Fiebre prolongada de orígen desconocido: consideraciones generales, diagnósticas y terapéuticas / Prolonged fever of undeterminated origin: general, diagnostic and therapeutical considerations

Se define el concepto de fiebre prolongada de origen desconocido. Se describen sus causas principales: infecciones, neoplasias, enfermedades autoinmunes y por hipersensibilidad y misceláneas. Se realizan consideraciones diagnósticas realzando la vigencia de una anamnésis y examen físico cuidadosos y señalando el aporte de técnicas complementarias. Finalmente se efectuan algunas consideraciones terapéuticas destacando la inconveniencia de realizar tratamientos de prueba sin un diagnóstico definitivo

Fiebre tifoidea asociada a amebiasis invasora / Thyfoid fever associated with invading amebiasis

Se presenta el caso de una paciente de 23 años quien 3 semanas después de un parto operatorio presenta un cuadro diarreico agudo más un síndrome febril con hemocultivos y coprocultivo positivos a Salmonella thyphi y que fallece al cabo de 20 días. La necropsia demuestra la asociación de una tifoidea con ulceración de las placas de Peyer del íleon, pero sin perforación intestinal y de una extensa amebiasis invasora con úlceras en botón de camisa con trofozoitos de Entamoeba histolytica, localizadas de preferencia en ciego y colon ascendente

Tratamiento de la úlcera gástrica con sucralfato y famotidina / Treatment of gastric ulcer: sucralfate vs famotidine

We conducted a double blind random study on 79 patients with gastric ulcer: 39 received sucralfate, 1 g 4 times a day (Group 1) and 40 received a single evening dose of famotidine, 40 mg (Group 2). At 4 weeks, endoscopy revealed healing of the ulcer in 46% of patients in Group1 and 40% in group 2 (NS). At 8 weeks, corresponding figures were 90% and 75 (NS). All patients were able to complete treatment and minor side effects were reported from all patients, 36% with sucralfate and 28% with famotidine. Thus, sucralfate and famotidine are equally effective for therapy of gastric ulcer. The higher percentage of helaing with sucralfate observed in this study was not statistically significant

Comparación de dos esquemas de tratamiento para erradicar helicobacter pylori / Comparison of 2 treatment schemes to erradicate helicobacter pylori

Introduction: Anti secretory drugs, antimicrobials and bismuth salts are used with variable success to erradicate helicobacter pylori. Aim: To assess the effectiveness and rates of reinfection of 2 therapeutic modalities H pylori infection in adult patients with duodenal ulcer or non ulcer dyspepsia. Methods: during upper gastrointestinal endoscopy, 5 antral and 2 fundic biopsies were obtained and sent for microbiological and anatomopathological study. Patients infected with Helicobacter pylori were randomly assigned to receive during 2 weeks omeprazole 20 mg od plus amoxicillin 500 mg tid (group A) or bismuth subsalicylate 260 mg bid, metronidazole 250 mg tid and amoxicillin 500 mg tid (group B). A new endoscopy with antral and fundic biopsies was performed to all patients four weeks after discontinuing treatment and six months later to those in whom H pylori was eradicated. Results: 80 patients (40 in each treatment group) completed the treatment and follow up. H pylori was eradicated in 22 patients of group A (55 percent) and 28 of group B (70 percent). Minor adverse effects were reported by 5 patients in group A (12 percent) and 11 in group B (27.5 percent). Six months later, reinfection was documented in 12 patients of group A and 8 of group B (54 percent and 30 percent of those with successful treatment respectively). Ten of 25 patients with duodenal ulcer had reinfections, but there was only one ulcer relapse. Conclusion: These 2 treatment modalities have similar results