Revista Medica Herediana

El arbitraje editorial en las revistas médicas.

Hipertiroidismo en gestación: Clínica, morbi-mortalidad materna, fetal y perinatal.

Objetivo: Determinar la prevalencia y características clínicas del hipertiroidismo en gestantes y definir la influencia de hipertiroidismo sobre la morbimortalidad materna, fetal y perinatal. Material y métodos: Se incluyeron 29 pacientes con diagnóstico de hipertiroidismo y gestación, que cumplieron los criterios de inclusión. Las pacientes fueron divididas en dos grupos, hipertiroidismo compensado durante toda o la mayor parte de la gestación (Grupo I, n=11) y con hipertiroidismo no compensado (Grupo II, n=18). Resultados: La prevalencia de hipertiroidismo y gestación fue de 0.03%. La enfermedad de Graves estuvo presente en el 96.5% de los casos; el 62% cursó con náuseas y vómitos y el 90% con bocio de 40 a 60 gramos. Comparando los grupos I y II, observamos en este último, una mayor frecuencia cardíaca y una menor ganancia de peso (p<0.001 y p<0.0002, respectivamente). Los productos del grupo II, tuvieron un mayor índice de prematuridad (5 de 7) y de bajo peso al nacer (p<0.0003); todos los abortos (4), óbitos (2) y malformaciones congénitas (2), se presentaron en este grupo. El tratamiento recibido fue metimazol a dosis variable (10 a 30 mg/día), no encontramos efectos deletéreos importantes atribuibles al tratamiento. Conclusiones: El hipertiroidismo mal controlado durante la gestación produce mayor morbimortalidad materna, fetal y perinatal. (Rev Med Hered 1995; 6: 107-114).

Objective: To find the prevalence, clinic characteristics of hyperthyroidism during pregnancy and is influence upon maternal, fetal and perinatal morbility and mortality. Material and methods: We included 29 patients with a diagnosis of hyperthyroidism and pregnancy fulfilling the inclusion criteria. The patients were divided in tow groups. Compensated hyperthyroidism during all or most part of pregnancy (Group I, n=11) and not compensated hyperthyroidism (Group II, n=18). Results: The prevalence of hyperthyroidism and pregnancy was 0.03%. Graves disease was present in 95.5% of cases; 62% presented nausea and vomits and 90% showed diffuse goiter of 40-60 gr. of weight. Comparing groups I and II, we observed that group II mothers had on the average, a higher heart frequency and smaller gain of weight (p<0.001 and p<0.002 respectively). The offspring of group II had the highest prematurity rate (5 of 7) and low body weight (p<0.003); all abortions (4), demised (2) and congenit malformations (2) occurred in this group. The treatment employed was metamizol in variable schedule (10-30 mg/day). We did not find any important adverse effect of treatment. Conclusions: No compensated hyperthyroidism during pregnancy produced greatest maternal, fetal and perinatal mobility and mortality. (Rev Med Hered 1995; 6: 107-114).

Insuficiencia ovárica prematura en mujeres infértiles atendidas en el Hospital Nacional Arzobispo Loayza.

Objetivo: Determinar la frecuencia y las manifestaciones clínicas de Insuficiencia Ovárica Prematura en las pacientes infértiles. Material y métodos: En un estudio retrospectivo, descriptivo, se revisaron las historias clínicas de las pacientes atendidas en el Consultorio de Infertilidad del Hospital Nacional Arzobispo Loayza (HNAL), entre enero de 1989 y marzo de 1995. Resultados: Se encontró 27 pacientes con el citado diagnóstico, de un total de 1,855 pacientes que acudieron a consulta (1.45%). Todas tuvieron valores de FSH elevado y 25pacientes tuvieron niveles bajos de estradiol. Se observó hipotrofia de genitales externos y de vagina en el 11.11%, y de mamas en el 14.8%. Se realizó biopsia ovárica a 7 pacientes, en seis de ellas se observó ausencia de folículos. El diagnóstico más frecuente fue el de Insuficiencia Ovárica Prematura Idiomática. El tratamiento consistió en terapia hormonal de reemplazo con estrógenos/progestágenos secuenciales. En una paciente se indujo ovulación con menotropinas y se obtuvo gestación gemelar. Conclusiones: La insuficiencia ovárica prematura es poco frecuente en mujeres infértiles del HNAL, generalmente se presenta como amenorrea secundaria. La tercera parte presentó síntomas vasomotores. (Rev Med Hered 1995; 6: 115-120).

Objective: To know the local incidence and clinical features of premature ovarian failure in infertile patients. Material and Methods: Descriptive, retrospective study was performed. We reviewed the clinical files of the patients evaluated at the infertility clinic of the Hospital Nacional Arzobispo Loayza (HNCH), in Lima, Perú, between January 1989 and March 1995. Results: The incidence of the disease was 1.45% (27 out of 1,75 infertile patients). Everybody had elevated FSH levels and 25 out of 27 had low estradiol levels. 11.11% and 14.8% had external genital and mammary glands hypotrophy, respectively. Ovary biopsy was performed in 7 patients; in six of them ovarian follicles were not found. In these patients, idiopatic premature ovarian failure was the most frequent diagnosis. Hormonal replacement therapy was the main treatment. Ovulation induction with menotropins in one patient was successful and resulted in a twin pregnancy. Conclusions: Premature ovarian failure was an infrequent pathology in infertile women at the HNAL; secondary amenorrhea was the most frequent symptom and a third had vasomotor symptoms. (Rev Med Hered 1995; 6: 115-120).

Receptores de progesterona en meningioma.

Objetivo: Determinar la presencia de los receptores de progesterona en meningiomas y su frecuencia mediante la inmunohistoquímica. Material y Métodos: Se analizaron 24 muestras provenientes de pacientes intervenidos quirúrgicamente en el Instituto Nacional de Enfermedades Neoplásicas entre los años 1990 y 1992 con diagnóstico anatomopatológico de meningioma. La determinación de los receptores se hizo mediante una técnica de inmunohistoquímica rápida que permite el estudio de tejidos fijados previamente en parafina. Resultados: De los 24 casos estudiados, nueve resultaron ser positivos en la determinación de receptores de progesterona (37%). Se pudo observar un marcado predominio dentro del grupo femenino quienes constituyeron 8/9 casos positivos. Conclusiones: El empleo de esta reciente técnica de inmunohistoquímica aplicada a tejido de fijado en parafina, nos ha permitido confirmar la presencia de receptores de progesterona en meningiomas con una frecuencia elevada que creemos amerita un estudio más amplio de manera sistemática que incluya la intervención terapéutica mediante el uso de antiprogestágenos, como el Mifepristone o RU 486. De este estudio podrían beneficiarse no sólo pacientes operados recientemente sino aquellos que, intervenidos en el pasado sean detectados como portadores de receptores de progesterona mediante la aplicación de esta novedosa técnica (Rev Med Hered 1995; 6: 121-130).

Objective: To determine the presence of the progesterone receptors in meningiomas and its frequency by means of immunohistochemistry. Material and methods: We studied 24 samples coming from patients who have been operated at the Instituto Nacional de Enfermedades Neoplasicas in Lima, Perú, between 1992 and 1992 because of the presence of a cerebral tumor which gave the final diagnosis of meningioma on the pathology report. The determination of the presence of these receptors was done by the immunohistochemical technic on meningioma tissue previously fixed on paraffin. Results: From the 24 cases studied we have found nine to be positive to progesterone receptors which represented the thirty seven per cent of the total of meningioma samples analyzed. We have observed a marked predominance in the female group which represented eight of the nine positive cases. Conclusions: The use of this recent developed technic of immunohistochemistry applied to fixed tissue in paraffin has permitted us to confirm the presence of progesterone receptors in meningiomas with an elevated frequency which merits a more ample study in a systematic way which should include a therapeutic approach with the use of antiprogestagens like Mifepristone or RU 486. From this study not only recently operated patients could be beneficiated but also those who have been operated in the past and that could be detected as carriers of progesterone receptors with the application of this new technic. (Rev Med Hered 1995; 6: 121-130).

Miositis aguda postinfecciosa.

A seven year old patient in described with acute focal myositis, following an influenza-like infection, involving exclusively the gastroenemius and soleus muscles. The patient improved only with bed rest and symptomatic treatment and made a full recovery in three days. Laboratory studies showed a normal white blood count with an increase in the band forms, elevated SGOT, DHL, and CPK, all of which returned to normal after one week. The patient remains asymptomatic one month after his discharge.

**Infecciones causadas por Candida spp. Resistente al fluconazol en pacientes con el síndrome de inmunodeficiencia adquirida (SIDA). : Reporte de un caso.**

Large, ulcerative lesions over the skin scalp, and oral mucosa were observed in a patient with acquired immunodeficiency syndrome (AIDS) receiving chronic suppressive therapy with fluconazole. Candida glabrata was recovered in culture from biopsy material, and was found to be resistant to reported frequency of infections with Candida spp. resistant to fluconazole has increased in recent years. We review the literature regardin fluconazole resistant infections in patients with AIDS, discuss the possible mechanisms of resistance, and management options.

Incontinentia pigmenti: A propósito de un caso.

Incontinentia Pigmenti is a rare X-linked multisystem neuroectodermic disorder with signs and symptoms related mainly to the dermatologic, dental, ocular and central nervous systems, and characterized by death in the majority of male embryos. Affected children do not appear sick, in spite of the skin eruption, the peripheral leucocytosis and marked eosinophilia. Most of the cases are reported in caucasians, although there are description in black children, orientals, north central and south american Indians, and in our mestizos. The name of Incontinentia Pigmenti describes the incontinence of the melanin pigment from the basal layer of the epidemermis into the superficial dermis.

Hiperplasia linfoide cervical por difenilhidantoína.

We present the case of a three year old girl who showed two adverse reactions to DPH, one of them a large cervical lymphatic hyperplasia, which responded to discontinuation of the drug. Laboratory test were normal and histological examination showed non specific adenitis. We discuss this unusual case and the importance of the cervical adenopathy differential diagnosis.

Fisiopatología de los trastornos hidroelectrolíticos y del equilibrio ácido-base, en la diarrea aguda coleriforme.

Tratamiento de reposición hidroelectrolítica en el paciente deshidratado por cólera.