Héctor Gatica R

Necrosis intestinal como presentación de enfermedad de Takayasu: Report of one case

A 32 years old female was admitted to hospital due to acute abdominal pain, nausea, vomiting and liquid stools. Physical examination was normal except for pain on her left inferior abdominal quadrant without peritoneal irritation signs. An abdominal CAT-scan suggested thrombosis at celiac trunk, although the echo Doppler showed no alterations except for signs of ischemia in the distal branch of the superior mesenteric artery. An exploratory laparotomy was performed disclosing a necrosis of the distal ileum and cecum, diffuse peritonitis and thrombosis of the ileocecoapendiculocolic artery. No vasculitis lesions were found in the arteries of medium size examined. A history of intermittent claudication for the past 3 years as well as acrocyanosis, asymmetry of pulses and blood pressure in the superior extremities was ascertained after the surgery. A MRI angiogram showed multiple stenoses and irregularities at the celiac trunk, hepatic, superior mesenteric and fibular arteries. No abnormalities at the aortic arch and its main branches were documented. A sepsis due to Candida sp complicated her postoperatory period. After recovery, prednisone 1 mg/kg/day was started and the anticoagulation continued. The abdominal pain, intermittent claudication and superior limb acrocyanosis disappeared. This is an unusual case of type IV Takayasus arteritis with acute abdominal signs as the first manifestation (Rev Med Chile 2002; 130: 1159-64)

Autoevaluación de fortalezas, debilidades y confianza de los médicos de atención primaria en el abordaje de enfermedades reumatológicas

A selfassessment and anonymous questionnaire was mailed to primary care physicians of two Chileanregions. Using a 10 points Likert scale, they were asked about personal interest, undergraduatetraining, continuous medical education, availability of medical literature, complementarylaboratory tests and consultation with a rheumatologist. Medical skills, knowledge, therapeuticapproach and performance of rheumatologic procedures were evaluated under the item confidence.

Valores normales de captación de 131Yodo de 2 y 24 horas

Background: Radiolabeled iodine uptake is a useful tool in the study of thyroid diseases. Aim: To obtain normal values for 131 Iodine thyroid uptake in healthy volunteers. Material and methods: A total of 105 subjects were included (52 males and 53 females), with a mean age of 45 years (range: 20 to 68, evenly distributed in decades). A questionnaire was applied and a clinical examination was performed to rule out endocrine diseases. Serum TSH and anti-thyroperoxidase antibodies were also measured. The oral 131I dose was 5-10 fiCi, and a Thyrad equipment was used for measurements at 2 and 24 h. Results: Mean global iodine uptake was 5.5%±1.8% (range: 2.3-12.0) at 2 h and 16.2±4.8% (range: 6.5-30.1) at 24 h. The values at 2 h among women and men were 6.0±1.8 and 4.9±1.6%, respectively, (p <0.02). At 24 h, the figures were 17.3±4.5 and 15.0±4.9%, respectively (p =0.01). Compared to their younger counterparts, radioactive iodine uptake was lower among volunteers older than 40 years, at 2 h (5.0±1.7 and 6.0±1.8, respectively, p <0.02) and at 24 h (14.9±4.4 and 17.6±4.9%, respectively, p <0.01). Conclusions: Normal thyroid uptake values in adults are influenced bygender and age. Normal thyroid iodine uptake values are slightly higher in females. Iodine thyroid uptake values decrease slightly in subjects aged more than 40years.

Características clínicas y respuesta al tratamiento sistémico de la epiescleritis y escleritis primarias y secundarias, refractarias al tratamiento local

Background: Scleritis and episcleritis may extend to adjacent ocular tissues with blinding consequences and may be associated with potentially lethal systemic disorders. Aim: To evaluate the ocular complications and systemic disease associations of the different types of scleritis and episcleritis. Patients and methods: Forty six patients with refractory scleritis and episcleritis were studied and treated during the period 1991 to 1998. Results: Necrotizing type was the most common and severe category in the scleritis group of patients. A decrease in vision occurred in 58.3% of patients with scleritis v/s a 23.5% of patients with epiescleritis (p<0,05). Uveitis was present in 35.4% of patients with scleritis and scleromalacia was present in 33.3% (p<0,05). A specific disease association was uncovered in 51% of scleritis and in 38% of episcleritis patients. Rheumatoid arthritis, primary systemic vasculitic disease and Sjogren syndrome with vasculitis were the most common associated systemic diseases. Three patients with scleritis had tuberculosis. Conclusions: Scleritis is more severe than episcleritis, and necrotizing scleritis is the most severe type of scleritis. Classification of scleritis and episcleritis provides valuable prognostic information. A meticulous approach for the detection of a specific associated disease must be undertaken. Scleritis associated with vasculitis has a worse ocular prognosis than other non infectious diseases. Cyclophosphamide is the most effective inmunosuppresive treatment to control severe ocular involvement (Rev Med Chile 2000; 128: 1205-14)

Anticuerpos a proteínas recombinantes Ro60 Kd, Ro52 Kd y La48 Kd, en el síndrome de Sjögren primario: Utilidad de la combinación de métodos analíticos para detectar anticuerpos anti Ro y anti La

Background: The use of new recombinant antigens may increase the sensitivity and specificity of the detection of anti Ro and anti La antibodies in Sjogrens syndrome. Aim: To determine the immune reactivity of sera from patients with Sjogrens syndrome, against fusion recombinant proteins (prf) Ro60 Kd, Ro52 Kd and La48 Kd expressed in E coli and recombinant protein Ro52 Kd, expressed in baculovirus (prb). Material and methods: Serum samples from 46 patients with a diagnosis of Sjogrens syndrome, according to the European criteria of 1997, were studied. Using conventional ELISA assays, 32 patients had positive anti Ro antibodies (group A) and 16 patients had negative anti Ro and anti La antibodies, but had positive antinuclear antibodies or rheumatoid factors (group B). Antibodies against recombinant proteins were measured by ELISA or Western Blot. Results: Reactivity against prf Ro60 was present in 69% of samples from group A patients and in 36% of samples from group B. Reactivity against prf Ro52 was present in 94% of samples from group A and 50% of samples from group B. Reactivity against prb Ro52 was present in 75% of samples from group A and 40% of samples from group B. Reactivity against prf La was present in 78% of samples by ELISA and 97% of samples by Western Blot. In 10 of 14 serum samples from group B patients, there was reactivity against at least one recombinant protein. Conclusions: A high prevalence of reactivity against recombinant Ro and La proteins was detected in serum samples from patients with Sjogren syndrome (Rev Med Chile 2002; 130: 841-9)

Crisis de esclerodermia renal.: Rol de la vasculopatía esclerodérmica en la inducción de fibrosis cutáneo-visceral en dos casos

Although fibrosis and vasculopathy coexist in most patients with progressive systemic sclerosis, it is not clear if these events are the result of an unique etiologic factor or if one is consequence of the other. We report two cases of progressive systemic sclerosis that evolved to a renal scleroderma crisis. A 36 years old female presented with a Sjogren syndrome and painful subcutaneous nodules whose biopsy showed perivascular lymphocytic infiltration, perivascular thickening and normal skin. The ESR was 100 mm/h. She developed an hypertensive crisis and progressive renal failure, followed by a rapidly evolving progressive systemic sclerosis. The patient died in the course of this crisis. A 32 years old female with a progressive systemic sclerosis refractory to D-penicillamine treatment, receiving cyclosporin, presented a renal scleroderma crisis, that was successfully treated, with complete recovery of renal function. We highlight the different evolution of these cases, probably due to an early diagnosis and a better experience in the management of this condition. (Rev Med Chile 2000; 128: 86-92)