Search

The most frequent diabetes-related complications are diabetic foot and glaucoma, which lead to amputation and loss of vision, respectively. Current scientific and technologic developments have permitted the design and implementation of prosthetic systems that are optimal for these patients, as the latter adapt themselves to them and can resume activities of daily living. The lack of economic resources compromises the quality of the prostheses patients can afford, as they resort to «artisanal» or «rustic» systems that hamper their adaptation process. We present herein the case of a 47 year-old female patient, housewife, with bilateral paresthesias and phantom limb sensation associated with amputation neuromas resulting from type II diabetes mellitus that had affected the patient for eight years. This patient of a low socioeconomic stratum underwent a post-amputation assessment and was diagnosed as being heavily dependent when performing activities of daily living and required assisted wheelchair for ambulation. This is a frequent variant resulting from bilateral loss of lower limbs together with complete loss of vision. We describe the rehabilitation therapy during the pre- and post-prosthetic stages, together with the results of the assessments to show the effectiveness of the treatment process, without forgetting the participation of the caregiver as a fundamental co-therapeutic element in this process.Las complicaciones más frecuentes asociadas con la diabetes incluyen al pie diabético y al glaucoma, que suelen llevar a la amputación y a la pérdida de la visión, respectivamente. El desarrollo científico y tecnológico actual ha permitido el diseño e implementación de sistemas protésicos óptimos para estos pacientes, asegurando una reincorporación a las actividades de la vida diaria, así como una correcta adaptación al uso de las mismas. La falta de recursos económicos compromete la adquisición de las prótesis ideales, recurriendo al uso de sistemas «artesanales» o «rústicos» que afectan la adaptación. Se presenta el caso de un paciente femenino de 47 años de edad, ama de casa, quien presenta parestesias bilaterales y sensación de miembro fantasma asociado a neuromas de amputación por diabetes mellitus tipo II de ocho años de evolución. La paciente, con bajos recursos económicos, es evaluada postamputación con diagnóstico de dependencia grave en la ejecución de las actividades de la vida diaria, con desplazamiento en silla de ruedas asistido; esta presentación es una variante frecuente como consecuencia de la pérdida bilateral de miembros inferiores, concomitante a la ausencia total de la visión. Se presenta el tratamiento de rehabilitación en etapa preprotésica y protésica, acompañados por los resultados de las evaluaciones para mostrar la efectividad del proceso terapéutico, sin olvidar la participación del cuidador como ente coterapéutico fundamental en el proceso.

Objective. To measure hepatitis C virus (HCV) sero-prevalence, prevalence, hepatitis risk characteristics frequency, and genotype correlation with viral load among clients attending health care clinics. Material and Methods. Venous blood samples from 112 226 consecutive consenting adults were collected from January 2006 through December 2009. HCV antibodies were detected by immunoassay. HCV RNA was detected by qRT-PCR and viral genotype was performed by PCR and LIPA test. Results. The HCV seroprevalence observed was 1.5 % (C.I. 95% 1.3-1.7), from seropositive individuals 60.9 % reported previous blood transfusion, 28.3% declared to have relatives with cirrhosis, 25.2% had tattoos or piercings, and 6.9% referred to have used drugs. Male gender and transfusion (p0.001) were the most frequent hepatitis risk characteristics in the HCV seropositive group. Among seropositive subjects 48.3% presented HCV RNA. The most frequent genotype detected in all geographic areas of Mexico was 1 (subtype 1A, 33%, subtype 1B, 21.4%) followed by genotype 2 (subtype 2A, 8.50%). Subjects withgenotype 1 had a significant correlation with the highest viral load. Conclusions. Our results show that nearly half of seropositive individuals are chronically infected. HCV infection has been shown in this study to be an emerging health problem in Mexico.

Thisstudy reports the results obtained with stent implanta-tion in young and adult patients with AC.•••Between September 1996 and August 2000, 56stents were implanted in 54 patients with AC (35male, 19 female; age range 8 to 49 years, mean 22 69). AC was defined as a stenosis with a peak-to-peakgradient of $20 mm Hg at rest. Fourteen patients hadassociated malformations: subaortic stenosis (2), ven-tricular septal defect (2), patent ductus arteriosus (1),coronary disease (2), and aortic valve disease (7). Fourpatients had undergone balloon angioplasty 2.5 to 7years before the study. Two had restenosis and 2 hadsmall saccular dilations. One case had surgical end-to-end repair with restenosis. All patients had local-ized AC, but 1 had a long tubular stenosis. Clinicalsuccess was defined as a peak-to-peak pressure gradi-ent of #20 mm Hg after stenting with no majorcomplications. Technical success was defined as suc-cessful stent deployment without complications. Clin-ical and Doppler examinations were performed at 1month and every 6 months. Pressure gradients beforeand after stenting were compared using Student’s t test(paired, 2-tail). A p value of ,0.05 was consideredsignificant.All cases were sedated. Antibiotic prophylaxis wasnot used. After arterial access, all patients received100 U/kg of heparin. Activated clotting time valueswere not measured. Gradient and arch angiographywere assessed. We used 55 Johnson & Johnson stents(41 P-308, 12 P-4014, and 2 P-5014, Warren, NewJersey) and one 60-mm-long Wallstent (Boston Sci-entific Corporation, Natick, Massachusetts). Stentswere selected for the diameter of the proximal aorta.The Wallstent was used for a long stenosis. Predila-tion was performed in only 3 patients. A stiff Amplatzguidewire was used with a 80-cm-long transseptal 9Frsheath (Cook, Bloomington, Indiana) with a P-308stent, or a 11Fr sheath with the P-4014 or P-5014stents. A dilator with a sheath was advanced across theAC. The dilator was removed, leaving the sheath andwire. Afterward, the stent was manually crimped on aballoon with a balloon-to-isthmus ratio of approxi-mately 1.0 to 1.2. Maximum balloon size was 25 mm.The stent was advanced to the stenosis and the sheathwas withdrawn, exposing the stent. The balloon wasinflated to 3 to 6 atm using a 20-ml inflator. Pressuresand angiography were repeated. Heparin was restarted4 hours after sheath removal and infused for 24 hours.Postprocedure heparin infusions were used to mini-mize femoral thrombotic complications, not for stentanticoagulation.Successful deployment was achieved in 53 patients(98%). Fifty-two patients (96%) had clinical success.The 1 failure was due to a residual gradient of 30 mmHg after stenting for restenosis after prior surgicalrepair. Although no high-pressure balloon was avail-able to us, there was no fluoroscopic calcification ofthe AC. This patient underwent a successful reopera-tion. Mean pressure gradient significantly decreased,from 50 6 20 mm Hg (range 11 to 110) to 5 6 8mmHg (range 0 to 30, p ,0.001). In 29 patients there wasno gradient after stent placement (Figure 1). In thepatient with long tubular AC (17 years old, 57 kg), thestenotic site was predilated with an 8-mm balloon toplace a Wallstent (16 3 60 mm length). The stent didnot totally expand, moving to the distal side of the AC.It was thus necessary to place a P-308 stent, whichresulted in expansion of the Wallstent. Fourteenmonths later, a small aneurysm was seen around theWallstent. The aneurysm did not involve the stentends, and may have been due to overdilation of theballoon (Figure 2). Magnetic resonance imagesshowed no growth of the aneurysm 9 months later. Inthe 2 cases in which an aneurysm occurred afterprevious balloon angioplasty, stent implantation wasenough to resolve the problem (Figure 3).One patient experienced vagal bradycardia thatrequired atropine. Two patients had paradoxical hy-pertension immediately after positioning the stent,which was treated with oral bblockers for 3 weeks. In1 case the stent was not delivered because ballooninflation moved the stent distally before the stentexpanded. In this patient, the stent was trapped in thefemoral artery when pulled back to the sheath. It wasremoved by surgery a few days later, and the AC wassurgically corrected.Two cases had stent migration during balloon in-flation. In the first, the stent deployed 2 mm below theAC site. There was complete resolution of the AC asa result of the balloon dilation and nothing further wasdone. This patient developed an aneurysm of the un-stented site. In the second patient, we implanted asecond stent to cover the dilation site after the firststent moved distally. There were no cases where bal-loon rupture caused stent migration.

Amyloid is a proteinaceous material that is deposited in the tissues in a large variety of clinical contexts; in the skin it can be found with or without concomitant systemic disease. Primary localized cutaneous amyloidosis encompasses those amyloidoses restricted to the skin without involvement of other systems. The most common forms within this group are macular and lichen amyloidosis. Nodular amyloidosis is extremely rare, and there are notable differences in clinical presentation, prognosis, histology, and pathogenesis between this entity and the macular and lichenoid variants. We report a new case of nodular primary localized cutaneous amyloidosis with disseminated plaques and nodules in which no systemic disease developed in the 3 years following the appearance of the lesions.

From September 1996 to March 1997 we implanted stents Palmaz (P-308 JohnsonJohnson) in six patients with aortic coarctation. Age ranged from 13 to 30 years (mean = 20), 3 female and 3 male. We implanted the stent without predilation. Balloon diameter was 12 mm in two cases and 15 mm in four cases for complete expansion we used 14 to 20 mm balloon diameter in five instances and in one case we used a dual balloon 15 + 15 mm. The gradient pre-stent ranged from 30 to 65 mmHg (mean = 44) and decreased to 0 mmHg in five cases and in one patient the residual gradient was 4 mmHg. Systolic aortic pressure pre-stent was 135 mmHg and decreased to 117 mmHg. There were no significant complications. In conclusion, we have demonstrated the feasibility of balloon-expandable stent implantation as a method of alleviation the obstruction in coarctation of the aorta in this group of patients. It is an excellent alternative to surgical treatment and it is better than balloon angioplasty that results in marked improvement in the angiographic appearance of the thoracic aorta. It eliminates the gradient, has minimum morbidity and no mortality, no aneurysm formation. Late restenosis and possible aneurysm formation remains an unlikely complication in view of the ample luminal diameter and the high velocity of flow.

To study the relationship of IgE titles to development of allergy disease in the nursing, it was quantified the levels of this immunoglobulin in blood of the umbilical cord in healthy term eutrofic infants born consecutively in a period of two months. A total of 74 infants were followed for six with monthly appointments. The mean of IgE was 0.08 IU/ml with standard deviation of 0.15. Only two infants developed allergy, this determined a negative predictive value for IgE of 94%. Our outputs agree with that of other authors with respect to high negative predictive value of the low or normal levels of IgE in blood of the umbilical cord and the development of allergy. We concluded that its determination should limit to infants with family antecedent of atopy in order to improve the capacity of prediction of this illness.

Epileptic paroxystic headache consists of an episode of pain that starts suddenly, in a varying area that is usually the same for the same patient, of medium to high intensity, lasting from a few seconds to minutes and, rarely, hours; the episode subsides spontaneously and tends to recur. This was found in 32 of 125 patients studied by the author. Average age of onset was 11 years, with 80% of cases presenting it in the first or second decade of life. Once diagnosed, the condition was present a maximum of 41 years and a minimum of one month, with an average of six years. Headache lasted from 30 seconds to 4 hours; in 62% of cases it was 15 minutes or less. Pain was severe in 24 patients and moderate in 8. Epileptic paroxystic headache can be the only epileptic symptom (31%) or be associated with other ictal manifestations, independently (56.2%) or simultaneously (12.5%). EEG studies showed focalization in temporal lobe (56%), in the midbrain (12.5%) or in other areas. Treatment with hydantoine, primidone and methylsuccimide gave excellent results. Differential diagnosis with other paroxystic headaches is noted.