[Torsional ovarian cyst in a newborn infant. Report of a case].
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Diagnosis, Differential↗
Biomedical subjects
E J Ramírez-Barba
Publications and source records attributed to E J Ramírez-Barba.
Update in internal medicine.
More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes. Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine.
Acquired Immunodeficiency Syndrome↗
[Breath tests as a noninvasive diagnostic method in Helicobacter pylori infection].
There are several diagnostic methods for Helicobacter pylori infection, some of them need an endoscopic procedure and biopsy to be performed (invasive) like the rapid urease test, culture and histology. Recently non invasive, specific, sensible, easy to perform and patient's well accepted methods had been developed known as breath test, based on the hydrolysis of labelled urea by Helicobacter pylori urease enzyme, to release ammonia and bicarbonate. Labelled CO2 reaches the bloodstream and the lungs, from where can be collected into the breath for quantification. Labelled urea has to options: 13C stable, non-radioactive and 14C unstable, radioactive. Breath test with 13C is based on the atomic mass difference between 12C and 13C and it is necessary a mass spectrometer and 40 minutes to perform it. Breath test with 14C has 1 uCi (one micro-curie) of radioactivity (1/300 of total radiation received in one year from the environment); the test takes 10 minutes and the samples are read in a beta counter. Both non-invasive tests had demonstrated sensitivity and specificity comparable to established "gold standards" for Helicobacter pylori infection diagnosis.
Breath Tests↗
[The incidence and opportunity for the diagnosis of diabetic retinopathy].
This study aims to establish the frequency of diabetic retinopathy (DR) in patients with diabetes mellitus (DM) type II in Leon, Guanajuato, Mexico, as well as the opportunity for their diagnosis. A prospective study was carried out in a sample of 100 patients. DR was stratified using the classification of the Early Treatment Diabetic Retinopathy Study Research Group and diagnosed in 42 per cent of the sample. The evolution time of diabetes in this group was different from that of the group without RD (p < 0.0001). A direct proportional and significant relationship between the duration of DM and an increasing severity of DR was found. Opportune diagnosis was made in 70 per cent of the cases with DR. In 81 per cent of the 42 patients with DR, no previous diagnosis was made. This study shows a high proportion of RD without diagnosis. The intensification of educational strategies for the opportune detection and early treatment of DR is recommended.
Confidence Intervals↗
[Nutritional support in severe acute pancreatitis. Controlled clinical trial].
INTRODUCTION: Severe acute pancreatitis is an ailment with a higher than 60% mortality. The nutritional support is a fundamental part of the treatment in these patients with the aim of ameliorating traumatic metabolic response. AIM: To compare total effectiveness of parenteral nutrition and enteral nutrition through jejunostomy in postoperated patients for acute pancreatitis. MATERIAL AND METHODS: A clinically controlled, longitudinal, prospective, experimental and at random survey was performed with our hospital's nutritional supportive service (which is a reference center) in a 16-month period. Patients postoperated on for severe pancreatitis were included (3 or more of Ranson's criteria), the ones who died before the first week were excluded. Group I was treated with total parenteral nutrition, and group II with enteral nutrition via jejunostomy through a silicon catheter placed at transoperative. The result variables were summed up at the beginning and every week for a 3-week period. The hipotheses were contrasted with Student's " t " test with a tail for independent samples of a 5% significance level. RESULTS: Groups I and II were integrated by 12 and 10 patients respectively. Sex and ages were similar. Urine nitrogen was kept high in both groups, being group I the highest (ns). Nitrogen balance was kept close to neutrality in both groups (ns). Serum albumin levels were slightly increased in both groups (ns). The creatinine/size index showed loss of progressive muscular mass in both groups, being group II the lowest (p < 0,05). Total lymphocyte count depletion level improved from mild to normal in both groups, but being this more important in group II (p < 0,05). Global mortality was 40%. CONCLUSIONS: Enteral nutrition was as effective as parenteral in these patients, having the advantage of being less expensive, easier to handle and with a lesser rate of septic complications. We consider that this must be the nutritional method of choice if there are contra indications for its use.
Acute Disease↗
[Treatment of enterocutaneous fistula with or without octreotide and parenteral nutrition].
OBJECTIVE: To evaluate the use of octreotide together with the conservative handling in the treatment of patients with external gastrointestinal fistulae. MATERIAL AND METHODS: Clinical essay in postsurgical gastrointestinal fistulae carriers assisted during a 54-month period. They were randomly distributed in two groups: group A was treated with conventional handling and group B was additionally treated with octreotide. RESULTS: 44 women and 55 men with an average age of 50 +/- 19 years old were treated. The following table summarizes the result variables. [table: see text] CONCLUSION: The use of octreotide is recommendable, for it was useful in diminishing both the closing time of the fistula and the time the nutritional support the patient requires. Mortality still continues to be very increased (because of sepsis), by which the phrase "primum non nocere" takes a relevant place since this pathology is greatly preventable.
Cutaneous Fistula↗
[Reflux esophagitis: a comparative study of lansoprazole and omeprazole as short-term therapy. Preliminary report].
BACKGROUND: Reflux Esophagitis is a common complaint from the upper gastrointestinal tract with a figured out prevalence of about 2%. Therapeutic results in this pathology have been unsatisfactory. AIM: To compare lansoprazole and omeprazole therapeutic effects in patients with reflux esophagitis. MATERIALS AND METHODS: A clinical, double-blinded, balanced survey was randomly designed with patients who would daily receive 30 mg lansoprazole (Group A) or 20 mg omeprazole (Group B) during a 4-week period. All patients were submitted to endoscopy and biopsy both at the beginning and at the end of the survey. RESULTS: Ten patients in each group were treated without any significant differences in sex, age, nicotinism, alcoholism, AINES ingestion, development time, pain regurgitations, pyrrosis, hematemesis, dysphagia, melena, nausea or vomiting, and esophagitis degree. A complete cure in 8/10 (omeprazole) and 7/10 (lansoprazole) patients was obtained (p = n.s.). However, the histological results of the biopsy at the end of the four-week period proved to be a failure in 4/10 (omeprazole) and in 5/10 (lansoprazole) patients (p = n.s.). The endoscopy and clinical result at the end of the study were similarly effective; but not so the histological damage to the esophagus, which continues to be important. CONCLUSIONS: The use of bomb inhibitors in esophagitis by reflux is advisable. Future surveys must assess the average time of treatment for the disappearance of the histologic lesion.
2-Pyridinylmethylsulfinylbenzimidazoles↗
[Diaphragmatic hernia caused by penetrating injury: emergency laparoscopic reconstruction].
OBJECTIVE: To inform a patient with penetrating thoracic trauma and diaphragm injury that produced stomach herniation, being reduced the hernia and repaired the injury by laparoscopy though abdominal route with excellent result. REPORT: 17-years-old male, hemodynamically stable with penetrating injury in the fifth left intercostal space, at the level of the middle auxiliary line, pneumothorax and left diaphragmatic hernia. Treatment. A pleurostomy tube was inserted. By laparoscopy 600 mL of free blood in abdominal cavity were aspired, the stomach hernia was reduced and the diaphragmatic repair was performed with nylon 3-0 running suture. The evolution was excellent, being integrated to his work at the twentieth postoperative day. COMMENTARY: Our case supports that laparoscopic surgery is at therapeutic alternative in select cases of trauma.
Adolescent↗
[Malnutrition and total parenteral nutrition: a cohort study to determine the incidence of refeeding syndrome].
UNLABELLED: The Refeeding Syndrome is conformed by a series of clinical manifestations related to electrolytic alterations associated with the restarting of the nutritive contribution both enteral and parenteral. AIM: To detect the Refeeding Syndrome incidence in malnourished patients who required nutritional, enteral or endovenous support and its relationship with mortality. MATERIAL AND METHODS: A cohort study was performed in the service of Nutritional Support of the IMSS (Social Security Mexican Institute) Specialties Hospital CMN León, from June 1995 to May 1996. All patients with mild and severe malnutrition were included, they received endovenous or enteral nutritious support for more than 7 days, without presenting previous electrolytic unbalance. Serum potassium, phosphorous, and magnesium levels were determined before starting the nutritious support and also on the 3rd, 7th, and 10th days. Descriptive statistics, Student's t and Z test were used, with a 5% significance level. RESULTS: 148 patients with total nutritional support, 23 (16%) of them with restrained malnutrition and 65 (44%) with severe deficit. 54 men and 34 women with an average age of 51.6 +/- 19.4 years. Nineteen patients were eliminated due to a nutrition period of less than 7 days, and other 19 were also eliminated for presenting electrolytic alterations before the nutritive support started. An incidence of 48% of electrolytic alterations compatible with the refeeding syndrome was the result in the remaining 50 patients. The alterations were: hypomagnesemia 13/24, hypokalemia 12/24 and hypophosphatemia 4/24; in 55% of the cases the syndrome appeared at the third day of administration. Hospital sojourn of patients with the syndrome was 26.7 +/- 18 days vs 15.3 +/- 7 (p < 0.05) of those who did not present it. 15 patients died, 5 of them had electrolytic alterations before nutrition, 7 (29%) with refeeding syndrome and 3 (12%) did not presented it (p = 0.059). CONCLUSIONS: Refeeding Syndrome is a frequent entity in malnourished patients submitted to enteral or parenteral nutrition; at least in this study it was of 48%; its presence was followed by a longer hospital stay and a higher mortality rate.
Adolescent↗