Púrpura trombótico trombocitopénico: revisión de la literatura a partir de 18 casos / Thrombotic thrombocytopenic purpura: experience in 18 cases and literature review

Background: Thrombotic thrombocytopenic purpura (TTP) is characterized by anemia, thrombocytopenia, neurological and renal involvement of variable severity and it has a dismal prognosis. Platelet-derived von Willebrand Factor-cleaving metalloprotease ADAMTS-13 activity may orient the diagnosis, but normal levels do not discard it. The most effective therapy thus known is plasmapheresis. Aim: To report the experience in 18 patients with TTP. Material and methods: Retrospective assessment of 11 patients and prospective assessment of seven subjects with TTP, aged 15 to 81 years. Results: All presented with anemia, thrombocytopenia and LDH elevation. Sixteen had neurological symptoms, five had fever, four had macroscopic urinary excretion of pigments, four had petechiae, and two had nosebleeds. Haptoglobin was low in 10 of 11 patients in whom it was measured. ADAMTS-13 had low activity in 15 of 17 patients (in 11, the inhibitor was found). Seventeen patients were treated with plasmapheresis and nine received steroids also. Seven patients died due to shock with respiratory involvement or múltiple organic failure. Conclusions: TTP has heterogeneous modes of presentation. If the diagnosis is strongly suspected, plasmapheresis can be started without laboratory confirmation. An ADAMTS-13 activity below 6 percent is almost exclusive of TTP .

Enfermedad por arañazo de gato: Características clínicas y de laboratorio en pacientes adultos hospitalizados por fiebre o adenopatías / Cat-scratch disease: Review of eight adult patients hospitalized for fever or adenopathy

Background: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. Aim: To report the clinical and laboratory features of eight patients with cat-scratch disease. Material and methods: Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). Results: Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. Conclusions: Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.

[Ascites and renal failure caused by a bladder fistula: report of one case]. / Ascitis y falla renal: no olvidar el uroperitoneo.

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Ascitis y falla renal: no olvidar el uroperitoneo / Ascites and renal failure caused by a bladder fistula: Report of one case

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Síndrome neuroléptico maligno y poliserositis en paciente usuaria de clozapina: una asociación infrecuente / Malignant neuroleptic syndrome and polyserositis associated to clozapine use: report of one case

Malignant neuroleptic syndrome is a complication of antipsychotic medication use. Clozapine use is also associated with polyserositis and eosinophilia. We report a 17 years old female treated with clozapine, valproic acid, lithium carbonate and lorazepam that consulted in the emergency room for confusion, lethargy, catatonia, rigidity, myalgya and fever. Complete blood count showed eosinophilia. An abdominal CAT scan showed ascites and pleural effusion. Clozapine was discontinued and bromocriptine was started. One week after admission, the patient remained febrile and liver enzymes were elevated. Valproic acid was discontinued. Inflammatory parameters stated to subside and the patient was discharged afebrile days after admission.

Nutrición enteral en UCI: ¿qué hay de nuevo? / Enteral nutrition in ICU: what's new?

This review analysis various controlled randomized studies and systematic reviews in which tolerance, complications, drawback factors, immunonutrition and other advances where evaluated in relationships to enteric nutrition in critical patients.

Virus papiloma humano: oncogénesis y avances terapéuticos / Human papillomavirus: oncogenesis and therapeutic advances

Los virus Papiloma Humano (HPV), abarcan más de cien subtipos de virus distintos. De ellos, muchos están involucrados en diversas patologías epiteliales benignas y malignas de piel y mucosas, como por ejemplo, el Carcinoma Espinocelular, la enfermedad de Bowen y numerosos tumores de la mucosa genitoanal. Los mecanismos patogénicos involucrados en la tumorogénosis, están en pleno conocimiento. La interacción de las proteínas virales E6 y E7, con las proteínas humanas P53 y la proteína del gen del retenoblastoma, juegan un rol fundamental. Esta revisión pretende poner al día, en cuanto a las lesiones asociadas al HPV, sus mecanismos patogénicos, y las nuevas terapias en desarrollo

Manifestaciones cutáneas de las picaduras y mordeduras por algunos artrópodos en Chile / Skin manifestations of bites and stings of some arthropods in Chile

Gran cantidad de especies de artrópodos pueden afectar al hombre, siendo atraídos hacia el huésped por el calor corporal, la sudoración, el dióxido de carbono del aire exhalado, el olor corporal, la microflora cutánea, la sobreinfección bacteriana y ciertos colores en la vestimenta. Estos, entre otros factores, contribuyen a una mayor susceptibilidad a mordeduras y picaduras y son motivo frecuente de consulta en la práctica médica. En esta revisión se profundizará en las manifestaciones cutáneas del huésped frente a la agresión de algunos artrópodos, considerando un rango de manifestaciones clínicas frecuentes, desde las que no ofrecen dificultades diagnósticas (e. g. urticaria papular, prurigo, pediculosis), aquellas más raras (e.g. causados por insectos foráneos, viajes, tungiasis) y a cuadros severos que pueden comprometer la vida del paciente (e.g. loxoscelismo, shock anafiláctico

Necrólisis epidérmica tóxica (NET) una entidad de alta morbimortalidad: a propósito de cuatro casos clínicos / Toxic epidermal necrolysis an entity of high morbimortality: a proposal of 4 clinical cases

La necrolisis epidérmica tóxica (NET) es una severa reacción cutánea caracterizada por la pérdida de grandes áreas de epidermis, producida principalmente por drogas. Poco se sabe en cuanto a la fisiopatología de esta enfermedad, involucrándose factores inmunológicos, infecciosos y genéticos. Al mismo tiempo, se desconoce un tratamiento específico para esta entidad, limitándose a cuidados generales, comparables a los de un gran quemado, y al uso de corticosteroides sistémicos, con resultados controversiales. En esta revisión discutiremos, a propósito de cuatro casos manejados en nuestro Hospital, la situación actual fisiopatológica y terapéutica de esta entidad nosológica. La necrolisis epidérmica tóxica, o síndrome de Lyell, es una severa reacción cutánea producida por drogas en una alta proporción de casos (80 por ciento), pero también por infecciones por gérmenes como mycoplasma pneumoniae y herpes simplex, inmunizaciones y aditivos de alimentos, en la cual se produce una eritrodermia descamativa aguda con necrosis epidérmica y destrucción de la unión dermoepidérmica, originando ampollas flácidas (que dan la apariencia de piel escaldada), generada por apoptosis de los queratinocitos. Tiene una incidencia de 0,4 a 1,2 casos por millón, y ocurre con mayor frecuencia por el uso de sulfonamidades, anticonvulsivantes y antiinflamatorios no esteroidades. Es un cuadro de alta mortalidad reportada, no conociéndose aún tratamiento específico (1,2)