RESUMEN
John Pringle Nichol (1804-1859), a Scottish Romantic astronomer, educator, and social reformer, used visual representations to develop and communicate key elements of his theory of evolution as a universal principle. Examining four of the diverse representations that appeared in Nichol's popular science books between 1846 and 1850 reveals the rich possibilities of evolutionary imagery prior to the emergence of more dominant forms of representation in the wake of Charles Darwin's On the Origin of Species (1859). The abstract and schematic nature of many of Nichol's visual representations-which included line diagrams and imaginative, mythic imagery (the latter developed in collaboration with the Scottish Romantic artist David Scott)-made them apt vessels for his Romantic evolutionary concepts, because a single image could simultaneously represent features of evolution across multiple domains, reflecting the Romantic concept of the unity of nature and the myriad analogies between its constituent parts. All of the images embodied narrative in one form or another and required use of the imagination in the act of interpretation. Many of the images facilitated the viewer's ability to conceptualize unobservable or only partially observable features of evolutionary change. Even as these visual representations acted as tools of perspective, insight, and clarity, they also helped to generate new ambiguities, such as a fundamental tension between teleology and contingency.
RESUMEN
BACKGROUND: NICE guidelines for the management of head injury were published in June 2003. Their recommendations differ markedly from previous guidelines published by the Royal College of Surgeons (RCS). In place of skull radiography and admission, computed tomography (CT) is advocated. The impact of these guidelines on service provision in the UK is unknown. METHODS: Data on all clinical correlates of children presenting with any severity of head injury was collected in three hospitals in the northwest of England. The current skull radiograph (SXR), CT scan, and admission rates were determined. The rates of SXR, CT scan, and admission that should have occurred when following either the RCS or NICE guidelines were then determined. RESULTS: Data from 10 965 patients who attended three hospitals between February 2000 and August 2002 was studied. Twenty five per cent of patients received a SXR, 0.9% a CT scan, and 3.7% were admitted. Strict adherence to the RCS guidelines would have resulted in a 50% SXR rate, a 1.6% CT scan rate, and a 7.1% admission rate. Adherence to NICE guidelines would result in a 0.3% SXR rate, an 8.7% CT scan rate, and a 1.4% admission rate, although the CT rate would drop to 6.3% if vomiting three or more times in the under 12s was used instead of more than one vomit. CONCLUSIONS: The new NICE guidelines do not increase the workload caused by patients attending with head injury but they move their management from the observation ward to the radiology department.
Asunto(s)
Traumatismos Craneocerebrales/terapia , Guías de Práctica Clínica como Asunto , Adolescente , Niño , Preescolar , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Medición de Riesgo/métodos , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Hiperplasia Nodular Focal/patología , Adulto , Femenino , Humanos , Imagen por Resonancia MagnéticaRESUMEN
Our patient had a history of chronic endometriosis and pelvic pain and complained of recent onset of right-sided abdominal pain, nausea, and vomiting. Transvaginal ultrasonography revealed a thick-walled mass superior and medial to the right ovary, which was thought to be an inflamed appendix. The woman was not pregnant, and the structure appeared to be anatomically separate from the uterus. Subsequent laparoscopy confirmed the diagnosis of acute appendicitis; uncomplicated laparoscopic appendectomy followed. In the setting of chronic endometriosis, other nongynecologic sources of acute pelvic pain must be considered. Surgical intervention is appropriate whenever clinical suspicion for an acute abdomen is high, and the a priori diagnosis of endometriosis should not result in operative delay.
Asunto(s)
Dolor Abdominal/etiología , Apendicitis/complicaciones , Apendicitis/diagnóstico por imagen , Endometriosis/complicaciones , Dolor Pélvico/complicaciones , Enfermedad Aguda , Adulto , Apendicectomía , Apendicitis/cirugía , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Laparoscopía , Tomografía Computarizada por Rayos X , Ultrasonografía , VaginaRESUMEN
INTRODUCTION: Small intestinal bacterial overgrowth syndrome (SIBOS) has various clinical and biological presentations. Six observations are described in this review which is aimed at reporting recent data on SIBOS and proposing diagnosis and therapeutic attitudes. CURRENT KNOWLEDGE AND KEY POINTS: Chronic diarrhea, malabsorption syndrome and exsudative enteropathy are the main criteria of diagnosis. Breath hydrogen testing is commonly performed to confirm diagnosis, with a 78% sensitivity and a 89% specificity. The aim of therapy is reparation of malabsorption consequences, reduction of intestinal bacterial overgrowth, and surgical correction of intestinal stasis. In the absence of consensus, norfloxacin or amoxicillin-clavulinic acid (administered for a mean of 7 to 15 days) seem the more appropriate antibiotics. When possible, surgery represents the primary treatment of SIBOS recurrences. FUTURE PROSPECTS AND PROJECTS: Diagnosis of small intestinal bacterial overgrowth syndrome must be evoked on the basis of either surgical or medical context, i.e., the existence of chronic diarrhea, malabsorption syndrome (complete or not), and exsudative enteropathy. This review reports essential factors for diagnosis and treatment.
Asunto(s)
Infecciones Bacterianas/microbiología , Enfermedades Intestinales/microbiología , Intestino Delgado/microbiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/patología , Pruebas Respiratorias , Enfermedad Crónica , Diagnóstico Diferencial , Diarrea/etiología , Femenino , Humanos , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/patología , Intestino Delgado/patología , Síndromes de Malabsorción/etiología , Masculino , Persona de Mediana EdadRESUMEN
The yellow nail syndrome, a combination of yellow discoloured nails, lymphedema and pleural effusions, is a rare clinical condition. We report a case of the yellow nail syndrome associated with intestinal lymphangiectasia revealed by chylous ascites and protein-losing gastroenteropathy. This association reported in only three cases in the literature leads us to discuss the relations between yellow nail syndrome, primitive intestinal lymphangiectasia and primary lymphatic disorders.
Asunto(s)
Linfangiectasia Intestinal/complicaciones , Enfermedades de la Uña/complicaciones , Anciano , Ascitis Quilosa , Humanos , Linfedema/complicaciones , Masculino , Pigmentación , Derrame Pleural , SíndromeAsunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Fiebre de Origen Desconocido/sangre , Inmunoglobulinas/sangre , Acebutolol/uso terapéutico , Anciano , Antiarrítmicos/uso terapéutico , Anticuerpos Antifosfolípidos/sangre , Digoxina/uso terapéutico , Humanos , Inhibidor de Coagulación del Lupus/sangre , Masculino , Fenindiona/análogos & derivados , Fenindiona/uso terapéutico , Fiebre Q/sangreAsunto(s)
Enfermedades del Íleon/etiología , Obstrucción Intestinal/etiología , Mesotelioma/complicaciones , Mesotelioma/diagnóstico , Neoplasias Peritoneales/complicaciones , Neoplasias Peritoneales/diagnóstico , Antineoplásicos/uso terapéutico , Biopsia , Terapia Combinada , Dispepsia/etiología , Humanos , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/cirugía , Masculino , Mesotelioma/terapia , Persona de Mediana Edad , Neoplasias Peritoneales/terapia , PronósticoAsunto(s)
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundario , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias del Recto/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugíaAsunto(s)
Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adulto , Anemia Ferropénica/etiología , Diagnóstico Diferencial , Femenino , Fiebre/etiología , Estudios de Seguimiento , Hemangioma/diagnóstico por imagen , Hemangioma/tratamiento farmacológico , Hepatomegalia/etiología , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Imagen por Resonancia Magnética , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Factores de Tiempo , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
INTRODUCTION: Dissecting aneurysms of the internal carotid artery are due to arterial wall dissection caused by hematoma. We report a case of spontaneous dissection. EXEGESIS: A 65-year-old man presented with painful Horner's syndrome and hypoglossal palsy, without a history of arterial traumatism. Magnetic resonance imaging showed carotid artery dissection. CONCLUSION: Distal and subadventicial dissection can induce compression of adjacent nerves without modifications of the arterial lumen. This type of wall hematoma may not be detected by ultrasonography and angiography. Magnetic resonance imaging proves to be the best method of investigation and should be primarily advocated. Anticoagulation treatment is necessary.
Asunto(s)
Disección Aórtica/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna , Aneurisma Intracraneal/diagnóstico , Anciano , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Síndrome de Horner , Humanos , Nervio Hipogloso , Imagen por Resonancia Magnética , Masculino , Dolor/fisiopatología , Parálisis/etiologíaAsunto(s)
Linfoma de Células B/complicaciones , Síndrome de Sjögren/complicaciones , Neoplasias de la Tiroides/complicaciones , Anciano , Terapia Combinada , Femenino , Humanos , Linfoma de Células B/radioterapia , Linfoma de Células B/cirugía , Dosificación Radioterapéutica , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
INTRODUCTION: Due to ifosfamide urotoxicity, encephalopathy is a frequent complication accompanying treatment with this drug. The various clinical, physiological and therapeutical aspects of ifosfamide-related encephalopathy are reviewed. We report two cases and review current literature. EXEGESIS: Ifosfamide-related encephalopathy has polymorphous and non-specific clinical picture. The disease severity is variable, as related deaths have been reported. Clinical signs disappear with treatment discontinuation. Routes of administration, doses, tumoral site and gender have been implicated in the disease physiopathology. Admittedly, metabolite mitochondrial toxicity would be the underlying mechanism. Treatment would be based on intravenous methylene blue. A clinical trial aimed at studying prophylaxis is in progress. A few number of patients have been cured until now. CONCLUSION: Further studies are required to confirm the involved physiopathological mechanisms and methylene blue effects.
Asunto(s)
Antineoplásicos Alquilantes/efectos adversos , Encefalopatías/inducido químicamente , Ifosfamida/efectos adversos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Fibrosarcoma/tratamiento farmacológico , Neoplasias Cardíacas/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Pleurales/tratamiento farmacológicoAsunto(s)
Hipertiroidismo/etiología , Tiroiditis/etiología , Adulto , Femenino , Humanos , Periodo Posparto , Embarazo , Remisión EspontáneaAsunto(s)
Enfermedad Coronaria/complicaciones , Trastornos de Deglución/etiología , Angiopatías Diabéticas/complicaciones , Embalaje de Medicamentos , Compuestos Ferrosos/administración & dosificación , Cuerpos Extraños/diagnóstico , Enfermedad Iatrogénica/prevención & control , Adenocarcinoma/complicaciones , Anciano , Trastornos de Deglución/prevención & control , Cuerpos Extraños/etiología , Cuerpos Extraños/terapia , Gastroscopía , Humanos , Masculino , Neoplasias Gástricas/complicacionesRESUMEN
INTRODUCTION: Empty sella syndrome is sometimes associated with anterior pituitary insufficiency, the latter being mostly partial or dissociated. EXEGESIS: We report a case of a profound panhypopituitarism revealing an empty sella syndrome. This case shows that empty sella syndrome, although a generally benign and asymptomatic condition, can be associated with hypopituitarism. CONCLUSION: In case of empty sella syndrome, especially if an endocrine dysfunction is clinically suspected, minimal hormonal analysis must be requested.