Biomedical subjects
Publications and source records attributed to S Castaño.
Bladder hernia is very uncommon. It tends to affect patients over the age of 50 and is predisposed by cervico-urethral obstruction. The condition is often diagnosed during inguinal hernia surgery. The authors report a case of massive inguino-scrotal bladder herniation. The different types of bladder hernia are described, and the clinical-radiological findings and surgical management are discussed.
Post-infectious demyelinating disorders are uncommon. In the Hospital Pediatrico de la Misericordia de Santafé de Bogotá there were 14 cases in three years. The commonest age group was the new born, as is found in the literature. The infections involved in these neurological changes are probably viral, since at the time the patient is seen most symptoms have cleared up spontaneously. According to several authors, the viruses are most often found to be those of measles or mumps. Between the infection and the development of neurological symptoms there is an interval of approximately two weeks. The main clinical findings are motor changes such as hemiparesis, involvement of cranial nerves and alterations of consciousness. The aetiology is not completely clear. Firm diagnosis is made on histopathological studies which are seldom available. Usually neuroimaging techniques and cerebrospinal fluid analysis are the basis of the diagnosis. Computerized axial tomography and magnetic resonance are the most useful noninvasive techniques for assessing the involvement of the white matter, the extent and sites of the lesions. It is useful to know the classification of the demyelinating disorders so as to prescribe, the most suitable treatment and give the prognosis in each case. There is still no specific treatment for these disorders. Supportive measures, the control of epileptic crises and the prevention of complications are the main aims. This paper reviews the definition, classification, diagnosis and management of these disorders.
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Treatment of heart failure (HF) has changed in recent years, despite the paucity of new approved drugs. Current treatment is directed not only towards improving symptoms, but also to preventing the development from asymptomatic systolic dysfunction to symptomatic heart failure, to preventing cardiac remodelling, renal dysfunction and to reducing mortality. The main families of drugs currently used are: cardiac glycosides, diuretics, angiotensin-converting enzyme inhibitors (ACEI), beta-blocking drugs (BB), angiotensin-II receptor blockers (ARB) and aldosterone receptor antagonists. The combination isosorbide dinitrate + hydralazine is hardly used due to its side effects and none of the new positive inotropic drugs has been approved in chronic HF, because all of them increase mortality. Levosimendan is a new positive inotropic agent approved for acute HF by an intravenous route, with a favourable effect on prognosis vs placebo and vs dobutamine (which worsens the prognosis). The approved oral drugs can be given at the same time if the patient tolerates them, because their beneficial effect is additive. Mortality in two years in mild to moderate HF is 34% with glycosides + diuretics. It falls to 22% when an ACEI is added, to 14% when a BB is added and to 10% when an aldosterone antagonist is added. ARB can be given instead of an ACEI or be added to the other drugs.
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