Fenomeno de Raynaud / Raynauds phenomenon

Raynauds phenomenos is a common paroxysmal vasomotor disorder. It must be distinguised between those with a functional character- primary phenomenon or Raynauds disease and secondary Raynauds phenomenon or syndrome. In our study the highest incidence (81 por ciento) corresponds to patients with secondary Raynauds syndrome; 58 por ciento of these patients showed capillary microscopy alterations and 64 por ciento were ANA test positive, showing those numbers their sensibility and specificity since primary Raynaud´s and healthy control patients did not show these figures. The clear prevalencxe of specific capillary microscopy alterations in secondary Raynauds patients schow that this technique is very useful in the differential diagnosis between primary and secondary Raynauds phenomenon. Serial capillaroscopy studies must then be performed to diagnose connective tissue diseases. Nailfold capillary microscopy is a very usefuld and easy complementary technique; it offers great help and also is of prognostic value in patient with Raynauds phenomenon or connwctive tissue diseases, together with the clinical and laboratory studies contributes for the early diagnosis of these disorders(AU)

Fenomeno de Raynaud / Raynaud's phenomenon

Raynaud's phenomenos is a common paroxysmal vasomotor disorder. It must be distinguised between those with a functional character- primary phenomenon or Raynaud's disease and secondary Raynaud's phenomenon or syndrome. In our study the highest incidence (81 por ciento) corresponds to patients with secondary Raynaud's syndrome; 58 por ciento of these patients showed capillary microscopy alterations and 64 por ciento were ANA test positive, showing those numbers their sensibility and specificity since primary Raynaudïs and healthy control patients did not show these figures. The clear prevalencxe of specific capillary microscopy alterations in secondary Raynaud's patients schow that this technique is very useful in the differential diagnosis between primary and secondary Raynaud's phenomenon. Serial capillaroscopy studies must then be performed to diagnose connective tissue diseases. Nailfold capillary microscopy is a very usefuld and easy complementary technique; it offers great help and also is of prognostic value in patient with Raynaud's phenomenon or connwctive tissue diseases, together with the clinical and laboratory studies contributes for the early diagnosis of these disorders

'Alveolar recruitment strategy' improves arterial oxygenation during general anaesthesia.

Abnormalities in gas exchange during general anaesthesia are caused partly by atelectasis. Inspiratory pressures of approximately 40 cm H2O are required to fully re-expand healthy but collapsed alveoli. However, without PEEP these re-expanded alveoli tend to collapse again. We hypothesized that an initial increase in pressure would open collapsed alveoli; if this inspiratory recruitment is combined with sufficient end-expiratory pressure, alveoli will remain open during general anaesthesia. We tested the effect of an 'alveolar recruitment strategy' on arterial oxygenation and lung mechanics in a prospective, controlled study of 30 ASA II or III patients aged more than 60 yr allocated to one of three groups. Group ZEEP received no PEEP. The second group received an initial control period without PEEP, and then PEEP 5 cm H2O was applied. The third group received an increase in PEEP and tidal volumes until a PEEP of 15 cm H2O and a tidal volume of 18 ml kg-1 or a peak inspiratory pressure of 40 cm H2O was reached. PEEP 5 cm H2O was then maintained. There was a significant increase in median PaO2 values obtained at baseline (20.4 kPa) and those obtained after the recruitment manoeuvre (24.4 kPa) at 40 min. This latter value was also significantly higher than PaO2 measured in the PEEP (16.2 kPa) and ZEEP (18.7 kPa) groups. Application of PEEP also had a significant effect on oxygenation; no such intra-group difference was observed in the ZEEP group. No complications occurred. We conclude that during general anaesthesia, the alveolar recruitment strategy was an efficient way to improve arterial oxygenation.

Localized myofibroblastic proliferation in the neck of a patient with an IgG myeloma.

We describe a myofibroblastic proliferation in the neck and lower part of the face involving skin and muscle of a 68-year-old female patient with an IgG kappa myeloma. Biopsies showed a fusocellular proliferation with scarce pseudoganglion cells involving the superficial fascia and the cutaneous muscle of the neck. The proliferative cells showed immunohistochemical and ultrastructural features characteristic of myofibrobasts with a proliferating cell nuclear antigen index of 48%; 42% of the cells displayed HLADR-positive membrane staining. Cellular proliferation subsided following the use of immunosuppressive drugs. Eight months after initial consultation, the patient developed polymyositis without a proliferative component and died of aplastic anemia.

[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.

Rápida eficacia de terbinafina oral en onicomicosis de los pies: experiencia clínica multicéntrica / Rapid efficacy of oral terbinafine in foot onychomycoses: multicentric clinical experience

Se presenta la experiencia clínica multicéntrica Chile-Uruguay en el tratamiento de la onicomicosis de los pies con Terbinafina oral administrada por 3 meses y en un período de observación postratamiento de 6 meses. Se incluyen 102 pacientes, 43 hombre y 59 mujeres, con una edad promedio de 50 años, que presentaban un cuadro clínico de onicomicosis de los pies, el que fue confirmado por la presencia de dermatofitos en el cultivo micológico inicial (73,5 por ciento trichophyton rubrum). Se seleccionó la uña más comprometida, en la que se evaluaron onicólisis, engrosamiento ungueal, cambio de coloración e inflamación paroniqueal como parámetros clínicos y la evaluación micológica se hizo por examen directo y cultivo. La uña seleccionada tuvo un crecimiento estadísticamente significativo tanto en la fase de tratamiento como la de postratamiento. Los signos clínicos mejoraron durante todo el seguimiento y el 73 por ciento a 86 por ciento de los pacientes alcanzó mejoría total de estos parámetros a los 9 meses de seguimiento. Los exámenes micológicos se fueron negativizando progresivamente, alcanzando en la evaluación final a los 9 meses un 85,9 por ciento y un 90,5 por ciento para exámenes directos y cultivos negativos, respectivamente. Recaídas con cultivos micológicos positivos fueron observadas en 3 pacientes (5 por ciento ). El medicamento fue bien tolerado y los efectos adversos mas frecuentes fueron los gastrointestinales en 11 pacientes. No hubo alteraciones de los parámetros bioquímicos hepáticos. En conclusión, la terbinafina aparece como un nuevo antimicótico de alta eficacia en un corto período de tratamiento

Adenocarcinoma mucinoso primario del piel / Primary mucious adenocarcinma of skin

Se presenta el caso de un adenocarcinoma mucionoso primitivo de piel, ubicado en la mejilla, con historia de 9 años de evolución signada por la recidiva lesional. Se hace una consideración y análisis de la literatura. La negatividad del antígeno carcino embrionario sugiere una línea de diferenciación más primitiva, quizás de una etapa precoz del germen epitelial

Adenocarcinoma mucinoso primario del piel / Primary mucious adenocarcinma of skin

Se presenta el caso de un adenocarcinoma mucionoso primitivo de piel, ubicado en la mejilla, con historia de 9 años de evolución signada por la recidiva lesional. Se hace una consideración y análisis de la literatura. La negatividad del antígeno carcino embrionario sugiere una línea de diferenciación más primitiva, quizás de una etapa precoz del germen epitelial (AU)

[Elastic nevi of a familial nature. Buschke-Ollendorf syndrome. Forme frustre?]. / Nevos elásticos de carácter familiar. Síndrome de Buschke-Ollendorf. Forma frustra?

Four cases of "connective naevus" have been revised in a family, mother and her two daughters and son. The histology shows as principal characteristic hyperplasia, thickness and crossing disposition of elastic fibers, forming an image similar to the one of an "elastic naevus". Because of its familiar features and the absence of osteopoikilosis, we postulate a frustrate form of the Buschke-Ollendorf syndrome.