Complicaciones de preeclampsia grave. Presentación de un caso clínico. Revisión bibliográfica / Severe preeclampsia complications. A clinical case report and bibliographic review

A continuación presentamos el caso de una paciente embarazada de 36 semanas que cursa con preeclampsia grave y evoluciona con síndrome HELLP complicado con ruptura hepática; realizando una revisión bibliográfica sobre dicha patología.

The case of a 36-week pregnant patient with severe preeclampsia and HELLP (H, hemolysis; EL, elevated liver enzymes; LP, low platelet count) syndrome evolution with liver rupture and a bibliographic review on such pathology are presented.

Incidencia poblacional del infarto con elevación del ST o bloqueo de rama izquierda a lo largo de 11 años en una comunidad de la provincia de Buenos Aires / Eleven years incedence of infarction with ST elevation or left bundle branch block on the population of a community in the Province of Buenos Aires

Introducción: El infarto agudo del miocardio (IAM) es una causa importante de muerte en la población argentina. Actualmente, su tratamiento está dirigido a intentar la reperfusión precoz de la arteria ocluida por un trombo. No conocemos estudios, realizados en nuestro país, que permitan estimar cuantas personas necesitan este tipo de tratamiento en una población determinada. Objetivos: a) Describir la tasa anual de hospitalizaciones por infarto agudo de miocardio (IAM) en un distrito de la provincia de Buenos Aires en el período 1995-2005. b) Describir la variación de dicha tasa según edad, sexo y época del año. c) Evaluar la mortalidad intrahospitalaria. Población, material y métodos: El presente es un estudio descriptivo retrospectivo (1995-2005) realizado en el distrito de Coronel Suárez, provincia de Buenos Aires, a partir de las hospitalizaciones de los únicos hospitales que internan pacientes con IAM. Se consideró a todo paciente que presentara un diagnóstico de IAM con supradesnivel del ST, se correlacionó con el censo 2001 del INDEC y se estimó la tasa anual de hospitalización para toda la población, por sexo, grupo etario y estación del año. Para analizar la significación estadística de la diferencia de tasas en hombres y mujeres y entre estaciones se utilizó el intervalo de confianza para la relación entre dos tasas independientes y la prueba de chi cuadrado. Resultados: A lo largo del estudio se identificaron 367 hospitalizaciones por IAM, 275 en hombres y 92 en mujeres. La tasa anual de hospitalización por IAM (cada 10.000 personas) para toda la población fue de 9,06 [8,13-9,98], en hombres fue de 13,8 y en mujeres de 4,47 (razón: 3,06[2,37-3,76]). La tasa anual mostró una tendencia creciente con la edad. Conclusiones: En nuestra población, aproximadamente 9 personas cada 10.000 habitantes requerirían internación por IAM por año. La tasa de hospitalización es mayor en hombres y en > 65 años, sin diferencias estacionales significativas...

Introduction: Acute Myocardial Infarction (AMI) is an important cause of death in the Argentine population. At present, its treatment is focused on attempting early reperfusion of the thrombosed artery. We are not aware of studies performed in our country that allowed evaluating how many people need this type of therapy in a given population. Objectives: a) To describe the anual rate of hospitalization due to acute myocardial infarction (AMI) in a district of the province of Buenos Aires within the period 1995-2005. b) To describe the variation of this rate based on sex and season of the year. c) To evaluate in-hospital mortality. Population, material and methods: This is a retrospective descriptive study (1995-2005) performed in the district of Coronel Suarez, province of Buenos Aires, based on the hospitalizations carried out in the only hospitals with AMI patients admissions. All the patients diagnosed ST segment elevation AMI were included, data was correlated with the INDEC 2001 census, and the annual rate of hospitalization was assessed for all the population by sex, age and season of the year. To assess the statistical significance of the difference between male and female patient rates and among seasons of the year, the chi square test was used, and the confidence interval in the relation between two independent rates. Results: Throughout the study, 367 AMI hospitalizations were identified,275 were males and 92 females. The annual AMI rate (each 10,000 people) for all the population was 9.06 [8.13-9.98], 13.78 in males and 4.47 in females (ratio: 3.06 [2.37-3.76]). The annual rate showed an increased trend with age. Conclusions: In our population, approximately 9 out of 10,000 inhabitants would require hospitalization due to AMI per year. The hospitalization rate increases in males and with > 65 years, there were no significant seasonal differences. The in-hospital mortality found in the study was 9%.

Programa de formación clínica complementaria para residencias de cardiología y terapia intensiva / Complementary clinical training program for cardiology and intensive care residences

El objetivo es presentar la estrategia utilizada por un Grupo Planificador de Clínica Médica para los residentes de primer año de cardiología y terapia intensiva. Se describen las características de la planificación, los tópicos y objetivos generales del programa. Se definen los distintos niveles de competencia esperado para cada habilidad: semiológica, procedimentales y de intervención. Se presenta un listado de habilidades con el nivel de intervención esperado al final del primer ciclo en Semiología, Procedimientos Diagnósticos y Terapéuticos. El modelo propuesto se relaciona con las estrategias de educación basada en competencias. Se destaca que el paso inicial para definir estos programas basados en competencias, es definir las necesidades para practicar en forma competente cada especialidad.

The objective of this work is to introduce the strategy used by a Medical Clinic Planning Group for cardiology and intensive care first year residents. First, planning characteristics and general topics and objectives of the program are described. Then, the different competence levels expected for each skill are defined, i.e. semiological, procedural, and interventional competences. A list of skills with the expected intervention level by the end of the first term in Semiology and Diagnostic and Therapeutic Procedures is presented. The proposed model is related to education strategies based on competences. The focus is on the fact that the initial step taken to define these programs based on competences is to establish the needs to practice each specialty in a competent way.

[Neumonía acquired in the community. Practical guide elaborated by a committee intersocieties]. / Neumonía adquirida en la comunidad. Guía práctica elaborada por un comité intersociedades.

Clinical practice guidelines for community-acquired pneumonia (CAP) contribute to improve patient's management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1% of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25% of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP). Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures.

[Treatment of insulinoma with diazoxide]. / Tratamiento del insulinoma con diazóxido.

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg% and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease.

Neumonia adquirida en la comunidad. Guia practica elaborada por un comite intersociedades / Neumonía acquired in the community. Practical guide elaborated by a committee intersocieties

Clinical practice guidelines for community-acquired pneumonia (CAP) contribute to improve patient's management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1 of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25 of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP). Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures

Tratamiento del insulinoma con diazoxido / Treatment of insulinoma with diazoxide

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg% and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease

Tratamiento del insulinoma con diazoxido / Treatment of insulinoma with diazoxide

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg% and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease (AU)

Tratamiento del insulinoma con diazóxido. / [Treatment of insulinoma with diazoxide]

Insulinomas are islet cell tumors of the pancreas that produce hypoglycemia due to inappropriate insulin secretion. They appear generally as solitary adenomas, and less commonly as multifocal microadenomas or malignant insulinomas. Their incidence is approximately one case per 1 million population per year, and they appear mostly in patients above thirty years old. They are mainly situated in the pancreas tail or body. The diagnosis is based on the symptoms related to hypoglycemia, a blood glucose level under 50 mg

and high levels of fast insulin and C-peptide. Selective angiography is the best preoperative procedure to localize the tumor. Occult adenomas, which cannot be represented by preoperative imaging diagnosis, are detectable through intraoperative methods. Primary treatment of insulinoma is surgical resection of the tumor. When it fails or is contraindicated, medical treatment is considered. We present a case of a patient with an insulinoma, who has had excellent response to medical treatment, and we review the clinical manifestations, diagnostic methods and different types of treatment for such a rare disease.

Neumonía adquirida en la comunidad. Guía práctica elaborada por un comité intersociedades. / [Neumonía acquired in the community. Practical guide elaborated by a committee intersocieties]

Clinical practice guidelines for community-acquired pneumonia (CAP) contribute to improve patients management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1

of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25

of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP). Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures.

Neumonia adquirida en la comunidad. Guia practica elaborada por un comite intersociedades / NeumonAía acquired in the community. Practical guide elaborated by a committee intersocieties

Clinical practice guidelines for community-acquired pneumonia (CAP) contribute to improve patients management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1 of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25 of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP). Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures (AU)

Síndrome de embolia grasa : A propósito de un caso / Fatty clot syndrome : Case report

Las complicaciones en los pacientes politraumatizados con fracturas de huesos son muy variadas. Se presenta a un paciente de sexo femenino con politraumatismo, con fractura de fémur, tibia y peroné, a la que se le realiza un bloqueo epidural para la reducción de sus fracturas utilizándose bupivacaína al 0,5 por ciento más fentanilo. A los 75 minutos del intraoperatorio la paciente en forma súbita comienza con disnea, taquipnea, taquicardia, hipotensión e hipoxemia acompañada por posterior deterioro del sensorio. Se procede a soporte ventilatorio con oxígeno al 100 por ciento y máscara, para luego trasladarla a la unidad de cuidados intensivos donde se le diagnostica, mediante elementos clínicos y pruebas de laboratorio, síndrome de embolia grasa seguido de falla multiorgánica.

Síndrome de embolia grasa : A propósito de un caso / Fatty clot syndrome : Case report

Las complicaciones en los pacientes politraumatizados con fracturas de huesos son muy variadas. Se presenta a un paciente de sexo femenino con politraumatismo, con fractura de fémur, tibia y peroné, a la que se le realiza un bloqueo epidural para la reducción de sus fracturas utilizándose bupivacaína al 0,5 por ciento más fentanilo. A los 75 minutos del intraoperatorio la paciente en forma súbita comienza con disnea, taquipnea, taquicardia, hipotensión e hipoxemia acompañada por posterior deterioro del sensorio. Se procede a soporte ventilatorio con oxígeno al 100 por ciento y máscara, para luego trasladarla a la unidad de cuidados intensivos donde se le diagnostica, mediante elementos clínicos y pruebas de laboratorio, síndrome de embolia grasa seguido de falla multiorgánica. (AU)