Monitoreo de DDI en la provincia de Santiago del Estero (2004) / Monitoring of DDI in the province of Santiago del Estero (2004)

Un total de 675 alumnos de escolaridad primaria, de ambos sexos, fue estudiado en este monitoreo de bocio endémico en dos ciudades de la provincia de Santiago del Estero: Santiago del Estero (360 niños) y Frías (315 niños). La edad de los escolares osciló entre 6 y 12 años. La palpación tiroidea fue hecha por el conjunto de los médicos participantes. Sin embargo, con la finalidad de aunar criterios con lo realizado previamente (1-19), se tomó como única referencia la palpación de H.N., que se llevó a cabo en la totalidad de los niños estudiados. La definición del grado de bocio fue similar a la utilizada en los otros relevamientos (1). Se determinó la yoduria en muestras casuales de orina emitidas por los niños una vez que fueron palpados (137 de Santiago del Estero y 154 de Frías). Se recolectaron 358 muestras de sal de consumo hogareño de Santiago del Estero y 299 de Frías, para medir su contenido en yodo. El examen palpatorio de los niños reveló la existencia de bocio grado 1 solamente. La prevalencia de bocio encontrada fue de 3,9 % en Santiago del Estero y de 2,9 % en Frías. Los niveles de yoduria alcanzaron, en Santiago del Estero, una media de 159 ± 147,3(DS)μg/L y una mediana de 132,5μg/L, al tiempo que en Frías la media fue de 178 ± 147,3μg/L y la mediana de 136μg/L. El contenido de yodo de las sales que aportaron los alumnos, si bien varió significativamente según la marca de sal utilizada, tuvieron un nivel relativamente adecuado de yodo en aquellas de consumo masivo. De esta manera, observamos que en la ciudad de Santiago del Estero el promedio de yodo en la sal, tomada en conjunto, fue de 30,1 ± 8,0 mg/Kg, mientras que para Frías fue de 29,1 ± 10 mg/Kg. Al analizar las concentraciones de yodo <15mg/Kg, observamos que fue del 6,4 % en Santiago del Estero y del 12,5 % en Frías. Teniendo en cuenta la línea de corte del 10 % que fija el ICCIDD (20) como valor óptimo, podemos observar que la situación de ambas poblaciones es satisfactoria. Concluímos que en estas dos ciudades de la provincia de Santiago del Estero no existe una prevalencia de bocio aumentada, por lo que puede afirmarse que, actualmente, esta región está libre de bocio endémico.

Tumores carconoides de pulmón: diagnóstico, tratamiento y factores pronósticos / Carconoides tumors of lung: diagnosis, treatment and factors prognoses

Antecedentes: Los tumores carcinoides pertenecen al grupo de neoplasias neuroendocrinas de pulmón. Objetivos: Determinar su forma más frecuente de presentación clínica, método diagnóstico más seguro y el éxito del tratamiento quirúrgico ofrecido a estos pacientes, evaluando factores pronósticos en relación a hallazgos anatomopatológicos. Métodos: Se realizó un análisis retrospectivo de todos los tumores carciniodes pulmonares operados desde enero de 1975 hasta agosto del 2005, incluyendo ambos tipos histológicos: típicos y atípicos. Resultados: De los 47 pacientes operados, 27 fueron mujeres y 18 hombres, con un promedio de edad de 39 + 15 años. La sintomatología de comienzo de la enfermedad fue tos, hemoptisis e infección respiratoria. El método diagnóstico más frecuentemente utilizado fue la fibrobroncoscopia (FBC) con toma de biopsia. Se realizaron 6 neumonectomías, 22 lobectomías y 19 plásticas bronquiales seguidas o no de resecciones pulmonares. La histología demostró 43 carcinoides típicos y 4 carcinoides atípicos. Entre los primeros, en 12 pacientes el tamaño del tumor fue mayor de 3 cm, se halló metástasis ganglionar en el nivel N2 en 3 y permeación linfática, afectación de la grasa periganglionar e invasión vascular en 9 casos, habiéndose observado supervivencia del 100% a 5 y 10 años. Conclusiones: Los tumores carcinoides típicos son lesiones de buen pronóstico. Para los carcinoides atípicos la evolución es marcadamente diferente y la supervivencia de estos enfermos pareciera estar relacionada con la extensión local de la enfermedad.

[Advantages of video assisted thoracic surgery in the treatment of spontaneous pneumothorax]. / Ventajas de la cirugia torácica videoasistida en el tratamiento del neumotórax espontáneo.

Spontaneous pneumothorax (SP) is a disabling condition mostly affecting young, thin and otherwise healthy males. It is usually caused by ruptured pleural blebs. The first treatment is the insertion of a chest tube (ICT) but in a great number of patients there is recurrence of the disease. We believe that the video assisted thoracoscopy (VATS) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence. In order to prove it, 40 patients admitted in a five-year period, with a SP, were randomly assigned to be treated by ICT or VATS. The ICT patients were in the hospital a mean time of 7.5 (4 to 15) days and the VATS patients, 5.3 (2 to 7) days (P < .05). ICT patients required analgesic drugs during 76.8 +/- 31 hours and VATS patients 38.4 +/- 13 hours (p < .05). From the ICT group, 8 (53%) patients had recurrence of the disease and 6 (40%) had a prolonged air leak, while none of the patients of the VATS group had any complication (< .001). Cost of ICT and VATS were $ 850 and $ 1730, respectively. According to these results, VATS should be the treatment of choice in SP patients. It treats the cause of the disease. It also reduces the hospitalization time, the use of analgesic drugs post surgery, decreases recurrence of the disease and the cost of the treatment. Moreover, the patients were back to work in less than 10 days.

Ventajas de la cirugia torácica videoasistida en el tratamiento del neumotórax espontáneo. / [Advantages of video assisted thoracic surgery in the treatment of spontaneous pneumothorax]

Spontaneous pneumothorax (SP) is a disabling condition mostly affecting young, thin and otherwise healthy males. It is usually caused by ruptured pleural blebs. The first treatment is the insertion of a chest tube (ICT) but in a great number of patients there is recurrence of the disease. We believe that the video assisted thoracoscopy (VATS) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence. In order to prove it, 40 patients admitted in a five-year period, with a SP, were randomly assigned to be treated by ICT or VATS. The ICT patients were in the hospital a mean time of 7.5 (4 to 15) days and the VATS patients, 5.3 (2 to 7) days (P < .05). ICT patients required analgesic drugs during 76.8 +/- 31 hours and VATS patients 38.4 +/- 13 hours (p < .05). From the ICT group, 8 (53

) patients had recurrence of the disease and 6 (40

) had a prolonged air leak, while none of the patients of the VATS group had any complication (< .001). Cost of ICT and VATS were $ 850 and $ 1730, respectively. According to these results, VATS should be the treatment of choice in SP patients. It treats the cause of the disease. It also reduces the hospitalization time, the use of analgesic drugs post surgery, decreases recurrence of the disease and the cost of the treatment. Moreover, the patients were back to work in less than 10 days.

Colestasis inducida por meloxican / Meloxicam-induced cholestasis

The cholestasis by meloxicam has not been often described. However, we present here the clinic, laboratory, histologic and follow up of a patient with cholestatic hepatitis produced by this drug. (Au)

Colestasis inducida por meloxican / Meloxicam-induced cholestasis

The cholestasis by meloxicam has not been often described. However, we present here the clinic, laboratory, histologic and follow up of a patient with cholestatic hepatitis produced by this drug.

[Meloxican-induced cholestasis]. / Colestasis inducida por meloxican.

The cholestasis by meloxicam has not been often described. However, we present here the clinic, laboratory, histologic and follow up of a patient with cholestatic hepatitis produced by this drug.

Colestasis inducida por meloxican. / [Meloxican-induced cholestasis]

The cholestasis by meloxicam has not been often described. However, we present here the clinic, laboratory, histologic and follow up of a patient with cholestatic hepatitis produced by this drug.

[Malignant pleural mesotheliomas]. / Mesoteliomas malignos pleurales.

An increase in incidence of malignant pleural mesotheliomas has been noted recently. In order to assess our own experience, we reviewed all medical records and biopsies of patients who were seen with this diagnosis in Hospital Maria Ferrer between January 1986 and December 1997. Clinical data of 17 patients were analyzed. Mean age was 59 years, 76% were male. Industrial or environmental exposure to asbestos was established in 9 patients (53%). Most common symptoms at presentation were dyspnea (88%) and chest pain (65%). Pleural thickening with or without effusion was the usual finding in chest X rays and CAT scans. Biochemical analysis of pleural fluids was consistent with exudate. Diagnosis was performed by thoracotomy (47%), needle biopsy (23.5%) and videothoracoscopy (29.5%). Histological samples were available for review in 16 of the 17 patients: they were epithelial (10), sarcomatoid (2) and mixed tumors (4). Treatment reflected varying approaches. Palliative methods (pleurodesis, chemotherapy and radiotherapy) were preferred at the beginning while more aggressive interventions are performed nowadays. Pleuroneumonectomy alone or in combination with other therapies was carried out in 5 patients with no operative mortality although some complications occurred such as empyema, bronchopleural fistula and severe chest pain. Survival rate for all groups was 10.5 +/- 5.9 months. However, the mean survival of patients who underwent surgery was 17.5 +/- 2.1 months (p < 0.04) with an associated improvement in quality of life. Therefore, we consider that surgery associated with other therapies offers at present, the best therapeutic option for this bad prognosis condition.

[Treatment with tuberculostatic drugs: compliance at a general hospital]. / Terapeutica con tuberculostaticos: cumplimiento en un hospital general.

The purpose of this study was to assess the compliance with tuberculostatic drugs treatment in a public hospital from Córdoba City and to establish the causes of noncompliance. All the patients to which treatment with tuberculostatic drugs was indicated from January 1991 up to December 1994 were included. 45 patients were included: 18 females (40%) and 29 males. Sixteen (35.6%) did not complete the time of treatment indicated. Nine (56.3%) abandoned the treatment 2 months after having initiated it. In the group that did not complete the treatment there was a higher percentage of female patients (62.5%) than in the group that did complete it (27.6%), p = 0.02. There were not statistically significant differences in age, percentages of pulmonar and extrapulmonar tuberculosis and months of treatment indicated between both groups. Thirty-six percent of the patients who abandoned the treatment referred having interrupted it due to their own negligency, knowing the risk of such behavior; 36% suffered side effects and did not come back to hospital; 21% referred having consulted another physician who indicated to interrupt the treatment without performing other tests; and 7% misunderstood the indications. It is concluded that in a general hospital from Córdoba City, the percentage of patients who abandoned tuberculostatic treatment is high. In most cases the cause was related to failures in the conduct of patients, physicians or both.

[Clinical and epidemiologic characteristics of acute diarrhea in adults at a hospital from Cordoba city]. / Caracteristicas clinico-epidemiologicas de la diarrea aguda del adulto en un hospital de la ciudad de Cordoba.

The purpose of this work was to assess the clinical and epidemiologic presentation features of adult acute diarrhea in a general hospital form Córdoba City. All the patients older than 14 years old who assisted to the Hospital Nacional de Clínicas Central Guard for acute diarrhea, during the periods: A (15-12-89 to 15-03-90), B (15-12-93 to 15-03-94) and C (15-12-94 to 15-03-95), were included. 594 patients were studied: 337 female (56.7%) and 257 male, 143 in the period A, 250 in B and 201 in C. The means +/- SD age was 34.6 +/- 13.3 and stool loose per day at admission 7.3 +/- 4.7. Eighty six percent of patients presented liquid consistent stool, 89.6% abdominal pain, 44.7% vomiting and 18.8% bloody stools. The rate of patients who consulted Central Guard referring acute diarrhea increased from period A (2.4%) to B (3.61%); p = 0.002 and decreased form B to C (2.85%); p = 0.01. The mean (+/- SD) days transcurred from the beginning of diarrhea episode till consultation was 3.5 +/- 2.7; 2.7 +/- 2.3 y 2.9 +/- 3.5 in the periods A, B and C respectively, statistically significant difference between A and B, p < 0.01. Thirty six percent, 21.1% and 23.1% of patients presented mucus with their stools in the periods A, B and C (p = 0.01), and high temperature 61.1%, 48.1% and 48.5% respectively (p = 0.04). Twenty seven percent of stools samples cultures became positive in the periods A, 17.6% in B and 11.5% in C, statistically significant difference between A and C; p = 0.008. The results show that in a general hospital from Córdoba City the adult acute diarrhea is a frequent cause of consult. In the last years there were modifications in its clinical an epidemiologic presentation features.

[Rounded atelectasis: another pulmonary pseudotumor]. / Atelectasia redonda: otro seudotumor de pulmón.

Rounded atelectasis or Blesovsky's syndrome (also called pleuroma, folded lung or shrinking pleuritis with atelectasis) is the association of plaque-like pleural fibrosis with a folding visceral pleura and nodular atelectasis of the underlying lung. It can mimic a peripheral lung tumor or a mesothelioma. Radiography and computed tomography (CT) show a characteristic opacity with a comet-tail sign. The pathogenesis in some of the cases is considered to be secondary to pleural effusions and in others to a contraction of a focus of pleural fibrosis, not associated with effusion. In many cases, there was a history of asbestos exposure. We report the case of a 44-year-old, man who had smoked and worked with materials containing asbestos. He referred thoracic pain of 6 months duration and dyspnea. An X-ray of the chest (Fig. 1, 2) and a CT scan (Fig. 3) revealed a round peripheral mass in the left lower lobe. A fine needle aspiration biopsy of the lung was performed revealing clusters of large atypical cells with abundant cytoplasm. A thoracotomy was decided upon and no frozen section was requested. Gross examination of the resected lobe (Fig. 4) demonstrated a 2.5 cm white, irregular, firm and retracting pleural plaque. On sectioning, a peculiar folding of the visceral pleura delimited by anthracotic pigmentation was noted below the fibrotic plaque. The folding extended perpendicularly deep into the parenchyma. It was possible to separate the folding and liberate the underlying parenchyma, which was firm, fibrotic and atelectatic. No tumor was found anywhere within the lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Atelectasia redonda: otro seudotumor de pulmon / Rounded atelectasis: another pulmonary pseudotumor

La atelectasia redonda o síndrome de Blesovsky, es la asociación de una placa localizada de fibrosis pleural con invaginación de la pleura visceral y atelectasia del pulmón subyacente. Su importancia clínica radica en que radiológicamente simula un tumor periférico. La imagen radiológica y la tomografía computada presentan, no obstante, algunas carcterísticas que permitirían descartar una neoplasia y harían innecesario procedimientos de estudios invasores. En algunos de los casos publicados existió el antecedente de exposición a asbestos. Presentamos a un paciente de 44 años, fumador, que refirió dolor epigástrico irradiado al dorso y disnea, que tenía antecedentes de haber trabajado con materiales que contenían amianto. Las radiografías de tórax y la TAC mostraron un nódulo de densidad heterogénea en el lóbulo inferior del pulmón izquierdo. En una punción aspirativa con aguja fina (PAAF), se observaron células atípicas. En razón de todos estos antecedentes de decidió realizar una toracotomía. En el examen de la pieza de lobectomia no se encontró tumor, pero se hallaron las lesiones pleurales y pulmonares características de la AR: parche pleural fibroso grueso y retraido, plegamiento de la pleura visceral y parénquima atelectásio. Aunque las imágenes que se observan en esta lesión han sido descriptas como muy características, creemos que es necesaria la confirmación anatompatológica, aun recurriendo a la toracotomía, ya que, al menos en un caso publicado, idénticos signos radiológicos correspondían a un adenocarcinoma

Atelectasia redonda: otro seudotumor de pulmón. / [Rounded atelectasis: another pulmonary pseudotumor]

Rounded atelectasis or Blesovskys syndrome (also called pleuroma, folded lung or shrinking pleuritis with atelectasis) is the association of plaque-like pleural fibrosis with a folding visceral pleura and nodular atelectasis of the underlying lung. It can mimic a peripheral lung tumor or a mesothelioma. Radiography and computed tomography (CT) show a characteristic opacity with a comet-tail sign. The pathogenesis in some of the cases is considered to be secondary to pleural effusions and in others to a contraction of a focus of pleural fibrosis, not associated with effusion. In many cases, there was a history of asbestos exposure. We report the case of a 44-year-old, man who had smoked and worked with materials containing asbestos. He referred thoracic pain of 6 months duration and dyspnea. An X-ray of the chest (Fig. 1, 2) and a CT scan (Fig. 3) revealed a round peripheral mass in the left lower lobe. A fine needle aspiration biopsy of the lung was performed revealing clusters of large atypical cells with abundant cytoplasm. A thoracotomy was decided upon and no frozen section was requested. Gross examination of the resected lobe (Fig. 4) demonstrated a 2.5 cm white, irregular, firm and retracting pleural plaque. On sectioning, a peculiar folding of the visceral pleura delimited by anthracotic pigmentation was noted below the fibrotic plaque. The folding extended perpendicularly deep into the parenchyma. It was possible to separate the folding and liberate the underlying parenchyma, which was firm, fibrotic and atelectatic. No tumor was found anywhere within the lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Atelectasia redonda: otro seudotumor de pulmon / Rounded atelectasis: another pulmonary pseudotumor

La atelectasia redonda o síndrome de Blesovsky, es la asociación de una placa localizada de fibrosis pleural con invaginación de la pleura visceral y atelectasia del pulmón subyacente. Su importancia clínica radica en que radiológicamente simula un tumor periférico. La imagen radiológica y la tomografía computada presentan, no obstante, algunas carcterísticas que permitirían descartar una neoplasia y harían innecesario procedimientos de estudios invasores. En algunos de los casos publicados existió el antecedente de exposición a asbestos. Presentamos a un paciente de 44 años, fumador, que refirió dolor epigástrico irradiado al dorso y disnea, que tenía antecedentes de haber trabajado con materiales que contenían amianto. Las radiografías de tórax y la TAC mostraron un nódulo de densidad heterogénea en el lóbulo inferior del pulmón izquierdo. En una punción aspirativa con aguja fina (PAAF), se observaron células atípicas. En razón de todos estos antecedentes de decidió realizar una toracotomía. En el examen de la pieza de lobectomia no se encontró tumor, pero se hallaron las lesiones pleurales y pulmonares características de la AR: parche pleural fibroso grueso y retraido, plegamiento de la pleura visceral y parénquima atelectásio. Aunque las imágenes que se observan en esta lesión han sido descriptas como muy características, creemos que es necesaria la confirmación anatompatológica, aun recurriendo a la toracotomía, ya que, al menos en un caso publicado, idénticos signos radiológicos correspondían a un adenocarcinoma

Drenaje del conducto toracico. Su aplicacion para la prevencion del rechazo en el transplante renal con dadores vivos. / Drainage of the thoracic duct. Its use for prevention of rejection in kidney transplantation with alive donnors

Los autores han realizados 66 trasplantes de rinon, habiendo indicado en solo 3 casos el drejane del conducto toracico.Todos habian sido efectuados con dadores vivos, sin optima compatibilidad. La buena evolucion inmunologica los estimulos a su consideracion

Drenaje del conducto toracico. Su aplicacion para la prevencion del rechazo en el transplante renal con dadores vivos. / Drainage of the thoracic duct. Its use for prevention of rejection in kidney transplantation with alive donnors

Los autores han realizados 66 trasplantes de rinon, habiendo indicado en solo 3 casos el drejane del conducto toracico.Todos habian sido efectuados con dadores vivos, sin optima compatibilidad. La buena evolucion inmunologica los estimulos a su consideracion

Autotransfusion: alternativa natural para la reposicion de la volemia transquirurgica en casos de emergencia o necesidad. / Autotransfusion: natural alternative for the replacement of intraoperative blood volume in emergency cases

Se presenta un metodo de autotransfusion intraoperatoria, como apoyo de la cirugia de los aneurismas de la aorta abdominal.Teniendo en cuenta los tipos de autotransfusion, se eligio a la intraoperatoria como metodo de eleccion, analizando en extenso sus ventajas e inconvinientes; el material utilizado para el procedimiento (modulos aspiradores y reservorios-filtros) y los resultados obtenidos en esta grave patologia de emergencia de vida.Cinco pacientes sobrevivieron, uno fallecio en las primeras 24 horas por falla cardiocirculatoria. No hubo variantes en la morbimortalidad; un enfermo presento ictericia hemolitica postoperatoria controlada.Se proyecto una pelicula testimoniando el procedimiento empleado en 3 pacientes

Autotransfusion: alternativa natural para la reposicion de la volemia transquirurgica en casos de emergencia o necesidad. / Autotransfusion: natural alternative for the replacement of intraoperative blood volume in emergency cases

Se presenta un metodo de autotransfusion intraoperatoria, como apoyo de la cirugia de los aneurismas de la aorta abdominal.Teniendo en cuenta los tipos de autotransfusion, se eligio a la intraoperatoria como metodo de eleccion, analizando en extenso sus ventajas e inconvinientes; el material utilizado para el procedimiento (modulos aspiradores y reservorios-filtros) y los resultados obtenidos en esta grave patologia de emergencia de vida.Cinco pacientes sobrevivieron, uno fallecio en las primeras 24 horas por falla cardiocirculatoria. No hubo variantes en la morbimortalidad; un enfermo presento ictericia hemolitica postoperatoria controlada.Se proyecto una pelicula testimoniando el procedimiento empleado en 3 pacientes