Amniotic fluid embolism direct cause of maternal death. Clinical case report

Embolic complications in pregnancy are not common, but require prompt attention due to their high mortality, with reports of numbers up to 80% in patients with presence of amniotic fluid embolism. Of the embolic complications, deep vein thrombosis is the most frequent and 15-24% of patients could present with amniotic fluid embolism. In the case of a 42-year-old female who had this syndrome, it was considered an obstetric catastrophe. A review of the world literature was carried out to report on the physiopathology of the case.     

Inferior vena cava leiomyosarcoma. Report of two cases and review of management

El leiomiosarcoma de la vena cava es un tumor vascular maligno de presentación rara que tiene mal pronóstico. Habitualmente se presenta en mujeres entre la quinta y sexta décadas de la vida. Es una lesión de bajo grado de malignidad pero habitualmente fatal. En este artículo se revisan dos casos clínicos de leiomiosarcomas de la vena cava inferior de localización pararrenal. Ambos ocurrieron en mujeres y la resección radical fue la forma de manejo. En un paciente se utilizó pericardio bovino y en el otro un injerto de politetra-fluoroetileno como reemplazo de la vena cava. Ambos pacientes presentaron recurrencias locales y sistémicas. Una falleció 5 a?os después del diagnóstico con recurrencia local y sistémica, la otra se encuentra viva pero con recurrencia local y hepática.     

Intravesical bacillus Calmette-Guèrin for the treatment of superficial bladder cancer in renal transplant patients

BACKGROUND: Intravesical instillations with bacillus Calmette-Guérin (BCG) is considered the treatment of choice in the prophylaxis of high-grade superficial bladder carcinoma and in the treatment of carcinoma in situ (CIS) of the bladder. METHODS: There is no previous experience with BCG treatment in patients with renal transplantation. Theoretically, immunosuppression is a contraindication because of the risk of severe morbidity and sepsis. We present our experience with endovesical BCG in three renal transplant patients, under immunosuppressive treatment, with high-grade superficial bladder cancer and CIS. RESULTS: Two patients are free of disease at 17 and 60 months. One patient developed disease recurrence and underwent a radical cystectomy. There was neither change in renal function nor any clinical evidence of tuberculous infection. CONCLUSIONS: Intravesical BCG in superficial bladder cancer and/or CIS is a valid option, with no added morbidity to renal transplant patients.     

Microvessel damage by B. jararacussu snake venom: pathogenesis and influence on muscle regeneration.

The loss of muscle mass consequent to poor muscle regeneration is a common sequela following the injection of Bothrops jararacussu snake venom. Since an intact microvasculature plays a central role in the success of muscle regeneration, the poor muscle regeneration seen after envenomation could be explained by damage to the local microvasculature. In this work, we investigated the pathogenesis of microvessel damage caused by B. jararacussu venom and its correlation with poor muscle regeneration. The right soleus muscle of adult mice was injected with 80 microg of venom and the mice were killed from 2 min to 3 months later. Similarly, the soleus muscle of other mice was injected with 80 microg of bothrosptoxin-I (BthTX-I), a non-vasculotoxic myotoxin. Tissue samples were prepared for analysis by electron (venom only) and light (venom and BthTX-I) microscopy. The extent of revascularization was assessed using light microscopy by examining recanalization of thrombi and calculating the individual capillary-to-fiber-ratio, the number of capillaries around a fiber and the capillary/muscle cell ratio. Microvessel damage by venom started within 5 min and, after 6 h, there was total degeneration of the capillaries with failure of the local microcirculation. The time-course of the ultrastructural lesions suggested that endothelial cells were probably damaged by a direct action of B. jararacussu venom on these cells. The revascularization of muscle damaged by venom, but not by BthTX-I, occurred later and was very poor. These results indicate a central role for vascular lesions in muscle regeneration after damage by B. jararacussu venom.     

Hyperinsulinemia and tinnitus: a historical cohort

Tinnitus affects millions of people worldwide, and it signals the presence of several underlying diseases, including hyperinsulinemia. The aim of this study was to evaluate the response to dietary treatment in 80 patients with associated tinnitus and hyperinsulinemia. On the basis of data obtained by a questionnaire, two groups were established: One included patients who followed the prescribed diet; the other group included patients who did not comply with the treatment. The likelihood of improving tinnitus symptoms was fivefold higher in hyperinsulinemic patients who followed the diet than in those who did not (relative risk [RR], 5.34; 95% confidence interval [CI], 1.85-15.37; p < .05). In addition, resolution of tinnitus was reported by 15% of the patients who followed the diet as compared to 0% of those who did not. These findings underscore the importance of including hyperinsulinemia in the routine diagnostic investigation of patients with tinnitus regardless of whether associated with neurosensory dysacusis or vertigo (or both).     

A preliminary study of the prevalence of intestinal parasites in immunocompromised patients with and without gastrointestinal manifestations

The objective of the present study was to determine the prevalence of the intestinal parasites most commonly found in immunocompromised patients. A group of 111 individuals with acute lymphoid leukaemia (ALL), chronic myeloid leukaemia (CML), human immunodeficiency virus (HIV) and other immunocompromised conditions (principally haematological disorders) was selected. A battery of tests was performed on each individual to identify the presence of parasites (three stool specimens with saline solution and Lugol both directly and by concentration, culture and special staining). No significant differences were found among the frequencies of the different parasites with the several types of immunocompromised conditions. The overall frequencies of potentially pathogenic and opportunistic parasites were 32.4% (36/111) and 9% (10/111) respectively, the most frequently encountered among the latter being Cryptosporidium sp., Microsporidia spp. and Strongyloides stercoralis.