Cluster headache attack due to sildenafil intake.
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Biomedical subjects
Publications and source records attributed to J Ferreiro.
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A new schedule with cisplatin and gemcitabine administered biweekly was prospectively evaluated in stage IIIB or IV non-small cell lung cancer. We report the interim analysis of the safety and efficacy with the first 23 patients included. The mean age was 60. Thirteen patients (56.5%) were stage IIIB and 10 (43.5%) were stage IV The overall response rate was 47.8%: 69.2% for stage IIIB and 20% for stage IV The median survival among the 23 patients was 33 weeks and 1-year survival was 39%: 53.8% for stage IIIB and 20% for stage IV Seventy-seven cycles (154 administrations) were given. The mean number of cycles/patient was 3.3 (range: 1 to 6). Of the 154 administrations, 26 were delayed 1 week for recovery from toxicity. The dose intensity (Hryniuk criteria) was 94% of the planned dose. There was one toxic death with grade 4 thrombocytopenia and grade 4 esophagitis. In two patients, grade 3-4 vascular toxicity was observed, with distal arterial ischemic changes in the lower extremities. There were three (3.9%) episodes of grade 2 neutropenia, one (1.7%) of grade 3 and another one of grade 4. No cases of febrile neutropenia were seen. Predominant nonhematologic toxicities were asthenia and nausea/vomiting. This schedule of cisplatin and gemcitabine has a good therapeutic index and, as it is active, enrollment is ongoing to complete the second part of the study.
We present a widely metastatic islet cell tumor of the pancreas with focal areas resembling rhabdomyosarcoma. To our knowledge, this is the first reported case of islet cell/carcinoid tumor exhibiting such differentiation. Desmin was localized to the rhabdoid areas by immunohistochemistry. Cross striations were not seen by light microscopy, but Z-lines and thick filaments were seen on electron microscopy.
The pituitary gland was examined at autopsy in 88 patients who died with acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC). Pathologic findings included focal to widespread necrosis and/or fibrosis of the anterior pituitary gland in 10 cases, evidence of cytomegalovirus infection without an apparent inflammatory component in the anterior pituitary in 3 cases, and microglial nodules in the pars nervosa in 5 cases. In one instance, a multinucleated giant cell identical to those associated with direct human immunodeficiency virus infection of brain was identified in the pars nervosa. One patient showed focal anterior pituitary infection by Cryptococcus neoformans in the context of widespread and severe cryptococcosis. These findings are discussed in relation to the possible clinical manifestations and the neuropathologic and systemic pathologic findings in AIDS patients.
Fifty patients with major fractures of the pelvis (Trunkey's classification types I and II) treated in an urban Level I Trauma Center were analysed to assess the role of peritoneal lavage and urological studies in the initial evaluation. The mechanisms of injury were automobile v. pedestrian (44 per cent), falls from heights (44 per cent), and motor vehicular accidents (12 per cent). Important hypotension was present in 46 per cent of patients on arrival. Peritoneal tap or lavage was selectively used in 11 patients (22 per cent). Four patients in refractory hypotension despite vigorous resuscitation had positive results. There were no false-positive results or missed intra-abdominal injuries in any of the 50 patients. Laparotomy was carried out in 10 of 50 patients. IVP or cystography was performed in 25 of 50 patients. However, injuries of the urinary tract requiring operative correction (eight injuries in six patients) were all associated with gross haematuria. Urological studies were negative in patients with 1 to 3+ microscopic haematuria. Peritoneal lavage is recommended on a selective basis in patients with pelvic fractures. Microscopic haematuria does not warrant contrast studies of the urinary tract.
Most recent studies discussing tachycardias with alternating QRS polarity have referred to those known as torsade de pointes. This report, in contrast, deals with bidirectional tachycardia and the effects of lignocaine on 10 patients with this arrhythmia. Three of the patients also had digitalis-induced atrial tachycardia with block. In one patient, a single bolus of lignocaine was followed (five minutes later) by ventricular fibrillation, but the other nine patients received two boluses of 75 mg followed by a drip infusion of 3 mg/min. The drug terminated the episodes of atrial tachycardia with block and bidirectional tachycardia in all patients thus treated. Whereas the abolition of the bidirectional tachycardia was permanent in the seven patients with digitalis intoxication, it recurred after stopping the drip infusion in the two patients without digitalis toxicity. It is concluded that lignocaine can be useful in the treatment of digitalis-induced bidirectional tachycardia and atrial tachycardia with block. From this study no conclusions can be drawn, however, as to whether lignocaine is superior to other class I or class IV agents.
Introduction of 0.9% NaCl or undiluted fetal tracheal fluid into the laryngeal region produced no suppression of breathing in lambs during the perinatal period. As NaCl or tracheal fluid solutions were increasingly diluted with water, progressively greater respiratory suppression associated with rapid swallowing was observed. Introduction of amniotic fluid was associated with variable suppression of respiration. The swallowing induced by the dilute solutions was as rapid as two swallows per sec. Lambs 3 months of age swallowed when water was introduced into the laryngeal region, but were able to alternate swallows between breaths without suppression of breathing.
The teaching of neurology as an entity within the concept of teaching in medicine is analized through the following questions: what are we teaching? To whom are we teaching? and why are we teaching? The first question concerns the pedagogical, sociological and psychological patterns used to elaborate locally-arranged goals for the creation of criteria and conduct. The second establishes the relationship between the influence of the technical-industrial adult generation on the present university generation and the reappraisal of human values through new pedagogic techniques. The third establishes the supply and demand process of assistant teaching and research physicians; it also dwells on the influence of the residency programmes and research trends, and their repercussion on the methodology of the medical curriculum.
Programmed teaching of neurologic semiology, charted in agreement to subsequent learning in clinical neurology, is conceived. The basis of the pedagogic system consists of respecting the systems that bind physiologically among themselves. The goal is the creation of areas of comprehension, dramatizing common functions and signology. To know "all" is of less validity than to posses an engram prepared by key information. The anatomic physiology memory, previous to the course and the weekly partial evaluation, is considered useful. The problematic of the competitive test is analyzed and its negative and positive criterions are exposed. Anatomy, physiology, semiology and clinical neurology spun together are estimated to favor pedagogic goals redundantly.
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