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2009-01-01
Introduccion y objetivos La cistatina C es una proteina con una concentracion plasmatica estable y eliminacion exclusivamente renal. El objetivo del presente estudio es evaluar el valor pronostico de la cistatina C en pacientes con sindrome coronario agudo. Metodos Estudiamos prospectivamente a 203 pacientes ingresados por sindrome coronario agudo. Se realizo una determinacion analitica a las 24 h del ingreso que incluia creatinina, cistatina C, hemograma, colesterol total y fraccionado y marcadores de necrosis miocardica. Se estimo la tasa de filtrado glomerular mediante la ecuacion MDRD. Se compararon 2 grupos segun las concentraciones sericas de cistatina C (
2008-01-01
La insuficiencia aortica es un fenomeno diastolico, aunque ha sido descrita durante la sistole en casos aislados. Nos propusimos evaluar la incidencia en la practica habitual del fenomeno de insuficiencia aortica sistolica y el tipo de pacientes en que se presenta. Inclusion exhaustiva y prospectiva de todos los estudios realizados durante 1 mes en una agenda de ecocardiografia hospitalaria. Detectamos 5 casos de insuficiencia aortica sistolica en un total de 216 estudios (2,3%). En todos los casos los pacientes tenian insuficiencia cardiaca de algun grado. El fenomeno estaba presente en el 5,9% de los pacientes ingresados con insuficiencia cardiaca. En un paciente con fibrilacion auricular la insuficiencia aortica sistolica desaparecio y el estado clinico mejoro tras la modulacion del nod...
2008-01-01
Objetivo Se recomienda la tromboprofilaxis con heparina de bajo peso molecular a dosis fijas en pacientes medicos agudos que requieran ingreso hospitalario. El objetivo de este estudio ha sido determinar si la actividad antifactor Xa de la enoxaparina depende del peso corporal cuando se administra a pacientes hospitalizados por un proceso respiratorio agudo como profilaxis de la enfermedad tromboembolica venosa. Pacientes y metodos Se incluyo prospectivamente en el estudio a todos los pacientes ingresados en el Servicio de Neumologia entre enero y diciembre de 2006 por un proceso respiratorio agudo con indicacion de tromboprofilaxis farmacologica. Se determino la actividad anti-Xa 4 h despues de la administracion de la enoxaparina, en el tercer dia de ingreso hospitalario. El criterio de e...
2009-01-01
Introduccion y objetivos El objetivo de este estudio es evaluar si una intervencion domiciliaria reduce la mortalidad y los reingresos hospitalarios de pacientes con insuficiencia cardiaca y mejora su calidad de vida. Metodos Ensayo clinico aleatorizado, realizado desde enero de 2004 a octubre de 2006. Se aleatorizo a 283 pacientes, diagnosticados de insuficiencia cardiaca e ingresados en el hospital, al grupo de atencion domiciliaria (grupo intervencion) o al grupo de atencion habitual (grupo control). La variable principal de resultado se midio al ano de seguimiento y fue la combinacion de la mortalidad por todas las causas y los reingresos hospitalarios debido al empeoramiento de la insuficiencia cardiaca. Resultados La variable principal se observo en el 41,7% de los pacientes del grup...
2009-01-01
Introduccion y objetivos En el electrocardiograma inicial de los pacientes con infarto agudo de miocardio, diferentes variables tienen valor pronostico. La elevacion del segmento ST, ademas, es un indicador del tratamiento de reperfusion. Nuestro objetivo es conocer las diferencias electrocardiograficas en relacion con el sexo de los pacientes con infarto agudo de miocardio con elevacion del segmento ST (IAMEST) y la posible asociacion del sexo con una marcada elevacion del segmento ST. Metodos Estudio observacional, longitudinal y prospectivo de los pacientes ingresados consecutivamente en dos unidades coronarias con un primer IAMEST e ingreso precoz (n=1.422). Las variables del ECG inicial se compararon por sexos. Se realizo un analisis multivariable para conocer las variables con influe...
2009-01-01
The colorectal cancer presents high incidence. This pathology occupies the fifth place among the neoplasias in both sexes in Cuba. With the objective of characterizing this disease we carried out a descriptive transversal study at the service of General Surgery of the University Military Hospital of Matanzas 'Dr. Mario Munnoz Monroy', in the period from January 2001 to January 2005, studying age, sex, familiar oncological antecedents, presentation form, localization and diagnosis of the tumor, and also the surgical technique used in the treatment. The results showed predominance of the male sex in ages between 60 and 69 years old, different symptoms depending on the localization, predominance of the rectal cancer, and others. It was concluded that there is a delay between the beginning of the symptoms and the diagnosis, considerably diminishing the healing possibilities ...
2008-01-01
El valor pronostico del peptido natriuretico cerebral (BNP) tras un episodio de insuficiencia cardiaca aguda (ICA) no ha sido totalmente establecido. El objetivo de este trabajo fue evaluar la relacion entre las concentraciones de BNP y la mortalidad y los reingresos por ICA. Analizamos a 569 pacientes ingresados consecutivamente con el diagnostico de ICA. Se determino el BNP tras la estabilizacion inicial del paciente. La relacion entre el BNP y la mortalidad fue evaluada mediante regresion de Cox y la relacion con el reingreso, mediante regresion con ajuste para episodios competitivos. Durante una mediana de seguimiento de 9 (3-18) meses, se registraron 156 muertes (27,4%) y 140 reingresos (24,6%). En el analisis multivariable se observo una asociacion positiva y lineal entre el riesgo d...
2008-01-01
La angina preinfarto precoz (semana previa) se asocia a una reduccion de las complicaciones cardiovasculares en la fase aguda del infarto, pero es escasa la informacion sobre su relacion con el pronostico tras la fase hospitalaria (muerte cardiovascular y desarrollo de insuficiencia cardiaca e isquemia miocardica). Estudiamos a 290 pacientes consecutivos ingresados con un primer infarto, 107 con angina precoz (36,9%) y 183 sin ella. Se excluyo a los pacientes con antecedentes de cardiopatia isquemica de mas de 1 semana o cardiopatia estructural de base. No se aprecian diferencias en las caracteristicas basales de ambos grupos. No hay diferencias en las complicaciones cardiovasculares tras el alta hospitalaria (mortalidad cardiovascular, 7 frente a 12,6%; p = 0,3), insuficiencia cardiaca (7...
2010-01-01
Introduction and objectives: Prognosis and in-hospital management of patients with acute coronary syndrome (ACS) and a history of coronary artery bypass graft (CABG) surgery are still debated. The objective of this study was to characterize ACS patients with a CABG and to compare their in-hospital and postdischarge outcomes with those of patients without a CABG. Methods: This ongoing prospective observational study included 1,495 consecutive patients admitted for ACS to a coronary care unit and followed up for a mean of 19 months. There were two groups: group A (n=73), with CABGs; and group B (n=1,223), without CABGs. Results: Group A patients were more often male (86.3% versus 69.1%; P=.002), and more frequently had a history of diabetes, myocardial infarction and heart failure. Group B p...
Importance of Cardiovascular Risk Profile for In-Hospital Mortality Due to Cerebral Infarction
2008-01-01
Introduccion y objetivos Analizar el perfil cardiovascular y su pronostico en los infartos cerebrales y sus subtipos etiologicos. Metodos Se efectua un analisis retrospectivo de una serie clinica de 2.704 pacientes con infartos cerebrales procedentes de un registro hospitalario de ictus ingresados entre 1986 y 2004 (770 tromboticos, 763 cardioembolicos, 733 lacunares, 324 indeterminados y 114 inhabituales). Se compara el perfil cardiovascular de cada subtipo etiologico y su influencia con la mortalidad hospitalaria mediante un analisis multivariable. Resultados La hipertension arterial (HTA) se presento en el 55,5%, seguida por la fibrilacion auricular (FA) (29,8%) y la diabetes mellitus (23,4%). La mortalidad hospitalaria fue del 12,9% y estaba relacionada con la FA (odds ratio [OR] = 2,3...
2008-01-01
Se analizaron los resultados en 54 pacientes con una media de edad de 39 (18-66) anos; el 25% eran mujeres; 21 pacientes presentaban diseccion (aguda en 15 y cronica en 6 pacientes) y 33, aneurisma. La operacion fue de maxima urgencia en 3 pacientes, urgente en 15 y programada en 36. Utilizamos tubo valvulado en 39 pacientes, reimplante valvular en 9, tecnica de Cabrol en 3 y homoinjerto en 3. El diametro promedio aortico fue de 66,6 mm. La mortalidad hospitalaria total fue del 3,7% (maxima urgencia, 33,3%; programada, 2,8%; p
Cardiac Resynchronization Therapy and Valvular Cardiomyopathy After Corrective Surgery
2008-01-01
La terapia de resincronizacion cardiaca (TRC) ha mostrado utilidad terapeutica en un determinado grupo de pacientes con insuficiencia cardiaca avanzada. Sin embargo, los pacientes con diagnostico de miocardiopatia de origen valvular estan infrarrepresentados en los estudios clinicos aleatorizados. El objetivo del estudio fue evaluar el efecto de la TRC en pacientes con insuficiencia cardiaca de etiologia exclusivamente valvular a medio plazo (6 meses). Se incluyo a 40 pacientes consecutivos a quienes se implanto un dispositivo de resincronizacion cardiaca. A los 6 meses de seguimiento, se produjo una mejora de la clase funcional, el remodelado ventricular izquierdo y los parametros de asincronia intraventricular en los pacientes tratados. En este subgrupo de pacientes, la TRC muestra un be...
Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients
2006-05-01
Full Text Available.SUMMARYSETTING: Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients.DESIGN: A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia.RESULTS: Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54).CONCLUSION: Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance.CONTEXTE: Chezles patients tuberculeux russes, l’utilisation d’alcool, la résistance aux médicaments antituberculeux et un comportement à risque pour le virus de l’immunodéficience humaine (VIH) sont des sujets croissants d’inquiétude.SCHÉMA: Une étude: de prévalence de l’utilisation d’alcool et du comportement à risque pour le VIH a été menée sur un échantillon de 200 hommes et femmes adultes, admis dans des hôpitaux pour la tuberculose (TB) de Saint-Pétersbourg et d’Ivanovo en Russie.RÉSULTATS: Il y avait 72% d’hommes dans l’échantillon. L’âge moyen est de 41 ans. On a diagnostiqué la TB active par l’emploi d’une combinaison du cliché thoracique, de la bacilloscopie et des cultures d’expectoration. Chez 62% des patients, les critères DSM-IV pour utilisation courante d’alcool ou pour dépendance étaient présents. L’utilisation de drogues est inhabituelle: deux patients seulement ont signalé une utilisation récente de l’héroïne par voie intraveineuse. Il n’y avait qu’un seul cas d’infection VIH. Le score total moyen de la batterie d’évaluation des risques a été de 3,4. Il y avait de la dépression chez 60% de 1’échantillon, dont 17% étaient en dépression sévère. L’utilisation ou la dépendance à l’égard de l’alcool étaient associées avec une multiplication par huit de la résistance aux médicaments (OR 8,58 ; IC95% 2,09-35,32). Les patients atteints de rechute de TB ou de TB chronique sont plus susceptibles de répondre aux critérés d’abus ou de dépendance de l’alcool (OR 2,56; IC95% 1,0-6,54).CONCLUSION: Les maladies liées à l’utilisation d’alcool sont fréquentes chez les patients traités pour TB active et sont associées à une morbidité significative. Des enquêtes complémentaires sont nécessaires pour examiner les relations entre les maladies liées à l’utilisation d’alcool et la résistance à l’égard des médicaments antituberculeux.MARCO DE REFERENCIA: El consumo de alcohol, la tuberculosis (TB) farmacorresistente y los comportamientos de riesgo para la infección por el virus de la inmunodeficiencia humana (VIH) constituyen una preocupación creciente en los pacientes con TB en la Fedéración de Rusia.MÉTODOS: Se llevó a cabo un estudio de prevalencia del consumo de alcohol y del comportamiento de riesgo para la infección por el VIH en una muestra de 200 adultos, hombres y mujeres, ingresados por TB en dos hospitales de San Petersburgo e Ivanovo en la Federación de Rusia.RESULTADOS: El 72% de los individuos fueron de sexo masculino. La media de la edad fue 41 años. El diagnóstico de TB activa se estableció mediante una combinación de criterios que incluyeron la radiografía de tórax y la baciloscopia y cultivo del esputo. El 62% de los individuos cumplió con los criterios diagnósticos de alcoholismo actual o dependencia al alcohol de la nomenclatura del DSM-IV. El consumo de drogas fue poco frecuente, pues sólo dos pacientes comunicaron uso intravenoso reciente de heroína. Se observó un caso de infección por el VIH. La media total obtenida con el cuestionario auto-administrado para evaluación de los comportamientos de riesgo para sida (risk assessment battery) fue 3,4. El 60% de los pacientes presentaron depresión y en 17% la depresión fue grave. El alcoholismo y la dependencia al alcohol se asociaron con una frecuencia ocho veces mayor de farmacorresistencia (OR 8,58; IC95% 2,09-35,32). Los pacientes con TB crónica o recaída tuvieron mayor probabilidad de cumplir con los criterios para alcoholismo y dependencia al alcohol (OR 2,56; IC95% 1,0–6,54).CONCLUSIÓN: Los trastornos por consumo de alcohol son frecuentes en pacientes tratados por TB activa y se asocian con una morbilidad considerable. Se precisan estudios adicionales para evaluar la relación entre estos trastornos y la resistencia a los medicamentos antituberculosos.
Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients
SUMMARYSETTING: Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients.DESIGN: A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia.RESULTS: Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54).CONCLUSION: Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance.CONTEXTE: Chezles patients tuberculeux russes, l’utilisation d’alcool, la résistance aux médicaments antituberculeux et un comportement à risque pour le virus de l’immunodéficience humaine (VIH) sont des sujets croissants d’inquiétude.SCHÉMA: Une étude: de prévalence de l’utilisation d’alcool et du comportement à risque pour le VIH a été menée sur un échantillon de 200 hommes et femmes adultes, admis dans des hôpitaux pour la tuberculose (TB) de Saint-Pétersbourg et d’Ivanovo en Russie.RÉSULTATS: Il y avait 72% d’hommes dans l’échantillon. L’âge moyen est de 41 ans. On a diagnostiqué la TB active par l’emploi d’une combinaison du cliché thoracique, de la bacilloscopie et des cultures d’expectoration. Chez 62% des patients, les critères DSM-IV pour utilisation courante d’alcool ou pour dépendance étaient présents. L’utilisation de drogues est inhabituelle: deux patients seulement ont signalé une utilisation récente de l’héroïne par voie intraveineuse. Il n’y avait qu’un seul cas d’infection VIH. Le score total moyen de la batterie d’évaluation des risques a été de 3,4. Il y avait de la dépression chez 60% de 1’échantillon, dont 17% étaient en dépression sévère. L’utilisation ou la dépendance à l’égard de l’alcool étaient associées avec une multiplication par huit de la résistance aux médicaments (OR 8,58 ; IC95% 2,09-35,32). Les patients atteints de rechute de TB ou de TB chronique sont plus susceptibles de répondre aux critérés d’abus ou de dépendance de l’alcool (OR 2,56; IC95% 1,0-6,54).CONCLUSION: Les maladies liées à l’utilisation d’alcool sont fréquentes chez les patients traités pour TB active et sont associées à une morbidité significative. Des enquêtes complémentaires sont nécessaires pour examiner les relations entre les maladies liées à l’utilisation d’alcool et la résistance à l’égard des médicaments antituberculeux.MARCO DE REFERENCIA: El consumo de alcohol, la tuberculosis (TB) farmacorresistente y los comportamientos de riesgo para la infección por el virus de la inmunodeficiencia humana (VIH) constituyen una preocupación creciente en los pacientes con TB en la Fedéración de Rusia.MÉTODOS: Se llevó a cabo un estudio de prevalencia del consumo de alcohol y del comportamiento de riesgo para la infección por el VIH en una muestra de 200 adultos, hombres y mujeres, ingresados por TB en dos hospitales de San Petersburgo e Ivanovo en la Federación de Rusia.RESULTADOS: El 72% de los individuos fueron de sexo masculino. La media de la edad fue 41 años. El diagnóstico de TB activa se estableció mediante una combinación de criterios que incluyeron la radiografía de tórax y la baciloscopia y cultivo del esputo. El 62% de los individuos cumplió con los criterios diagnósticos de alcoholismo actual o dependencia al alcohol de la nomenclatura del DSM-IV. El consumo de drogas fue poco frecuente, pues sólo dos pacientes comunicaron uso intravenoso reciente de heroína. Se observó un caso de infección por el VIH. La media total obtenida con el cuestionario auto-administrado para evaluación de los comportamientos de riesgo para sida (risk assessment battery) fue 3,4. El 60% de los pacientes presentaron depresión y en 17% la depresión fue grave. El alcoholismo y la dependencia al alcohol se asociaron con una frecuencia ocho veces mayor de farmacorresistencia (OR 8,58; IC95% 2,09-35,32). Los pacientes con TB crónica o recaída tuvieron mayor probabilidad de cumplir con los criterios para alcoholismo y dependencia al alcohol (OR 2,56; IC95% 1,0–6,54).CONCLUSIÓN: Los trastornos por consumo de alcohol son frecuentes en pacientes tratados por TB activa y se asocian con una morbilidad considerable. Se precisan estudios adicionales para evaluar la relación entre estos trastornos y la resistencia a los medicamentos antituberculosos.
Effect of Statin Treatment on Mortality in a Large Cohort of Heart Failure Patients
2009-01-01
Con el objetivo de determinar si el tratamiento con estatinas influye en el pronostico de pacientes con insuficiencia cardiaca, se estudio a 3.162 pacientes con este diagnostico incluidos en el registro BADAPIC, con seguimiento durante una media de 35 +- 22 (mediana, 32) meses. Los pacientes con estatinas eran con mayor frecuencia varones y tenian mayor prevalencia de factores de riesgo, cardiopatia isquemica y disfuncion sistolica (p
Etapa final de la vida (PDQ) (Patient)
Sumario informativo revisado por expertos sobre el tratamiento y la atencin del paciente de cncer desde los ltimos das hasta las ltimas horas de vida; esto incluye los sntomas comunes, los dilemas ticos que pueden surgir y la funcin que desempea el onclogo en proveer cuidados al paciente y su familia durante este perodo.
Comunicacin en la atencin del cncer (PDQ) (Health Professional)
Resumen de informacin revisada por expertos sobre la comunicacin con el paciente de cncer y su familia, incluso los aspectos distintivos de la comunicacin con pacientes de cncer, los factores que afectan la comunicacin y el entrenamiento de las aptitudes para la comunicacin.
2008-01-01
Introduccion y objetivos Los pacientes con insuficiencia cardiaca presentan un elevado grado de fragilidad y dependencia. Durante 1 ano de seguimiento, examinamos la relacion de la fragilidad y los sintomas depresivos con la mortalidad a 1 ano y con la hospitalizacion por insuficiencia cardiaca. Metodos Todos los pacientes fueron sometidos a una valoracion geriatrica que permitiria la deteccion de fragilidad y de sintomas depresivos. Se evaluo a 622 pacientes (el 72,5% varones; mediana de edad, 68 anos; el 92% se hallaba en clase II o III de la NYHA; la mediana de fraccion de eyeccion era del 30%). Resultados Fallecieron durante el seguimiento 60 (9,5%) pacientes, y 101 (16,2%) tuvieron que ser hospitalizados por insuficiencia cardiaca. Se detecto fragilidad en el 39,9% de los pacientes y ...
2009-01-01
Introduccion y objetivos Los resultados obtenidos con los stents liberadores de farmacos (SLF) en el grupo de pacientes de alto riesgo formado por los pacientes diabeticos con infarto agudo de miocardio con elevacion del segmento ST (IAMCEST) tratados con angioplastia primaria no se han estudiado con anterioridad. Nuestro objetivo fue evaluar la eficacia y la seguridad de los SLF en pacientes diabeticos con IAMCEST. Metodos Llevamos a cabo un analisis combinado de los datos de pacientes individuales de 7 ensayos aleatorizados en los que se comparo el empleo de stents liberadores de sirolimus o de paclitaxel (SLF) con el de stents convencionales (SC) en el contexto de un IAMCEST. Se incluyo en este analisis a 389 pacientes con diabetes mellitus de un grupo total de 2.476. Los objetivos del ...
Development of a Questionnaire to Measure Asthmatic Patients Knowledge of Their Disease
2007-01-01
Objetivo Desarrollar un cuestionario en espanol, auto-administrado, que mida los conocimientos del paciente as-matico en relacion con su enfermedad y que sea valido, fia-ble y sensible. Pacientes y metodos La validez de apariencia y conteni-do de las preguntas redactadas se establecio por consenso de neumologos expertos. Para la calificacion de la importancia de las preguntas participaron 100 pacientes asmaticos. La reduccion del numero de preguntas para la version final del cuestionario se realizo por consenso y tomando en conside-racion la escala de importancia determinada por los mismos pacientes. Para evaluar la fiabilidad y sensibilidad partici-paron otros 25 pacientes. El cuestionario se aplico en 5 oca-siones diferentes: 2 previas y 3 posteriores a la intervencion educativa. Se midi...
Tuberculin Reaction Size in Tuberculosis Patient Contact
2007-01-01
Objetivo En este trabajo se ha analizado la asociacion del tamano de las reacciones tuberculinicas con diversas variables del contacto y del caso indice en contactos de pacientes tuberculosos con prueba de la tuberculina positiva. Pacientes y Metodos Se revisaron los estudios de contactos realizados a pacientes tuberculosos en el Centro de Prevencion y Control de la Tuberculosis de Lleida durante un periodo de 7 anos. Se incluyeron en el trabajo las revisiones realizadas a pacientes tuberculosos con localizacion pulmonar y/o extrapulmonar. Para el diagnostico de infeccion tuberculosa se realizo el test de Mantoux con 2 UT de tuberculina PPD-RT23. Para detectar la enfermedad tuberculosa se examinaron la situacion clinica, la radiografia de torax y la bacteriologia. Se analizo la asociacion ...
Trastorno de tensin postraumtica (PDQ) (Patient)
Resumen de informacin revisada por expertos acerca del trastorno por tensin postraumtica en los pacientes con cncer, supervivientes del cncer y miembros de la familia. Se discuten la evaluacin y tratamiento de este trastorno.
Risk Factors for Mortality in Chronic Obstructive Pulmonary Disease
2007-01-01
Objetivo Aunque los factores que predicen la supervivencia en pacientes con enfermedad pulmonar obstructiva cronica (EPOC) han sido ampliamente estudiados, no disponemos de un consenso establecido. El objetivo de este estudio ha sido contribuir a clarificar el papel que desempenan los parametros de funcion pulmonar, tolerancia al esfuerzo y calidad de vida en la supervivencia en la EPOC. Pacientes Y MEtodos Se diseno un estudio prospectivo en el que se incluyo a 60 pacientes diagnosticados de EPOC. Al inicio del estudio realizaron pruebas funcionales respiratorias, prueba de esfuerzo maximo y prueba de la marcha de 6 min, y respondieron un cuestionario de enfermedad respiratoria cronica para determinar la calidad de vida relacionada con la salud. El seguimiento de los pacientes fue de 7 an...
Los resultados preliminares de un estudio clínico grande con asignación al azar de pacientes de 16 a 60 años de edad con leucemia mieloide aguda (LMA), un cáncer de la sangre y de la médula ósea, que no había sido tratada anteriormente, muestran que los pacientes que recibieron una alta dosis de daunorrubicina, un fármaco de quimioterapia disponible comercialmente, durante la terapia inicial vivieron más que los pacientes que recibieron una dosis normal del mismo fármaco.
Pulmonary and Nonpulmonary Alterations in Duchenne Muscular Dystrophy
2007-01-01
Objetivo Describir nuestra experiencia en el manejo de pacientes con distrofia muscular de Duchenne (DMD). PACIENTES Y METODOS En 27 pacientes con DMD analizamos los gases arteriales y la funcion pulmonar antes y despues de la ventilacion mecanica (VM); la pulsioximetria (saturacion de oxihemoglobina) y la capnografia (presion arterial de anhidrido carbonico por determinacion transcutanea) nocturna; la funcion cardiaca y la evaluacion de la disfagia. RESULTADOS Se incluyo en el estudio a 27 pacientes con una edad media +- desviacion estandar de 26 +- 6 anos, 24 de los cuales recibian VM, que se habia iniciado cuando contaban 21 +- 5 anos. El 62% eran portadores de traqueostomia y VM invasiva. Una vez iniciada la VM, se observo la normalizacion de los gases arteriales, que se mantuvo durant...
2008-01-01
Introduccion y objetivos El objetivo de este estudio retrospectivo es mostrar nuestra experiencia en la cirugia de la diseccion aortica aguda tipo A y analizar la influencia de la proteccion cerebral en nuestros resultados. Metodos Entre marzo de 1990 y octubre de 2007, 98 pacientes consecutivos fueron intervenidos por diseccion aortica aguda tipo A. En 85 pacientes se reemplazo la aorta ascendente, que en 13 se extendio al arco aortico. La valvula aortica fue sustituida en 34 pacientes y se preservo en el resto. La rotura intimal pudo identificarse en 83 pacientes. Resultados La mortalidad hospitalaria fue del 15%. Los factores de riesgo de mortalidad hospitalaria fueron la edad [.greaterequal] 70 anos y el shock cardiogenico preoperatorio (p
Physiologic Effects of Noninvasive Ventilation in Patients With Chronic Obstructive Pulmonary Diseas
2007-01-01
Objetivo La ventilacion mecanica no invasiva ha sido util en el tratamiento de algunas formas de insuficiencia respiratoria aguda y cronica. Sin embargo, sus posibles beneficios para pacientes con enfermedad pulmonar obstructiva cronica (EPOC) grave en fase estable continuan siendo objeto de controversia. La combinacion de presion positiva continua de la via aerea (CPAP) y presion de soporte (PS) puede mejorar la mecanica respiratoria, el trabajo muscular y la ventilacion alveolar. Estudiamos los efectos fisiologicos de diferentes cifras de CPAP y CPAP + PS en pacientes con EPOC grave en fase estable. Pacientes y Metodos En 18 pacientes se determinaron el trabajo respiratorio, el patron respiratorio, la oximetria de pulso y los gases sanguineos en las siguientes condiciones: a) basal; b) C...
Performance Assessment of an Emergency Department Chest Pain Unit
2007-01-01
Introduccion y objetivos Establecer la prevalencia y caracteristicas de los pacientes con dolor toracico (DT) no traumatico y la calidad de proceso de una unidad de dolor toracico (UDT) estructural. Calcular teoricamente la dimension de futuras UDT estructurales. Metodos Estudio prospectivo que incluyo, en un grupo, a 1.000 pacientes consecutivos visitados por DT en la UDT y, en el otro, al resto de pacientes visitados por otros motivos. Se recogieron datos clinicos, diagnostico final, destino, tiempo de espera y tiempo hasta el alta. En la UDT, ademas se registro el tiempo puerta-ECG y, cuando procedia, el puerta-aguja y el puerta-balon. Para el dimensionado, se utilizo el numero de pacientes con DT y el tiempo hasta el alta o ingreso. Resultados La prevalencia del DT fue del 4,4% (22.468...
Isolated Right-Sided Valvular Endocarditis in Non-Intravenous Drug Users
2008-01-01
Introduccion y objetivos La endocarditis derecha aislada es una entidad poco conocida cuando afecta a pacientes no portadores de marcapasos y no adictos a drogas por via parenteral (ADVP). Nuestro objetivo es estudiar la frecuencia actual de esta entidad y describir su perfil clinico, microbiologico, ecocardiografico y pronostico. Metodos Hemos analizado 17 casos de endocarditis derecha aislada en pacientes no ADVP y no portadores de marcapasos, de un total de 583 episodios consecutivamente diagnosticados de endocarditis infecciosa (3%). Resultados La media de edad fue 38 +- 15 anos y 11 pacientes eran varones. El 47% de los pacientes presentaban alguna enfermedad predisponente. El cateter intravascular fue la puerta de entrada mas frecuente (35%). Los sintomas y signos mas comunes al ingr...
Influence of the Preimplantation QRS Axis on Responses to Cardiac Resynchronization Therapy
2008-01-01
Introduccion y objetivos El objetivo del estudio es evaluar si el eje QRS puede ayudar a predecir el resultado en pacientes sometidos a terapia de resincronizacion cardiaca. Metodos Se ha incluido a 78 pacientes a los que se implanto con exito un dispositivo de resincronizacion. Los pacientes se clasificaron en eje normal (QRS entre -30degree y +120degree) y eje izquierdo (QRS entre -30degree y -90degree). Se considero respondedores a los pacientes que cumplian todos los criterios siguientes: mejorar al menos un grado en su clase funcional, aumentar al menos un 5% la fraccion de eyeccion del ventriculo izquierdo, no requerir hospitalizacion por insuficiencia cardiaca y seguir vivos a los 12 meses de seguimiento. Resultados Tras ajustar por edad, fraccion de eyeccion preimplante, etiologia ...
2007-01-01
Objetivo Valorar la influencia de la toracocentesis y la biopsia pleural en la bioquimica y la citologia del liquido en los pacientes con un exudado linfocitario. Pacientes y metodos Se ha realizado un estudio prospec-tivo y descriptivo de 72 pacientes con derrame pleural que te-nian un exudado linfocitario e indicacion de biopsia. Se anali-zaron y compararon la bioquimica y citologia del liquido pleural al inicio, a las 48 h de la puncion (antes de la biopsia) y a las 48 h de la biopsia pleural. Resultados Los pacientes tenian una edad media +- desviacion estandar de 63 +- 17 anos, el 57% eran fumadores y el 61%, va-rones. El derrame era derecho en un 36%, unilateral en un 80% y masivo en el 21%. La etiologia era benigna en 43 casos y neoplasica en 29 (40%). La lactatodeshidrogenasa (LDH)...
2007-01-01
Objetivo La asociacion entre carcinoma broncogenico y enfermedad pulmonar obstructiva cronica (EPOC) se situa en torno al 70% en nuestro medio. Aproximadamente un 60% de los pacientes con dichos diagnosticos son rechazados para cirugia de reseccion del carcinoma broncogenico debi-do a la intensa alteracion de su funcion pulmonar. El objeti-vo del presente trabajo es evaluar el efecto de un programa de rescate en la mejoria de la funcion pulmonar de pacientes con EPOC y previamente descartados para cirugia por la alteracion de su funcion pulmonar. Pacientes y metodos Se incluyo en el estudio a pacientes con EPOC descartados inicialmente porque se habia calcu-lado que su volumen espiratorio forzado en el primer segun-do (FEV1) tras la intervencion quirurgica seria menor de 1 l. Todos ellos p...
2009-01-01
We present a case of a 67 years old woman with dermatopolymiosytis that after initiated the imunosuppression treatment develops a necrotizing pneumonia. Histoplasma capsulatum was identified. She received antimycotic treatment but then after develops cardiogenic shock and die
2007-01-01
Introduccion y objetivos Evaluar si los criterios de Cornell y Sokolow-Lyon permiten identificar a los pacientes con hipertrofia ventricular izquierda (HVI) de distinto perfil y si hay asociacion entre la severidad de la hipertrofia y la prevalencia de enfermedad cardiovascular. Metodos Estudio transversal y multicentrico, en consultas de cardiologia, en pacientes hipertensos con HVI por Cornell o Sokolow-Lyon. Se recogieron los valores de la presion arterial (PA), asi como los datos clinicos y analiticos. Se dividio a la poblacion en cuartiles segun los complejos electrocardiograficos para valorar la asociacion con la enfermedad cardiovascular. Resultados En total fueron analizables 3.074 pacientes con HVI; 978 pacientes (31,8%) cumplieron ambos criterios, 1.244 (40,5%) cumplieron solo lo...
Closure of Perivalvular Leaks Using an Amplatzer Occluder
2009-01-01
La reintervencion de los pacientes con fugas perivalvulares por insuficiencia cardiaca o hemolisis esta asociada a una elevada morbimortalidad. La utilizacion percutanea de los dispositivos Amplatzer supone una alternativa atractiva. Presentamos nuestra experiencia inicial: entre 2004 y 2006 realizamos cierre percutaneo con dispositivo Amplatzer a 8 pacientes con fugas perivalvulares (4 aorticas y 4 mitrales), sintomaticos y con alto riesgo quirurgico. La implantacion del dispositivo fue posible en todas las mitrales y en 3 aorticas. No hubo complicaciones durante el procedimiento. En 4 (57%) de los 7 implantes se logro una reduccion significativa del grado de regurgitacion y, tras 12 meses de seguimiento, solamente estos pacientes mejoraron clinicamente. De los 3 restantes, 1 paciente pre...
Association Between Bronchiectasis, Systemic Inflammation, and Tumor Necrosis Factor a
2008-01-01
Objetivo La relacion existente entre la presencia de inflamacion sistemica y los diferentes parametros de gravedad en pacientes con bronquiectasias no ha sido descrita. El objetivo del estudio ha sido analizar la relacion entre las concentraciones plasmaticas de factor de necrosis tumoral alfa (pTNF-a), como marcador de inflamacion sistemica, y algunos criterios de gravedad comunmente utilizados en pacientes con bronquiectasias, en fase de estabilidad clinica, no debidas a fibrosis quistica. Pacientes y metodos Se incluyo en el estudio a 68 pacientes con bronquiectasias clinicamente estables y 19 controles sanos ajustados segun edad y sexo. Se recogieron datos referentes a antecedentes patologicos, sintomas, extension, variables funcionales, volumen de esputo y aspectos micro-biologicos, a...
2008-01-01
Antecedentes y objetivo El incumplimiento terapeutico con los corticoides inhalados (CI) es frecuente en los pacientes con asma. Se ha senalado que la eleccion del dispensador por el paciente facilitaria la solucion del problema. El FSI-10 (Evaluacion de la Satisfaccion con el Inhalador) es un cuestionario autorrellenable que valora las opiniones sobre comodidad, dificultad, transportabilidad y manejabilidad de los dispositivos para CI. El objetivo de este trabajo ha sido definir las propiedades metricas del FSI-10 y comparar, mediante este inventario, la satisfaccion y las preferencias de los pacientes con asma respecto a 3 dispositivos para CI: Turbuhaler (T), Accuhaler (A) y Novolizer (N). Pacientes y metodos Hemos realizado un estudio observacional, prospectivo y multicentrico en 112 a...
2008-01-01
Introduccion y objetivos El proposito de este estudio es analizar mediante gated-SPECT con bajas dosis de dobutamina (BDD) el engrosamiento segmentario del ventriculo izquierdo (VI) y su relacion con los cambios de la fraccion de eyeccion (FE) y los volumenes ventriculares en los pacientes con miocardiopatia isquemica. Metodos Estudio prospectivo y multicentrico de 89 pacientes con miocardiopatia isquemica (FE
2006-01-01
Introduccion y objetivos En la estratificacion del sin-drome coronario agudo disponemos de variables clinicas para identificar a los pacientes con alto riesgo de presen-tar complicaciones. Analizamos si los pacientes de alto riesgo, sin antecedentes de cardiopatia isquemica, que presentan un primer episodio de sindrome coronario agudo sin elevacion del segmento ST presentan variables clinicas predictoras de estenosis significativa (
The impact of childhood sexual abuse in anorexia nervosa
2006-01-01
ResumenObjetivoEl objetivo de este estudio fue examinar el impacto del abuso sexual infantil (CSA) en las caracteristicas clinicas y un final prematuro del tratamiento en anorexia nervosa (NA).MetodoLos participantes fueron 77 pacientes consecutivos con AN admitidos a una unidad de internamiento de desordenes del comer. Los pacientes fueron evaluados en terminos de los sintomas del desorden del comer, psicopatologia general, e historia de CSA en el momento de la admision al hospital.ResultadosTreinta y siete pacientes (48%) reportaron una historia de CSA antes del inicio del desorden del comer. Los sujetos con una historia de CSA reportaron significativamente mayor comorbilidad psiquiatrica, incluyendo niveles mas altos de depresion y ansiedad, autoestima mas baja, mas problemas interperso...
2007-01-01
OBJETIVO La mayoria de los pacientes con carcinoma de pulmon no microcitico y estadio III no son candidatos a cirugia y pueden beneficiarse del tratamiento combinado con quimioterapia (QT) y radioterapia (RT). En este trabajo se han analizado los resultados de una pauta combinada secuencial y el valor pronostico de variables clinicas y analiticas iniciales. PACIENTES Y METODOS Se ha realizado un estudio retrospectivo de 92 pacientes con carcinoma de pulmon no microcitico y estadio III tratados con una pauta secuencial combinada de QT (3 combinaciones diferentes de carboplatino: con etoposido, con gencitabina y con paclitaxel) y RT (6.000 cGy: 200 cGy diarios, 5 dias/semana). Se evaluaron la respuesta, la supervivencia global y el valor pronostico de variables epidemiologicas, clinicas y an...
2007-01-01
La asociacion de arco aortico a la derecha con persis-tencia del conducto arterioso ipsolateral es rara, principal-mente cuando no hay otras anomalfas intracardiacas asociadas. Comunicamos los casos de 3 pacientes del sexo femenino de 26, 35 y 9 anos con esta enfermedad e intentos previos infructuosos de cierre quirurgico a traves de toracotomia y esternotomia, a quienes se realizo cierre percutaneo del defecto con dispositivos tipo Amplatzer con exito. En 2 pacientes, aunque las angiograffas docu-mentaron la presencia de persistencia del conducto arterioso tipo A, no se pudo definir bien el diametro mfnimo y fue necesario determinarlo con el balon medidor. Se im-plantaron Amplatzer Duct Occluder en 2 pacientes y Amplatzer para comunicacion interventricular muscular en el otro. En todos se...
Psychological defense styles, childhood adversities and psychopathology in adulthood
2006-01-01
ResumenObjetivoEste estudio explora la relacion entre el autoinforme de maltrato fisico y/o abuso sexual y los estilos psicologicos de defensa, asi como la asociacion de ambos con el malestar psicologico en la edad adulta. Se han analizado dos muestras de pacientes que se diferencian en el malestar psicologico y la somatizacion. En ambas muestras se examina si las adversidades notificadas y lo estilos defensivos inmaduros estan asociados con sintomas psicopatologicos.MetodoSe examinan 266 pacientes consecutivos en el departamento de enfermedades psicosomaticas y 109 pacientes con dolores en la zona inferior de la espalda tratados en el departamento de traumatologia. Ambos departamentos pertenecen a un hospital universitario aleman. Los estilos psicologicos de defensa fueron examinados a tr...
2008-01-01
Objetivo Evaluar la prevalencia de micobacterias ambientales (MA) en pacientes con fibrosis quistica (FQ). Pacientes y metodos Se ha realizado un estudio prospectivo de 2 anos de duracion en pacientes con FQ mayores de 6 anos, procedentes de 6 unidades monograficas. En las muestras respiratorias, recogidas cada 6 meses, se efectuo una tincion de auramina-rodamina, ademas de cultivos en medios solido y liquido. Si se detectaba una tincion o cultivo positivo para MA, se recogian 1 o 2 esputos mas y se hacia un seguimiento estricto para valorar la necesidad de tratamiento especifico. Se consideraron las siguientes variables clinicas: edad, sexo, insuficiencia pancreatica, diabetes, uso de aerosolterapia antibiotica y de azitromicina de forma continua, tratamientos con corticoides inhalados o ...
2009-01-01
Introduccion y objetivos La influencia pronostica del sexo de los pacientes sometidos a sustitucion valvular aortica por estenosis severa tiene un papel controvertido, y algunos estudios le atribuyen un papel relevante como marcador de riesgo independiente. El objetivo del estudio es valorar la influencia pronostica perioperatoria del sexo de los pacientes sometidos a sustitucion valvular por estenosis aortica severa. Metodos Estudio retrospectivo en el que se analizo una cohorte de 577 pacientes sometidos a cirugia de re-emplazo valvular aortico por estenosis aortica entre 1996 y abril de 2007. Resultados Las mujeres (44%) tenian mayor edad (70,3+-7,9 frente a 66,8+-9,8 anos; p
Importance of Recognizing Occult Renal Disease in Hypertensive Patients
2009-01-01
Introduccion y objetivos La enfermedad renal oculta (ERO) es una entidad que define los estadios mas iniciales de insuficiencia renal y no se detecta con los metodos usados habitualmente. El objetivo es determinar la prevalencia de ERO en los pacientes hipertensos en consultas de cardiologia y su relacion con los distintos factores de riesgo y tratamientos cardiovasculares. Metodos. Estudio observacional, transversal, retrospectivo y multicentrico que se llevo a cabo en 1.214 hipertensos de consultas de cardiologia. Resultados . Se analizo a 1.190 pacientes (98%). El filtrado glomerular (FG) fue calculado (MDRD) por el cardiologo responsable en el 11% de los pacientes. Tras su determinacion a posteriori, el 9,5% presentaba ERO, mas probablemente mujeres, con mas edad, mas antecedents de di...
Experience With Imatinib to Treat Pulmonary Arterial Hypertension
2008-01-01
A pesar de los avances en el tratamiento de los pacientes con hipertension arterial pulmonar (HAP), su supervivencia sigue estando muy afectada. El imatinib, un antagonista del factor de crecimiento derivado de las plaquetas con accion antiproliferativa, ha sido eficaz en modelos experimentales y en algunos casos comunicados. Se describe el resultado del tratamiento con imatinib en 4 pacientes con HAP en clase funcional IV y refractarios al tratamiento con asociaciones de medicamentos para la HAP. La respuesta final fue favorable solo en uno de los 4 casos, que 5 meses despues de iniciado el tratamiento estaba en clase funcional III y con mejoria significativa de los parametros hemodinamicos. Sin embargo, el paciente fallecio por hepatitis toxica grave en la que el imatinib pudo haber part...
2006-01-01
Objetivo Hemos realizado un trabajo comparativo en pacientes con enfermedad pulmonar obstructiva cronica (EPOC), sindrome de hipoventilacion-obesidad (SHO) e insuficiencia cardiaca congestiva (ICC) sometidos a ventilacion no invasiva (VNI) en una unidad de monitorizacion de neumologia por presentar acidosis hipoxemica-hipercapnica. El objetivo ha sido valorar la respuesta clinica y gasometrica en funcion del diagnostico. Pacientes y metodos Se trata de un estudio prospectivo (12 meses de duracion) en 53 pacientes con acidosis hipoxemica-hipercapnica, de los que 27 presentaban EPOC; 17, SHO, y 9, ICC. Realizamos un analisis de la gravedad gasometrica inicial, de la evolucion gasometrica (tras tratamiento convencional y tras VNI a las 1-3 h y 12-24 h) y de la mortalidad. Todos ellos recibier...
Computed Tomography-Guided Radiofrequency Ablation of Malignant Lung Lesions: Early Experience
2008-01-01
Objetivo Presentar la experiencia inicial en el tratamiento de las lesiones pulmonares malignas (primarias y metasta-sicas) mediante la ablacion por radiofrecuencia (RF). Pacientes y metodos De agosto de 2004 a enero de 2007 tratamos a 19 pacientes (mediante 26 procedimientos) con intencion curativa o paliativa. Todos los casos correspondian a lesiones no quirurgicas, tratadas o no previamente. La tecnica se practico en la sala de radiologia, con sedoanalgesia consciente Ilevada a cabo por el anestesiologo. Se trato a 14 pacientes con lesion pulmonar y a 5 con enfermedad metastasica pulmonar, con la enfermedad primaria controlada. En 15 casos el tratamiento se realizo con intencion curativa y en 4 era paliativo. Resultados La tecnica de RF pudo realizarse en los 26 procedimientos. La media...
Bronchogenic Carcinoma 2000-2001: Characteristics and Overall Survival
2007-01-01
Objetivo Describir las caracteristicas clinicas y la super-vivencia de los carcinomas broncogenicos (CB) diagnosticados durante los anos 2000 y 2001 en un hospital terciario. Pacientes y metodos La informacion se recogio de la base de datos del Registro de Tumores del hospital y se valido con fuentes independientes. De todos los pacientes con CB diagnosticados o tratados en nuestro centro, se selecciono a los que provenian exclusivamente del area de salud correspondiente. Resultados Se diagnosticaron 482 casos en los 2 anos del estudio; un 90% de los pacientes eran varones. La edad media +- desviacion estandar fue de 66,6 +- 9,65 anos. El 29,4% eran CB de celulas grandes. El 41,3% de todos los CB se diagnosticaron en estadio IV. El 30% de los CB no microciticos se clasificaron en estadio I...
2007-01-01
OBJETIVO La desnutricion es frecuente en pacientes con fibrosis quistica (FQ) e implica un desequilibrio entre la ingesta y los requerimientos. Nuestro objetivo ha sido calcular el gasto energetico en reposo (GER) mediante calorimetria indirecta en adultos con FQ, compararlo con las formulas estimativas habitualmente empleadas y valorar la influencia de parametros clinicos sobre el GER. PACIENTES Y METODOS Estudiamos a 21 pacientes con FQ que se encontraban estables clinicamente. Se efectuaron medidas de parametros antropometricos, dinamometria de mano, impedanciometria bioelectrica y del GER medido por calorimetria indirecta (CI). Estudiamos la concordancia entre los valores del GER medidos y estimados por las formulas de la Organizacion Mundial de la Salud (OMS) y de Harris-Benedict (HB)...
2008-01-01
Objetivo Presentamos un analisis de incidencia de disfuncion renal y mortalidad de los pacientes a quienes se practico un trasplante pulmonar en nuestro centro segun el grado de insuficiencia renal que desarrollaron en el postoperatorio inmediato, a los 30 dias, a los 6 meses y al ano de realizado el trasplante. Material y metodos Durante el periodo definido (de marzo de 1997 a enero de 2006) se realizaron 144 trasplantes de pulmon en nuestro centro. Hubo 6 perdidas en el seguimiento de los pacientes. Se clasifico a los pacientes en 5 grupos dependiendo del valor del filtrado glomerular en el momento de ingreso en la unidad de cuidados intensivos, al mes, a los 6 y 12 meses de realizado el trasplante, segun la clasificacion Chronic Kidney Disease (CKD). Se realizo un analisis estadistico d...
Información acerca de un programa establecido por el Instituto Nacional del Cáncer y la Sociedad Estadounidense de Oncología Clínica para ayudar a que pacientes con cáncer puedan ponerse en contacto con los servicios de tratamiento médico y sus expedientes médicos en caso de una catástrofe natural o nacional.
1996-01-01
The main objective of this study, was to contribute with new elements, to the clinical diagnostic and the monitoring of hematologic diseases, through molecular techniques. Such technique is known as Southern Blot. Non radioactive and radioactive methods were used, to sift the presence or absence of Ph chromosome. The sound denominated Transprobe-1 and the Endonuclease Bgl II were used. 41 samples proceeding from pacients diagnosed with LLMC and 9 patients grouped with myloproliferatives sindromes or myeloplast sindromes, which were getting treatment at Hospital San Juan de Dios or at Hospital Mexico, were analyzed. The studies detected the presence of rearrangements between Mocr/ABL and (Ph +), and in the remaining. The results were negative Ph . The author found that the application of one single endonuclease is usefull to make a first general ...
Acute Respiratory Failure Immediately Following Surgery for Morbid Obesity
2008-01-01
Los pacientes con sindrome de apneas-hipopneas durante el sueno tienen una mayor probabilidad de presentar mas complicaciones postoperatorias. La utilizacion precoz de tratamiento con presion positiva continua de la via aerea puede evitar su aparicion. Se presenta el caso de un paciente intervenido de obesidad morbida que desarrollo, en el postoperatorio inmediato, un cuadro de insuficiencia respiratoria aguda, que preciso el reingreso en la unidad de reanimacion y evoluciono favorablemente tras la instauracion de tratamiento con presion positiva con 2 niveles de presion. Posteriormente se confirmo que presentaba sindrome de apneas-hipopneas durante el sueno.
1996-12-31
The skin absorbed doses were evaluated on patient submitted to the following x-ray exams : chest, facial sinus, lumbar spine. Thermoluminescent dosimetry was used and a variety of irradiation techniques performed. The results shown considerable differences on the absorbed dose for the various alternative technical conditions
2006-01-01
The possibility of using 99mTc as an effective marker for the follow up of differentiated thyroid carcinoma is demonstrated. 99mTc will avoid the blind use of radioiodine and it makes possible, in the case of rhTSH stimulation, to establish the need of 131I therapy and the prompt application of this treatment
Sumarios sobre los cuidados médicos de apoyo (PDQ®)
Los sumarios de información sobre cuidados médicos de apoyo en Physician Data Query, PDQ®, se refieren al cuidado que se ofrece para mejorar la calidad de vida de pacientes con cáncer. Los sumarios de información sobre cuidados médicos de apoyo en PDQ® para el paciente con cáncer proporcionan descripciones de la fisiopatología y tratamiento de complicaciones comunes físicas y psicosociales del cáncer y su tratamiento, como lo son el dolor, la hipercalcemia (exceso de calcio en la sangre) y las náuseas y vómitos. Los sumarios de cuidados médicos de apoyo en Physician Data Query, PDQ®, están diseñados en dos versiones. La primera versión es para pacientes con cáncer y la segunda es para profesionales médicos. Las versiones para pacientes están escritas con un vocabulario fácil de entender y no técnico. Cada documento de la versión para profesionales médicos contiene casi siempre una descripción, información sobre la etiología, evaluación y manejo, y bibliografía de la literatura actual.
1996-01-01
A case of richinocerebral mucormycosis is reported a patient with refractory sideroblastic anemia assessed by means of serial CT. The disorder initially mimicked bacterial rhino sinusitis, coursing later with sinonasal necrosis, orbital involvement and, finally, cerebral involvement. The CT findings are compared with those described in the literature. (Author) 8 refs
1996-12-31
Radiation doses received by tissues of the head and neck as a result of a full-mouth radiographic examination are studied. Simulations are carried out by irradiating the head and neck section of an anthropomorphic phantom. The radiation doses are determined through the use of thermoluminescent dosimeters 1 ref., 2 tabs.
1995-01-01
We present a patient with multiple pulmonary nodules associated with trans bronchial biopsies in a patient who underwent single lung transplantation. The nodules, which were not visible in chest radiography, present a hyperdense center and the so-called ground glass hypodense halo in CT. The halo sign has been reported in CT studies of hemorrhagic pulmonary nodules. 10 refs
1989-08-01
The psychological evaluation of 68 patients contaminated in the Goiania accident as well as of the personnel (about 27) working at the organizations responsible for the assistance given to the victims of the accident is presented 2 figs., 2 tabs.
... para el hiperparatiroidismo primario? El mdico escoge un tratamiento en base a la edad del paciente, los resultados de pruebas y los indicios ... mayoclinic.com/health/ hyperparathyroidism/DS00396 Indicios y sntomas del ... Severo ? nusea y vmitos ? dolor de huesos ? ms sed y ganas de orinar ? ...
2010-01-01
This secondary analysis of data from the MULTIRISC study investigated the prevalence of chronic kidney disease (CKD) in patients who either had or were at a high risk of cardiovascular disease. The original, epidemiological, cross-sectional, multicenter study was carried out in outpatient clinics belonging to cardiology, internal medicine and endocrinology departments. It included patients aged
2006-01-01
Introduccion y objetivos En este trabajo se estima la prevalencia de depresion y se identifican los factores biomedicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en Espana. Metodos Se estudio a 433 pacientes
1996-12-31
An evaluation of entrance skin dose in patients submitted to actual examinations, arising from present radiographic procedure in 10 rooms in Curitiba, PR, Brazil between December/95 and April/96 is presented. The basis for extensive studies, on local or regional level, is outlined 3 refs., 2 figs.
Osteonecrosis in HIV-infected patients; Osteonecrosis en pacientes con infeccion por VIH
2001-07-01
We present two cases of avascular osteonecrosis, one involving the knees and the other the hips, in patients with human immunodeficiency virus (HIV) infection who met the criteria for acquired immunodeficiency syndrome (AIDS). We review the literature concerning this rare complication of HIV infection, focussing especially on the clinical and radiological features and its possible etiopathogenesis. (Author) 30 refs.
Osteonecrosis in HIV-infected patients Osteonecrosis en pacientes con infeccion por VIH
2001-01-01
We present two cases of avascular osteonecrosis, one involving the knees and the other the hips, in patients with human immunodeficiency virus (HIV) infection who met the criteria for acquired immunodeficiency syndrome (AIDS). We review the literature concerning this rare complication of HIV infection, focussing especially on the clinical and radiological features and its possible etiopathogenesis. (Author) 30 refs
1990-01-01
Lumbosacral or brachial plexopathies are lesions of two or more roots of the same plexus. They are very frequent in cancer patients and are usually due to extra spinal involvement of these roots, by a primary or secondary neoplasm. The CT scan is very useful in the evaluation of patients with this disease. In the article anatomic al aspects, the main clinical symptoms and signs, and the performance of CT scan are reviewed with all these elements it is possible to make a diagnosis
El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonoma, que se presentan en la relacin mdico-paciente, durante la teraputica del intento de suicidio.La investigacin se realiz en dos hospitales psiquitricos de la Ciudad de Mxico. La muestra incluy a tres sujetos con intento de suicidio, mayores de 18 aos, que eran atendidos en consulta externa a causa de una lesin autoinfligida en el ltimo ao, y a tres psiquiatras que trataban a estos pacientes. La informacin se obtuvo previo consentimiento informado en entrevistas individuales. Se llev a cabo un anlisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioticos y las posibles disyuntivas entre stos.Las discordancias entre la beneficencia y la autonoma estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones ticas relevantes en el escenario clnico, al ofrecer al psiquiatra un anlisis biotico que le permita actuar de acuerdo con la beneficencia y respetando la autonoma del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atencin para ellos.
2009-01-01
Refers frequency of cystoid macular edema diagnosed with optical coherence tomography in patients operated on from senile cataract at 'Ramon Pando Ferrer' Cuban Institute of Ophthalmology in the period from December 2006 to February 2007
1989-01-01
A computerized tomography study in the skull of 72 patients with various forms of neurocysticercosis was performed during at least 6 months. 48 patients were treated with Praziquantel and 24 were not. The tomographic alterations observed in the skull after the use of Praziquantel did not confirm the therapeutic effects reported in the literature. (M.A.C.)
Resumen de informacin revisada por expertos acerca de las complicaciones orales, como la mucositis y disfuncin de la glndula salival, que se presenta en pacientes con cncer tratados con quimioterapia y radioterapia de la cabeza y del cuello.
Boletín del Instituto Nacional del Cáncer - 07-20-2010
El grupo fue convocado el ao pasado por el Colegio Americano de Medicina Deportiva (ACSM) para que elaborara directrices sobre el ejercicio y la actividad fsica en pacientes que estn en tratamiento activo contra el cncer o que ya lo han terminado.
Adaptacin normal y sus trastornos (PDQ) (Health Professional)
Resumen de informacin revisada por expertos acerca de las difciles respuestas emocionales que se presentan en muchos de los pacientes con cncer. Este sumario se enfoca en asuntos de la adaptacin normal, alteracin psicosocial y trastornos de adaptacin.
[Ajuste del riesgo: ms all de los sistemas de clasificacin de pacientes]
Los grupos relacionados con el diagnstico (GRD) se utilizan ampliamente en diferentes pases. Sus diversas versiones tratan de estimar el coste de la produccin hospitalaria. En Europa, los sistemas de clasificacin de pacientes y los pesos relativos estndares utilizados habitualmente son los originales norteamericanos.Objetivos: El objetivo del presente estudio fue analizar el grado hasta el cual los GRD y las ponderaciones GRD explican la variabilidad del coste del paciente. Tambin se analizaron los diferentes componentes del coste del paciente (gravedad, comorbilidades, complicaciones y posicin socioeconmica) que no se explican adecuadamente mediante los GRD y que pueden abordarse utilizando datos administrativos.Mtodos: Se analizaron un total de 35.262 altas de dos hospitales pblicos de Barcelona. Se calcularon los GRD de la Health Care Financing Administration (HCFA) y los GRD refinados de todos los pacientes (APR). La gravedad se ajust mediante la Disease Staging, y las comorbilidades y complicaciones se calcularon utilizando las agrupaciones de comorbilidades de Elixhauser y Charlson. Se utiliz un indicador ecolgico de la posicin socioeconmica. Para explicar la variabilidad del coste por paciente se estimaron regresiones lineales.Resultados: Pusimos de manifiesto que las ponderaciones GRD Medicare slo explicaron un 19% de la variabilidad del coste. Las ponderaciones basadas en el coste explicaron casi un 40% (38-42%, dependiendo de la clasificacin GRD utilizada). La exclusin de los valores extremos aument la potencia explicativa hasta un R2 = 47-48%. Las variables de ajuste restantes aumentaron el R2 hasta un 49-51%.Discusin: Las ponderaciones GRD Medicare no son apropiadas para Europa. Las ponderaciones GRD basadas en el coste y la reduccin de los valores extremos se caracterizaron por una potencia explicativa significativamente mayor. Para las variables clnicas y socioeconmicas restantes se identific una potencia explicativa considerablemente menor, fueron estadsticamente significativas y se comportaron como se esperaba. Las autoridades sanitarias espaolas y de otros pases europeos deben adaptar los sistemas de clasificacin GRD a sus mbitos para utilizarlos en la evaluacin del coste de la produccin hospitalaria.
Troponin-T Monitoring in Outpatients With Nonischemic Heart Failure
2008-01-01
Introduccion y objetivos El valor del seguimiento prolongado de las determinaciones de troponina T (TnT) en pacientes ambulatorios con insuficiencia cardiaca no isquemica no esta aclarado. Estudiamos la incidencia de las concentraciones aumentadas de TnT, sus determinantes y su valor pronostico. Metodos Se incluyo a 80 pacientes ambulatorios (56 +- 14 anos; el 69% varones) con insuficiencia cardiaca cronica (fraccion de eyeccion del ventriculo izquierdo, 24% +- 9%), situacion estable (NYHA II, 51; NYHA III, 29) y etiologia no isquemica confirmada por coronariografia. Los valores de TnT se midieron a la inclusion y en cada visita ambulatoria (mediana, 3,1 [intervalo intercuartilico, 1,8-5] meses), durante un seguimiento de 22,2 +- 10,6 meses. Se definio TnT+ como aquella detectable (
2005-01-01
ResumenObjetivos:Examinar la relacion entre el abuso sexual y el logro academico en una poblacion de pacientes psiquiatricos internos adolescentes. Se midieron los factores individuales que se esperaba influyeran en esta relacion para explorar la manera en que cada uno interactuaba con el abuso sexual y su relacion con el logro academico.Metodo:Ochenta y dos pacientes psiquiatricos internos adolescentes participaron en un estudios (12 a 18 anos de edad: M=16.0). A los participantes se les administraron pruebas de aprovechamiento academico (variable dependiente) e inteligencia, y completaron una serie de medidas de auto-reporte de sus experiencias con diferentes tipos de maltrato, su percepcion de la crianza recibida, status socio economico, abuso de sustancias y psicopatologia.Resultados:E...
Results of Smoking Cessation Therapy in a Specialist Unit
2007-01-01
OBJETIVO Valorar los resultados del tratamiento del tabaquismo en una unidad especializada, mediante el calculo de la probabilidad de permanecer abstinente a los 6 meses del seguimiento, y analizar las diferencias existentes segun las caracteristicas de los individuos. PACIENTES Y METODOS Se ha realizado un estudio analitico prospectivo y longitudinal entre los fumadores que recibieron tratamiento multicomponente durante 3 meses. Se considero la abstinencia continuada mediante la declaracion de los propios participantes, confirmada con cooximetria. Se realizo un analisis de supervivencia por el metodo de Kaplan-Meier. Se aplicaron contrastes de rangos logaritmicos para estudiar las diferencias en la abstinencia continuada de los pacientes para las distintas categorias de las variables cual...
2009-01-01
ResumenIntroduccion y objetivos La proteina surfactante tipo B (PS-B) es un marcador de dano en la barrera alveolocapilar y podria ser util en la monitorizacion del deterioro pulmonar asociado a la insuficiencia cardiaca cronica (ICC). Metodos Se estudio a 43 pacientes ambulatorios con ICC (edad, 51 +- 10 anos; el 77% varones; fraccion de eyeccion del ventriculo izquierdo [FEVI], 33% +- 11%) a los que se realizo una prueba de esfuerzo cardiopulmonar limitada por disnea. Se obtuvieron muestras de sangre periferica en reposo y en el primer minuto tras el maximo esfuerzo. La presencia y la cantidad de PS-B en suero sanguineo se analizaron mediante analisis Western blot. Resultados En reposo, se detecto PS-B circulante en 35 (82%) pacientes, frente a solo 6 (23%) voluntarios sanos de una muest...
Percutaneous Treatment of Mitral Valve Periprosthetic Leakage. An Alternative to High-Risk Surgery?
2009-01-01
La insuficiencia mitral periprotesica secundaria a fugas perivalvulares es una complicacion de la cirugia de reemplazo valvular. Presentamos una serie de 8 casos con insuficiencia mitral periprotesica severa y sintomatica, rechazados para cirugia por alto riesgo y en los que se decidio el cierre percutaneo de la fuga periprotesica mitral. En todos se utilizo dispositivo Amplatzer de cierre ductal. El procedimiento fue exitoso en 5 de los pacientes. Se objetivo disminucion significativa de la insuficiencia periprotesica y mejoria clinica en el seguimiento en 4 pacientes. Se fracaso en 3 (2 por interferencia con los discos de la protesis y 1 por no poder atravesar la fuga), de los que 1 fallecio a las pocas horas del procedimiento por ictus masivo. El cierre percutaneo de dehiscencias periva...
Perception of Dyspnea and Treatment Adherence in Asthmatic Patients
2008-01-01
Objetivo El cumplimiento terapeutico en una enfermedad cronica como el asma no supera el 50% en la mayoria de las series. Aunque las razones sean de muy diversa indole, es evidente que el incumplimiento es un factor determinante en el mal control de la enfermedad. Por otra parte, la falta de percepcion de la disnea se ha asociado con el asma de control dificil y con la aparicion de crisis de asma fatal o casi fatal. Asi pues, el objetivo del presente estudio ha sido intentar demostrar que una de las razones por las cuales los asmaticos no toman su medicacion es que no tienen percepcion de disnea cuando sus bronquios se obstruyen. Pacientes y metodos Hemos estudiado a 2 grupos de pacientes con asma persistente y moderada, a quienes se habia prescrito el mismo tratamiento de forma continuada...
Orthotopic Heart Transplantation in Patients With Transposition of the Great Arteries
2009-01-01
Debido a la evolucion de la cirugia cardiaca y la cardiologia, los pacientes pediatricos que antano fallecian a causa de cardiopatias congenitas actualmente llegan a la edad adulta. Los pacientes con transposicion de grandes vasos y reparacion fisiologica en el seguimiento pueden evolucionar hacia la insuficiencia cardiaca, como consecuencia del fallo progresivo del ventriculo derecho en posicion sistemica. En esta situacion, el trasplante cardiaco aparece como una posible alternativa terapeutica. Las alteraciones anatomicas y la presencia de conductos intraauriculares hacen que el trasplante precise de una serie de variaciones tecnicas. Presentamos la experiencia en nuestro centro. Entre 1992 y 2004 se han realizado 4 trasplantes cardiacos en transposicion de grandes vasos y correccion fi...
Contribution of Exhaled Nitric Oxide Measurements to Abbreviated Bronchial Challenge Test Protocols
2008-01-01
Objetivo La prueba de provocacion bronquial es un procedimiento habitual en el diagnostico del asma, pero su realizacion resulta larga y tediosa. Por ello se han propuesto metodos que acortan su duracion. Sin embargo, en los ultimos anos se ha senalado que dichos metodos pueden dar lugar a broncoconstricciones excesivas (BE). Los objetivos del presente estudio han sido: a) determinar la frecuencia de BE en pacientes con asma tras la aplicacion del metodo abreviado de la prueba de provocacion bronquial, y b) cuantificar si la determinacion de oxido nitrico en aire exhalado (ONE) puede predecir la aparicion de BE. Pacientes y metodos Se ha realizado un estudio prospectivo sobre 210 asmaticos a quienes se determino el ONE y se realizo una prueba de provocacion bronquial siguiendo el protocolo...
[Percutaneous sacroplasty in sacral insufficiency fracture treatment]
Stress (insufficient) sacral bone fracture is a seriously painful disease with discussed and disunited therapy. Older women sufferig from osteoporosis create the main group in which this fracture occurs. Clinically, serious pain in sacral area is the most common symptome. This pain may last for a long time when treated conservatively and it can lead to pacient's immobilization with related comorbidity. In 2% of patients, neurological complications can be observed. Authors present summary of published studies and demonstrate an own case treated using percutaneous sacroplasty.
2005-01-01
In this paper the main design requirements concerning the setting up of a telemetry ECG monitoring system are presented. The design's most important technical solutions as well as some details are also discussed. This system is intended to provide skilled medical assistance during the cardiac rehabilitation of both asymptomatic and high risk coronary patients
2008-01-01
Thymoma are thymic tumors that arise from epithelial cells, they have different morphological characteristics. It is known for its association with autoimmune diseases such as myasthenia gravis, pure red cell aplasia, systemic lupus erythematosus, or hipogamaglobulinemia pemphigus foliaceus. The association thymoma-myasthenia gravis-pure red cell aplasia is a rare one. There will be a case report with the corresponding discussion and review of the literature
1997-07-01
This work presents the results of the evaluation of radiation dose delivered to the patients undergoing conventional radiological procedures. Based in the realized measurement some indicators are settled to quantitative appraisal of the radiological protection conditions offered to the population. Data assessment was done in the county of Curitiba, in Parana State, Brazil, from 12/95 to 04/96, in ten rooms of three different institutions, under 101 patients, adults with 70 {+-} 10 kg, during real examinations of chest PA, chest LAT and abdomen AP. (author)
2005-07-01
The objective of the work was to determine the utility of the SPECT (Single Photon Emission Computerized Tomography) of myocardial perfusion for the ischemia detection in asymptomatic patients with Coronary Atherosclerosis Illness. It was concluded that the SPECT of myocardial perfusion has a high sensitivity (97%) for the silent ischemia diagnosis.
Metas terapeuticas en pacientes con angina refractaria cronica
2010-01-01
Refractory angina presents a major clinical challenge for everyday medical practice. Despite the widespread use of statins and improvements in revascularization techniques, a substantial proportion of patients with preserved left ventricular function and no life-threatening arrhythmias remain symptomatic, with severe debilitating angina. Because the rate of major cardiac events in this population is relatively low, the major aim of therapy should be not only to prolong survival but also to improve quality of life. The cornerstone of therapy for all these patients should be the aggressive modification of risk factors using evidencebased treatment, with the aim of stabilizing the disease process and improving overall survival. No opportunity for revascularization should be overlooked. Comple...
2001-07-01
We describe a case of lymphoid nodular hyperplasia in a woman with severe combined immunodeficiency disease. the patient complained of constipation and episodes of abdominal pain, and examination revealed the presence of a large abdominal mass. The diagnosis was suspected on the basis of the initial radiological studies, but intestinal biopsy was necessary to rule out lymphomatous involvement. We point out the radiological features of this entity which, despite the fact that it may be a chance finding of no pathological significance, requires special attention, especially in immuno deficient individuals. (Author) 10 refs.
2007-07-01
The objective of this work is to correlate the expulsion fraction of the left ventricle (FEVI) obtained by means of g-SPECT and other diagnostic methods: ECO 2D and ventriculography for heart catheterization (CTT). (Author)
2007-01-01
The objective of this work is to correlate the expulsion fraction of the left ventricle (FEVI) obtained by means of g-SPECT and other diagnostic methods: ECO 2D and ventriculography for heart catheterization (CTT). (Author)
2006-01-01
In patients with differentiated thyroid carcinoma it is indispensable to raise the values of TSH to determine thyroglobulin and to effect the total tracking with radioiodine. Traditionally to raise the endogenous TSH it is necessary to suspend the opotherapy during a prolonged time with the consistent hypothyroidism. The objective of this work is to increase the endogenous TSH, shortening the time of abstinence of opotherapy
2001-07-01
In this work were presented 22 cases of radiation deterministic effect in patients submitted to catheterism procedures by means of X-fluoroscope. Evaluation of the results suggest that the most of patients receive potential skin entrance doses over 2 Gy and some of them may have received doses over 12 Gy. At these doses, radiation induced erythema, ulceration and necrosis are all possible complications if the same entrance skin surface is exposed for the duration of the procedure.
2000-06-01
The brain single photon emission computed tomography (SPECT) is s functional neuroimaging method that can detect localized changes in cerebral blood flow. The temporal lobe epilepsy (TLE) is the most common epileptic syndrome in adults, and more than 50% are medically refractory. The SPECT can contribute to investigation of epileptogenic focus and is one of the methods of pre-surgical evaluation of these patients. (author)
2003-01-01
We report a case of inflammatory pseudotumor of the spleen in a 4 years old child. Clinical findings were limited to diffuse abdominal pain and a palpable mass at the left hypochondrium. Ultrasonography and CT revealed a solid homogeneous mass in the lower pole of the spleen, with irregular enhancement with IV contrast. Laparoscopic splenectomy was performed. The diagnosis was histological. The pseudotumor of the spleen is extremely rare, especially in children, with only 4 cases (including our own) reported in the literature. Our patient constitutes the youngest case ever reported. (author)
2008-01-01
A 72 years old male patient with previous history of pulmonary thrombosis was admitted with an ischemic stroke. In a trans thoracic echocardiogram, as well as in a posterior transesophagic one, a mobile mass suggesting a thrombus going through a patent foramen ovale, was found. Facing an imminent paradoxical embolism, surgical thrombectomy was considered that could no be realized due to infection. Anticoagulation with low molecular weight heparin was initiated. A control echocardiogram showed complete disappearance of the mass. The patient was discharged with oral anticoagulation
1998-01-01
Hydatid disease is caused by Echinococcus granulosus. The most common locations for hydatid cysts are lung and liver. The central nervous system is involved in only 2% of cases, and these cysts are usually located in the brain parenchyma. Primary involvement of the bones of the skull is very uncommon. We report the case of a child with cranial echinococcosis which presented in the form of an osteolytic lesion with an extradural cyst. This was the unique feature of the disease. The CT and MR findings are described. This presentation has rarely been reported in the literature. (Author) 5 refs
2004-01-01
In the posterior aspect of the T8 vertebral body appears exostoses in a 12-year-old girl with family history of hereditary multiple exostoses causing compression inside the canal giving as a result paraparesia. Which was treated with staged posterior decompression corpectomy and posterior spinal fusion instrumentation. The patient had complete resolution of his paraparesia after days undergoing removal of the exostoses through a posterolateral approach costotransversectomy
2005-07-01
The obtained results in presently study demonstrate that the feasibility of the detection of the sentry ganglion in cervix uterine cancer using a boarding by laparoscopic via, being necessary the use of twice labelled as much with patent blue and radioisotope (colloid of labelled rhenium with {sup 99m}Tc, total dose of 3 MCi) to achieve the identification of the ganglion. (Author)
Control del dolor: Apoyo para las personas con cáncer
Libro sobre el control del dolor en pacientes con cáncer. Cubre los métodos y medicinas, así como los efectos físicos y emocionales del dolor. Es una adaptación cultural para el público de habla hispana del libro en inglés Pain Control.
Control del dolor: Apoyo para las personas con cáncer
Libro sobre el control del dolor en pacientes con cáncer. Cubre los métodos y medicinas, así como los efectos físicos y emocionales del dolor. Es una adaptación cultural para el público de habla hispana del libro en inglés Pain Control.
2006-01-15
The oral cavity is of fundamental importance to the speech, chewing, deglutition, suction and salivation functions. When an illness like cancer develops in this region, radiation therapy is very important, but can cause many sequels to the affected functions and structures of the Oral Motor System, especially to chewing, deglutition and speech. In such cases, the phonoaudiology support as part of a multidisciplinary staff can help providing esthetic and functional rehabilitation as well as social re-integration for a better quality of life of these patients. (author)
2006-01-01
The oral cavity is of fundamental importance to the speech, chewing, deglutition, suction and salivation functions. When an illness like cancer develops in this region, radiation therapy is very important, but can cause many sequels to the affected functions and structures of the Oral Motor System, especially to chewing, deglutition and speech. In such cases, the phonoaudiology support as part of a multidisciplinary staff can help providing esthetic and functional rehabilitation as well as social re-integration for a better quality of life of these patients. (author)
2009-01-01
Introduccion y objetivos Describir las caracteristicas de la endocarditis infecciosa sobre valvula protesica por Propionibacterium acnes (EIVPPA) Metodos Descripcion prospectiva y consecutiva de 16 casos de EIVPPA. Resultados Siete pacientes presentaron EIVPPA precoz y 9 tardias. Las tardias siempre tenian el antecedente de algun tipo de manipulacion de la barrera mucocutanea. El retraso diagnostico fue
RELACIÓN MÉDICO PACIENTE: DERECHOS DEL ADULTO MAYOR
2009-01-01
Full Text Available.Existen prejuicios en relación con la vejez, incluso entre los profesionales que se dedican a la gerontología. Uno común y peligroso es considerar que los viejos son todos enfermos o discapacitados.La relación médico-paciente es la piedra angular de la práctica y ética médicas. Para alcanzar el respeto por los adultos mayores es necesaria una medicina prudente, basada en una práctica en la cual la reflexión ética y clínica pueda contribuir. Esto último es posible si se hacen valer los derechos del adulto mayor, en particular como paciente para la toma de decisiones.
RELACIÓN MÉDICO PACIENTE: DERECHOS DEL ADULTO MAYOR
Existen prejuicios en relación con la vejez, incluso entre los profesionales que se dedican a la gerontología. Uno común y peligroso es considerar que los viejos son todos enfermos o discapacitados.La relación médico-paciente es la piedra angular de la práctica y ética médicas. Para alcanzar el respeto por los adultos mayores es necesaria una medicina prudente, basada en una práctica en la cual la reflexión ética y clínica pueda contribuir. Esto último es posible si se hacen valer los derechos del adulto mayor, en particular como paciente para la toma de decisiones.
2005-01-01
There are few studies that have demonstrated the usefulness of prognostic factors in patients with RA using only variables commonly recorded in the clinical records at the beginning of the disease. The aim of our study was to elaborate a simple questionnaire (PPS: Poor Prognosis Score) to evaluate risk factors at the beginning of the illness classifying it in a mild, moderate or severe. We want to know if this simple questionnaire correlates with known variables of worst outcome such as incapacity, mortality, utilization of health services and surgery. Prognostic factors that have shown an association with the worse outcome of RA in different studies were revised. According to literature and published relative risks (RR) of associations, these can be classified as mild (RR 2.0 and 3.0). In accordance with the levels of association, ...
2008-01-01
The number of patients with tetralogy of Fallot who survive complete reparative surgery is increasing. For this reason the late complications of this procedure, such as pulmonary regurgitation, right ventricular dysfunction, arrhythmias, pulmonary artery stenosis or pseudo aneurysms outflow tract, are becoming more common in clinical practice. Magnetic resonance imaging is the method of choice for the global evaluation of these patients because the ability to evaluate the morphology, quantifying right ventricular function and characterization of the anatomy and function of the pulmonary valve. The knowledge of the embriopathology and the anatomy of this congenital heart disease, and the different interventions, palliative or corrective and the complications are essential for the proper interpretation of the images and making therapeutic decisions
2008-07-01
In recent years, several cytoprotective agents have been developed o protect normal cells form the toxic effects of chemotherapy and radiotherapy. The ideal cytoprotectant agent would be that one able to allow the intensification of chemotherapy's dose.; to protect largest number of normal tissues and organs when used with a variety of chemotherapy agents; to confer specific protection for normal tissues; to preserve anti tumor effect and to have little and/or manageable toxicity and side effects. Amifostine fits in on these questions also presenting a broad spectrum of action. This paper aims the discussion of the use of cryoprotective amifostine, their main characteristics/functions, adverse effects, action mechanism, administration and recommended dosage. (author)
2008-01-01
In recent years, several cytoprotective agents have been developed o protect normal cells form the toxic effects of chemotherapy and radiotherapy. The ideal cytoprotectant agent would be that one able to allow the intensification of chemotherapy's dose. To protect largest number of normal tissues and organs when used with a variety of chemotherapy agents. To confer specific protection for normal tissues. To preserve anti tumor effect and to have little and/or manageable toxicity and side effects. Amifostine fits in on these questions also presenting a broad spectrum of action. This paper aims the discussion of the use of cryoprotective amifostine, their main characteristics/functions, adverse effects, action mechanism, administration and recommended dosage. (author)
2005-01-01
The recent therapeutic advances as the cellular implant as well as those different protocols of image acquisition in the field of the Nuclear Cardiology its have allowed that the patient with severe myocardial damage and without some possibility of revascularization is benefited with these advances. Doubtless the Tl-201 par excellence has an important paper for standardize the more appropriate therapeutic behavior for the heart attack patient. Reason by this investigation protocol was developed. The objective of the study was to identify the heart attack regions without viable tissue with SPECT in patient with important myocardial damage without some possibility of traditional revascularization. For the 'Stem cell' cellular implantation therapy. The methodology it was carried out by a study of myocardial perfusion in 10 patients with important myocardial damage ...
1999-07-01
The postural headache syndrome associated with a decrease in the cerebrospinal fluid (CSF) pressure is generally secondary to the CSF leakage that usually occurs after diagnostic lumbar puncture. Spontaneous intracranial hypotension can not be attributed to any known cause or previous diagnostic or therapeutic intervention. The syndrome is characterized by severe headache that is relieved by lying supine. During lumbar puncture, the CSF pressure is normally low. We present two patients in whom gadolinium-enhanced magnetic resonance imaging showed widespread thickening and enhancement of the dura mater and subdural fluid collections. (Author) 13 refs.
2005-01-01
Sirolimus is an immunosuppressive drug that has been used during the past few years. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. This drug has been associated with infrequent but severe pulmonary toxicity. Cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We describe a case of pulmonary toxicity associated with the use of sirolimus in a 59-yr-old liver transplant recipient. We also review all reported cases of sirolimus-associated lung toxicity among liver transplantation recipients, with the intention of understanding the risk factors, the clinical picture and the outcomes of this complication. Five cases have been reported since January 2000, including the present case. Clinical presentation is similar, with ...
2008-01-01
Introduction: The acute toxoplasmosis in the immunocompetent patient, unlike of the positive HIV patient, it is characterizes for prolonged fever, lymph node and nonspecific infectious symptoms, generally with benign course and without systemic commitment. This pathology acquired a very importance in the pregnancy people, where the primary infection can to derivates in the congenital transmission of the illness with irreversible sequels in newborn. Nevertheless, the travel of the people to inhospitable woodsy areas, and the contact with wild-type strain of toxoplasma gondii, to be permitted a new expression of the illness in the immunocompetent patient, with pulmonary, cardiovascular and central nervous system manifestations. They are a high risk for the patient life's. In this study, one case of severe pulmonary commitment for toxoplasma gondii in ...
2010-07-01
The growth that the number of procedures which can be classified as interventional radiology techniques has experienced in the last years, has been accompanied by the concern of professionals and public health authorities about the potential effects caused by the radiation employed. Nowadays, these procedures represent, among all the procedures employing radiation, the highest doses to patients, apart from the radiotherapy techniques. Since the early 1990s, some radiation-induced effects on the skin of patients undergoing some of these procedures, from transient erythema to more serious injuries, have been reported. this work reviews the most relevant aspects of the radiation related risks in this kind of procedures and the suggested strategies to minimize them. (Author) 33 refs.
2010-01-01
The growth that the number of procedures which can be classified as interventional radiology techniques has experienced in the last years, has been accompanied by the concern of professionals and public health authorities about the potential effects caused by the radiation employed. Nowadays, these procedures represent, among all the procedures employing radiation, the highest doses to patients, apart from the radiotherapy techniques. Since the early 1990s, some radiation-induced effects on the skin of patients undergoing some of these procedures, from transient erythema to more serious injuries, have been reported. this work reviews the most relevant aspects of the radiation related risks in this kind of procedures and the suggested strategies to minimize them. (Author) 33 refs
2010-01-01
Introduction and objectives: To investigate negative contractile responses in the left ventricle during low-dose dobutamine (LDD) gated single-photon emission computed tomography (SPECT) in patients with ischemic cardiomyopathy. Methods: Sixty-eight consecutive patients (mean age, 60 [11] years; 7 male) with ischemic cardiomyopathy (ie, left ventricular ejection fraction [LVEF] 40%) were evaluated using gated-SPECT at rest and during LDD infusion. Associations between a negative contractile reserve (ie, a
2007-01-01
Sarcoidosis is a chronic granulomatous disease of unknown etiology characterized by the presence of noncaseating epithelioid granulomas that can take place in every organ or system of the human body. This disease can be acute or sub acute and self limited in presentation or can have a chronic course characterized by exacerbations and remissions. Hypercalcemia can be detected in 10 to 20 percent of the patients with the disease. It is caused by the over expression of vitamin D-receptor and 25-hydroxyvitamin D 1-? hydroxylase enzyme in monocytes and activated macrophages within the granuloma in a way that is resistant to the natural inhibition driven by high serum calcium Levels. This autonomous enzymatic activity leads to the overproduction of calcitriol which increase intestinal absorption of the calcium present in the diet and also increase the activity of osteoclast with ...
1996-01-01
The epidemic of acquired immunodeficiency syndrome (AIDS) increased the incidence of lymphoma, particularly the non-Hodgkin's lymphoma. The lymphoma in immune deficient patients is usually high-grade, very aggressive and with poor prognostic. We report the radiologic characteristics of AIDS-related lymphoma in 19 patients and correlate with the literature. The disease was predominant in homosexual male patients, with mean age of 38 years. The radiological characteristics are nonspecific to differential diagnosis, but we must suspect of lymphoma. We found ring-enhanced lesions in the radiologic studies of central nervous system. Hylar and mediastinal lymphadenopath, nodules and alveolar infiltration were detected on thoracic examinations. Abdominal examinations showed hepatosplenomegaly, lymphadenopathy, hepatic focal lesions and thickneded with ...
1999-01-01
Was collected a total of 1348 radiodiagnostic studies for the following analysis: thorax, cranium, abdomen, hip and pelvis, dorsal columns, lumbar columns and intravenous pielograms. The reading and analysis of dose of the crystals was carried out in the Laboratory of Nuclear Physics of the University of Costa Rica. Upon comparing the dose with the reference values of dose of the International of Atomic Energy Agency, is found that for all the studies exist figures by above the value recommended. To be able to explain to patient the quantity of radiation received in terms not scientific, is proposed to utilized a qualitative unit, the Bert (equivalent time to natural radiation). Due to the large variations in the dose, is recommended to implement quality control programs, where be guaranteed the diminution of the collective dose and be maintained or improve the quality of the ...
2007-01-01
The radiation protection of patients in medical exposures as a project is composed of 5 regional covers some 80 countries, 94 hospitals and 120 activities related to radiology and radiation. A workshop was developed with the following objectives: to provide theoretical and practical elements for professionals in radiation protection of patients developing tasks assigned, to identify the methodology by measurement through sheets for data collection and interpretation of the same, to perform practical exercises of the procedures to apply in radiology, mammography, computed tomography and interventionism. The workshop was divided into theoretical and practical sections, sections for analysis and interpretation of data and a final exam. This project aims to identify strengths and weaknesses, simple primary objectives with fast results, involvement of doctors, ...
2007-01-01
The radiation protection of patients in medical exposures as a project is composed of 5 regional covers some 80 countries, 94 hospitals and 120 activities related to radiology and radiation. A workshop was developed with the following objectives: to provide theoretical and practical elements for professionals in radiation protection of patients developing tasks assigned, to identify the methodology by measurement through sheets for data collection and interpretation of the same, to perform practical exercises of the procedures to apply in radiology, mammography, computed tomography and interventionism. The workshop was divided into theoretical and practical sections, sections for analysis and interpretation of data and a final exam. This project aims to identify strengths and weaknesses, simple primary objectives with fast results, involvement of doctors, ...
2002-01-01
This didactic text is devoted to patients' protection against unnecessary exposure to ionizing radiation. There are obvious benefits to health from medical uses of radiation, i.e. in X-ray diagnostics, in interventional radiology, nuclear medicine and radiotherapy. However, there are well-established risks from improperly applied high doses of radiation (therapy, interventional radiology) and possible deleterious effects from small radiation doses used in diagnostics). Appropriate use of large doses prevents serious harm from therapy, but low doses carry a risk that cannot be entirely eliminated. Diagnostic use of radiation requires therefore such methodology that would secure high diagnostic gains while limiting the possible harm to the lowest possible level. The text provides ample information on opportunities to minimize the doses, and therefore the risk ...
2006-01-01
After an initial period of conviction for installing an active discussion on Radiation Protection of Patients inside the medical community, there were organized working groups in Radiodiagnosis, Radiotherapy, Nuclear Medicine and on radiation protection of pregnant women. These groups began systematical activities, which received a strong institutional support of the Argentine Society of Radiology, toward the implementation of a Program of RPP that is being put nowadays into practice. This program has three aims and a series of targets to be fulfilled in successive stages: Basic aims and short term targets: 1) To guarantee the Justification. First goal: Development of the Prescription Guide (achieve) 2) To optimize the radioprotection: First goal: Development of a Manual of Procedures (achieved) 3) To prevent potential exposures. First goal: Design of a Basic Quality ...
2006-01-01
After an initial period of conviction for installing an active discussion on radiation protection of patients inside the medical community, there were organized 'working groups' in radiodiagnosis, radiotherapy, nuclear medicine and on radiation protection of pregnant women. These groups began systematical activities, which received a strong institutional support of the Argentine Society of Radiology, toward the implementation of a 'Program of RPP' that is being put nowadays into practice. This program has three aims and a series of targets to be fulfilled in successive stages: basic aims and short term targets: 1) To guarantee the justification: first goal: development of the 'Prescription Guide' (achieved). 2) To optimize the radioprotection: first goal: Development of a 'Manual of Procedures' (achieved). 3) To prevent potential exposures: first goal: Design of a ...
1999-05-01
Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin`s lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs.
2009-01-01
The incidence of primary central nervous system lymphoma (PCNSL) has increased during the past 40 years. This has been associated with immunodeficiency, mainly in patients infected with the human immunodeficiency virus (HIV) and in transplant patients. Tumor genesis is related with the Epstein-Barr virus (EBV). The most frequent PCNSL immuno phenotype is B-cell lymphoma. Clinical manifestations depend on tumor localization, and are usually behavior dysfunctions and intracranial hypertension syndrome. Differential diagnosis must take into consideration infectious processes, stroke, primary brain tumors, and metastases. The diagnosis of PCNSL requires brain MRI and brain biopsy. It is important to assess HIV infection when diagnosing PCNSL. This review reports a case of primary brain lymphoma in a patient who underwent renal transplantation due to polycystic ...
2004-07-01
Orofacial complications are unfortunately common with all modalities used in the management of patients with head and neck cancer. It is well known that hypo salivation develops if radiation therapy involves the salivary glands. A significant decrease in salivary volume can adversely affect oral comfort, mucosal health, dentition, deglutition and mastication. Xerostomia may lead to consumption of diet high in carbohydrates and make good oral hygiene difficult. (author)
2004-06-01
Orofacial complications are unfortunately common with all modalities used in the management of patients with head and neck cancer. It is well known that hypo salivation develops if radiation therapy involves the salivary glands. A significant decrease in salivary volume can adversely affect oral comfort, mucous health, dentition, deglutition and mastication. Xerostomia may lead to consumption of diet high in carbohydrates and make good oral hygiene difficult. The purpose of this study is to report a new prevention and management guidelines to oral and dental health care for patients with head and neck cancer who will treat with radiotherapy. New materials as HCT20, Carisolv and chlorhexidine varnish are suggested. (author)
2008-01-01
The perspective of patient protection at the Radio neurosurgery National Service of the Social Security Mexican Institute is divided into three parts: the testing program for equipment acceptance, an assurance quality program based on periodic tests, an also other assurance quality based on tests during the application. Among the technical aspects that influence in the equipment acceptance tests, it is the collimation type, the characteristics of the lineal accelerator, the platform for planning and the network type. In the case of the collimation system and the accelerator characteristics, we consider the manufacturer's specifications and requirements of Mexican Official Standard NOM-033-NUCL-1999, Technical Specifications for the Teletherapy Units Operation, Linear Accelerators. Planning for the platform takes into account the ...
1996-01-01
With the aim of assessing the possible benefits of nutritional therapy , 140 patients were prospectively studied during radiotherapy of the head and neck (81%) and esophageal cancer (19%). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 +- 45 days. Tube feeding was the primary modality in 50.7% of the population, and oral regimens in the remaining 49.3%, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100% and a lymphocyte count diminished along this period (1933 +- 1033 vs 1265 +- 688, p.0.001). A subjective improvement was reported by 84% of the population, and total calorie intake, that was below 60% of estimated needs in 100% of the cases ...
Nefropatia induzida por meio de contraste: Uma realidade para quem se submete a exames invasivos
2005-01-01
A nefropatia induzida por contraste é uma doença que vem, na atualidade, aumentando sua incidência, tal fato pode ser atribuído à realização cada vez mais freqüente de procedimentos diagnósticos e terapêuticos que empregam contraste radiológico e ao perfil clínico mais complexo dos pacientes que se submetem a tais exames. A nefropatia por contraste é a terceira causa de insuficiência renal aguda em pacientes hospitalizados1, rara em pacientes sem lesão renal prévia, aumentando sua freqüência com a progressiva redução da função renal2. Caracteriza-se pela diminuição aguda da função renal após o uso de contraste·endovenoso, em um período de 24 a 48 horas, com pico entre três e cinco dias e retorno·ao valor basal entre sete e dez dias. Os principais fatores de risco para o desenvolvimento de nefropatia por contraste são: disfunção renal prévia, diabetes melito, desidratação, insuficiência cardíaca congestiva e uso concomitante de drogas nefrotóxicas. Algum grau de disfunção renal prévia tem sido relatado em até 30% dos casos de nefropatia por contraste1. Além disso, o risco aumenta quando uma segunda dose de contraste é administrada em período curto de tempo (72 horas) da primeira exposição, fato de importância clinica, já que não é infreqüente que pacientes sejam submetidos a procedimentos diagnósticos e a seguir tratados na mesma internação, o que eleva o risco de lesão renal em até 40%. Publisher: Sociedade Brasileira de Cardiologia Coverage: 2005-10-01T00:00:00Z
2005-01-01
In patients with cancer, fever of unknown origin can be caused by some infections of difficult diagnosis. Here we describe two cases of fatal mycobacteremia The former in a patient with acute Lymphoid leukemia who developed pleural effusions, emphysema and febrile neutropenia, and whose thoracic Computed Tomography (CT) showed multiple nodules that resembled mycotic infection. He was treated with amphotericin B without significant improvement. At 61th hospital day blood cultures grew mycobacterium. Treatment with antituberculous agents was started. Seven days later the patient died.in the second patient the initial presentation was fevers of unknown origin He has history of multiple myeloma and bone marrow transplantation five years ago. During his hospitalization he developed neutropenia and pancytopenia. Bone marrow biopsies revealed myelodysplasia ...
2010-01-01
Introduction and objectives: Heart failure mortality is similar to or even higher than that due to various cancers. It is usually associated with disease progression, though sudden death has also been reported as a frequent cause of mortality. The objectives of this study were to investigate mortality and its causes in outpatients with heart failure of different etiologies who were treated in a specialist multidisciplinary unit, and to identify associated factors. Methods: The follow-up cohort study (median duration, 36 months) involved 960 patients (70.9% male; median age, 69 years; ejection fraction, 31%; and the majority had an ischemic etiology and were in functional class II or III). Results: Overall, 351 deaths (36.5%) occurred: 230 due to cardiovascular causes (65.5%), mainly heart ...
1998-01-01
Chemonucleolysis involving of chemopapain into the intervertebral disk is a widely used treatment for symptomatic hernia that seldom fails. Our objective is to assess the changes in the MR findings in patients in whom chemonucleolysis has failed, correlating the changes observed between pretreatment and pos treatment MR studies with the chemopapain dose and the time interval between chemonucleolysis and the MR study. A retrospective analysis was done of 205 patients treated with chemonucleolysis who had undergone MR prior and after therapy. The changes in the following parameters were recorded: T2-weighted height and signal in the disk. Size and signal of the disk herniation: changes in edema, fat or adjacent joint plates, and the presence of associated soft tissue tumefaction. Upon intravenous administration of the contrast material, the uptake in the disk and adjacent ...
Lanzamiento del estudio de tratamiento personalizado para el cáncer de seno
Hoy se inició el Estudio de Asignación de Opciones Individualizadas de Tratamiento (Trial Assigning IndividuaLized Options for Treatment (Rx), o TAILORx, el cual evaluará si los genes que están frecuentemente asociados con el riesgo de recurrencia entre las mujeres con cáncer de seno en etapa inicial pueden ser utilizados para asignar a las pacientes el tratamiento más adecuado y efectivo. Preguntas y respuestas
2010-01-01
Introduction: Neuromuscular disease (NMD) patients frequently have impaired cough. Mechanical insufflation-exsufflation (MI-E) has proven efficacy in improving airway clearance, however data related to its long-term home use is lacking. The purpose of this study was to describe indications, safety and compliance of home MI-E in NMD patients. Methods: Four years observational analysis of 21 NMD patients on home MI-E. Diagnosis included bulbar and non-bulbar Amyotrophic Lateral Sclerosis (ALS) and other NMD. Median age was 58 years. Only cooperative patients with unassisted baseline Peak Cough Flow (PCF)
1996-01-01
Bone scanning performed in the Nuclear Medicine Center (IPEN-INEN) to patients with neoplastic diagnosis between January 1995 and June 1996, permitted the incidental finding of increased uptake images in the knees of 28 patients associated to an asymptomatic arthropathy: osteoarthritis. The histories and bone scanning of this patients were reviewed obtaining their weight, occupation, symptomatology, neoplastic diagnosis and previous scan diagnosis. Patients under 66 years old, asymptomatic, were included, not presenting secondary focuses, without arthropathia antecedent and with a body mass index equal or above class I. The arthropathy was classified according to the localization of the compromised compartment of the knee.
2000-01-01
Among the new applications of helical CT is the study of the ureteral pathology. The objective of this paper was to evaluate patients with suspected pathology of this organ and the repercussion in the therapeutic plans. We studied 23 patients with a helical CT protocol, without IV contrast injection and performed multiplanar reconstruction (MPR). We called this procedure Pielo CT. Thirteen ureteral stones were detected, 6 calculi, 2 urinary tract tumors, dilatation of the system in a patient with neo-bladder. In 2 patients, in whom ureteral pathology was ruled out, we found other alterations that explained the symptoms, (gallbladder stones, disk protrusion). The Pielo CT let decide a therapeutical approach in 20 or 21 patients with ureteral pathology. (author)
2005-01-01
This is a case of a 23 year old woman with an initial clinical syndrome compatible with glomerulonephritis of uncertain origin, who later showed lesions of purpuric rash characteristics of Henoch- Schonlein Purpura and then complicated with a pulmonary hemorrhage and a rapidly progressive glomerulonephritis, with a mixed lung-kidney syndrome. The renal biopsy showed presence of linear deposits of immunoglobulin A and extra capillary proliferative changes. The case was concluded corresponding to Goodpasture's syndrome for antibodies antiglomerular basement membrane of the type of IgA in the context of a Henoch-Schonlein Purpura
2010-01-01
Introduction: Asthma control has been found to be inadequate in all populations studied to date and accounts for the majority of costs for this disease. The objective of our study was to evaluate the prevalence of poorly-controlled asthma in primary care patients and to identify some of the factors associated with this situation. Methods: We conducted a transversal study that included asthmatic patients over 18 years of age who were monitored in primary care visits (n = 2159). Asthma control was evaluated using the Asthma Control Questionnaire. The demographic variables and the adherence to therapy were evaluated using a questionnaire. The OR for poorly controlled asthma was calculated using logistic regression using asthma control as the dependent variable, which was assessed using the AC...
2001-07-01
In this work the results of a survey of skin entrance dose imparted on pediatric patients are present. Positioning the thermo luminescence dosimeters in contact with the patient's skin, in the center of the incident X-ray beam, collected the skin entrance dose data. The patients were grouped in five age groups: infants, 1,1 to 4 years, 4,1 to 6 years, 6,1 to 10 years and older than 10 years. The results show that the average of skin entrance doses is very higher as compared to the European Community Commission reference levels and to other values found in literature. (author)
2001-07-01
In nuclear medicine, radioisotopes are bound to various pharmaceuticals for use in diagnostic and therapeutic applications. These unsealed sources are administered in various forms to patients, who remain radioactive for hours or days, and represent a source of potential radiation exposure for others. Thus, in nuclear medicine departments, radiation protection of workers and members of the public (especially persons accompanying patients) must consider this exposure. In this study, thermoluminescent dosimeters were given to various persons who were accompanying patients in two nuclear medicine departments in Recife, Pernambuco State, Brazil. Exposure results are given, and issues regarding exposure conditions and times for members of the public in these departments are discussed. (author)
2006-07-01
The purchase of a digital X-Ray equipment specific for paediatric cardiology in 2003 has allowed a careful examination of the technical characteristics of these patients. This data review includes the analysis of a dose index with several variable factors such as weight, size and age of patients, purpose, type and characteristics of the study and its development over time as a results of the experience gained by the staff involved. (Author)
2009-01-01
The aim of this study was to determine whether there are differences in echocardiographic findings or in the level of a biochemical marker (ie, N-terminal probrain natriuretic peptide [NT-proBNP]) between controls and type-2 diabetic patients with or without ischemic heart disease. Echocardiography was used to assess left ventricular function and morphology. In addition, the plasma NT-proBNP concentration was measured. The prevalence of diastolic dysfunction was greater in diabetics without ischemic heart disease than in controls (88% vs 74%, respectively; P490 fmol/mL had a sensitivity of 84% and a specificity of 75% for detecting ischemic heart disease in diabetics.
2010-01-01
Introduction and objectives: The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. Methods: This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively u...
Estudio de Asignación de Opciones Individualizadas de Tratamiento (TAILORx): preguntas y respuestas
Hoy se inició el Estudio de Asignación de Opciones Individualizadas de Tratamiento (Trial Assigning IndividuaLized Options for Treatment (Rx), o TAILORx, el cual evaluará si los genes que están frecuentemente asociados con el riesgo de recurrencia entre las mujeres con cáncer de seno en etapa inicial pueden ser utilizados para asignar a las pacientes el tratamiento más adecuado y efectivo.
2006-01-01
Hysterosalpingography (HSG) is a relatively frequent radiological procedure, which is used to access and study the uterine cavity and the tubary permeability. The estimate of the radiation doses received by the patients, and of the associated risks, has become of great interest in recent years. The importance in evaluating the received doses becomes even higher when the gonads region is irradiated. As in the case of hysterosalpingography, where the patients are relatively young, existing a high probability of future pregnancy. In HSG procedure the physician stays beside the patient, being also exposed. The purpose of this study was to analyze, during HSG procedures, the exposition of patients, measuring the kerma-area (PK,A) product by using an ionization chamber of big area, to evaluate the doses received by the radiologist using thermoluminescent ...
2004-01-01
An electrocardiographic study made in 2.130 blood donors in the city of Bucaramanga, Colombia between 1999 and 2004 is presented. The findings between 486 seropositive T (+) patients in relation with 1.644 seronegative T (-) for trypanosome Cruzi are compared. Differences in percentages that were statistically significant were found in the T (+) population respect to the T (-) regarding the following parameters: right bundle branch block (6, 1/2,6 p
2000-01-01
To describe the radiological findings associated with ectopic ureterocele and ectopic ureter in pediatric patients. To assess the role of ultrasound (US), serial micturating cystourethrography (SM-CU) and intravenous urography (IVU) in the diagnosis of these two entities. The authors performed a retrospective study of 132 patients, 73 with ectopic ureterocele and 59 with ectopic ureter. The imaging studies used were US, SMCU, IVU and methods to determine renal function (diuretic renography and renal scintigraphy). The findings were confirmed during surgery in every case. The most common radiological findings in ectopic ureterocele were renal duplication (86,3%). vesicoureteral reflux (VUR) to the lower half of the kidney (46.6%), dilatation of the lower pole of the kidney (38.4%) and contralateral duplication (30.1%). In boys, the ectopic ureter entered via ...
2001-01-01
The antiphospholipid syndrome (AFS) is characterized by vascular thrombosis and/or pregnancy morbidity associated to presence of antiphospholipid antibodies (anticardiolipin and/or lupus anticoagulant), This syndrome may occur alone primary -PAFS-) or in association with systemic lupus erythematosus (secondary -SAFS, Both primary and secondary AFS can be responsible for systemic manifestations other than vascular, among them pulmonary, Here is presented a patient with dyspnoea due to pulmonary hypertension (PHT) and interstitial pulmonary disease (IPD), in whom a diagnostic of SAFS was done, The pulmonary manifestations of the AFS are revised including pulmonary thromboembolism, PHT, IPD, pulmonary hemorrhage, and adult respiratory syndrome with multisystemic failure
2009-01-01
Introduction and objectives: Diabetes mellitus (DM) is associated with the development of both impaired left ventricular diastolic function (LVDF) and pathological changes in the coronary macro- and microcirculation. The aim of this study was to investigate the relationship between these manifestations of diabetic heart disease. Methods: The severity of atherosclerosis in the left anterior descending coronary artery (LAD) was quantified using intravascular ultrasound (IVUS) in 13 patients with DM and ischemic heart disease. The coronary flow velocity reserve (CFVR), instantaneous hyperemic diastolic velocity pressure slope index (IHDVPS) zero-flow pressure were derived from digital intracoronary pressure and flow velocity measurements. The relationships between indices of LVDF (ie, E/A and...
2008-01-01
Las hemorragias alveolares difusas son cuadros clinicos que pueden ser catastroficos si no se diagnostican y tratan a tiempo. Suelen estar causadas en gran parte por vasculitis de vasos pequenos pulmonares. Existen 3 grandes grupos: a) las pauciinmunitarias, generalmente asociadas a capilaritis y anticuerpos citoplasmicos antineutrofilos; b) las producidas por depositos inmunologicos, que pueden detectarse mediante inmunofluorescencia, y c) un gran grupo miscelaneo, que incluye toxicidad por farmacos, infecciones y causas idiopaticas. El diagnostico se basa en la integracion de signos, sintomas, estudios serologicos y morfologicos. Se debe recomendar la realizacion de una biopsia por videotoracoscopia en los pacientes con hemorragia alveolar difusa de causa inexplicada, sin un diagnostico ...
2002-01-01
Sixty patients with abdominal pain and suspected renal colic were studied. All of them underwent Helical Computed Tomography (HCT) with no oral or intravenous contrast material. The HCT was used to assess absence or presence of stones. The final diagnose was reached by clinical follow up in each case. With the obtained results the positive predictive value of the HCT is of 98% in the group of patient suspected of lithiasis. The effectiveness, easy performing and no contraindications of the CT of the urinary system make this method a modality of choice in the study of the patient with probable reno ureteral stones. (author)
2004-01-01
Purpose: To determine the role of imaging diagnostic methods in the location of infection causes of unknown origin in the critical care patient. Material and methods: A comprehensive medical literature search has been done. Recommendations for the diagnostic imaging of septic focus in intensive care patients are presented for each case, with analysis based on evidence. The degree of evidence utilized has been that of Oxford Center for Evidence-based Medicine. Results: Nosocomial infection is the most frequent complication in the intensive care unit (25 to 33%) with high sepsis incidence rate. In order to locate the infection focus, imaging methods play an important role, as a diagnostic tool and to guide therapeutic procedures. The most frequent causes of infection are: ventilation associated pneumonia, sinusitis, intra-abdominal infections and an acute acalculous ...
2009-01-01
In this work, we present an electronic interface design based on optics devices. Micro-controller with an Usb module was used. Development of a device and software has been implemented. This device allows using a computer to the people with severe motor incapacity in extremities superiors, especially those that present quadriplegia. To establish command control to a distance of the cursor without cables, the interface used a communication protocol with infrared light. A mechanical device able to adjust with different faces contours and take advantage with optimal movement of the face was designed too. Software that emulates a physical keyboard in the screen of the computer allows the writing of characters in any text processor is necessary in this design. (Author)
2010-06-01
Full Text Available.El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.
El objetivo del trabajo es conocer las disyuntivas entre los principios de beneficencia y autonomía, que se presentan en la relación médico-paciente, durante la terapéutica del intento de suicidio.La investigación se realizó en dos hospitales psiquiátricos de la Ciudad de México. La muestra incluyó a tres sujetos con intento de suicidio, mayores de 18 años, que eran atendidos en consulta externa a causa de una lesión autoinfligida en el último año, y a tres psiquiatras que trataban a estos pacientes. La información se obtuvo previo consentimiento informado en entrevistas individuales. Se llevó a cabo un análisis de discurso argumentado para encontrar los significados que los participantes otorgaron a los principios bioéticos y las posibles disyuntivas entre éstos.Las discordancias entre la beneficencia y la autonomía estuvieron relacionadas con el beneficio del tratamiento, el respeto por los valores y las creencias de los pacientes, entre otros. Este trabajo presenta consideraciones éticas relevantes en el escenario clínico, al ofrecer al psiquiatra un análisis bioético que le permita actuar de acuerdo con la beneficencia y respetando la autonomía del paciente frente a casos de intento de suicidio y, de esta forma procurar una mejor atención para ellos.
2003-01-01
A female patient with cardiomyopathy caused by Chagas' disease and incessant ventricular tachycardia is presented. The electrocardiographic characteristics suggested a left ventricular origin. The patient underwent a surgical procedure in order to correct an anterolateral ventricular aneurysm, but the tachycardia persisted. An electrophysiological study induced the arrhythmia through atrial and ventricular stimulation. The tachycardia morphology and its electrical axis, as well as the he are and the anterosuperior hemifassicle's mapping, led to the recognition of a reentrant mechanism between the hemi fascicles. Ablation of the site where the potential of the anterosuperior hemi fascicle preceded the potential of the fascicle successfully suppressed the tachycardia. The arrhythmia could not be induced again, even through isoproterenol infusion. No ...
2006-01-01
In this work the experience obtained in a course organized in Argentina to qualify professionals in the radiopharmaceutical dosimetry using the methodology MIRD and the patient's images is presented. The motivation to carry out it was based on the continuous development of new radiopharmaceuticals with therapeutic purposes that makes necessary the knowledge of the distribution of the absorbed dose to be able to establish the dose-response relationship. The main objective was the study of the biokinetic model and those techniques available that starting from images can contribute information of specific parameters of the patient to calculate with more accuracy the doses in the tumor and in different organs. In the design of the program of this course it was considered to approach the different focuses for the calculation of specific dose of the patient and includes the ...
1999-01-01
To evaluate the computed tomography (CT) findings in a series of 100 pleural metastasis effusions. A retrospective study was carried out that consisted of assessing the CT images of 100 malignant pleural metastasis effusions, evaluating the amount of the effusion, its distribution, the presence of swelling or nodules in the different pleural surfaces, the existence and the characteristics of the extrapleural fat and the changes in other locations different to the pleural cavity, mainly the mediastinum and the pulmonary parenchyma. The effusion was located in 12 patients. The amount of the effusion was slight in 14% and massive in 10% of the sick patients. Pleural nodules were detected in 19% of the studies, in all those that affected the costal parental pleura, being less frequent in the other pleural surfaces. The costal parental pleura was swollen in 43% of the sick patients. ...
2009-01-01
Introduction and objectives: This study was designed to compare differences in the incidence of contrast-induced nephropathy (CIN) and changes in serum creatinine (SCr) level following iso-osmolar iodixanol or low-osmolar ioversol administration in diabetic patients undergoing coronary angiography, with or without percutaneous coronary intervention (PCI). A number of studies have indicated that iodixanol reduces the risk of CIN in patients with renal impairment, with or without diabetes. Diabetic patients may have some degree of renal dysfunction despite having a normal SCr level. Methods: The study included 250 consecutive diabetic patients undergoing coronary angiography with or without PCI. Those enrolled during the first 7 months of the study received ioversol and those enrolled during...
1991-01-01
Tumoral collision has been defined as a coexistence of two or more central nervous system tumors histologically distinct, in a patient not harbouring a neuro-ectodermic disease (phakomatosis). Several theories exist for explaining this phenomenon but most of them assume that there is spacial proximity between the tumors and/or ionizing radiation effects. We report the case of coexistence of meningothelial meningioma and glioblastoma multiforme in a same patient, occurring in different hemispheres on different times. The tomographic aspects of the gliomatous lesion and the difficulty in differentiating by neuroimaging among high grade gliomas and recent hemorrhagic cerebral events are discussed. (author)
2002-01-01
Chylomicrons are the triglyceride-rich lipoproteins that carry dietary lipids absorbed in the intestine. In the bloodstream , chylomicron triglycerides are broken-down by lipoprotein lipase using apoliprotein (apo) CII as co factor. Fatty acids and glycerol resulting from the enzymatic action are absorbed and stored in the body tissues mainly adipose and muscle for subsequent utilizations energy source. The resulting triglycerides depleted remnants are taken-up by liver receptor such as the LDL receptor using mainly apo E as ligand. For methodological reasons, chylomicron metabolism has been unfrequently studied in subjects despite its pathophysiological importance, and this metabolism was not evaluated in the great clinical trials that established the link between atherosclerosis and lipids. In studies using oral fat load tests, it has been shown that in ...
2006-01-01
Aim: to report our experience with breast radio-guided surgical biopsy (RGSBs) and to assess the rate of carcinomas diagnosed as from the incorporation of Mammotome. Material and methods: 2060 RGSBs performed between March 1995 and April 2004 were analyzed. Imaging findings were classified as microcalcifications, circumscribed nodules, nodules with irregular borders (non-specific densities included), spiculated masses and architectural distortions. Histological patterns were categorized as malignant (intraductal and infiltrating), high-risk lesions (atypical hyperplasia, lobular carcinoma in situ) and benign masses. The correlation between the percentage of carcinomas and imaging findings was evaluated. Changes in the proportion of carcinomas found with RGSB and the number of RGSB procedures as from the introduction of Mammotome were also evaluated. ...
Boletín del Instituto Nacional del Cáncer - 03-02-2010
En un pequeo estudio clnico aleatorizado, las pacientes con cncer de mama que tenan dolor en las articulaciones y rigidez por el tratamiento con inhibidores de la aromatasa (IA) reportaron un alivio del dolor cuando usaron la acupuntura. Ochenta por ciento de las mujeres que recibieron acupuntura informaron de una mejora de 2 puntos por lo menos en una escala de dolor de 10 puntos, comparadas con 22% de las mujeres que recibieron un tratamiento simulado.
2008-01-01
Biological Dosimetry allows individual dose assessments based on the effect produced by ionizing radiation on a given biological parameter. The current biological endpoint being scored is chromosomal aberrations, relying on a lymphocytes culture from the patient's blood. The measured yield of chromosome aberrations is referred to a calibration curve obtaining the whole body dose. Different scenarios of overexposure can be taken into account by modifying the calculations leading to the dose estimate. Differentiated Thyroid Carcinoma patients undergo thyroidectomy followed by internal radiotherapy with 131I. The treatment's success entails the delivery of a lethal dose to the tumour within the maximum tolerable dose to a critical organ (blood doses over 2 Gy could lead to bone marrow depression). Currently, there is no established agreement for the ...
2006-01-01
The administration of I-131 to patient with Differentiated Thyroid Carcinoma (CaDiT) it is used inside the therapeutic outline as later step to the thyroidectomy. However, the good activity to give is of difficult determination due to factors such as, the variability in the capacity of tumoral reception of the I-131, distribution of the pharmaceutical, physiologic status, other associate pathologies, grade of advance of the illness, and previous treatments. Additionally, the activity to administer is dependent of the dose of tolerance in the healthy tissues. Superior dose to 2 Gy in bone marrow, its could drive to myelotoxicity. At the moment, the form more extended of administration it is the empiric prescription that considers clinical parameters and of laboratory for their determination. Presently work, the protocol of applied treatment incorporates the evaluation ...
2007-01-01
The differentiated thyroid carcinoma (DTC), constitutes the 90 % of the thyroid gland cancers. 80% of patients are cured after the initial therapy and 12% remained disease-free after successive treatments. The 24 patients included in this study represent a sample of the aforementioned 12% and 8%, with recurrence in the first decade post-treatment (local disease and/or recurrence at distance). The internal radiotherapy with 131I in patients with DTC is used within the therapeutic schema as a step post-thyroidectomy. The success of the therapy is to get a lethal dose in the tumor tissue, which depends on the therapeutic activity and the retention of 131I, without exceeding the dose of tolerance in healthy tissues. The most widespread way of administration is the empirical prescription which considers the clinical and laboratory parameters for its ...
2010-01-01
Background: There is little information regarding the clinical management of hospital inpatients diagnosed with exacerbation of Chronic Obstructive Pulmonary Disease (COPD). AUDIPOC is a clinical audit dealing with the clinical management of COPD in Spain. Objectives: To examine the adequacy and validity of the instruments used to measure the variables proposed by AUDIPOC Spain (Preliminary Study) and to verify the viability of AUDIPOC in a complex environment with hospitals of different sizes, resources, and organizational layout (Pilot Study). Materials and methods: The Preliminary Study took place in 4 hospitals and studied 213 cases. The Pilot Study took place in 30 hospitals of 6 Autonomous Communities (i.e. Regions) and studied 1203 cases. Results: The results of both studies contrib...
2009-01-01
The PCXMCR computational methodology was applied as a evaluation tool of the organ doses in patients submitted to different X-ray conventional diagnoses examinations. Simulations were made based in x-ray parameters and exposure geometry of three patient of same age group in an Emergency Hospital of the metropolitan area of Belo Horizonte city. Contributions to the effective dose from critical organs were evaluated and analyzed in terms of patient height and weight for the examinations of abdomen and pelvis. (author)
2009-01-01
The aim of this study was to describe the echocardiographic characteristics of patients with an atrioventricular criss-cross who underwent segmental cardiac morphological analysis. The study involved 5 patients with a criss-cross heart (0.6% of the studies). The patients' average age was 6 years and 3 months. All patients presented with situs solitus. Three had a discordant atrioventricular connection and 2 had a concordant connection. In addition, 4 patients had a ventriculoarterial connection with a double-outlet right ventricle while 1 had a concordant connection. Two patients had superior-inferior ventricles. Other associated lesions included ventricular septal defect in all patients, pulmonary stenosis, persistent ductus arteriosus, and atrial septal defect in 3, pulmonary perforation...
1999-01-01
The report summarizes the assessment made of an accidental overexposure of radiotherapy patients that occurred at the San Juan de Dios Hospital in San Jose, Costa Rica, in August and September 1996. The assessment was carried out by an Expert Team convened by the IAEA in July 1997 at the request of the Government of Costa Rica. An overview provides background information on radiotherapy in general and the situation in Costa Rica in particular. It also contains a description of the biological effects of radiotherapeutic exposure, the framework for radiation protection in radiotherapy and the role of the IAEA in this area. The report summarizes the history of the accident. An account of previous investigations in Costa Rica, made both before and after the accident, is presented. The circumstances and causes of the accident are also detailed. The findings of the Expert Team's ...
Sexuality in the palliative–terminal phase of cancer
2007-01-01
ResúmenEl objetivo de éste artículo es de enriquecer nuestros conocimientos de la intimidad y de la sexualidad de los pacientes en fase paliativa–terminal del cáncer. Con éste fin hemos recogido informaciones cualitativas a lo largo de las consultas en sexología con parejas sobrevivientes (generalmente en consulta con una nueva pareja). A lo largo de las primeras fases del cáncer el objetivo principal del paciente es hacer frente al diagnóstico y a la supervivencia. Durante éste periodo la mayoría de las parejas se abandonan a las caricias íntimas. A continuación de la fase de tratamiento comienza el proceso de recuperación. En función de su flexibilidad y de sus valores, y de los trastornos físicos sufridos,...
2010-01-01
Full Text Available.Este estudo avalia quanto o corpo médico do Hospital Dr. Darío Contreras de República Dominicana conhece, respeita, informa e aplica a Lei Geral de Saúde em relação aos direitos do paciente Testemunha de Jeová de negar-se a ser transfundido (respeito a sua autonomia); também se os Testemunhas de Jeová conhecem a Lei Geral de Saúde e até que ponto têm se beneficiado diante dessa proposição. O estudo revelou que nem médicos, nem Testemunhas de Jeová conhecem de fato essa lei.
Tobacco Cessation: Action-Stage Result as a Predictor of Successful Long-Term Maintenance
2007-01-01
Objetivo La escasez de estudios a largo plazo dificulta la valoracion de la abstinencia mantenida en el tiempo de los fumadores que consiguen dejar de fumar. El objetivo de nuestro estudio ha sido determinar en que medida los resultados obtenidos tras la intervencion para dejar de fumar se consolidan en el tiempo, al cabo de 5 anos. Pacientes y Metodos Se ha realizado un estudio longitudinal y prospectivo sobre 502 fumadores, cuasi experimental, al considerar el grado de dependencia nicotinica como criterio para la asignacion del tratamiento: intervencion minima sistematizada en los fumadores con dependencia baja o que aun no se encontraban en fase de preparacion, y tratamiento sustitutivo con nicotina en aquellos con dependencia moderada-alta y/o alto consumo de cigarrillos. Resultados De...
2006-07-01
The rise in ionizing radiation applications within the field of diagnostics, with the corresponding increase in both number and doses received by patients, requires adequate resources for education and training in radiological protection. In is quite difficult to assemble professionals at a specific place to carry out training. However, the use of Information and Communication Technologies (IT) makes it possible to carry out training. However, the use of Information and Communication Technologies (IT) makes it possible to carry out training through Internet in an effective, easy and amusing way (e-learning). An on-line course of patient radiological protection and quality control in computer tomography has been developed aimed at professionals that use these diagnostic techniques. The course has been run twice in the period 2005-2006. The course is found on an Internet-accessible Virtual Campus, which allows access to multimedia contents, communication between students and instructors and follow-up of students performance. Final evaluation is done on-line and successfully passing the course counts for 8.9 credits in the Continuous Education Programme of Spanish Health Systems. (Author)
2002-01-01
Clinical examination alone is not sufficient to precisely evaluated lymph node involvement in head and neck cancer. The results of computed tomography on the neck and lymphoscintigraphy were evaluated in 21 patients with carcinoma of the mouth and oropharynx staged NO. Nine patients were treated by homolateral and 12 by bilateral neck dissection. Sensitivity and specificity of computed tomography were 16% and 73% for homolateral side and 0% and 90% for contralateral side, respectively. Lymphatic drainage was observed in 76.2% of the cases. No-migration was associated with cases involving the retromollar region and tonsillar fossa, where injection of the 99m Tc-Dextran 500 is more difficult. Bilateral migration occurred only in carcinomas of the floor of the mouth, with involvement of the midline. From these results it was concluded that computed tomography ...
2005-01-01
The sinonasal involvement is one of the most common manifestations in cystic fibrosis. Data show a high incidence of chronic rhino sinusitis in these patients. Although it has been found radiographic opacification of the sinus in more than 90% of cases, few are symptomatic. So that, it is difficult to recognize nasossinusal disease in patients with cystic fibrosis. Questionnaire, nasal endoscopy and CT-scan are very important methods in this approach. Aim: to evaluate the diagnosis of chronic rhino sinusitis in patients with cystic fibrosis by anamnesis, nasal endoscopy and CT-scan and compare those results.Study Design: Clinical prospective. Material and method: evaluation of 34 patients - older than 6 years and with a confirmed diagnoses of cystic fibrosis - by anamnesis (questionnaire), nasal endoscopy (score Lund-Kennedy) and CT-scan (score Lund-Mackay). Results: ...
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