Complications of Bothrops, Porthidium, and Bothriechis snakebites in Colombia. A clinical and epidemiological study of 39 cases attended in a university hospital.

The clinical and epidemiological features, as well as complications presented by 39 patients with Bothrops, Porthidium and Bothriechis snakebites, are described. Patients were admitted during 1 year in 25 hospitals of Antioquia and Chocó and then, they were transferred to the Hospital Universitario San Vicente de Paúl in Medellín, 30 of them because of the presence of complications, eight because of lack of antivenoms and another one because of the desire of his relatives. Thirty--one (79.5%) of the patients were male, 13 (33.3%) children, 59% of them were bitten at the lower extremities, the majority (74.4%) by Bothrops asper. Twenty-one (53.8%) of the patients were initially attended by traditional healers and sought medical attention at the local hospitals after 2h in 87.2% of the cases. Edema (100%), hemorrhage (74.4%), blistering (38.5%) and necrosis (38.5%), were the local signs of envenomation, while blood coagulation alteration (79.5%), hematuria (74.4%), gingival bleeding (43.6%), hypovolemic shock (23.1%) and oliguria (23.1%), were the systemic signs of envenomation. The final grade of envenomation was severe in 29 patients (74.4%). Thirty patients (76.9%) had one or more complications of the envenomation: acute renal failure (ARF), 15 (38.5%); soft-tissue infection, 12 (30.8%); central nervous system (CNS) hemorrhage, 5 (12.8%); compartment syndrome, 3 (7.7%); soft--tissue hematomas, 6 (15.4%); and Abruptio placentae, one (2.6%). There were four deaths (10.3%), two from ARF and two from cerebral hemorrhage. Fourteen other patients (35.9%) had sequelae. The onset of serotherapy after 2h of the bite was associated with the occurrence of ARF and CNS hemorrhage (p=0.02), as well as the risk of death and sequelae (RR=2.5).

Quiste oseo aneurismatico subperiostico e intracortical: reporte de casos / Aneurismal bone cist subperiostial and intracortical

El quiste óseo aneurismático es un tumor óseo benigno, metafisario que se presenta en la segunda década de la vida; compromete los huesos alrededor de la rodilla, elementos posteriores de la columna y húmero proximal. El diagnóstico es clínico y radiológico. Se confirma mediante biopsia que debe descartar malignidad concomitante. Este tumor puede tener un comportamiento agresivo por lo que es importante darle un tratamiento minucioso con resección, curetaje e injerto óseo. La radioterapia tiene indicaciones muy precisas y no debe ser utilizada de rutina por el riesgo de malignización. Su pronóstico es bastante bueno

Miositis osificante progresiva / Fibrodysplasia ossificans progressive

El artículo presenta el caso de una niña de diez años de edad con diagnóstico de miosistis osificante progresiva (MOP), punto de partida para analizar los hallazgos radiológicos que sugirieron el diagnóstico. Se revisan,además, los principales conceptos de esta entidad, entre éstos su incidencia en la población pediátrica, los factores de riesgo, la presentación clínica, las características radiológicas, los diagnósticos diferenciales, el tratamiento y el pronóstico