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Ex-Hacienda el Hospital, Mexico

Background: In the general population café-au-lait macules are very common benign lesions that are isolated or unique, that are not associated with any systemic disease; however, in the disseminated presentation, they may become a marker of genetic syndromes, among which the most common is neurofibromatosis. In this paper we estimate the prevalence of café-au-lait macules in a tertiary hospital. Objectives: To establish the prevalence, topography, size and number of café-au-lait macules on an outpatient basis; also to know the distribution of café-au-lait macules to establish the primary diagnosis and to know their frequency as indicator of certain systemic diseases. Patients and method: We studied all patients with café-au-lait macules attending outpatient clinic and who were treated from September 2006 to January 2008 in the service of Dermatology, National Medical Center 20 de Noviembre, ISSSTE. All patients underwent medical history -including topography, morphology, size and number of café-au-lait macules-, were physically explored and photographed with a Sony Cyber-shot® 7.2-megapixel camera. Results: From a total of 2,159 patients, 48 had café-au-lait macules. The average age of these patients was 17.5 ± 16.7 years, the range was 1.9 to 66 years and the median value was 11 years. Of the 48 patients with café-au-lait macules, 36 patients (75%) had isolated macules and in 12 (25%) they were associated with a syndrome: there were 9 patients (18.7%) with neurofibromatosis type 1, 1 patient (2%) with Noonan syndrome, 1 patient (2%) with Bannayan-Riley-Ruvalcaba syndrome and 1 patient (2%) with Bloom syndrome. Regarding the topography of café-au-lait macules, they were classified as follows: 25 located (52.1%), 17 disseminated (35.4%) and 6 generalized (12.5%). Respect to their multiplicity, the macules were grouped into two categories: 25 unique (52.1%) and 23 multiple (47.9%). Conclusions: The prevalence of café-au-lait macules was similar to that reported worldwide, the isolated café-au-lait macules are more frequent than those associated with a syndrome, although this study was conducted in a third level closed population. It is required to make a complete physical examination to determine the clinical characteristics of the macules and to diagnose them as "isolated café-au-lait macules" or "café-au-lait macules associated with a genetic syndrome". Source


Ortiz G.,Hospital de Santa Clara | Frutos-Vivar F.,CIBER ISCIII | Ferguson N.D.,University of Toronto | Esteban A.,CIBER ISCIII | And 9 more authors.
Chest | Year: 2010

Background: Few data are available regarding the benefits of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support. Methods: This was a secondary analysis of an observational study conducted in 349 ICUs from 23 countries. A propensity score stratified analysis was used to compare 350 patients ventilated with SIMV-PS with 1,228 patients ventilated with A/C ventilation. The primary outcome was in-hospital mortality. Results: In a logistic regression model, patients were more likely to receive SIMV-PS if they were from North America, had lower severity of illness, or were ventilated postoperatively or for trauma. SIMV-PS was less likely to be selected if patients were ventilated because of asthma or coma, or if they developed complications such as sepsis or cardiovascular failure during mechanical ventilation. In the stratified analysis according to propensity score, we did not find significant differences in the in-hospital mortality. After adjustment for propensity score, overall effect of SIMV-PS on in-hospital mortality was not significant (odds ratio, 1.04; 95% CI, 0.77-1.42; P 5.78). Conclusions: In our cohort of ventilated patients, ventilation with SIMV-PS compared with A/C did not offer any advantage in terms of clinical outcomes, despite treatment-allocation bias that would have favored SIMV-PS. © 2010 American College of Chest Physicians. Source


Gonzalez M.,Pontifical Bolivarian University | Arroliga A.C.,Texas A&M University | Frutos-Vivar F.,Hospital Universitario Of Getafe | Frutos-Vivar F.,CIBER ISCIII | And 12 more authors.
Intensive Care Medicine | Year: 2010

Purpose: To compare characteristics and clinical outcomes of patients receiving airway pressure release ventilation (APRV) or biphasic positive airway pressure (BIPAP) to assist-control ventilation (A/C) as their primary mode of ventilatory support. The objective was to estimate if patients ventilated with APRV/BIPAP have a lower mortality. Methods: Secondary analysis of an observational study in 349 intensive care units from 23 countries. A total of 234 patients were included who were ventilated only with APRV/BIPAP and 1,228 patients who were ventilated only with A/C. A case-matched analysis according to a propensity score was used to make comparisons between groups. Results: In logistic regression analysis, the most important factor associated with the use of APRV/BIPAP was the country (196 of 234 patients were from German units). Patients with coma or congestive heart failure as the reason to start mechanical ventilation, pH <7.15 prior to mechanical ventilation, and patients who developed respiratory failure (SOFA score >2) after intubation with or without criteria of acute respiratory distress syndrome were less likely to be ventilated with APRV/BIPAP. In the case-matched analysis there were no differences in outcomes, including mortality in the intensive care unit, days of mechanical ventilation or weaning, rate of reintubation, length of stay in the intensive care unit or hospital, and mortality in the hospital. Conclusions: In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation. © 2010 Copyright jointly held by Springer and ESICM. Source


Pelosi P.,University of Genoa | Ferguson N.D.,University of Toronto | Frutos-Vivar F.,CIBER ISCIII | Anzueto A.,University of Texas Health Science Center at San Antonio | And 11 more authors.
Critical Care Medicine | Year: 2011

Objective: To describe and compare characteristics, ventilatory practices, and associated outcomes among mechanically ventilated patients with different types of brain injury and between neurologic and nonneurologic patients. Design: Secondary analysis of a prospective, observational, and multicenter study on mechanical ventilation. Setting: Three hundred forty-nine intensive care units from 23 countries. Patients: We included 552 mechanically ventilated neurologic patients (362 patients with stroke and 190 patients with brain trauma). For comparison we used a control group of 4,030 mixed patients who were ventilated for nonneurologic reasons. Interventions: None. Measurements and Main Results: We collected demographics, ventilatory settings, organ failures, and complications arising during ventilation and outcomes. Multivariate logistic regression analysis was performed with intensive care unit mortality as the dependent variable. At admission, a Glasgow Coma Scale score ≤8 was observed in 68% of the stroke, 77% of the brain trauma, and 29% of the nonneurologic patients. Modes of ventilation and use of a lung-protective strategy within the first week of mechanical ventilation were similar between groups. In comparison with nonneurologic patients, patients with neurologic disease developed fewer complications over the course of mechanical ventilation with the exception of a higher rate of ventilator-associated pneumonia in the brain trauma cohort. Neurologic patients showed higher rates of tracheotomy and longer duration of mechanical ventilation. Mortality in the intensive care unit was significantly (p < .001) higher in patients with stroke (45%) than in brain trauma (29%) and nonneurologic disease (30%). Factors associated with mortality were: stroke (in comparison to brain trauma), Glasgow Coma Scale score on day 1, and severity at admission in the intensive care unit. Conclusions: In our study, one of every five mechanically ventilated patients received this therapy as a result of a neurologic disease. This cohort of patients showed a higher mortality rate than nonneurologic patients despite a lower incidence of extracerebral organ dysfunction. Copyright © 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source


Meurehg C.C.,Hospital ABC
Dermatologia Revista Mexicana | Year: 2011

The most frequent cutaneous lymphoma of T cells is mycosis fungoide, a chronic disease with an inadequate name and different phases of evolution. This paper reports the case of a 69 year-old male patient with mycosis fungoide, patch stage, who has developed three basal cell carcinomas, one treated with imiquimod, another treated with surgical excision and primary closure and the last one reconstructed with a rotation flap type O-Z. Source

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