 and 4 months after discharge. The objectives were to estimate the impact that surgery has on functional status in the elderly, determine how long each of the measurements returned to preoperative values at 4 months follow-up. Recovery curves compared the baseline AIVD, grip strength and hand speed on the fly, between two groups defined by baseline walking speed in slow (< 0.8 m/s) and fast (> 0.8 m/s). The impact of surgery on physical fitness showed a statistically significant decrease in ADL, IADL, and the get up and walk test and walking speed, with variable time recovery beyond convalescence. All return to baseline at 4 months except test walking speed that exceeded the baseline. Functional status can be evaluated quickly and should be included in the preoperative evaluation, since it allows planning strategies to meet the needs and limitations of patients and their families, in the immediate postoperative period.

Acute and Chronic Anti-ganglioside Neuropathies: From Theory to Practice in Buenos Aires, Argentina.

BACKGROUND AND AIMS: During the last two decades important advances have been made regarding the knowledge of immunomediated neuropathies, which entitled them to evolve from a theoretical existence to subtype differentiation. Nevertheless, questions regarding antigen topography or antibody's pathogenicity still need to be answer. Moreover, antibody typification is not necessarily available during clinical practice and usually diagnostic decisions or follow-up are done without it. The aim of this study is to raise awareness of the importance of divergent clinical findings in patients with immunomediated neuropathies. METHODS: We present an acute and a chronic case of anti-ganglioside neuropathy immunologically studied with the best anti-ganglioside antibody panel available nowadays in our country along with an update of the current knowledge of these entities. RESULTS: Although there is no consensus regarding the pathogenicity of these antibodies, diverging clinical features (mainly ataxia and ophthalmoparesis) and disease prognosis (as markers of axonal damage) are known to be associated with different antibodies. CONCLUSIONS: Antibody characterization in anti-ganglioside neuropathies is an evolving field, which we believe should periodically updated and minded for patient's diagnosis and follow-up, even if laboratory confirmation is not immediate, if available at all.

[Wegener's granulomatosis and tuberculosis. A bad combination]. / Granulomatosis de Wegener y tuberculosis. Una mala combinación.

Wegener's disease is a vasculitis of small and medium-sized vessels associated with anti-neutrophil cytoplasm antibodies (ANCA). Within their target organs the lungs are involved in 85% of cases. Many entities are part of the differential diagnosis, including pulmonary tuberculosis. We present the case of a 54 years old man, diagnosed as Wegener's disease in 1996 which begins in August 2007 with cough, hemoptysis, progressive dyspnea on effort and serial sputum positive for AFB and then starts TB treatment. Subsequent bronchoalveolar fluids resulted negative for AFB. The patient evolved with impaired renal function, palpable purpura and positive anti-neutrophil cytoplasm antibodies cytoplasmic pattern (c-ANCA), interpreted as Wegener's disease relapse. He started hemodialysis and immunosuppressive therapy and tuberculosis treatment was stopped. One month after discharge was readmitted with a similar picture with serial sputum positive for AFB.

Repercusión de la cirugía torácica y abdómino-pélvica en el estado funcional del anciano / Impact of thoracic and abdominopelvic surgery on the functional status in the elderly

La calidad de vida de los ancianos está determinada por su capacidad funcional, más que por el número o tipo de enfermedades que padecen. Se analizaron 43 pacientes mayores de 65 años sometidos a cirugías mayores. Se siguió longitudinalmente la evolución del estado funcional mediante el análisis de 6 variables, las actividades de la vida diaria (AVD), actividades instrumentales de la vida diaria (AIVD), la prueba de levántate y anda, prueba del alcance funcional del brazo, fuerza de prensión de la mano y velocidad de la marcha, medidas previas a la cirugía (medición basal) y a los 1, 2, 3 y 4 meses posteriores al alta. Los objetivos fueron: estimar la repercusión que la cirugía tiene en el estado funcional de ancianos, determinar el tiempo que cada una de las mediciones regresa a los valores del preoperatorio en el seguimiento a 4 meses, comparar las curvas de recuperación de los valores basales de AIVD, fuerza de prensión de la mano y velocidad en la marcha, entre 2 grupos definidos por la velocidad de la marcha basal, en lentos ( 0.8 m/s). La repercusión de la cirugía en la aptitud física presentó una disminución estadísticamente significativa en AVD, AIVD, la prueba de levántate y anda y velocidad en la marcha con recuperación en tiempo variable, más allá de la convalecencia. La evaluación del estado funcional permite planear estrategias tendientes a cubrir limitaciones y necesidades del paciente y su familia en el post operatorio mediato.(AU)

The quality of life of older people is determined by their functional capacity, rather than by the number or type of disease suffered. We analyzed 43 patients over 65 years undergoing major surgery. Longitudinally continued evolution of functional status by analyzing six variables, activities of daily living (ADLs), instrumental activities of daily living (IADL), the get up and walk test, functional reach test of arm, strength of handgrip and walking speed, measured before surgery (baseline measurement) and at 1, 2, 3 and 4 months after discharge. The objectives were to estimate the impact that surgery has on functional status in the elderly, determine how long each of the measurements returned to preoperative values at 4 months follow-up. Recovery curves compared the baseline AIVD, grip strength and hand speed on the fly, between two groups defined by baseline walking speed in slow ( 0.8 m/s). The impact of surgery on physical fitness showed a statistically significant decrease in ADL, IADL, and the get up and walk test and walking speed, with variable time recovery beyond convalescence. All return to baseline at 4 months except test walking speed that exceeded the baseline. Functional status can be evaluated quickly and should be included in the preoperative evaluation, since it allows planning strategies to meet the needs and limitations of patients and their families, in the immediate postoperative period.(AU)