Revista Clínica Escuela de Medicina UCR-HSJD
URI permanente para esta comunidadhttps://hdl.handle.net/10669/14674
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Ítem POLINEUROMIOPATIA DEL PACIENTE CRITICAMENTE ENFERMO(2011-01-01 00:00:00) Vindas Miranda, TatianaThe critically ill patient’s myopathy is one of the most frequent complications in the intensive care units, it was described for the first time in 1977 by MacFarlane and collaborator. Different names have been used to describe the clinical status that more than a unique entity corresponds to multiple types of muscular damage. Among the most used there are: necrotizing myopathy,quadriplejic myopathy, post-paralysis syndrome and heavy filaments myopathy, although some authors prefer to include these clinical signs under the name of polyneuromyopathy. Nevertheless the most common denomination is acute neuromuscular syndrome. The objective of this document is to analyze the different causes and manifestations of the muscular weakness that critically ill patients develop in the intensive care unit period, and the diagnosis and evaluation of the myopathy of the critically ill patients, taking into account that the most common factors that trigger the development of this entity are: the clinical status, etiopathogenesis in sepsis processes, drug use like the neuromuscular blockaders, corticoids, sedative drugs, the relaxation, the respiratory muscle deficiency and the prolonged stay in bed.Ítem INFILTRADO MILIAR EN PACIENTE CON CUADRO FEBRIL SUBAGUDO Y ANTECEDENTE DE ENFERMEDAD DE LYME.(2011-01-01 00:00:00) Ávila Sánchez, Diego; Bucknor Masis, JorgeÍtem ENDOCARDITIS INFECCIOSA EN EL HOSPITAL SAN JUAN DE DIOS 2000 A 2010(2011-01-01 00:00:00) Solís Solís, Luis Diego; Quesada Aguilar, Carlos I.In our country there are no studies about epidemiology of Infective Endocarditis. Its microbiologic behavior is unknown, as well as the antibiotic resistance pattern. A retrospective, descriptive study is shown, based on medical files of patients discharged from Hospital San Juan de Dios and diagnosed as IE, between 2000 and 2011. The etiologic agents and its antimicrobial resistance pattern were assessed. Also, the risk factors, clinical presentation at the diagnosis and laboratory findings are described. The information from this study, are planted as basis for further national guidelines of IE in our country, based on clinical presentation and germen.Ítem MASCULINO 39 AÑOS CON ALCALOSIS METABÓLICA HIPOCALÉMICA SAL RESISTENTE(2011-01-01 00:00:00) Quesada Aguilar, Carlos I.; Solís Solís, Luis DiegoAn analysis of a case of hipokalemic metabolic alkalosis, salt resistant and a description of a systematic medical approach according to clinical analysis methodology in Internal Medicine is exposed.Ítem SÍNDROME HEMOFAGOCÍTICO ASOCIADO A LINFOMA T PERIFÉRICO NO ESPECIFICADO DE HÍGADO, ÓRBITA Y A HEPATITIS B(2011-02-01 00:00:00) Sedó Mejía, Giovanni; García Chinchilla, Lionel; Carvajal Cuenca, Alejandra; Rodríguez, Lidia; Granados Brenes, GabrielaWe report a 52 years old male patient who presented with acute inflammatory rightperiorbital process and febrile syndrome. Hepatosplenomegaly was documented, a rightretro orbital mass, without lymphadenopathy,with laboratories that support the diagnosis ofhemophagocytic syndrome, chronic hepatitis B. Peripheral T-cell lymphoma was documented inretro orbital and liver tissue, we discuss theprevalence of peripheral T-cell lymphoma associated with hemophagocytic syndrome.Ítem GENERALIDADES SOBRE INMUNOTERAPIA(2011-02-01 00:00:00) Quesada Aguilar, Carlos I.In the past few years there has been an explosion in the development of new therapeutic alternatives for immune therapy. Its main role is in oncology, however, each day they are more useful to treat autoimmune diseases. As aconsequence of this growth, every day we have to treat more patients that have been exposed to this kind of medication and, as we expect,patients that show their adverse effects. A 49 years old female with Ulcerative Colitis,treated with infliximab, presented to our hospital. Her main complain was night fever. The diagnostic work up showed pulmonary tuberculosis. This finding motivated us to make the present revision, assessing the basic concepts of immune therapy as well as their main adverse effects.Ítem MASA DE TEJIDOS BLANDOS CON EROSIÓN Y DESTRUCCIÓN ÓSEA EN MUJER DE 41 AÑOS.(2011-02-01 00:00:00) Vargas Solís, Sussy; Duarte Sancho, Paolo C.Ítem Bosquejo Histórico del Hospital San Juan de Dios- Escuela de Medicina UCR(2011-02-01 00:00:00) González Pacheco, Carlos EduardoÍtem ENDOCARDITIS INFECCIOSA EN EL HOSPITAL SAN JUAN DE DIOS 2000 A 2010(2011-02-01 00:00:00) Solís Solís, Luis Diego; Quesada Aguilar, Carlos I.In our country, there are few studies that assess the clinical evolution of the patients with Infective Endocarditis (IE) as well how oftenthose patients get complicated. Also, there is no clarity about the antimicrobial therapeuticschemes. A retrospective and descriptive study was performed. It was based on file revision of patients discharged with de diagnosis of IE, in the Hospital San Juan de Dios, between 2000 and 2010. The rate of complications, dead andtreatment were determined.Ítem DEXTROCARDIA EN PACIENTE CON CUADRO DE DENGUE CLÁSICO.(2011-03-01 00:00:00) Duarte Sancho, Paolo C.Ítem INFECCIÓN VIRAL ASOCIADA A NEUMONÍA ADQUIRIDA EN LA COMUNIDAD EN PACIENTES INTERNADOS EN EL SERVICIO DE MEDICINA INTERNA DEL HOSPITAL CALDERÓN GUARDIA ENTRE LOS MESES DE MAYO A SETIEMBRE DEL 2009(2011-03-01 00:00:00) Grant Villegas, StanleyBackground: Respiratory tract infection is one of the most common causes of seeking medical attention. Viruses are among the most common etiologic al agents of viral pneumonia, with apercentage that ranges between el 5 and 34%. In Costa Rica there are no epidemiological studies that describe the percentage of pneumonias associated to viral infections in hospitalized patients. Given the investment in in patient days and use of antibiotics, it is important to know what is the percentage of viral infections. Methods: The methodology was based on an observational retrospective cohort throughpatient files review. The primary outcome was to identify the prevalence of viral infection in the population hospitalized for community acquired pneumonia. The study was conducted at the Hospital Dr. Rafael Angel Calderon Guardia, during the months from May through September 2009. Findings: Out of 320 patients, 59 were included in the study. Viral infection was found in 18,4%.Most patients were healthy adults under 40 yearsold. Influenza A H1N1 was the most commonvirus in 50,8% of cases (n=30). The most frequent comorbidities were hypertension (20,3%) and asthma (13,6%). Patients with viralinfection had important elevation in biomarkers such as LDH, CPK, ALT, AST and creatinine. Conclusion: Viral infection in community acquired pneumonia is frequent. Measures to identify patients with pandemic Influenza influenced the high percentage of cases found inour cohort.Ítem MASCULINO 21 AÑOS CON CUADRO SÚBITO DE DEBILIDAD, MIALGIAS Y CPK MAYOR A 400.000 UI/L(2011-03-01 00:00:00) Méndez Rodríguez, Juan DiegoAfter physical exertion, the patient was admitedto the hospital with clinical and laboratoryfindings compatible with a clinical syndrome ofrhabdomyolysis, which main cause is an abnormal release of intracellular muscularcomponents, mainly creatine kinasa, into theblood flow, leading to metabolic, kidney andheart complications. Still, it is necessary toperform an focused clinical history to achieve athorough analysis that can help us to make anadequate diagnostic and therapeutic approach.Ítem NEFROPATÍAS POR TÓXICOS(2011-03-01 00:00:00) Avellán Boza, MartaDrug induced acute kidney injury has arelatively high frequency when it comes to the management of both, ambulatoryand hospitalized patients.Based on a clinical case, of a 49 years oldfemale, who presented to our hospital with non oliguric acute renal failure, after a short term tratment with nephrotoxic medication, aliterature review of toxic nephropathies, themechanism of injury, such as common riskfactors and general preventive measures is made. It is determined that the most common mechanism of injury is acute tubular necrosis, butother mechanisms playanincreasingly important role, especially in the understanding that the majority of renal changes regarding toxins are not only reversible, but preventable.Ítem Importancia de la adecuada preparación antes del ejercicio físio y la probabilidad de desarrollo de rabdomiolisis(2011-03-01 00:00:00) Barguil Meza, IbrahimÍtem MASCULINO 58 AÑOS, DIABÉTICO E HIPERTENSO CON CUADRO SUBAGUDO DE CERVICALGIA, PARESTESIAS Y DEBILIDAD EN MIEMBROS SUPERIORES QUE EVOLUCIONA A TETRAPARESIA ESPÁSTICA(2011-04-01 00:00:00) Ávila Sánchez, Diego; Barguil Meza, IbrahimA 58 years old male, with history of diabetesmellitus and hypertension whom presented to ourhospital with subacute neck pain and paresthesias of upper limbs, complicated later with cervicalcord syndrome. There was evidence of C6-C7 vertebral osteomyelitis and cervical instability.Debridement was performed, along with stabilization and repair of the cervical spine. Blood andbone cultures were negative and empirical therapy with parenteral vancomycin (4-week course) was started, followed by oral ciprofloxacin (4-weeks course). Clinical evolution was satisfactory.Ítem HISTORIA DE LA REANIMACIÓN DEL PACIENTE QUEMADO(2011-04-01 00:00:00) Navarro Coto, José Francisco; Granados Quesada, Ronny; Jiménez Pereira, EliécerSince it was proven in 1863 that fluid loss wasthe cause of death in burnt patients, a number offormulas and therapeutic options have beenestablished with the aim of improving thepatients’ survival. The Parkland ́s formula andthe use of Ringer’s lactate have been the twomethods with the best results. The use of colloidsand hypertonic solutions as well as gelatins havebeen analyzed however, there hasn’t been animprovement in the patient’s survival on thecontrary, the adverse effects have beendocumented in various revisions and clinicaltrials.Ítem EVOLUCIÓN CLÍNICA DE LOS PACIENTES CON DIABETES MELLITUS SOMETIDOS A ANGIOPLASTÍA CORONARIA CON IMPLANTACIÓN DE STENT DE ENERO A DICIEMBRE DEL 2009 EN EL HOSPITAL SAN JUAN DE DIOS(2011-04-01 00:00:00) Monge Ortega, Patricia; Arauz Chavarría, JorgeBackground: Percutaneous coronary angioplasty(PTCA) with stent placement is both safe and effective interventional treatment for ischemicheart disease. This disease has a high prevalenceand impact in the morbidity and mortality in the general population. The purpose of this study is to describe the outcomes obtained with PTCA/stent terapy at the San Juan de Dios Hospital during the period between January 2009 and December 2009. Methodology: A descriptive, retrospective and observational study was performed by collecting information from medical files of 268 patient streated with PTCA during the study period. Ananalysis of the outcomes was performed on those patients that met inclusion criteria. Results: We included 88 diabetic patients (62 males and 26 females). 18,3% of the patients haddyslipidemia, 49,8% were smokers and 87,5%had hypertension. In relation with previous procedures, 12,5% of the patients had one previous angioplasty and 2,3% had bypasssurgery. On average there were 1,4 ± 0,6 vessel streated, with a minimum of 1 vessel and amaximum of 3 vessels. On average there were 1,7 ± 1,0 stents perpatient, with a minimum of one and a maximumof five stents. The number of stents per treatedvessel was 1,3. Medicated stents were used in 89,4% of the cases. Succesful PTCA accountedfor 96,6% of the individuals (85 cases), and only6 patients (6,8%) had procedure related complications. Major cardiovascular events after PTCA ocurredun 23 patients (26,1%). Twentythree patients(26,1%) had major cardiovascular events after PTCA, and 39,1% of these, required another PTCA. There were two patients who were tratedfor two different lesions (9,33%) and 4,5% of the patients had reestenosis. A 3,4% (3 cases) dieafter the procedure due to cardiovascular causes (two cases because of cardiogenic shock and onecase because of advanced coronary arterydisease). The first two died during the firstmonth after the procedure and the other one die done year after the angioplastic procedure. Conclusion: Diabetic patients had higher risk ofthrombosis, restenosis, reintervention and overallmortality on both groups of stents.Ítem DOLOR ABDOMINAL Y VÓMITOS EN UNA MUJER JOVEN.(2011-04-01 00:00:00) Vargas Solís, Sussy; Duarte Sancho, Paolo C.Ítem Bienvenida al aporte científico de la Unidad Nacional de Quemados - Servicio de Cirugía Plástica y Reconstructiva HSJD(2011-04-01 00:00:00) Barguil Meza, IbrahimÍtem QUEMADURA ELÉCTRICA DE PARED ABDOMINAL COMO CAUSA DE PERFORACIÓN DE INTESTINO DELGADO(2011-05-01 00:00:00) Jiménez Pereira, Eliécer; Jiménez Montero, Valeska; Navarro Coto, José FranciscoA 49 years old male patient who suffered anelectric burn by direct contact with a currentwhile manipulating a metallic object ispresented. He showed minor dermal manifestations of 5% burnt body surface areaand on the seventh day of hospitalizationdeveloped an acute abdomen which required anexploratory laparotomy that documented aperforation of the jejunum that was resected without complications.