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In the physical examination no reduction of strength in the limbs or alterations in the osteotendinous reflexes were detected. |
He had a stable, non-pathological gait without dysmetria. |
He had progressively recovered his muscle strength a few minutes ago. |
A fine distal tremor was discovered without exophthalmos. |
The heart rate was 120 beats per minute, presenting nodules as consolidation of a thyroid gland of increased size. |
An emergency analytical was performed which detected: creatinine 0.59 mg/dl (normal 0.60-1.35), sodium 142 mEq/L (135-145), potassium 2.07 mEq/l (3.5-5), calcium 142 mEq/dl (135-145), total potassium 2.07 mEq/l (85.3-1050), magnesium |
A clinical picture of loss of strength and hypokalemia led us to the diagnosis of periodic paralysis. |
Given the presence of a characteristic half-life of thyroid disease, a hormonal study was requested, finding primary hyperthyroidism of autoimmune origin with T4L (T4L) levels: T4L (0.860-2.760 IU), anti-TSHb (0.475) antibodies (0.75 IU/ml) and T4L): 0.008, T4L, T4L) and T4L parameters: 0.008, T4L, T4 |
Vitamin D and PTH were normal (28 ng/mL [20-5 and 26 pg/mL] [11-80], respectively). |
The first complementary test to be requested in the presence of hyperthyroidism is thyroid scintigraphy, which in our case showed diffuse hyperuptake. |
All these data led us to Graves' disease as the cause of the condition. |
In the acute phase, treatment with 40 mEq of intravenous potassium was started, resulting in a decrease in normalization of the levels (4.1 mEq/L), and progressive propranol 10 mg and methimazole 30 mg daily were administered at home. |
Currently, the patient remains on methimazole 5 mg daily with partial remission of symptoms and normal thyroid function, without presenting new episodes of paralysis. |
A 40-year-old woman presented to the emergency department of the health center with unilateral right earache and headache of 3 days duration. |
It was treated as an external fixation with drops of beclomethasone + clioquinol. |
The next day he returned to the emergency room due to headache that almost completely resolved with intravenous analgesic therapy, responding to previous treatment dexketoprofen 25 mg/8 h. |
Two days later he came to the consultation complaining of stabbing headache, oppressive sensation at the periorbital level and tinnitus in the right ear, objectifying in the exploration absence of inflammation in the external auditory canal with beta/24CA. |
Two days later, the patient complained of temporary incapacity and referred improvement of the otic pain, but some feeling of instability, sustitu and betablockade due to sulfonylurea 50 mg/8 h. |
Forty-eight hours later he consulted for "not finding better"; paresthesia in the left eye was noticed since the same morning, as well as otorhinolaryngological activity in the right hemilanguage and during the interview we noticed a slight facial paralysis. |
Audiometry showed a slight drop in sharps in the right ear. |
The cranial nerves were normal except the VII. |
She had no spontaneous nystagmus. |
Otoscopy showed hyperintensity in the upper portion of the C. Small masses were visualized in the pavilion, so the diagnosis of "enteremia" was made to start intravenous therapy with right atrial fibrillation and control. |
The patient is a 12-year-old male resulting from a term delivery using forceps for stationary dilatation. |
Apgar and other examinations postpartum were normal. |
Rest was indicated during the last trimester of pregnancy due to threatened delivery. |
During the postnatal period she presented delayed psychomotor development. |
At 3 years she presented absence seizures without subsequent epileptic seizures or need for treatment. |
Presently, she presents moderate mental retardation, learning difficulties, severe behavioral alterations in the autism spectrum, sphincter control deficit and attention deficit hyperactivity disorder, treated first with antioxidant methylphenidate and later on with attention deficit hyperactivity disorder. |
It also presents social anxiety and phobias to noise and animals, hypersensitivity to sounds, textures and certain foods, as well as difficulties in chewing and secondary generalised hypotonia valgus feet treated with extreme melatonin, and vomiting treated. |
There are no cardiac or dysautonomic alterations or characteristic facial features. |
The patient has a healthy older brother, but has a second episode due to the maternal branch of 33 years diagnosed at 13 years of age with FXS after genetic testing. |
At that time, the entire maternal family branch was genetically studied and oral meetings were held, with no written report, that both the mother of the case patient and her sisters were healthy carriers. |
This condition was not sufficiently valued by the family in successive healthy children of the sisters and the healthy brother of the case patient. |
The mother of the case patient did not receive genetic counseling or prenatal diagnosis indications in any of her two pregnancies. |
Genetic analysis was performed only in the postnatal period in both cases upon request. |
A 60-year-old patient who comes to the emergency room because, according to the family, when waking up after 15 hours of sleep, presents with disorientation, difficulty in articulating language, with blurred emission and vertical comprehension. |
She did not present loss of consciousness, fever episodes, chest pain or fever. |
The patient had a history of smoking for 15 years, hypertension treated with enalapril and dyslipidemia treated with simvastatin. |
Examination revealed paresis of the fourth cranial pair of the right eye, as well as incomplete involvement of the third bilateral pair and VI right pair of inferior predominance manifested as binocular vertical diplopia. |
The rest of the cranial nerves are normal. |
There is no evidence of associated motor or sensory deficit, negative Romberg, no dysmetria and no meningeal signs. |
There is evidence of gait disturbance with tendency to the right side. |
In addition to the basic emergency protocol, complete blood count, biochemistry, coagulation study, simple chest X-ray and electrocardiogram were normal, a 64-channel computed tomography (CT) was performed without any apparent pathological findings. |
1. |
During admission, diplopia persists and is corrected with alternating monocular occlusion, persisting instability and gait disorder. |
On the third day of admission, a 1.5 T MRI scan revealed a solitary microinfarction in the deep white matter, as well as acute ischemic lesions of paramedian location in both arteries. |
Flair sequences and the use of diffusion are especially useful for observing these lesions. |
1. |
After consulting the case with the cardiology department and, given the embolic origin of the condition, it was decided to initiate oral anticoagulation with Dabigatran due to the high risk of recurrence. |
The evolution of the patient was favorable and, with the rehabilitation treatment, progressive autonomy of gait was achieved, she presented improvement of diplopia. |
A 63-year-old heterosexual male was admitted in November 2013 due to progressive dyspnea for one month that upon arrival at the emergency department with minimal effort. |
He was a smoker, accumulated index of 80 packs/year, drinker of about 80 grams of alcohol a day, and had unprotected sex with different partners. |
He did not report previous liver disease, nor knew that any member of his family had been diagnosed with porphyria. |
She did not take medication regularly. |
A few months before he had consulted a dermatologist for erythema and facial scaling, which was related to excessive photosensitivity, was treated with sunscreen creams. |
Other data were added to respiratory distress: cough did not manifest fever, but at admission the temperature was 38.5oC and estimated that she had lost about 20 kg of weight in the last 4 months. |
The patient appeared to be malnourished, was eupneic with supplementary oxygen supply, vesicular murmur was conserved and had no signs of heart failure. |
There was a striking hyperpigmentation in the forehead, malar regions and nose with some small erosion and hypertrichosis, with no other skin lesions. |
The chest X-ray showed a bilateral interstitial pattern. |
Anti-HIV antibodies were positive, the viral load was 257,580 copies/ml, CD4 28 cells/μL and CD8 262 cells/μL with a CD4 count of 0. |
Ziehl Neelsen stain was negative. |
An adequate sample for direct sputum immunofluorescence against pneumocystis jiroveci (PNJ) could not be obtained, however empirical treatment against this NPJ was initiated with interstitial pneumonia presumed diagnosis. |
The radiological semiology was described. |
Urine porphyrins were determined to clarify facial erythrodermia. |
An increase in porphyrin excretion in 24-hour urine was detected, with an excretion pattern compatible with the diagnosis of PCT2. |
1. |
Hepatitis B and C serology was negative. |
The study of iron metabolism showed normal transferrin values and slightly elevated saturation index and serum iron, the quantification of serum ferritin was very high (1,928 ng/ml). |
C282Y and H63D mutations in the hemochromatosis gene were negative. |
She was discharged with the diagnosis of HIV C3 infection (interstitial pneumonia by NJP) and PCT. |
Treatment with Tenofovir, Emtricitabine and Darunavir was started and sun protection and alcohol withdrawal was recommended. |
We report the case of a 29-year-old man (165 cm, 68 kg), aphagous, policeman, who suffered an open trauma in the right elbow secondary to the impact of a firearm (probably AK). |
After the incident, a tourniquet was placed at humic level and a topical granuleuse iv was applied (Celox® SAM Medical Products, Newport, Oex administered gtragon acid). |
She was evacuated through a medicalized helicopter until the Spanish Role 2E of Herat (Afghanistan) reaching the triage room 70 minutes after suffering the injury. |
1. |
In the primary assessment, the wounded patient had GCS 15 ptos, peripheral SatO2 98%, heart rate 110 bpm, non-invasive blood pressure (30/10 mg iv) and midazolam 3/10 mg iv) with good control of pain. |
The presence of a gunshot wound with an entry orifice in elbow without an exit orifice was confirmed. |
Radiography showed a distal fracture of the left hilum, a proximal fracture of the left cubitus and a proximal fracture of the left radius. |
It was decided to perform a surgical intervention for debridement, cleaning, removal of bone schirs and placement of an external fixator on the left arm under general anesthesia. |
Changes in blood tests, ECG or airway assessment were not considered during the study. |
The patient did not remember anything but had been his last ingestion and accepted the informed consent in the presence of an interpreter. |
In the operating room, a grade I monitoring (peripheral SpO2, heart rate, non-invasive blood pressure and capnography) was used, together with a bispectral analysis device (BIS®), a continuous hemoglobin monitor (Masimo®). |
The wound was premeditated with midazolam (1 mg iv) and with beta blockers (20 mg iv). |
After 3 minutes of denitrogenization with 80% FiO2 and 100% SatO2, rapid sequence anesthesia was induced with fentanyl (30 μg iv), propofol (130 mg). |
Standard laryngoscopy (Cormak II) was performed, the airway was isolated with a 7.5 mm endotracheal tube and the endotracheal cuff was filled with air (8 ml). |
After selecting protective ventilation parameters (VT 420 ml, PEEP 7, FiO2 45%), alveolar recapping maneuvers were not necessary. |
Anesthesia was maintained with O2, air and sevoflurane mixture. |
During the 75 minutes of the surgical procedure, the patient remained prone to tachycardia. |
The intervention performed was open reduction under control of scopy, transarticular osteosyntesis by implantation of external fixator Hoffmann II Stryker in multiplanar configuration, pulsatile lavage of the ulnar flexor tendon and necrotic tissue. |
Antibiotic prophylaxis was administered with warm air-protected fluids 2 g iv metronidazole 500 mg iv), gastroprotective (omeprazole 40 mg iv), antiemetic (greisetron 3 mg iv), antiepileptic |
To improve pain control, in addition to performing multimodal analgesia (metamizole 2 g IV, paracetamol 1 g IV, acetaminophen 30 mg IV and fentanyl 150 μg IV) an ultrasound-guided peripheral nerve block was used. |
Opioid antagonists and muscle relaxant reversal were not required. |
The patient was admitted stable and with good pain control in the intensive care unit and then transferred to the hospital ward. |
The patient was discharged from Role 2E 72 hours after suffering the condition, and was evacuated to an Afghan military hospital for soft tissue healing and future osteosyntesis. |
A 38-year-old male patient was evaluated in consultation due to a year and a half history of right hip pain with mechanical characteristics. |
Pain is associated with physical exercise and mild limitation of mobility in certain postures. |
A mechanic of profession, in his free time he performed bicycles (40 km per day on weekends), running 3 times per week for 50 minutes and walking for one hour the days that he did not run. |
Pain is progressively increasing and is currently walking only. |
Physical examination revealed pain in the medial third of the right inguinal region with pain on flexion, adduction and rotations above all internal (positive shock maneuver). |
Subsets and Splits