Comparación entre pacientes hipertensos con infarto cerebral lagunar y hemorragia intracerebral profunda primaria

It was carried out a descriptive and prospective study of the hypertensive patients with diagnostic of lacunar cerebral infarct or deep primary intracerebral hemorrhages in acute phase who were assisted in the intermediate care Unit and in the neurology Service of the Provincial University Hospital Arnaldo Milián Castro during the period among July 1 2000 to June 30 2001. We intended to compare the factors of cerebrovascular risk, the localization of the lesions and the prognosis among hypertensive patients with lacunar cerebral infarct and deep primary intracerebral hemorrhages, and the relationship of these factors in the functional state at the time of remission and in the mortality. For the statistical analysis it was created a database of the results obtained in the pattern of collection of data and later it was used Windows SPSS program. We find that the lacunar cerebral infarct and deep primary intracerebral hemorrhages have the same localization in deep areas of the brain, the affectation of same arteries, and also that the main factor of risk is the arterial hypertension. Besides the fundamental difference (isquemia versus hemorrhage) there are other differences in the behaviour of the factors of risk, in the specific localization of the lesion and in the prognosis at the time of remission. These findings made us consider that the differences in certain factors of risk and in specific localization of the lesions can be the key to explain the outcome of the ischemic and hemorrhagic lesion of the small cerebral arteries.Se realizó un estudio descriptivo y prospectivo de los pacientes hipertensos con diagnóstico de infarto cerebral lacunar o de hemorragia profunda primaria en fase aguda que fueron atendidos en la Unidad de Cuidados Intermedios y en el Servicio de Neurología del Hospital Provincial Universitario Arnaldo Milián Castro durante el período comprendido entre el 1 de julio de 2000 hasta el 30 de junio de 2001. Nos propusimos comparar los factores de riesgo cerebrovascular, la localización de las lesiones y el pronóstico entre pacientes hipertensos con infarto cerebral lacunar y con hemorragia intracerebral profunda primaria, y la relación de estos factores en la situación funcional al egreso y en la mortalidad. Para el análisis estadístico se creó una base de datos a partir de los resultados obtenidos en el modelo de recogida de datos y posteriormente se utilizó el programa SPSS para Windows. Encontramos que el infarto cerebral lacunar y la hemorragia intracerebral profunda primaria tienen en común la localización en áreas profundas del cerebro, la afectación de las mismas arterias y la hipertensión arterial como principal factor de riesgo, y que poseen además de la diferencia fundamental, isquemia versus hemorragia, otras diferencias en cuanto al comportamiento de los factores de riesgo, la localización específica de la lesión y el pronóstico al egreso. Estos hallazgos nos hicieron considerar que las diferencias en cuanto a determinados factores de riesgo y a la localización específica de las lesiones pueden ser la clave para explicar el desenlace de la enfermedad isquémica y hemorrágica de las pequeñas arterias cerebrales

Ensiling on chemical composition and in vitro fermentation in rabbits of different forages

The effect of chemical composition of silages on in vitro gas fermentation profiles in rabbits was examined. The study was performed using 7 silages: beans (Phaseolus vulgaris), faba bean (FB, Vicia faba), common vetch (CV, Vicia sativa), ryegrass (Lolium perenne), barley (B, Hordeum vulgare), barley with common vetch (BCV) and barley with faba bean (BFB). We used 3 New Zealand White (NZW) rabbits as donors of caecal content in each incubation run (n=3). Data were analyzed in a completely randomized experimental design. The CV silage showed higher values of crude protein (CP), followed by FB and bean silages (P<0.001). Barley silage had the lowest CP content (96g kg -1 DM) (P=0.001). The NDF and ADF content were lower (P<0.001) for beans and CV compared with the rest of the forage silages. Ryegrass silage had higher values of dry matter degradation, organic matter degradation, relative GP and SCFA (P<0.001). The highest values of digestible energy were for CV and bean silages (P<0.001). Ryegrass and CV silages showed higher levels in GP parameters, which could be associated with their better chemical composition characteristics, mainly pr otein and fiber content

Púrpura de Schönlein-Henoch fulminante

A female patient of 51 years old with personal pathological precedent of bronchial asthma, hypertension and ulcerative colitis and infection by chikungunya virus for a month. She incomes with dark pasty diarrhea with mucus and blood, she evolved unfavorably with flaccid paraplegia and recticularis livedo, which became extensive purple; then phlyctena and generalized edema. She remained hypotensive with electrolyte imbalance and impairment of consciousness, complementaries were performed, she was transfused and underwent to hemodialysis; she evolved to coma and death. The pathological findings showed an adult, fulminant and deadly form of anaphylactoid purpura or Henoch-Schönlein. Mesangial proliferation with fushinofílicos mesangial deposits werefound corresponding to immunoglobulin A with immunofluorescence, leukocytoclastic vasculitis and necrotizing vasculitis of small vessels. Purple of Schönlein-Henoch is a peculiar form of vasculitis that tends to spontaneous healing and occasionally may have a fatal course or proceed to a chronic nephritis.Se trata de paciente femenina de 51 años, con antecedentes patológicos personales de asma bronquial, hipertensión arterial y colitis ulcerativa e infección por el virus de la chikungunya desde hacía un mes. Ingresó con diarreas pastosas oscuras con moco y sangre, evolucionó desfavorablemente con paraplejia flácida y livedo reticularis, que se transformó en púrpura extensa; posteriormente flictenas y edema generalizado. Se mantuvo hipotensa con desequilibrio hidroelectrolítico y deterioro del estado de conciencia, se le realizaron complementarios, fue transfundida y se le realizó hemodiálisis; evolucionó al coma y a la muerte. Los hallazgos anatomopatológicos mostraron una forma adulta, fulminante y mortal de púrpura anafilactoide o de Schönlein-Henoch. Se encontró proliferación mesangial con depósitos mesangiales fushinofílicos correspondientes a inmunoglobulina A con inmunofluorescencia, vasculitis leucocitoclástica y vasculitis necrotizante de pequeños vasos. La púrpura de Schönlein-Henoch es una forma peculiar de vasculitis que tiende a la curación espontánea y, ocasionalmente, puede tener un curso mortal o proseguir hacia una nefritis crónica

Meningitis por criptococo y trombosis venosa cerebral en paciente sicklémica

A 47-year-old woman diagnosed with sickle cell anemia and a vaso-occlusive crisis in the brain was admitted with fever, general malaise and headache, with transient episodes of disorientation. In her evolution, there was a motor defect in the right side, dysarthria and convulsive seizures refractory to therapy. The cranial tomographic study revealed a hypodense image in the left parietal lobe in relation with an infarction, and evidence of contrast enhancement in the turns in the affected area due to cortical vein thrombosis. The patient had a torpid evolution, and died with neurological impairment and septic respiratory symptoms. At necropsy, it was concluded the presence of Cryptococcus neoformans meningitis and cerebral venous thrombosis in a sickle cell anemia patient, associated with severe bilateral bacterial bronchopneumonia that lead to her death. Infections in immunocompromised patients, and especially fungal infections, may not be suspected and may not be treated, as occurred with this patient. This fact, and the association with cerebral venous thrombosis, motivated a discussion in the clinicopathological session of the institution. The study of the autopsy is reported, as well as a review of the condition as a way of focusing attention on opportunistic fungal infections. This is another tough battleground for the diagnosis and treatment of patients, in which the main weapon is the proper use of the epidemiological-clinical method in all medical specialties – efforts must be directed that way.Mujer de 47 años de edad con diagnóstico de sicklemia y crisis vaso-oclusiva cerebral que fue ingresada por fiebre, toma del estado general y cefalea, con episodios de desorientación transitoria; en su evolución aparecieron un defecto motor derecho, disartria y episodios convulsivos refractarios a la terapéutica. El estudio tomográfico de cráneo reveló una imagen hipodensa en el lóbulo parietal izquierdo en relación con infarto, así como evidencias de realce de contraste en los giros en el área afectada debido a trombosis de venas corticales. Evolucionó tórpidamente y falleció con deterioro neurológico y cuadro respiratorio séptico. En la necropsia se concluyó: meningitis por Cryptococcus neoformans y trombosis venosa cerebral, asociadas a bronconeumonía bacteriana bilateral severa en paciente sicklémica, todo lo que la conduce a la muerte. Las infecciones en el paciente inmunodeprimido, y en especial las infecciones por hongos, pueden no ser sospechadas ni tratadas, como sucedió en este caso; este hecho, y la asociación con trombosis venosa cerebral, motivaron a discusión en Sesión Clínico-Patológica Institucional. Se presenta el estudio de la autopsia y la revisión de la enfermedad como forma de enfocar la atención en las infecciones micóticas oportunistas, otro duro campo de batalla para el diagnóstico y el tratamiento de los enfermos, cuya arma fundamental es el empleo adecuado del método clínico en todas las especialidades médicas, hacia lo que se deben dirigir los esfuerzos

Combination therapy of Epidermal Growth Factor and Growth Hormone-Releasing Hexapeptide in acute ischemic stroke: a phase I/II non-blinded, randomized clinical trial

ObjectiveThis study tested the hypothesis that a neuroprotective combined therapy based on epidermal growth factor (EGF) and growth hormone-releasing hexapeptide (GHRP6) could be safe for acute ischemic stroke patients, admitting up to 30% of serious adverse events (SAE) with proven causality.MethodsA multi-centric, randomized, open-label, controlled, phase I-II clinical trial with parallel groups was conducted (July 2017 to January 2018). Patients aged 18–80 years with a computed tomography-confirmed ischemic stroke and less than 12 h from the onset of symptoms were randomly assigned to the study groups I (75 μg rEGF + 3.5 mg GHRP6 i.v., n=10), II (75 μg rEGF + 5 mg GHRP6 i.v., n=10), or III (standard care control, n=16). Combined therapy was given BID for 7 days. The primary endpoint was safety over 6 months. Secondary endpoints included neurological (NIHSS) and functional [Barthel index and modified Rankin scale (mRS)] outcomes.ResultsThe study population had a mean age of 66 ± 11 years, with 21 men (58.3%), a baseline median NIHSS score of 9 (95% CI: 8–11), and a mean time to treatment of 7.3 ± 2.8 h. Analyses were conducted on an intention-to-treat basis. SAEs were reported in 9 of 16 (56.2%) patients in the control group, 3 of 10 (30%) patients in Group I (odds ratio (OR): 0.33; 95% CI: 0.06–1.78), and 2 of 10 (20%) patients in Group II (OR: 0.19; 95% CI: 0.03–1.22); only two events in one patient in Group I were attributed to the intervention treatment. Compliance with the study hypothesis was greater than 0.90 in each group. Patients treated with EGF + GHRP6 had a favorable neurological and functional evolution at both 90 and 180 days, as evidenced by the inferential analysis of NIHSS, Barthel, and mRS and by their moderate to strong effect size. At 6 months, proportion analysis evidenced a higher survival rate for patients treated with the combined therapy. Ancillary analysis including merged treated groups and utility-weighted mRS also showed a benefit of this combined therapy.ConclusionEGF + GHRP6 therapy was safe. The functional benefits of treatment in this study supported a Phase III study.Clinical Trial RegistrationRPCEC00000214 of the Cuban Public Registry of Clinical Trials, Unique identifier: IG/CIGB-845I/IC/1601

Linfoma primario no Hodgkin del sistema nervioso central

Female patient, 72 years old, diagnosed with cerebral infarction and residual hemiparesis, admitted for a worsening of motor deficits and dysarthria. The computed tomography of the skull revealed complex images suggestive of brain metastases. No primary site of origin was demonstrated in the tests performed. The patient died from acute respiratory failure. In the necropsy, it was determined a pulmonary thromboembolism and primary cerebral lymphoma as the causes of death. The low incidence of this tumor, its presentation with multiple lesions in 25 to 50% of patients and its morphologically heterogeneous aspect motivated a discussion at the clinicopathologic session. The debate was focus in setting the cronopathogram of the disease. A study of the autopsy and a review of the condition are presented as a way to get experiences in order to extend life in other patients, by sharing this fatal case, which is the fundamental objective of post-mortem studies.Mujer de 72 años de edad con diagnóstico de infarto cerebral y hemiparesia residual que fue ingresada por empeoramiento del déficit motor y disartria. El estudio tomográfico de cráneo reveló imágenes complejas sugerentes de metástasis cerebrales; no se demostró sitio primario de origen en los exámenes practicados. Falleció por insuficiencia respiratoria aguda; en la necropsia se concluyó tromboembolismo pulmonar y linfoma primario cerebral como causas de muerte. La baja incidencia de esta neoplasia, la presentación con lesiones múltiples (del 25-50% de los pacientes) y su aspecto morfológico heterogéneo motivaron a discusión en Sesión Clínico-Patológica institucional; se suscitó el debate para establecer el cronopatograma de la enfermedad. Se presenta el estudio de la autopsia y la revisión de la enfermedad como forma de obtener experiencias que permitan prolongar la vida de otros enfermos mediante este caso con desenlace fatal, objetivo fundamental de los estudios post-mortem

Qué hacen y qué hacemos en el cáncer de esófago y cardias What do others do and what do we do in esophagus and cardia cancer

A pesar de los avances en las técnicas quirúrgicas para las resecciones esofágicas en el cáncer de esófago y en los cuidados perioperatorios a los pacientes en este tipo de cirugía, los resultados continúan siendo heterogéneos y variados los procedimientos en la terapéutica quirúrgica de esta enfermedad. Se exponen las principales controversias sobre el tratamiento quirúrgico y las evidencias científicas relevantes respecto a cada caso en particular y se realiza un análisis crítico de cada una de ellas. Finalmente se presentan los resultados obtenidos por nuestros grupos de trabajo en el tratamiento de esta afecció