[AA amyloidosis with cutaneous manifestations. Report of one case]. / Manifestaciones cutáneas de amiloidosis sistémica como clave diagnóstica. Caso clínico.

BACKGROUND: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.

Manifestaciones cutáneas de amiloidosis sistémica como clave diagnóstica: Caso clínico / AA amyloidosis with cutaneous manifestations: Report of one case

Background: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated.

Seguridad y eficacia de celiprolol en hipertensos con enfermedad pulmonar obstructiva crónica / Safety and efficacy of celiprolol in patients with chronic obstructive lung disease

Background: Third generation beta blockers have an intrinsic simpatico-mimetic activity and are cardioselective. Therefore, they should not have adverse bronchial effects and could even have a slight bronchodilator activity. Aim: To test the efficacy and safety of celiprolol in hypertensive patients with chronic obstructive lung disease. Patients and methods: Uncomplicated hypertensive patients with chronic obstructive lung disease received celiprolol during 12 weeks. They were subjected to monthly clinical assessment and ventilatory function was measured on the basal period and at the end of the trial. Results: During the study period, blood pressure fell significantly from 179ñ6/112ñ8 to 161ñ4,7/98ñ1.6 mmHg. No changes were observed in forced expiratory volume in 1 s or in forced expiratory flow between 25 and 75 percent of the vital capacity. No subjective changes in respiratory function were reported during the trial. Conclusions: No changes in ventilatory function were observed in these patients with chronic obstructive lung disease, treated with celiprolol during 12 weeks

Síndrome hepatopulmonar en pacientes cirróticos descompensados / Hepatopulmonary syndrome in decompensed cirrhotic patients

Hypoxemia is common in cirrhotic patients and when obvious pulmonary or cardiac causes are discarded, it is attributed to the so-called hepatopulmonary syndrome. The aim of this work was to assess the frequency of hypoxemia and orthodeoxia ans its relationship with the degree of liver failure, in cirrhotic alcoholic patients. We studied 30 alcoholic cirrhotics. In all, arterial blood gases were measured in supine and standing positions in 26 a chest X ray examination was done and in 20 a spirometry. Twelve patients had a subnormal PaO2 and this parameter fell more than 10 percent when assuming the standing position in one of these. The same reduction was observed in 2 subjects with normal supine PaO2. In the chest X ray examinations, pleural effusions were observed in five hypoxemic subjects and 4 with normal PaO2. Likewise minimal athelectasis was found in 6 and 7 subjects and interstitial infiltrates in one and two subjects. A significant association between hypoxemia and Pugh score was observed. Similarly, subjects with hypoxemia had a higher frequency of large esophageal varices. It is concluded that hypoxemia is frequent in alcoholic cirrhotic patients and since it is associated to obvious pulmonary causes, it may be attributed to the hepatopulmonary syndrome

Falla respiratoria aguda en el embarazo, parto y puerperio / Acute respiratory failure in pregnancy labor and puerperium

Se presentan dos casos clínicos de falla respiratoria aguda en el puerperio. Se enfatiza la clínica, método de diagnóstico, elementos instrumentales y de laboratorio. Se destaca el aumento de esta patología en la embarazada