[Glomus tumor of subungual presentation in the thumb and use of ultrasound in its diagnosis. Case report and literature review]. / Tumor glómico de presentación subungueal en pulgar y uso de ecografía en su diagnóstico. Reporte de caso y revisión de bibliografía.

INTRODUCTION: the glomus tumor is a benign neoplasm originated in the smooth muscle cells of the vascular glomus. Approximately 80% of lesions are located on the upper extremity and, of these, the majority are in the subungual area. The diagnosis must include imaging tests, among which ultrasound stands out, being a good alternative due to its low cost and accessibility. OBJECTIVE: we present a case of late diagnosis of surgically managed glomus tumor, as well as a review of the existing literature for diagnosis, treatment, and prognosis of this uncommon pathology. CLINICAL CASE: the case of a 52-year-old female patient who reported chronic, burning pain, radiating to the distal phalanx of the thumb with no history of trauma, of 2 years of evolution and which limited her daily life activities, is presented. The exploration with interphalangeal Doppler ultrasound is complemented, being an excellent alternative due to its easy accessibility. A glomus tumor was diagnosed in the interphalangeal thumb. An "H" approach was performed on the interphalangeal fold with subungual dissection with resection of the tumor piece and follow-up by an outpatient clinic where a surgical wound with adequate healing was found. Physical examination with capacity for the mobilization of the distal interphalangeal joint (IFJ) and visual analogue scale (VAS) 1 point. The updated pathological evaluation of the existence of a glomus tumor. CONCLUSIONS: ultrasound is an excellent aid in the diagnosis, as well as in the surgical planning for the treatment of the glomus tumor; for being accessible, low cost and highly effective. The anatomopathological study is the gold standard.

INTRODUCCIÓN: el tumor glómico es una neoplasia benigna originada en las células musculares lisas del glomus vascular. Aproximadamente 80% de las lesiones se localiza en la extremidad superior y, de éstas, la mayoría se sitúa en la zona subungueal. El diagnóstico debe incluir exámenes de imágenes, entre los que destaca la ecografía, siendo una buena alternativa por su bajo costo y accesibilidad. OBJETIVO: presentamos un caso de diagnóstico tardío de tumor glómico manejado quirúrgicamente, así como revisión de la literatura existente para diagnóstico, tratamiento y pronóstico de esta patología poco común. CASO CLÍNICO: paciente femenino de 52 años que refería un dolor crónico, ardoroso, irradiado hacia falange distal del pulgar sin antecedente traumático, de dos años de evolución y que limitaba actividades de su vida diaria. Se complementa exploración con ultrasonido Doppler interfalángico siendo una excelente alternativa por su fácil accesibilidad. Se diagnostica tumor glómico en interfalángica pulgar. Se realiza abordaje en "H" sobre pliegue interfalángico con disección subungueal con resección de pieza tumoral y seguimiento por consulta externa donde se encuentra herida quirúrgica con adecuada cicatrización. Exploración física con capacidad para la movilización de movilización de la articulación interfalángica distal (IFD) y escala visual análoga (EVA) de 1 punto. La evaluación anatomopatológica informó la existencia de tumor glómico. CONCLUSIONES: la ecografía es una excelente ayuda en el diagnóstico, así como en la planificación operatoria para el tratamiento del tumor glómico, por ser accesible, de bajo costo y de alta efectividad. El estudio anatomopatológico es el estándar de oro que da la certeza diagnóstica.

[Cervical vertebral hemangioma with aggressive behavior]. / Hemangioma vertebral cervical con comportamiento agresivo.

INTRODUCTION: Hemangiomas are the most common primary tumors of the spine. Mainly asymptomatic Incidental finding when performing an imaging study. The incidence reported at autopsies is 11% in the spine, multifocal lesions are present in 25 to 30% of cases. CLINICAL CASE: Vertebral cervical hemangioma with benign and stable characteristics that underwent surgical treatment, observing aggressive post-surgical behavior two months later. CONCLUSION: The approach to vertebral pathology is algorithmic and protocolized, it is necessary to determine the treatment based on the overall understanding of the disease and according to the clinical practice guidelines.

INTRODUCCIÓN: Los hemangiomas son los tumores primarios más comunes de la columna, principalmente asintomáticos, de hallazgo incidental al realizar un estudio de imagen. La incidencia reportada en autopsias es de 11% en la columna y lesiones multifocales en 25 a 30% de los casos. CASO CLÍNICO: Hemangioma cervical vertebral con características benignas y estables. Se realizó tratamiento quirúrgico, observando un comportamiento agresivo postquirúrgico dos meses después. CONCLUSIÓN: El abordaje de la patología vertebral es algorítmico y protocolizado, es necesario determinar el tratamiento con base en la comprensión global de la enfermedad y de acuerdo a las guías de práctica clínica.

[Bruns Garland syndrome. Report of a case and differential diagnosis with cauda equina syndrome]. / Síndrome de Bruns Garland. Informe de un caso y diagnóstico diferencial con el síndrome de cauda equina.

BACKGROUND: The Bruns Garland syndrome (diabetic amyotrophy) it is a very rare condition, with few cases reported in the literature. Clinical differentiation of diabetic amyotrophy or cauda equine syndrome may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. We report a case of diabetic amyotrophy that mimics a cauda equina syndrome. CASE DESCRIPTION: A 59 years old man diabetic patient that suddenly begins with weakness of lower extremities and loss of sphincters control. The patient was seen in the emergency room, the anteroposterior and lateral radiographs of the lumbosacral spine evidenced spondylolisthesis L5-S1 level II of Meyerding. However, the MRI show no vertebral canal compression, nerve root compression or disc extrusion. Electrodiagnostic study revealed diabetic amyotrophy (Bruns Garland syndrome). The patient rapidly improves with treatment based in antineuritics, diabetes control, physical therapy and rehabilitation. Four months after the diagnosis he recover his muscle strength, has no alterations in the march, no loss of balance, his sensitive is preserved and has no pain. CONCLUSION: Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from cauda equina syndrome. Treatment of both diseases may be needed for relief of the patients pain.

ANTECEDENTES: El síndrome de Bruns Garland (amiotrofia diabética) es una condición con pocos casos reportados en la literatura. La diferenciación clínica de una amiotrofia diabética o un síndrome de cauda equina puede ser difícil. El problema de un mal diagnóstico ha sido discutido como una razón para un mal resultado después de una cirugía de la columna lumbar. Se presenta un caso de amiotrofia diabética que imita un síndrome de cauda equina. DESCRIPCIÓN DEL CASO: Masculino de 59 años de edad con diabetes, comienza repentinamente con debilidad en las extremidades inferiores y pérdida del control de los esfínteres. Este paciente fue atendido en la sala de urgencias, las radiografías anteroposterior y lateral de la columna lumbosacra evidenciaron espondilolistesis L5-S1 nivel II de Meyerding. Sin embargo, la IRM no mostró ninguna compresión del canal vertebral, compresión de la raíz nerviosa, ni extrusión del disco. El estudio de electrodiagnóstico reveló amiotrofia diabética (síndrome de Bruns Garland). El paciente rápidamente mejoró con el tratamiento basado en antineuríticos, control diabético, terapia física y rehabilitación. Cuatro meses después del diagnóstico, el paciente recuperó su fuerza muscular, no mostró alteraciones en la marcha, ni pérdida del equilibrio, su sensibilidad se conserva y no manifiesta dolor. DISCUSIÓN: Deberán utilizarse estudios de electrodiagnóstico y radiológicos en todo paciente diabético que presente dolor en la pierna y/o debilidad para diferenciar una neuropatía diabética de un síndrome de cauda equina. El tratamiento en ambas enfermedades puede ser necesario para aliviar el dolor del paciente.

Dengue 2 genotypes in the state of Oaxaca, Mexico.

To genetically characterize dengue 2 (DEN-2) viruses in Oaxaca, Mexico, the C protein, and a portion of the prM protein genes of 8 isolates from the 2001 DEN epidemic were sequenced. The sequences were compared to those of prototype DEN-2 viruses from various parts of the world. Phylogenetic analysis suggested that the 2001 isolates of DEN-2 were of the American/Asian genotype and were most similar to the Jamaica and Venezuelan isolates MARA3, LARD1996 and LARD1910. Molecular analyses confirmed the origin of the isolates. This study indicates that DEN-2 strains of American/Asian genotype probably from Southeast Asian are circulating in Oaxaca.

Caminos y semáforos en la fundoplicatura de Nissen laparoscópica / Ways and traffic lights in the fundoplicatura of laparoscópica

El refinamiento de la técnica quirúrgica y los múltiples reportes de buenos resultados en alrededor del 95 por ciento de pacientes sometidos a la fundoplicatura de Nissen, han convertido a la cirugía laparoscópica antirreflujo como el gold standard de tratamiento, desde luego, en los pacientes con indicaciones apropiadas para esta cirugía. A continuación se describirán los detalles de la técnica quirúrgica, utilizando además el concepto de caminos y semáforos como una guía sobre todo para quienes se inician o tienen experiencia limitada, concepto que se refiere a recomendaciones para seguir las etapas y pasos técnicos que eviten complicaciones o iatrogenias.

Hemoperitoneo masivo luego de colecistectomía laparoscópica: pseudoaneurisma de rama de la arteria hepática secundaria a lesión térmica durante la disección del lecho vesicular / massive Hemoperitoneo after laparoscópica colecistectomía: pseudoaneurism of branch of the secondary hepática artery to thermal injury during the dissection of the vesicular bed

Se reporta el caso de una paciente femenina de 50 años de edad con hemoperitoneo masivo luego de colecistectomía laparoscópica. Luego de arteriografia se evidencia la presencia de pseudoaneurisma de la arteria hepática. Se trata de una complicación muy poco frecuente de uno de los procedimientos realizados más comúnmente en la práctica del cirujano general.

Plasma epinephrine and norepinephrine response to stimuli in autonomic neuropathy of type 2 diabetes mellitus.

The objective of this study was to examine epinephrine and norepinephrine plasma levels in patients with clinical type 2 diabetes mellitus, at different stages of autonomic neuropathy. Eighteen patients were classified in groups without (n = 6) and with early (n = 6), definite (n = 3) and severe (n = 3) neuropathy. Blood catecholamine levels were measured after the Valsalva maneuver, cold exposure and orthostatic tests. The norepinephrine basal levels were lower in patients with severe neuropathy (0.4 +/- 0.2 nmol/l), compared with the group with no neuropathy (1.3 +/- 0.5 nm/l, p = 0.034), or with early neuropathy (1.3 +/- 0.7 nm/l, p = 0.035). After the Valsalva maneuver, no increase was found in the group with severe alteration. In patients without neuropathy, cold exposure induced a peak of norepinephrine at 5 min (delta = 1.9 +/- 1.6 nmol/l). The increase was lower in groups with definite and severe damage. In patients with definite or moderate neuropathy, the orthostatic test induced minimal or no response. The epinephrine response to the maneuvers was not significant, and no differences were found among the groups. Norepinephrine basal levels and cold responses are diminished in patients with definite and severe autonomic neuropathy. This provides further evidence on their impaired response to stress. The comparable epinephrine levels in patients with or without autonomic neuropathy indicates that adrenal medullar function is not significantly altered.

Putative dengue virus receptors from mosquito cells.

Dengue viruses are arthropod-borne, single-stranded RNA viruses. Aëdes aegypti and Aëdes albopictus are the principal vectors. In order to understand the molecular basis of dengue virus infections we explored the biochemical identity of dengue-2 (DEN-2) virus receptors in the Aëdes albopictus-derived cell line C6/36. We show here that DEN-2 interacts with two major polypeptides of 80 and 67 kDa. Polyclonal anti-C6/36 membrane antibodies block DEN-2 binding to intact C6/36 monolayers as well as to membrane extracts. Our results strongly suggest that the identified polypeptides are part of the DEN-2 receptors.

[Some epidemiological aspects of myasthenia gravis in Cuba]. / Algunos aspectos epidemiológicos de la miastenia gravis en Cuba.

We estimated the rates of prevalence, incidence, mortality and lethality for myasthenia gravis in Cuba based upon previous epidemiological studies carried out in eight of Cuba's fourteen provinces: Pinar del Río, Havana City, Havana, Matanzas, Cienfuegos, Sancti Spíritus, Camagüey and Guantánamo. Rates of incidence, prevalence and mortality were 4.52, 29.22 and 0.72 per million inhabitants respectively. Lethality rate was 10.77%.

[Maximum oxygen consumption and serum lipids in diabetics, controls, and athletes]. / Consumo máximo de oxígeno y los lípidos séricos en diabéticos, controles y atletas.

Although it has been pointed out that the main cardiovascular risk factors in diabetic are dyslipidemias, hypertension, and cigarette smoking, very few studies have analyzed other risk factors, such as sedentarism and maximal aerobic capacity (VO2 max). The purpose of this study was to evaluate VO2 max and blood lipids (total cholesterol = TC, high density lipoproteins cholesterol = HDL; low density lipoproteins cholesterol = LDL; triglycerides = TG), in 19 diabetics subjects, 19 sedentary and 19 long distance runners. The diabetics of 5-10 years of evolution were non obese (body fat < 28%), and in regular metabolic control (Hb A1 < 12%). The athletes had more than five years of uninterrupted training. The diabetics had significantly lower VO2 max, than the other groups. The mean +/- SEM (mL/kg/min) in diabetics was 30.5 +/- 1.6 versus 41.3 +/- 2.3 in the controls and 54.2 +/- 2.5 in the athletes. There were significant group differences in TG (218 +/- 44 in diabetics vs 106 +/- 16 in controls and 94 +/- 10 mg/dL in athletes) and in HDL (27.3 +/- 4.3 in diabetes versus 34.1 +/- 4.3 and 43.9 +/- 6.3 mg/dL). These data suggest that sedentarism and low VO2 max may be important risk factors in diabetics. An aerobic program for them could perhaps change their blood lipids favorably as their VO2 max was significantly correlated with TG (r = -0.45), HDL (r = 0.52) and the TC/HDL ratio (r = -0.57).

Algunos aspectos epidemiológicos de la miastenia gravis en Cuba / Some epidemiological aspects of Myasthenia Gravis in Cuba incidence mortality and lehality for myastenia gravis in Cuba

Se estimaron las tasas de incidencia, prevalencia, mortalidad y letalidad pormiastenia gravis en Cuba, previo estudios epidemiológicos desarrollados en 8 de las 14 provincias del país: Pinar del Río, Ciudad de La Habana, La Habana, Matanzas, Cienfuegos, Sancti-Spíritus, Camaguey y Guantánamo. Las tasas de incidencia, prevalencia y mortalidad dieron de 4,52, 29,22 y 0,72 por millón de habitantes respectivamente. La tasa de letalidad fue de 10,77

[Symptoms in adolescents in two Mexican cities and association with the menstrual cycle]. / Síntomas en adolescentes de dos ciudades de México y su asociación con el ciclo menstrual.

Frequency an severity of physical and emotional symptoms in young female students from two cities of México (a medium and a large sized city), were studied. An interview was carried out in 447 female adolescents, non seeking treatment, in a cross sectional design (146 from Guadalajara, and 301 from León). The mean age was 16.7 years (16.5 + SD 1.7 and 17.1 +/- 1.9 respectively). Most frequent symptoms for both groups were abdominal bloating, acne, increased appetite, low back pain, polydipsia, and emotional symptoms related to depression such as fatigue, desire to stay at home, desire to be alone and anxiety. Adolescents from Guadalajara reported increased intensity of diverse symptoms in comparison with adolescents from León: Breast tenderness, polydipsia and symptoms of depression. Difference was maintained after adjustment for covariates. In regards to the phase of the menstrual cycle, significantly different symptoms were: Abdominal bloating, breast tenderness, constipation, pruritus, lack of concentration, lack of coordination and symptoms of depression. It is concluded that female adolescents report increased scores on several physical and emotional symptoms during the menstrual phase of the cycle. Women from large urban populations report symptoms with increased intensity.

[Influence of the autonomic nervous system on the initial response of heart rate to active and passive orthostatism]. / Influencia del sistema nervioso autónomo en la respuesta inicial de la frecuencia cardíaca al ortostatismo activo y pasivo.

Influence of the autonomic nervous system on the heart rate response to active and passive orthostatism. The purposes of this study were twofold. First, to compare heart rate responses as measured by R-R interval under two conditions of orthostatic stress, i.e. a change from supine to an active free standing-up position (active orthostatism, AO), and from supine to a passive 70 head-up tilt posture (passive orthostatism, PO) second, to utilize a standard pharmacological model to study the participation of the autonomic nervous system upon heart rate responses evoked by AO. In the first part of the research, eight healthy subjects (seven men, one woman) were evaluated for AO and PO. In both occasions, subjects were supine for 5 minutes and then adopted an upright or a tilted position in 3-5 seconds and remained motionless during 5 minutes. In the second part, eight men participated twice in the pharmacological studies. In day one, they stood up for control (AOC), after IV administration of atropine sulfate (0.04 mg/kg) (AO+atro) and after IV administration of propranolol hydrochloride (0.16 mg/kg) (AO+ATRO+PROPRA). In day two, subjects repeated the control AO (AOCII) and after the administration for propranolol hydrochloride alone. In the first study, AO was characterized by a fast shortening of R-R interval, which was maximal at beat 15th (relative tachycardia), followed by a rebound lengthening of R-R interval, reaching a plateau at beat 30 (relative bradycardia), demonstrating a biphasic response. PO was characterized by a small and gradual shortening of R-R interval without the biphasic responses of AO.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of body posture on serum concentration of lipids]. / "Efecto de la postura corporal sobre la concentración de los lipidos séricos".

The purpose of this study was to evaluate the effects of body postural changes (supine-upright), upon the serum concentration of cholesterol (CT), triglycerides (TG), high density lipoproteins (HDL), low density (LDL) and very low density lipoproteins (VLDL) and hemoglobin, hematocrit, and plasma proteins (to calculate delta% change in plasma y volume). Nine healthy men participated as subjects. Their age ranged from 32 +/- 3 years old, and 16 +/- 4% body fat (X +/- SD). After 10-12 hours post absorptive and appropriate rest, they performed a standard orthostatic maneuver: subjects remained supine for 30 minutes, then assumed the standing position (unsupported and with minimal movement) for additional 30 minutes. Blood samples were obtained after 30 minutes supine and at 10, 20 and 30 minutes of standing. At 10 minutes of orthostatism, CT, TG, HDL and VLDL had a significant increase as compared to supine values; these changes were associated with a reduction of 8.9% on plasma volume (PV) (p less than 0.05). After 30 minutes of orthostatism CT, TG, HDL and VLDL showed increments of 8.5%, 33.3%, 20.1% and 32% respectively, in relation to the supine values (p less than 0.05). Changes on serum lipids were associated with PV reductions until 20 minutes of orthostatism. However, there was not a significant association between these variables at 30 minutes of standing. These data indicated that the body position and the time in which blood samples are obtained significantly influence lipid and lipoprotein serum level. Therefore, in any study related to lipids, such variables should be considered and properly controlled.

[Effects of an aerobic exercise program and diet on body composition and cardiovascular function in obese persons]. / Efectos de un programa de ejercicio aeróbico y dieta sobre la composición corporal y función cardiovascular en obesos.

The purpose of this study was to determine the effect of a combination of aerobic exercise and hypocaloric diet on body composition, cardiovascular function and some cardiovascular risk factors in obese patients. Ten subjects, (8 women 2 men X age 30 years and 138% of ideal body weight) volunteered as participants. The program lasted 12 weeks and consisted of a hypocaloric diet (1257 kcal/day) and 3-5 days/week supervised sessions of aerobic exercise (65-90% maximal heart rate and/or 50-80% of maximal oxygen uptake). The program resulted in a significant mean decrease in body weight of 7.7 kg. for the group (P less than or equal to 0.05). Mean (+/- EE) relative body fat significantly decreased from 35.9 +/- 2 to 31.6 +/- 2%. Interestingly, the decrease in relative body fat was solely accounted for by a significant decrease in fat weight, as body free of fat remained constant. Cardiovascular function as evidenced by oxygen uptake, increased 11.3%. Resting systolic and diastolic blood pressure fell significantly from 131/90 +/- 8/9 to 115/76 +/- 2/1 mmHg. Total cholesterol significantly dropped from a mean value of 247 +/- 24 to 183 +/- 20 mg/100 ml (P less than 0.05). Triglycerides significantly decreased from 212 +/- 32 to 45 +/- 10 mg/100 ml (P less than 0.05). It was concluded that a combination of aerobic exercise and hypocaloric diet can favorably improve body composition, cardiovascular function and cardiovascular risk factors.

[Effects of orthostatism on heart rate and arterial pressure in sedentary subjects and in those in good physical condition]. / Efectos del ortostatismo sobre la frecuencia cardíaca y presión arterial en sujetos sedentarios y en los fisicamente acondicionados.

Heart rate (HR), Systolic (SBP), Diastolic (DBP), and Mean Blood Pressures (MBP), were evaluated during a resting sitting and during upright moveless positions, in fifty seven highly trained runners with a maximal oxygen consumption equal or superior to 55 ml/kg. min. (VO2 max greater than or equal to 55 ml/kg . min., group I), and in fifty seven sedentary untrained men (group II). During sitting position the members of group I, had a significantly lower DBP and MBP than the members of group II. In the members of group II the assumption of upright posture did not produce significant changes in blood pressure, whereas subjects of group I showed a significantly drop in SBP, DBP and MBP. The results of this investigation indicated that in human, vigorous physical activity produce lower values of arterial blood pressure, and might be of value in the prevention of high blood pressure. On the other hand, the observed responses in group I during orthostatism, reveal a different regulation of the cardiovascular system. Changes in sympathetic and parasympathetic nervous system, venous compliance and plasma volume are designated as responsible of observed differences. This finding might also support the tendency to faintness reported by some authors in athletes.

[Actions of chlorpheniramine and its isomers on the auricular fibers of the mammalian heart]. / Acciones de la clorofeniramina y sus isómeros sobre las fibras auriculares del corazón del mamífero.

The effects of the antihistaminic agent, chlorpheniramine and its optical isomers, were studied on the transmembrane potentials of specialized atrial conducting tissue and ordinary auricular muscle fibers. On atrial myocardium fibers, both isomers increase the duration of the action potential to a different degree and they also reduce the maximum rate of rise of phase O or dV/dt. In specialized conducting atrial tissue, the levo isomer increase the duration of the action potential in a larger proportion than the dextro compound. This occurs at the expense of the repolarization process. The l-compound produces only minimal changes in the dV/dt. The effects observed on both types of atrial tissues leads us to conclude: 1) Either type of tissue responds differently to each optical isomer of chlorpheniramine; 2) the results confirm the participation of specialized conduction pathways in atrial flutter; 3) the levo isomer may be considered as a possible candidate for clinical trial in patients with atrial flutter.