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Conversatorio clínico patológico en el Hospital Nacional Arzobispo Loayza_2008-02. Translated title: Clinical Case at the Hospital Nacional Arzobispo Loayza- 2008-2

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      Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature.

      Histoplasmosis is a serious opportunistic infection in patients with AIDS, often representing the first manifestation of the syndrome. Most infections occurring within the endemic region are caused by exogenous exposure, while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions. However, prospective investigations are needed to prove the mode of acquisition. The infection usually begins in the lungs even though the chest roentgenogram may be normal. Clinical findings are nonspecific; most patients present with symptoms of fever and weight loss of at least 1 month's duration. When untreated, many cases eventually develop severe clinical manifestations resembling septicemia. Chest roentgenograms, when abnormal, show interstitial or reticulonodular infiltrates. Many cases have been initially misdiagnosed as disseminated mycobacterial infection or Pneumocystis carinii pneumonia. Patients are often concurrently infected with other opportunistic pathogens, supporting the need for a careful search for co-infections. Useful diagnostic tests include serologic tests for anti-H. capsulatum antibodies and HPA, silver stains of tissue sections or body fluids, and cultures using fungal media from blood, bone marrow, bronchoalveolar lavage fluid, and other tissues or body fluids suspected to be infected on clinical grounds. Treatment with amphotericin B is highly effective, reversing the clinical manifestations of infection in at least 80% of cases. However, nearly all patients relapse within 1 year after completing courses of amphotericin B of 35 mg/kg or more, supporting the use of maintenance treatment to prevent recurrence. Relapse rates are lower (9 to 19%) in patients receiving maintenance therapy with amphotericin B given at doses of about 50 mg weekly or biweekly than with ketoconazole (50-60%), but controlled trials comparing different maintenance regimens have not been conducted. Until results of such trials become available, our current approach is to administer an induction phase of 15 mg/kg of amphotericin B given over 4 to 6 weeks, followed by maintenance therapy with 50 to 100 mg of amphotericin B given once or twice weekly, or biweekly. If results of a prospective National Institutes of Allergy and Infectious Disease study of itraconazole maintenance therapy document its effectiveness, alternatives to amphotericin B may be reasonable.
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        Ileocecal masses in patients with amebic liver abscess: etiology and management.

        To assess the causes of ileocecal mass in patients with amebic liver abscess. Patients with amebic liver abscess and ileocecal mass were carefully examined and investigated by contrast-enhanced CT scan followed by colonoscopy and histological examination of biopsy materials from lesions during colonoscopy. Ileocecal masses were found in seventeen patients with amebic liver abscess. The cause of the mass was ameboma in 14 patients, cecal tuberculosis in 2 patients and adenocarcinoma of the cecum in 1 patient. Colonic ulcers were noted in five of the six (83%) patients with active diarrhea at presentation. The ileocecal mass in all these patients was ameboma. Ulcers were seen in only one of the 11 (9%) patients without diarrhea. The difference was statistically significant from the group with diarrhea (P< 0.005). Ileocecal mass is not an uncommon finding in patients with amebic liver abscess. Although, the ileocecal mass is due to ameboma formation in most cases, it should not be assumed that this is the case in all patients. Colonoscopy and histological examination of the target biopsies are mandatory to avoid missing a more sinister lesion.
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          Managing complicated urinary tract infections: the urologic view.

          Patients with complicated UTIs are a diverse group. These patients have upper UTIs and structural or functional abnormalities that reduce the efficacy of antimicrobial therapy. They are at increased risk for morbidity such as bacteremia and sepsis, perinephric abscess, renal deterioration, and emphysematous pyelonephritis. Appropriate urinary tract imaging, antimicrobials, medical and surgical therapies, and follow-up are required to avoid potentially devastating outcomes.

            Author and article information

            [1 ] Universidad Peruana Cayetano Heredia Peru
            [2 ] Universidad Peruana Cayetano Heredia Peru
            [3 ] Hospital Nacional Arzobispo Loayza Peru
            [4 ] Universidad Peruana Cayetano Heredia Peru
            Role: ED
            Role: ED
            Role: ED
            Role: ED
            Revista Medica Herediana
            Rev Med Hered
            Universidad Peruana Cayetano Heredia. Facultad de Medicina "Alberto Hurtado" (Lima )
            April 2008
            : 19
            : 2
            : 52-53


            Product Information: SciELO Peru
            MEDICAL ETHICS
            MEDICINE, LEGAL


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