[Orbit decompression surgery in patients with exophthalmos caused by Graves-Basedow disease]. / Cirugía descompresiva de la órbita en pacientes con exoftalmos por enfermedad de Graves-Basedow.

OBJECTIVE: To evaluate in a prospective trial two surgical technique routinely used for orbital decompression in Graves' disease ophthalmopathy. PATIENTS AND METHODS: Patients with Graves' disease exophthalmus (greater than 22 mm) that was euthyroid for at least six months after treatment were admitted to the study and randomly assigned to two groups, twenty six orbits in 17 patients were surgically decompressed with the Walsh and Ogura technique (group I) and 18 orbits in 18 patients were decompressed with Kennedy's surgical approach (group II). RESULTS: Both surgical techniques were equally effective in reducing the exophthalmus (p < 0.05). Morbility was significantly greater in terms of diplopia and infraorbital nerve lesion with Walsh and Ogura surgical approach. CONCLUSIONS: Due to reduced morbility, orbital surgical decompression with Kennedy's technique is recommended in patients with Graves' disease exofthalmus.

[Acute fatty liver of pregnancy complicated by pancreatitis]. / Hígado graso agudo del embarazo complicado con pancreatitis.

A woman with acute fatty liver of pregnancy developed fulminant hepatic failure after delivery, a time when spontaneous recovery was expected. Pancreatitis and multiple organ failure was documented and intensive treatment in a critical care unit was needed to support organ function. She underwent plasmapheresis due to extreme hyperbilirubinemia and coma. She recovered completely.

Pentoxifylline and oxygen consumption in severe sepsis--a preliminary report.

OBJECTIVE: To demonstrate that pentoxifylline (PTX) and not placebo improves oxygen consumption (VO2) in critically ill patients with severe sepsis. SETTING: Multidisciplinary intensive care unit in a university affiliated hospital. DESIGN: A randomized, double blinded clinical trial comparing 300 mg of PTX administered in a 120 min iv infusion with an identically looking placebo. PATIENTS: 13 patients (9 men and 4 women) average age 39 (24-62) years old received PTX, and 12 patients (5 men and 7 women) average age 38 (21-83) years old received placebo. All satisfied ACCP/SCCM criteria for severe sepsis. MEASUREMENTS AND INTERVENTIONS: Patients fulfilling criteria for severe sepsis was identified on admission, cardiac output, DO2 and VO2 were measured by thermodilution and standard oximetric technics after adequate volume replacement at baseline, 60 and 120 during infusion. F-test of analysis of variance was used to test hypothesis about differences of DO2 and VO2 by group, by time and for the interaction terms, a "p" value < 0.05 was considered significant. RESULTS: Evaluation of baseline measurements of both groups revealed no significant difference in any haemodynamic function or oxygen transport variables. The average VO2 difference (0-120 min) between groups was 21 mL/min.m2 and it was higher in the experimental group, however, this difference was non significant. CONCLUSION: We think that the trend in VO2 followed by the experimental group is clinically important. If this difference is sustained we will probably be able to demonstrate our hypothesis.

[Comparative treatment of acute optic neuritis with "boluses" of intravenous methylprednisolone or oral prednisone]. / Tratamiento comparativo de la neuritis óptica aguda con "bolos" de metilprednisolona endovenosa o prednisona oral.

Sixteen patients with acute optic neuritis were studied, and randomized into two groups of treatment. Group I was assigned to in hospital treatment with intravenous methylprednisolone 500 mg Q8 hours for 10 doses, followed by oral prednisone for two weeks and tapering doses thereafter. Group II was treated with oral prednisone one mg per kilogram of body weight for two weeks followed by tapering doses. All patients had examination of visual acuity, visual field at baseline and repeated on weeks two, four and sixteen. Two patients in group I were lost to follow up, and three patients (two in group I and one in group II) had previous established diagnosis of Multiple Sclerosis and the onset of acute optic neuritis was considered a recurrence of the disease. There was no statistical difference between the groups with regards to clinical outcome, visual acuity and visual field examination (p = 0.329) Fisher test.

[The diagnosis of Cushing's disease by the nocturnal dexamethasone administration test]. / Diagnóstico de la enfermedad de Cushing mediante la prueba de administración nocturna de dexametasona.

Prospective study performed at the General Hospital, National Medical Center, XXI Century, Endocrinology Ward, Mexico-City, to compare the diagnostic sensitivity in Cushing's disease of the oral high doses (8 mg) dexametazone suppression test in single doses with nocturnal administration (DXM-N) and the classic doses of two days (DXM-C). Fourteen patients with hypercortisolism were studied; on thirteen the hypophyseal origin was surgical confirmed. Sensitivity of high doses of oral dexametazone test was proved by using serial samples of serum cortisol; the Fisher test was used for analysis of the suppression of serum cortisol after the test was done.

[The somatostatin analog SMA (201-995) as adjuvant treatment in patients with external fistulae of the digestive system]. / El análogo de somatostatina SMS (201-995) como tratamiento adyuvante en pacientes con fístulas externas del aparato digestivo.

Six patients with gastrointestinal fistulae treated with a potent inhibitor of gastrointestinal hormones, the somatostatin analogue SMS 201-995 are reported. All patients had severe intraabdominal diseases and underwent a mean of 3.5 surgery procedures during their hospital stay. When the patients were analyzed individually a mean reduction of 42.5% (P < 0.050 of basal fistulae output was observed after treatment. In three patients the fistulae closed after seven and ten days of treatment with the analogue; the other three patients died after a protracted hospital stay which included multiple admissions to the Intensive Care Unit. When the output of all fistulae treated where analyzed together it showed a tendency to decrease, but it didn't reach statistical significance.

[Effect of a synthetic somatostatin analogue with delayed action (SMS 201-995) on the biliary expenditure in a patient with an external biliary tract fistula]. / Efecto de un análogo sintético de somatostatina de acción prolongada (SMS 201-995) sobre el gasto biliar en un paciente con una fístula externa de las vías biliares.

The effect of treatment with a long acting analogue of somatostatin (SMS 201-995) administered by subcutaneous route 165 micrograms every eight hours in a patient with a external biliary fistula is reported. There was a significant reduction of the daily fistula output during treatment when compared with the basal periods (p = 0.04), with an average decrease of 270 ml/day during the first period of treatment and 357 ml/day when the drug was administered the second time (p = 0.04). There where not changes in the chemical composition of the bile neither adverse side effects were observed during treatment. These results suggest that SMS 201-995 might be useful in the treatment of external biliary fistulas.

[Primary hypothyroidism associated with a chiasmatic syndrome simulating a prolactinoma]. / Hipotiroidismo primario asociado con un síndrome quiasmático que simula prolactinoma.

Three cases of primary hypothyroidism with optic chiasm compression due to pituitary hyperplasia are reported. Patients consulted for amenorrhea, galactorrhea and visual disturbances. The study of these patients disclosed a chiasm syndrome, persistent hyperprolactinemia, decreased thyroxine and triiodothyronine associated with elevated thyrotropin stimulating hormone in blood. Computerized tomography scan revealed the presence of pituitary enlargement. Treatment with thyroid hormones resulted in total resolution of clinical features and disappearance of tomographic abnormalities.