Síndrome del ligamento arcuato medio / Median arcuate ligament syndrome

Se presenta el caso de una paciente mujer de 63 años de edad, que por epigastralgia severa acompañada de náuseas y sudoración, cursa internaciones en noviembre de 2017 y en febrero de 2018. Como antecedentes de enfermedad cercana, en 2015 presentó un infarto agudo de miocardio (IAM) inferolaterodorsal por disección de la arteria circunfleja. Los estudios post IAM mostraron buena performance miocárdica. En ambas internaciones, la paciente fue evaluada en Unidad Coronaria (UCO) y en Clínica Médica detectándose leve aumento de transaminasas con fosfatasa alcalina (FAL), electrocardiograma (ECG) y Troponina T dentro de parámetros normales. En la primera internación, la ecografía abdominal y la ecoendoscopia biliar descartaron síndrome de la vía biliar y afección pancreática; las transaminasas hepáticas se normalizaron espontáneamente. Durante la segunda internación, y ante reiteración de la sintomatología, se sospechó afección vascular abdominal alta debido al antecedente de disección coronaria; por lo que se le solicitó Angiotomografía de tórax y de abdomen que confirmaron el diagnóstico de Síndrome del Ligamento Arcuato Medio diafragmático. Conclusiones: Los nuevos métodos complementarios de diagnóstico por imágenes permitieron realizar el diagnóstico de esta entidad poco sospechada. (AU)

The case of a 63-year-old female patient is presented, who -due to severe epigastric pain accompanied by nausea and sweating- was admitted to hospital in November 2017 and February 2018. In her medical history of recent disease, she had presented an acute myocardial infarction (AMI) inferolaterodorsal by circumflex artery dissection in 2015. Post-AMI studies showed good myocardial performance. In both hospitalizations, the patient was evaluated in the Coronary Unit (CU) and in the Medical Clinic, showing a slight increase in transaminases with alkaline phosphatase (AF); electrocardiogram (ECG) and Troponin T were within normal parameters. In her first hospitalization, abdominal ultrasound and echoendoscopy of the biliary system ruled out bile duct syndrome and pancreatic disease; liver transaminases normalized spontaneously. During the second hospitalization, and due to repeated symptoms, an upper abdominal vascular condition was suspected due to her history of coronary dissection. Therefore, chest and abdomen CT angiography were indicated which confirmed the diagnosis of diaphragmatic median arcuate ligament syndrome. Conclusions: The new complementary methods of diagnostic imaging allowed the diagnosis of this scarcely suspected syndrome. (AU)

A 30 años de la aparición del síndrome de inmunodeficiencia adquirida en la ciudad de Bahía Blanca / 30 years after the first case of acquired immunodeficiency syndrome (AIDS) in the city of Bahía Blanca

Se presenta un análisis fáctico e histórico sobre el primer caso del Síndrome de inmunodeficiencia Adquirida (SIDA) en la ciudad de Bahía Blanca. Se describe la relación entre el momento del diagnóstico con el estado de la medicina local y sus posibilidades en el año 1984. Se analizan los avances en el contexto de la ciencia médica nacional e internacional y su influencia en nuestra ciudad.

A factual and historic analysis of the the first case of Acquired Immunodeficiency Syndrome (AIDS) in the city of Bahía Blanca is presented. The relation between the time of diagnosis and the state of local medical practice and possibilities in 1984 is described. The national and international progress made in medical science and the influence of such progress in our city is analyzed.

Infecciones asociadas a catéteres en terapia intensiva del Hospital Privado del Sur de Bahía Blanca / Catheter-associated infections at the intensive care unit of the hospital Privado del Sur, Bahía Blanca

Introducción: El uso de accesos venosos centrales (AVC) es útil para tratamiento y monitoreo hemodinámico del paciente. Sin embargo, su implementación no está exenta de complicaciones, siendo el principal problema las complicaciones infecciosas asociadas al catéter. Materiales y Métodos. En el servicio de Terapia Intensiva del Hospital Privado del Sur (HPS), se realizó un estudio descriptivo, retrospectivo acerca de la incidencia de infecciones asociadas a catéter (IAC) en la población de pacientes adultos internados durante el período 2006 ­ 2011; y se midió el impacto del paquete de medidas propuestas por el Comité de Control de Infecciones diseñadas para reducir la incidencia de las IAC. Resultados: La tasa de uso de AVC fue de 73,76% y la tasa total de IAC fue de 7,16/1000 día catéter. Se observa un descenso de IAC, de 15/1000 día catéter en 2006 a 7,8 en el año 2011. De la flora predominante 53,8% fueron bacilos Gram negativos, cocos Gram positivo el 46,2% restante, y entre ellos sólo 5,13% fue por Staphylococcus aureus meticilinorresistente. Conclusiones: Nuestros datos muestran un importante descenso en las tasas de infección desde la implementación del Programa de Control de Infecciones diseñado por el Comité de Control de Infecciones del HPS, en 2008.

Introduction: The use of central venous accesses (CVA) is useful for the hemodynamic monitoring and treatment of patients. However, its implementation may present some complications being catheter-associated infections the major problem. Materials and Methods: In the Intensive Care Unit of the Hospital Privado del Sur (HPS), we conducted a descriptive study on the incidence of catheter-associated infections (CAI) in an adult patient population admitted during the period 2006-2011, and we measured the impact of the set of measures proposed by the Infection Control Committee designed to reduce the incidence of CAI. Results: The CVA prevalence rate was 73.76% and the overall rate was 7.16 CAI / 1000 catheter days. We observed a decrease in CAI, 15/1000 catheter days in 2006 to 7.8 in the year 2011. Predominant flora were Gram negative bacteria 53.8%, and Gram positive cocci the remaining 46.2%. Among them there was only 5.13% infections caused by methicillin-resistant Staphylococcus aureus. Conclusions: Our data show a significant decrease in infection rates since the implementation of the Infection Control Program designed by the Infection Control Committee of the HPS in 2008.

Complicaciones de preeclampsia grave. Presentación de un caso clínico. Revisión bibliográfica / Severe preeclampsia complications. A clinical case report and bibliographic review

A continuación presentamos el caso de una paciente embarazada de 36 semanas que cursa con preeclampsia grave y evoluciona con síndrome HELLP complicado con ruptura hepática; realizando una revisión bibliográfica sobre dicha patología.

The case of a 36-week pregnant patient with severe preeclampsia and HELLP (H, hemolysis; EL, elevated liver enzymes; LP, low platelet count) syndrome evolution with liver rupture and a bibliographic review on such pathology are presented.

Sindrome de desmielinización osmótica. Sindrome de mielinolisis extrapontina. Presentación de un caso / Osmotic demyelinization syndrome. Extrapontine myelinolysis syndrome. A case report

Presentamos el caso de una paciente que ingresa a la Unidad de Terapia Intensiva (UTI) por una sepsis grave de la comunidad secundaria a una neumonía a neumococco y que en su evolución presenta un cuadro clínico de mielinolisis extrapontina no asociada a trastornos del sodio. La clínica y la buena evolución del cuadro neurológico sugieren la búsqueda de los síndromes desmielinizantes en aquellos pacientes internados en UTI con cuadros neurológicos atípicos. Creemos que existe un subdiagnóstico de estos síndromes de desmielinización osmótica.

In this paper we present the case of a female patient admitted at an Intensive Care Unit (ICU) due to a serious community-acquired sepsis secondary to a pneumococal pneumonia that in its evolution showed a clinical condition of extrapontine myelinolysis not associated to sodium disorders. The clinical evaluation and good evolution of the neurological condition suggest the search for demyielinizing syndromes in those patients hospitalized at an ICU with atypical neurological conditions. We believe there is a sub-diagnosis of these osmotic demyelinization syndromes.

[Treatment of insulinoma with diazoxide]. / Tratamiento del insulinoma con diazóxido.

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg% and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease.

Tratamiento del insulinoma con diazoxido / Treatment of insulinoma with diazoxide

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg% and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease

Tratamiento del insulinoma con diazóxido. / [Treatment of insulinoma with diazoxide]

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg

and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease.

Tratamiento del insulinoma con diazoxido / Treatment of insulinoma with diazoxide

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg% and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease (AU)

Reperfusión Coronaria en el Infarto Agudo de Miocardio con Estreptoquinasa / Coronary Reperfusion in Acute Myocardial Infarction with Streptokinase

Se evaluó la acción de la estreptoquinasa sistémica entre 34 pacientes con Infarto Agudo del Miocardio. Se plantearon los objetivos del estudio, los criterios de inclusión, exclusión, la forma de uso de la droga, tratamiento posterior y seguimiento en la etapa aguda, como así también los factores de riesgo de los enfermos. Para determinar la efectividad del tratamiento (reperfusión) se analizaron criterios sintomatológicos, electrocardiográficos y de laboratorio, determinando la especificidad y sensibilidad de los mismos. La curva enzimática precoz fue la más sensible (92%), mientras que la asociación desaparición del dolor, curva enzimática y arritmia de reperfusión fue la más específica (88%). Todos los pacientes fueron evaluados con coronariografía, observándose revascularización en 26 de ellos (76%). Concluimos enfatizando el uso precoz de fibrinolíticos en la cardiopatía isquémica aguda, recordando la importancia de los criterios de reperfusión antes mencionados como índices de revascularización sobre todo en medios donde la angiografía no es factible de realizar en corto plazo.