Discordant expression of maternal SLE in twin pregnancy with a single fetal AV block: A case report.

There are multiple manifestations in the neonatal period for infants born to mothers with systematic lupus erythematosus (SLE), ranging from cardiac, hematologic and dermatologic abnormalities. Cardiac complications may arise in utero in the form of heart block with a resulting increase in fetal mortality. The fetal conduction system is suspected to be affected by transplacental maternal antibodies, however additional environmental and fetal factors appear to play a role. We describe a rare case of a dichorionic-diamniotic twin pregnancy in which only one twin developed a complete heart block progressing to hydrops fetalis and fetal demise.

Enteroscopia doble balón y videocápsula endoscópica en el diagnóstico de patologías del intestino delgado: hospital universitario de maracaibo. 2007-2010 / Double-balloon enteroscopy and endoscopic video capsule in the diagnosis of diseases of the small intestine: maracaibo university hospital. 2007-2010

Introducción: La Enteroscopia Doble Balón (EDB) y la Videocápsula Endoscópica (VCE) se introdujeron en el Hospital Universitario de Maracaibo desde 2007 y 2008, respectivamente. Se analizó y comparó el desempeño de estas pruebas para diagnosticar enfermedades del intestino delgado. Pacientes y Métodos: Se revisaron retrospectivamente los casos sometidos a EDB superior (EDBS), EDB inferior (EDBI) y/o VCE, desde su implementación hasta enero de 2010. Resultados: En 94 casos (55 ♂ y 39 ♀; 10-89 años) se realizaron 155 procedimientos: 52 EDBS, 8 EDBI, 16 VCE y 79 procedimientos combinados. Indicaciones predominantes: Hemorragia de origen oscuro, hemorragia digestiva superior o inferior, anemia, diarrea crónica y sospecha de tumoración intestinal. Visualización completa del tracto entérico: 86,7% (EDBS), 57,7% (EDBI) y 100% (VCE). Biopsias, terapias y/o cromomarcaje: 58,2% (EDBS) y 23,1% (EDBI). Diagnósticos endoscópicos predominantes: Malformaciones vasculares, enteropatías de aspecto parasitario, neoplasias malignas, enteropatías ulcerosas y erosivas. Concordancia indicación/diagnóstico: 74,3% (EDBS), 57,7% (EDBI) y 70% (VCE). Conclusiones: La EDB y la VCE constituyen herramientas eficientes con ventajas particulares para diagnosticar patologías del intestino delgado: La EDB permite realizar procedimientos adicionales; la VCE ofrece mayor probabilidad de visualizar todo el tracto entérico. En casos concretos, combinar estar pruebas podría aumentar su eficiencia diagnóstica y terapéutica.

Introduction: Double Balloon Enteroscopy (DBE) and Endoscopic Viocapsule (EVC) were introduced in the University Hospital of Maracaibo since 2007 and 2008, respectively. Their performance in diagnosing small bowel diseases were analyzed and compared. Patients and Methods: Cases undergoing upper DBE (UDBE), lower DBE (LDBE) and/or CE, were retrospectively reviewed since the introduction of these techniques, until January 2010. Results: In 94 cases (♂: 55; ♀:39; Ages: 10 to 89), 155 diagnostic procedures were performed: 52 UDBE, 8 LDBE, 16 EVC and 79 combined procedures. Predominating indications: obscure gastrointestinal bleeding, upper and/or lower gastrointestinal bleeding, anemia, chronic diarrhea, and suspicion of an intestinal tumor. Full visualization of small bowel: 86.7% (UDBE), 57.7% (DBUE) and 100% (EVC). Biopsies, therapies and/or India ink tattooing: 58.2% (UDBE) and 23.1% (DBLE). Predominant endoscopic diagnoses: vascular malformations, parasitic enteropathies, malign tumor, ulcerative enteropathies and erosive enteropathies. Agreement indication/diagnosis: 74.3% (UDBE), 57.7% (LDBE) and 70% (EVC). Conclusions: DBE and EVC constitute efficient methods with particular advantages for diagnosing small bowel pathologies: DBE allows additional procedures; EVC provides a greater chance of full visualization of small intestine. In specific cases, combination of these tests could improve their diagnostic and therapeutic efficiency.

Necrosis gástrica masiva secundaria a ingesta de ácido clorhídrico / Massive gastric necrosis from hydrochloric acid ingestion

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Meningocele manque dorso-lumbar: a propósito de un caso / Lumbar back meningocele manque: a purpose of a case

EL meningocele manque es una patología infrecuente que se caracteriza por una protrusión de meninges y liquido cefalorraquídeo, con una banda anclante de raíces nerviosas libres funcionantes o de la medula misma sin placoda neural. Se presenta este caso de un recién nacido masculino con diagnóstico de meningocele manqué, que fue operado en el Hospital Central “Dr. José María Vargas” San Cristóbal (HCJMV), evolucionando satisfactoriamente. Esta entidad es infrecuente, sin predilección de sexo y se reporta en menos del 4 por ciento con una tasa de 1 x 100000 nacidos vivos; en pacientes con localización dorsolumbar, el conocer esta entidad permitiría al neurocirujano, identificar claramente estos casos durante su práctica profesional.

Teratoma quístico mediastinal: reporte de dos casos / Mediastinal cystic teratoma: reviw of two cases

Los teratomas extragonadales son más frecuentes en la región sacro coccígea y en el mediastino. En el presente trabajo se reportan dos casos de teratomas mediastinales que simularon procesos infecciosos. Estos casos se presentaron en el primer semestre del año 2000 y representan la casuística del Instituto Autónomo Hospital Universitario de los Andes (IAHULA) en un periodo de diez años (1996-2005). Dos pacientes pediátricos de 10 años y 8 meses de edad respectivamente, ingresaron con los diagnósticos de absceso pulmonar y bronconeumonía con manifestaciones clínicas de tos, disnea, malestar general y fiebre. Se realizó toracotomia posterolateral con resección total de la neoplasia. En ambos casos la pieza quirúrgica correspondió a masa tumoral multiloculada, con espacios ocupados por material sebáceo, pelos y sangre. Histológicamente se demostró la presencia de células neoplásicas parenquimatosas derivadas de más de un estrato germinal. Los teratomas mediastinales son poco frecuente durante la infancia, pero el diagnóstico debe ser considerado en niños con sintomatología respiratoria. El diagnóstico definitivo se realizó después del examen morfológico de la pieza quirúrgica. El diagnóstico microscópico fue sencillo y no requirió de técnicas histológicas adicionales. El tratamiento de elección en estos casos es quirúrgico. La evolución de los pacientes cinco años después es satisfactoria.

[Mediastinal cystic teratoma. Review of two cases]. / Teratoma quístico mediastinal. Reporte de dos casos.

Extragonadal teratomas are more frequent in the mediastinum and sacrococcygeal region. In this work, two cases of mature mediastinal teratoma, that simulated infection processes are reported. These cases appeared during the last semester of the year 2000 and represent the casuistry of the University Hospital of The Andes (IAHULA) between 1996 and 2005. Two patients, one ten-year-old and the other eight-month-old were admitted at the hospital with a diagnosis of bronchopneumonia and pulmonary abscess with clinical manifestations of cough, dyspnea and chest pain. During surgery, a multicystic tumor composed of fat, sebaceous and mucinous materials, hair, mineralized elements and blood was found in both cases. A histological examination revealed the presence of neoplastic cells derived from more than one germinal strata. Teratomas are infrequent, but the diagnosis must be considered in children with respiratory symptoms. A full histological examination was required to reach a definitive diagnosis. The histological diagnosis was easily performed by conventional light microscopic examination. No additional techniques were necessary. Surgical resection should thus be the first choice for treatment. Four years later, there is no evidence of tumor recurrence.

Norwalk virus infection in Venezuela.

The presence of antibodies against Norwalk virus (NV) was studied in sera from different Venezuelan populations, using an enzyme immuno-assay (EIA) based on recombinant NV protein. Antibodies to NV were found in 47%-53% of urban subjects from Caracas, 83% of rural subjects from the west of the country, and 73%-93% of Amerindian subjects. The prevalences found in the rural and Amerindian groups were significantly higher than that in the urban group. Although about 50% of the children studied were seropositive for NV by the age of 5 years, only four (0.4%) of 1120 faecal samples from children with diarrhoea which were tested for the presence of NV antigen by sandwich EIA were found positive. An increase of at least 4-fold in the titre of anti-NV IgA was found in three (5%) of 61 pairs of sera taken during and 1 month after an acute episode of diarrhoea not due to rotavirus. NV was therefore not a predominant aetiological cause of gastro-enteritis in young children in Venezuela between 1993 and 1995, although it can be the cause of diarrhoea in infants.

Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment.

PURPOSE: Our aim was to assess the value of a parasympathomimetic drug (neostigmine) in the early resolution of acute colonic pseudo-obstruction (Ogilvie's syndrome). METHODS: A prospective study was undertaken in 18 consecutive patients (mean age, 76 (range, 31-87) years) with acute colonic pseudo-obstruction. After a varying period of conservative treatment in all cases, 16 patients with persistent, massive abdominal distention were given intravenous neostigmine. RESULTS: A rapid and satisfactory clinical and radiologic decompression of the large bowel was obtained in 12 patients (75 percent) after a single dose of the drug; another patient had complete resolution after a second dose, and the other 3 patients had only partial resolution, in one of them after a second dose of the drug. No patient required surgical decompression of the bowel. CONCLUSION: These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's syndrome. The treatment with intravenous neostigmine has proved very effective, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoiding surgical treatment in a consecutive series of patients.

[Ulcerative jejunitis: a complication of celiac disease]. / Yeyunitis ulcerativa: una complicación de la enfermedad celiaca.

We report the case of a 57-year-old woman with celiac disease of long standing, who developed episodes of intestinal obstruction during two months. They were misdiagnosed as intestinal obstructions caused by adhesions. The barium meal and follow-through examination disclosed several jejunal stenoses. Therefore, the patient underwent early surgery where an intestinal resection was carried out. The histological examination showed the presence of benign ulcers at the stenoses. After surgery, the patient began to gain weight and her nutritional state improved remarkably.

Determination of phagocytosis of Leishmania spp. by human polymorphonuclear leukocytes using anti-Leishmania monoclonal antibodies.

Phagocytosis of Leishmania is an early event in the capacity of human polymorphonuclear cells to limit the spread of this infectious agent. We compared two methods to assess the phagocytosis of Leishmania by PMN cells; the first using histochemical staining with Wright or Giemsa, and the second using the immunoperoxidase technique with anti-Leishmania monoclonal antibodies. The quantitative results obtained with either of the cytochemical methods were comparable with the immunoperoxidase technique, but the latter offered the advantage of an easier identification of the intracellular parasites. This improvement greatly reduced the time required to quantify phagocytosis compared to the conventional staining techniques.

Captopril como droga monoterapica de la hipertensión diastolica / Captopril as drug monotherapy of diatolic hypertension

La efectividad e inocuidad del captopril, como droga monoterápica, fue evaluada en 35 pacientes con hipertensión diastólica crónica de etiología desconocida, en un estudio abierto de 8 días de duración. Fueron administrados 75 mg diarios de la droga, en forma de comprimidos por vía oral. La efectividad hipotensora fue del 82 por ciento. El 31,4 de los pacientes presentaron efectos adversos, ocurriendo la respuesta a primera dosis en el 11,2 por ciento no siendo necesaria la suspensión de la medicación en ningún caso

Allergic reactivity and socio-economic level in a tropical environment.

As some factors associated with the tropical environment can modify the expression of atopic disease, various indicators of allergic reactivity were compared between allergic and non-allergic subjects of different socio-economic level in Caracas, Venezuela (Lat. 10 degrees N). The socio-economic levels considered were high (HSEL), medium-high (MSEL) or low (LSEL). As generally found in temperature climates, in the HSEL the total serum IgE levels of allergic patients were significantly greater than those of non-allergic individuals (geometric means of 274 vs 126 IU/ml, respectively), as were also the specific serum IgE antibody levels (55.6 vs 23.8% positive, respectively, for house dust). These results correlated closely with the skin-test reactivity of these subjects (60.3 vs 17.5% positive for house dust). In this group, the degree of intestinal helminthic infection was low (5.6% positive for Ascaris). In contrast, for the MSEL where the degree of parasitic infection was higher (13.0%), the total serum IgE levels were elevated in both allergic and non-allergic subjects (602 vs 363 IU/ml). Similarly, positivity for specific IgE antibody was high, and comparable between allergics and non-allergics of this group (61.5 vs 54.2%), as was also the case for skin-test reactivity (71.9 vs 60.4%). In the LSEL, parasitic infection was prevalent (47.6%), and the total serum IgE levels were markedly elevated, with little difference occurring between allergic and non-allergic individuals (2269 vs 1981 IU/ml). The positivity for specific IgE antibody was high, and effectively independent of the allergic state (75.6 vs 53.7%), but in contrast the skin test reactivity was relatively low (22.0 vs 9.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

Estudio doble ciego comparativo entre melagenina y placebo en el tratamiento del vitiligo / Comparative double-blind study between melagenina and placebo in the vitiligo therapy

Se realizó un estudio a doble ciego comparativo y aleatorio para evaluar la efectividad terapéutica del extracto placentario humano EP-50 Melagenina R, en el tratamiento del vitiligo. El estudio incluyó a 24 pacientes de ambos sexos, de diferentes grupos etarios y cuadros clínicos variables de acuerdo con la extensión de las lesiones y tiempo de evolución de la enfermedad. La duración del estudio fue de 6 meses. A todos los pacientes se les practicó, además de la evaluación clínica, un estudio de las subpoblaciones linfocitarias en sangre periférica y una evaluación de la respuesta linfoproliferativa frente a la fitohemaglutinina (PHA) y Concavalina A, al iniciar y finalizar el estudio. La evaluación clínica e inmunológica no arrojó diferencias significativas entre el grupo que recibió Melagenina R y el grupo que recibió placebo. De los 24 pacientes evaluados, se encontró una mejoría leve en 9 pacientes del grupo tratado con Melagenina (75%) y en 6 pacientes del grupo placebo (50%). Estas diferencias no fueron estadísticamente significativas

An unusual case of hyper-production of IgE, treated by plasmapheresis.

A 15-year-old boy with severe inflammatory skin lesions from an early age was found to have extremely elevated serum IgE levels (up to 376.000 IU/ml). His skin showed positive direct immunofluorescence for IgE and he had peripheral and bone marrow eosinophilia. No evidence for atopic disease was found, but he suffered intestinal helminthic infection of moderate intensity. He showed a somewhat depressed cell mediated immune response but a normal polymorphonuclear function. Various treatments that included anti-inflammatory, anti-allergic, anti-parasitic, anti-mycotic and PUVA therapy did not significantly improve his condition A therapeutic test using plasmapheresis produced marked, though short-lived clinical improvement. We believe that this case might result from the superimposition of the stimulatory effects of intestinal helminthiasis on a background of intrinsic hyper-production of IgE.

High allergic reactivity in a tropical environment.

The prevalence of atopic disease in tropical populations is often considered to be low, and this has been attributed to an immunological modulating effect of intestinal helminthiasis. We, however, report that the frequency of positive allergic history and skin-test reactivity to groups of major environmental allergens is extremely high (43 and 63% respectively) in children in Caracas, Venezuela (Lat. 10 degrees N). These values were statistically significantly greater than in a group of children with a similar age and sex distribution studied in parallel, but having limited or no contact with a tropical environment (29 and 37% respectively). The two groups differed with respect to the sporadic and light intestinal helminthic infections (such as ascariasis) experienced by the Venezuelans, compared to rare contact in the 'non-tropical' group. This was probably the cause of the increased total serum IgE levels of the former children (369 vs 68 iu/ml), and possibly, therefore, their higher allergic reactivity.

Incidence of atopic disease in a tropical environment: partial independence from intestinal helminthiasis.

The reported incidence of atopic disease in the tropical environment, albeit somewhat controversial, has often been very low. This has been postulated to be due to an inhibitory influence of intestinal helminthiasis, although the predominantly rural nature of the populations studied might also be an important factor to consider. We evaluated two tropical groups in Venezuela that were basically comparable, both being highly parasitized but one of which was urban and the other rural. The apparent incidence of allergic conditions in the urban group was, in fact, comparable to that in temperate countries, whereas that of the rural subjects was markedly lower. A similar difference was found in skin test positivity to common inhalant allergens, although reactivity to Ascaris extract was comparably high between the two groups, and total serum IgE and eosinophil levels were uniformly elevated. Our results suggest that the incidence of atopic disease in the topical environment may depend not only on the intensity of helminthiasis suffered but also on factors related to the urban-rural situation.

Diagnosis of atopic conditions in the tropics.

Controversy surrounds studies of the incidence and clinical importance of atopic disease in tropical populations. This could be due in part to the methods of evaluation employed. The value of some of the tests commonly used in the diagnosis of atopic disease was therefore examined in a tropical situation. Extracts of environmental allergens are usually obtained from suppliers located in more temperate regions of the world, and skin tests, the radio-allergosorbant test (RAST) and RAST-inhibition demonstrate that these can lack important tropical allergens. In addition, although some local extracts are used in clinical practice, these have great variability in their protein content, allergenicity and toxicity. In the tropical environment serum IgE levels can have a greater relation to intestinal helminthic infestation than to atopic disease, even after anti-parasitic treatment, and thus the definition of "normal" IgE values must take into account the socio-economic status of the groups examined. The helminth-induced elevation of total serum IgE levels can also cause false-positive RAST results.