Síndrome cistocerebral: a propósito de un caso / Cystocerebral syndrome: A case report

RESUMEN El síndrome cistocerebral fue descrito por primera vez en 1990 por Blackburn y Dunn. Los casos estudiados fueron varones ancianos con síndrome confusional agudo y retención urinaria aguda que, tras un drenaje vesical, presentaron resolución completa del cuadro clínico. Se reporta el caso de un anciano con disminución rápida del nivel de consciencia, mioclonías, hipotensión arterial, bradicardia y retención aguda de orina que experimentó total remisión del cuadro clínico luego del drenaje vesical correspondiente. Se describen, asimismo, los posibles mecanismos implicados en el origen de este síndrome y las alteraciones hemodinámicas y autonómicas subyacentes. Se sugiere considerar al síndrome cistocerebral en el diagnóstico diferencial de pacientes varones ancianos con síndrome confusional o deterioro cognitivo e hipertrofia prostática y que presenten, además, un episodio de retención urinaria aguda.

SUMMARY Cystocerebral syndrome was first described in 1990 by Blackburn and Dunn, in elderly males with acute confusion syndrome and urinary retention, who after bladder drainage experienced full resolution of the clinical picture. We report the case of an elderly male patient with Cystocerebral syndrome and symptoms such as a rapid decrease in consciousness level, myoclonies, hypotension, bradycardia and acute urinary retention who, after bladder drainage presented a complete remission of the clinical picture. The potential mechanisms involved in the origin of this syndrome are described, as well as its underlying hemodynamic and autonomic alterations. Cystocerebral syndrome should be considered in the differential diagnosis of patients with a confusional syndrome and cognitive impairment, diagnosed with prostatic hypertrophy and presenting, in addition, an episode of acute urinary retention.

Síndrome PHACES: comunicación de un caso con compromiso hepático e intestinal / PHACES syndrome: a report of a case with liver and intestinal involvement

El síndrome PHACES representa un espectro de anormalidades: malformaciones de la fosa posterior, hemangiomas segmentarios, anomalías vasculares, cardíacas, oculares y hendidura esternal o rafe supraumbilical, asociado también a hemangiomatosis extracutánea.Comunicamos el caso de una paciente de 4 meses de edad, con un hemangioma segmentario gigante en la hemicara izquierda, además de la presencia de una malformación de Dandy-Walker, malformación cardiovascular, hendidura esternal e hipotiroidismo.También tenía un hemangioma en el hígado y otras lesiones vasculares en el intestino.

PHACES syndrome represents a spectrum of anomalies such as posterior fossa malformations, segmental hemangiomas, vascular and cardiac abnormalities, eye abnormalities and sternal cleft or raphe supraumbilical, hemangiomatosis extracutánea. We present a 4 months of age female, who presented a segmental giant hemangioma in the left hemiface with Dandy-Walker malformation, cardiovascular malformation, sternal cleft and hypothyroidism, who also presented an hemangioma in the liver and other vascular lesions in the intestine.

Attentional selection of levels within hierarchically organized figures is mediated by object-files.

Objects frequently have a hierarchical organization (tree-branch-leaf). How do we select the level to be attended? This has been explored with compound letters: a global letter built from local letters. One explanation, backed by much empirical support, is that attentional competition is biased toward certain spatial frequency (SF) bands across all locations and objects (a SF filter). This view assumes that the global and local letters are carried respectively by low and high SF bands, and that the bias can persist over time. Here we advocate a complementary view in which perception of hierarchical level is determined by how we represent letters in object-files. Although many properties bound to an object-file (i.e., position, color, even shape) can mutate without affecting its persistence over time, we posit that same object-file cannot be used to store information from different hierarchical levels. Thus, selection of level would be independent from locations but not from the way objects are represented at each moment. These views were contrasted via an attentional blink paradigm that presented letters within compound figures, but only one level at a time. Attending to two letters in rapid succession was easier if they were at the same-compared to different-levels, as predicted by both accounts. However, only the object-file account was able to explain why it was easier to report two targets on the same moving object compared to the same targets on distinct objects. The interference of different masks on target recognition was also easier to predict by the object-file account than by an SF filter. The methods introduced here allowed us to investigate attention to hierarchical levels and to object-files within the same empirical framework. The data suggests that SF information is used to structure the internal organization of object representations, a process understood best by integrating object-file theory with previous models of hierarchical perception.

Numerical capacities as domain-specific predictors beyond early mathematics learning: a longitudinal study.

The first aim of the present study was to investigate whether numerical effects (Numerical Distance Effect, Counting Effect and Subitizing Effect) are domain-specific predictors of mathematics development at the end of elementary school by exploring whether they explain additional variance of later mathematics fluency after controlling for the effects of general cognitive skills, focused on nonnumerical aspects. The second aim was to address the same issues but applied to achievement in mathematics curriculum that requires solutions to fluency in calculation. These analyses assess whether the relationship found for fluency are generalized to mathematics content beyond fluency in calculation. As a third aim, the domain specificity of the numerical effects was examined by analyzing whether they contribute to the development of reading skills, such as decoding fluency and reading comprehension, after controlling for general cognitive skills and phonological processing. Basic numerical capacities were evaluated in children of 3(rd) and 4(th) grades (n=49). Mathematics and reading achievements were assessed in these children one year later. Results showed that the size of the Subitizing Effect was a significant domain-specific predictor of fluency in calculation and also in curricular mathematics achievement, but not in reading skills, assessed at the end of elementary school. Furthermore, the size of the Counting Effect also predicted fluency in calculation, although this association only approached significance. These findings contrast with proposals that the core numerical competencies measured by enumeration will bear little relationship to mathematics achievement. We conclude that basic numerical capacities constitute domain-specific predictors and that they are not exclusively "start-up" tools for the acquisition of Mathematics; but they continue modulating this learning at the end of elementary school.

Escrofuloderma asociada a osteítis tuberculosa / Scrofuloderma associated with tuberculous osteitis

La escrofuloderma es una forma de tuberculosis cutánea que resulta de la extensión directa a la piel de un foco tuberculoso contiguo (linfático u óseo), con frecuente fistulización y evolución crónica, pudiendo ocurrir curación espontánea que deja cicatriz retráctil. Se presenta el caso de un paciente varón de 7 años de edad, que presenta dos úlceras en la pared torácica izquierda con un aumento del volumen torácico del mismo lado de 7 meses de evolución; recibe tratamientos antibióticos múltiples y curaciones sin mejoría. En la radiografía de tórax se evidencia compromiso de pleura y arcos costales izquierdos, que es compatible con osteítis tuberculosa. Se realiza biopsia de piel, observándose granulomas tuberculoides con necrosis caseosa y coloración Ziehl Neelsen positiva para BAAR. Inicia tratamiento con tuberculostáticos obteniendo una mejoría clínica evidente. A las 8 semanas de iniciado el tratamiento, se obtiene cultivo positivo para Mycobacterium tuberculosis.

The scrofuloderma is a form of cutaneous tuberculosis that results of the extension of a contiguous tuberculous focus (lymphatic or bone) to the skin, with frequent fistulization and chronic evolution; spontaneous healing may occur in some cases leaving a scar. We present the case of a 7 years old male patient who complained of two ulcers with deformation of the thoracic wall that started 7 months previous to the diagnosis. He received multiple antibiotic treatments without improvement. The chest radiograph showed left pleura and costal arches involvement. Skin biopsy showed the presence of tuberculoid granulomas with caseous necrosis, and Ziehl Neelsen staining was positive for BAAR. The patient received tuberculostatic treatment and had clinical improvement. After 8 weeks of treatment, the culture resulted positive for Mycobacterium tuberculosis.

Granuloma tricofítico de Majocchi: comunicación de un caso / Majocchi trichophytic Granuloma: case report

El granuloma tricofítico de Majocchi es una infección causada por hongos dermatofitos que invaden dermis profunda y tejido celular subcutáneo. Existen pocos reportes de esta entidad. Se han descripto diferentes características clínicas de acuerdo al estado inmune del paciente. Presentamos el caso de una paciente de 8 años de edad con múltiples nódulos ligeramente dolorosos, en cuero cabelludo y cara, de 6 meses de evolución, que había sido tratada con corticoides tópicos y sistémicos. El estudio anatomopatológico evidenció abundantes estructuras micóticas con formación de granulomas en dermis profunda. Se estableció el diagnóstico de granuloma tricofítico de Majocchi y se inició terapia antimicótica con itraconazol, 5 mg/kg/día, con mejoría clínica parcial a la cuarta semana de tratamiento

Trichophytic Majocchi granuloma is an infection by dermatophytes which invade deep dermis and fat. There are few reports about this disease. Some clinical features have been described depending on immune state of patients. We present a case in an 8 years old girl with tenderness nodules in scalp and face of 6 months of evolution, who had been previously treated with topical and systemic steroids. Histological findings showed many fungal structures and a dermal granulomatous inflammatory infiltrate in deep dermis. Diagnosis of trichophytic Majocchi granuloma was done and initiated anti fungal therapy with itraconazole 5 mg/kg once a day with partial improvement at the fourth week of treatment

Estudio de casos de urticaria anular aguda en pacientes hospitalizados en el servicio de Dermatología del Instituto de Salud del Niño durante el período 2003 al 2004 / Acute annular urticaria case study in patients hospitalized in the service of Dermatology of the Institute of Health of the Child during the period 2003 to 2004

La urticaria aguda en niños es una entidad frecuente, sin embargo su incidencia no está bien establecida. Una variante es la urticaria anular aguda o gigante que ha sido caracterizada en varios trabajos. Objetivo: Caracterizar la urticaria anular aguda en el Instituto Nacional de Salud del Niño. Material y métodos: Estudio observacional no concurrente de serie de casos. Se revisaron historias clínicas de pacientes hospitalizados del servicio de Dermatología del Instituto Nacional de Salud del Niño, Lima-Perú, con criterios de inclusión y exclusión. Resultados:Se hallaron 27 niños con diagnóstico de urticaria anular aguda,las lesiones más frecuentes fueron las placas violáceas y manchas residuales. El área más afectada fue el tórax y dentro de los factores desencadenantes más importantes se encontró el uso de furazolidona en el 59% de los casos. Conclusiones: La urticaria anular aguda o gigante es una reacción de hipersensibilidad con características propias asociada en un alto porcentaje al uso de furazolidona (AU)

Acute urticaria in children is a frequent disorder; however its incidence has not been established. Annular acute urticaria or giant urticaria is a variant which has been reported in several surveys. Objetive: Characterize acute annular urticaria at Instituto Nacional de Salud del Niño, Lima-Peru. Methods: Observational non-concurrent series of cases. We reviewed the medical records of hospitalized patients at Dermatology Service, Instituto Nacional de Salud del Niño, with inclusion and exclusion criteria. Results: We found 27 children with diagnosis of acute annular urticaria; the most frequent lesions were lilaceous plaques and residual patches.The most frequently affected area was chest and the most important triggering factor was the use of furazolidone. Conclusions: Acute annular urticaria is a hypersensitivity reaction with special characteristics, which is associated in a high percentage to use of furazolidone (AU)

Manifestaciones orales en niños con VIH/SIDA hospitalizados en el Servicio de Infectología del Instituto de Salud del Niño (enero-junio 1998) / Oral manifestations in children with VIH/SIDA hospitalized in the Service of Infectology of the Institute of Health of the Boy (January-June 1998)

Las manifestaciones orales observadas en los 50 niños con VIH/SIDA hospitalizados en el Servicio de Infectología del ISN entre enero y junio de 1998 fueron: candidiasis pseudomembranosa (82 por ciento), queilitis angular (38 por ciento), gingivitis asociada a VIH (22 por ciento), candidiasis eritematosa (14 por ciento), úlceras aftosas menores (6 por ciento), úlceras aftosas mayores (4 por ciento) y verrugas orales (2 por ciento). Ocho niños no presentaron manifestaciones orales (16 por ciento): La vía de contagio de infección por VIH, en 48 niños (96 por ciento) fue por vía vertical madre-hijo y en 2 niños (4 por ciento) por abuso sexual.

Anticuerpos IgM leptospirosicos en casos de hepatitis infecciosa aguda (HIA) en niños / IgM leptospira's antibodies in children with acute infectious hepatitis

Con el objetivo de conocer la frecuencia de asociación de infección aguda por Leptospiras y Hepatitis Infecciosa Aguda (HIA) en niños, se estudiaran 50 niños de ambos sexos, menores de 15 años, con evidencias de HIA (hiperbilirrubinemia bifásica y transaminasas elevadas), a los cuales se les determinó Ac-IgM-leptospirosica mediante el método de UREASA-ELISA encontrando 5 casos positivos (10 por ciento ), tres de los cuales también estuvieron asociados a la presencia de Ac. IgM. HAV, de aquí que solo en 2 casos (4 por ciento ) pudo encontrarse una relación entre infección aguda por Leptospira y HIA, concluyendo que aunque la infección leptospirósica es frecuente no lo es dentro del contexto de las HIA

[IgM Leptospira antibodies in acute infectious hepatitis cases in children]. / Anticuerpos IgM leptospirosicos en casos de hepatitis infecciosa aguda (HIA) en ninos.

PIP: 50 children under the age of 15 years were studied who had been hospitalized in two hospitals in the Dominican Republic with HIV diagnosed by the presence of biphasic hyperbilirubinemia and elevation of glutamic-pyruvic and glutamic-oxalacetic transaminases. The sera of the patients were examined for the presence of leptospirotic immunoglobulin M (IgM) antibodies by means of the enzymatic immunoassay method (UREASA-ELISA). The Leptospira-positive sera were also investigated for the presence of hepatitis B surface antigen (HBsAg) and for the IgM antibody (ab) of the hepatitis A virus (ab-HAV) by ELISA. 5 cases were positive for IgM Leptospira antibodies (10%), not finding in this percentage the presence of HBsAg; 3 of the 5 Leptospira-positive samples demonstrated the presence of ab-HVA-IgM. Only 2 cases (4%) presented IgM Leptospira antibodies. Out of the 5 cases with IgM antibodies, males predominated (3/5). When compared to negative cases, however, there were more rural elements among them than in negative cases: regarding origins (10% vs. 16%), agricultural workers (40% vs. 20%), contact with cattle and fresh water (80% vs. 40%), and daily contact with humid soil in living quarters (60% vs. 48%). The clinical picture of the 5 positive cases featured myalgia (p = 0.05) and abdominal pain (p = 0.05). The stiffness of neck was relatively more frequent in positive cases (20%) than in negative cases (7%); also, fever (100% vs. 80%), vomiting (60% vs. 22%), headache (80% vs. 56%), constipation (20% vs. 9%), and hepatomegaly (100% vs. 71%). There was clear evidence that leptospirotic infection must be watched and also its association with acute infectious hepatitis.^ieng

Infección leptospirósica aguda de casos de hepatitis infectiocs aguda (HIA) en niños

Con el objetivo de conocer la frecuencia de asociacion de infección aguda por Leptospiras y Hepatitis Infecciosa Aguda (HIA) en niños, se estudiaron 50 niños de ambos sexos, menores de 15 años, con evidencias de HIA (Hiperbilirrubinemia bifásica y transaminass elevadas), a los cuales se les determinó AcIgM-leptospirósica mediante el método de UREASA ELISA encontrando 5 casos positivos (10%), tres de los cuales tambén estuvieron asociados a la presencia de AcIgm HAV, de aquí que solo en 2 casos (4%) pudo encontrarse una relación entre infección aguda por Lpetospiras y HIA, concluyendo que aunque la infección leptospirósica es frecuente así como su asociación a la enfermedad hepática, la enfermedad es infrecuente dentro del contexto de las hepatitis no A no B (4%)