Endocarditis Bacteriana en paciente con sospecha de padecer Colagenopatía. Reporte de Caso / Bacterial endocarditis in patients with suspected collagen disease. Case Report

La endocarditis es la inflamación del endotelio valvular o parietal. La fisiopatología de la endocarditis se basa en la lesión del endotelio cardíaco que predispone a la formación de la vegetación, la cual consiste en una masa de plaquetas, fibrina y escasas células inflamatorias. En países industrializados la incidencia anual de la endocarditis infecciosa es de 3 a 9 casos por cada 100.000 personas. Las colagenopatías pueden lesionar el endotelio cardíaco predisponiendo así a una endocarditis infecciosa, aun siendo el paciente seronegativo para las pruebas reumatológicas. Se presenta el caso de una paciente de 38 años que consulta por dolores articulares y sensación febril de larga data en quien se diagnostica endocarditis bacteriana, sospechándose una enfermedad autoinmune de base por la cronicidad de la sintomatología y el grado de lesión de las válvulas nativas que terminan siendo reemplazadas por válvulas mecánicas; no se ha llegado a confirmar el origen autoinmune de la afectación valvular. Palabras clave: endocarditis, seronegativo, afectación valvular, colagenopatías.

Endocarditis is inflammation of the parietal or valvular endothelium. The pathophysiology of endocarditis is based on cardiac endothelium lesions predisposing to the formation of vegetation, which consists of a mass of platelets, fibrin and inflammatory cells. In industrialized countries, the annual incidence of infective endocarditis is 3-9 cases per 100,000 individuals. Collagen vascular disease can damage the heart and predispose an individual to infectious endocarditis, even if a patient is seronegative for rheumatologic serum markers of disease. We report the case of a 38-year female patient who presented with longstanding joint pain and fevers, who was diagnosed with endocarditis and in whom an autoimmune disease was suspected based on the chronicity of her symptoms and the degree of injury to her native heart valve that required replacement with a mechanical valve. The underlying autoimmune etiology of the damage to her heart valve has not been determined. Keywords: endocarditis, seronegative, valvular disease, collagen

[Radiofrequency ablation and simultaneous insertion of an Amplatzer device in a patient with atrial septal defect and nodal reentry tachycardia]. / Ablación con radiofrecuencia y colocación simultánea de un dispositivo Amplatzer en un paciente con comunicación interatrial y taquicardia por reentrada intranodal.

The association of AV nodal reentry tachycardia and interatrial septal defect has not been described previously. This article reports a 47-year-old woman with an atrial septal defect (ostium secundum) and history of palpitations without documental tachycardia through resting and ambulatory electrocardiography. Rapid atrial pacing under the influence of isoproterenol, during an electrophysiology study, elicited and AV nodal reentry tachycardia of the common type. Successful radiofrequency catheter ablation was performed targeting the slow pathway. Immediately an Amplatzer device was used for closure of the septal defect. Both procedures were successful and without complications. What makes this case unusual is that both interventional procedures were performed during the same session.

[Primaquine and travelers from the Arab world. A report and recommendations]. / Primaquina y viajeros del mundo arabe. Reporte y recomendación.

This paper reports on 2 hemolytic serious reactions in 2 Arabian patients because of the use of primaquine as presumptive antimalarial treatment given in Cuba to all travellers from countries where malaria is endemic. Taking into account the non-existence of imported malaria cases in travellers from the Arab-world since more then 15 years and the frequency of individuals presenting with glucose-6-phosphate dehydrogenase deficiency it is recommended not to use this therapeutic procedure, and to maintain the rest of surveillance measures to all travellers from such region.

[Infant colic]. / Cólico infantil.

The literature regarding infantile colic is reviewed. It is characterized by difficulties in definition. Different theories have been implied as to its etiology: behavioral and developmental as well as gastrointestinal causes are considered. The management and treatment based on both theories were revised. Most of them have proven to be effective in many cases. We recognize that future research is needed so that better management and treatment can be designed and prepared for this condition.

[Oral rehydration: experience in the management of patients with acute gastroenteritis in the emergency room at the Dr. Antonio Ortiz pediatric hospital]. / Rehidratación oral: experiencia en el manejo de pacientes con gastroenteritis aguda en la sala de emergencia hospital pediátrico Dr. Antonio Ortiz.

Oral rehydration solutions containing 50-90 mEq/L of sodium (Na+) have recently been recommended for the ambulatory management of children with acute diarrhea in the United States. We conducted a randomized study comparing the use of a commercial oral rehydration solution (Rehydralyte), containing 75 mEq/L of Na with the usual method of rehydration with an intravenous solution. Patients treated in the University Pediatric Hospital Emergency Room with acute diarrhea were randomly chosen to receive the oral rehydration solution (Rehydralyte) (Group A), control patients (Group B) were hydrated with the usual intravenous fluids, ie, Ringer's Lactate and then a solution of 56 mEq/L of Na. All patients received orientation about this modality of treatment. Both groups were compared as for weight gain, metabolic parameters, duration of diarrhea, impact on complications associated with use of intravenous solution and cost impact. When both groups were compared there were no differences in measurements of clinical, laboratory data and outcome. Advantages of oral rehydration on cost containment and less human suffering were demonstrated. It can be concluded that in Puerto Rican children oral rehydration solution containing 75 mEq/L Na may be used safely for the treatment of acute diarrhea on ambulatory basis.

Nicardipine and propranolol in the treatment of hypertension: similar antihypertensive but dissimilar hemodynamic actions.

Although the precise cause of essential hypertension is not known, empiric treatment is indicated to reduce cardiovascular risks. Several pharmacologic classes of a antihypertensive drugs are available to reduce blood pressure, but they do so by different hemodynamic mechanisms. The physiologic therapeutic goal in patients with hypertension is to normalize the systemic vascular resistance without inducing major alterations in the cardiac output. In this study we compared the antihypertensive and hemodynamic actions of nicardipine, a calcium antagonist, with propranolol, a beta-blocking drug. Both drugs were effective in the treatment of hypertension. However, while propranolol therapy decreased the resting and exercise left ventricular ejection fraction and cardiac output, cardiac function was well preserved during nicardipine therapy. It is concluded that both nicardipine and propranolol exert similar antihypertensive actions but that they cause dissimilar hemodynamic consequences in patients with uncomplicated hypertension.

Spinal cord insults and heterotopic ossification in the pediatric population.

Fifteen of 152 pediatric patients with spinal cord insults (10%) developed heterotopic ossification (HO) at 19 locations. The average age of the patient was eight and one-half years. The spinal cord levels were 13 thoracic and two cervical. The average time to detection of the HO from spinal insult was six and one-half years. The hip was involved in 15 of 19 HO lesions. Decreased range of motion of the affected extremity was the most common sign of occurrence. Alkaline phosphatase was elevated in five of eight patients at the time of detection. Three patients had some resorption of the HO, and one had nearly complete resorption. Five patients (3.3%) with HO had no other etiologic agent other than the neurologic insult, and their average age at time of injury was 13 and one-half years. The hip was involved in six of seven instances. The average time to diagnose this HO was 14 months after injury. Ten patients had late concurrent etiologic factors such as surgery, decubitus ulcers, late neurogenic hip dislocation, and late acute local trauma influencing HO formation. Pediatric patients who developed HO appeared to have a lower incidence, delayed onset, and fewer associated signs and symptoms compared with their adult counterparts with spinal cord injury. Patterns of ossification about the hip differ from adults. The HO lesion has the potential to resorb. HO may be initiated years after the spinal injury by an incidental insult.

How do elderly veterans who fail to keep outpatient clinic appointments differ from those who do not.

The study asked how do elderly veterans who fail to keep appointments in the General Medicine and Surgery Out-Patient Clinics in the San Juan, VA Hospital differ from those who do not. Three hypothesis were formulated: 1. Elderly patients who fail to keep appointments have other medical alternatives in non-VA facilities. 2. Elderly patients who fail to keep appointments have a longer waiting time between appointments. 3. Elderly patients who are given appointments in various clinics within a short period of time fail to keep appointments. A sample of fifty-three elderly veterans from the Medical Out-Patient Clinics was drawn. A face-to-face structured interview was used to collect the data. The interview was designed to obtain socio-demographic characteristics, use of clinics, and recommendations to improve services. A percentage analysis was used to point out differences and similarities. The findings supported the hypothesis that patients who failed to keep appointments not only used private non-VA facilities, but also had the financial resources to pay for them. Data confirmed that those who failed to keep appointments have to wait a longer time between appointments. Patients who failed to keep appointments considered them too infrequent which resulted in forgetting the appointments.

Renal hemodynamic effects of ketanserin therapy in essential hypertension.

Ketanserin is a novel agent that has been shown to be a specific 5-HT2-serotonergic antagonist. It has useful antihypertensive properties. Owing to its unique mechanism of action, it has been suggested that ketanserin may have a favorable effect on tissue blood flow during chronic therapy for hypertension. This double-blind study was designed to evaluate the acute (1 week) and chronic (8 weeks) effects of ketanserin on renal hemodynamic parameters and renin-aldosterone axis in patients with uncomplicated hypertension. Compared to placebo, ketanserin caused a significant blood pressure reduction at the end of the 8-week study period. Despite the reduction in systematic arterial pressure, glomerular filtration rate and renal plasma flow were preserved. Ketanserin therapy induced a slight reduction in plasma renin activity and a marginal increase in the sodium excretion. Although the results of this study are limited by the small number of patients, it appears that ketanserin may have favorable renal hemodynamic effects in uncomplicated essential hypertension.

Supervivencia en el tratamiento quirúrgico del carcinoma de colon / Survival in colon carcinoma surgical treatment

Se investigan 205 pacientes con cáncer de colon tratados en el servicio de cirugía general del hospital docente "General Calixto García" en un período de 10 años; se analiza, el tratamiento a que fueron sometidos y la sobrevivencia a los 5 años; se discuten nuestras estadísticas con las de otros autores y se llega a conclusiones, las cuales se exponen (AU)

The localization of multiple intra-abdominal abscesses by gallium scanning.

A septic course suggestive of intra-abdominal abscess followed surgery in a small child with a perforated appendix. Usual diagnostic studies, fluoroscopy, and rectal and wound exploration failed to localized an abscess. The use of gallium 67 scanning accurately localized multiple abscesses which were successfully drained.