S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300001 Hipertensión arterial Fuchs Cordon José R ,Hospital México 07 2005 2005 47 107 107
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300002 Fiebre amarilla Ávila-Agüero María L ,Hospital Nacional de Niños 07 2005 2005 47 108 108 Tomori O Yellow fever: the recurring plague Crit Rev Clin Lab Sci 2004 41 Gubler D.J The changing epidemiology of yellow fever and dengue, 1900 to 2003: full circle? Comp. Immun. Microbiol. Infect. Dis 2004 27 Gubler DJ Dengue and dengue hemorrhagic fever Clin Microbiol Rev 1998 11 Van der Stuyft P Gianella A Pirard M Cespedes J Lora J Peredo C Pelegrino JL Vorndam V Boelaert M Urbanization of yellow fever in Santa Cruz, Bolivia Lancet 1999 353 Massad E Bezerra Coutinho FA Nascimento Burattini MN Fernández Lopez L The risk of yellow fever in a dengue-infested area Trans R Soc Trop Med Hyg 2001 95 Bryant J Wang H Cabezas C Ramirez G Watts D Russell K Barrett A Enzootic transmission of yellow fever virus in Peru EID 2003 9
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300003 Epidemiología y patogenia de la hipertensión arterial esencial, rol de angiotensina II, óxido nítrico y endotelina Fiedler-Velásquez Eduardo Gourzong-Taylor Charles ,Hospital Calderón Guardia 07 2005 2005 47 109 117

Actualmente se considera que la hipertensión arterial esencial es un verdadero problema de salud pública. Se estima que 1/6 de la población mundial sufre la enfermedad y en algunas poblaciones susceptibles la prevalencia es tan alta que 1 de 4 adultos mayores de 18 años es hipertenso. Aparentemente en Costa Rica la situación no es diferente a lo que ocurre mundialmente, se estima que hasta un 15.0 % de los costarricenses son hipertensos; sin embargo, los reportes de prevalencia no se encuentran actualizados. No está clara la patogenia de la hipertensión arterial esencial y las hipótesis de que sus orígenes radicaban en el riñón y en el corazón no son válidas actualmente, debido a la evidencia que demuestra que esta es una enfermedad propia del endotelio vascular en donde se conjugan factores genéticos, ambientales, humorales e inflamatorios del vaso sanguíneo que inducen a disfunción vascular. Se discuten aspectos epidemiológicos y genéticos, enfatizando en el rol patogénico de los genes de angiotensina II, oxido nítrico y endotelina

It is considered actually that high blood pressure represents a real public health problem. It is estimated that 1/6 of the world have high blood pressure and in some susceptible populations the prevalence it’s as high as much as 1 of 4 adults over 18 years old suffers from high blood pressure. In Costa Rica the situation is not different of what happens worldwide and is estimated that 15.0 % of the costarrican population have high blood pressure although the prevalence data are not actualized. The pathogenesis of essential high blood pressure remains unclear and the hypothesis that their origins were on the kidney and the heart are no longer valid because actual evidence demonstrates that this is a disease of the vascular endothelium where genetic, ambiental, humoral and inflammatory factors of the blood vessels induce vascular dysfunction. We discuss epidemiologic and genetic factors emphasizing on the pathogenic role of the angiotensin II, nitric oxide and endothelin genes

 Hipertensión arterial epidemiología patogenia genes angiotensina II óxido nítrico endotelina Hypertension epidemiology patogenesis genes angiotesin II nitric oxide endothelin Joint National Comitee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JAMA289 19 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension: Guidelines Committee J Hypertens 2003 21 Burt VL Cutler JA Higgins M Labarthe D Whelton P Brown C Rocella EJ Trends in the prevalence, awareness, treatment and control of hipertensión in the adult US population: data from the health examination surveys, 1960 to 1991 Hypertension 1995 26 Fields LE Burt VL Cutler JA Hughes J Rocella E Sorlie P The Burden of Adult Hypertension in the United States 1999 to 2000 A Rising Tide. Hypertension 2004 44 Kearney PM Whelton M Reynolds K Muntner P Whelton PK He J Global burden of hypertension: analysis of worldwide data Lancet 2005 365 Arguedas-Chaverri C Vargas-Martínez H Soto-Arroyo VM Vargas-Sánchez YM Vega Méndez MA Estudio de la prevalencia de hipertensión arterial en Zarcero de Alfaro Ruiz, provincia de Alajuela Act Med Cost 1982 25 Laclé-Murray A Diagnóstico y control de la hipertensión arterial en el adulto mayor (comparación urbana/rural) Acta Méd Costarric 1999 41 Ulate-Montero G Valores de presión arterial en una muestra de niños y adolescentes del valle central de Costa Rica Acta Méd Costarric 1989 33 Muñoz S Muñoz H Zambrano F Blood pressure in a school age population Mayo Clin Proc 1980 55 Vasan RS Beiser A Larson M Kannel W D`Agostino R Levy D Residual Lifetime Risk for Developing Hypertension in Middle-aged Women and Men: The Framingham Heart Study JAMA 2002 287 Luepker RV Jacobs DR Prineas RJ Sinaiko AR Secular trends of blood pressure and body size ina a multi-ethnic adolescent population: 1986-1996 J Pediatr 1999 134 Buzzard CJ Lipshultz SE Hoekelman RA High blood pressure in infants, children, and adolescents High blood pressure in infants, children, and adolescents 2001 4th St Louis Mosby Rosner B Prineas R Daniels SR Loggie J Blood pressure differences between blacks and whites in relation to body size among US children and adolescents Am J Epidemiol 2000 151 Adrogué H Sinaiko AR Prevalence of Hypertension in Junior High School-Aged Chinldren: Effect of New Recommendations in the 1996 Updated Task Force Report Am J Hypertens 2001 14 Williams ChL Hayman L Daniels S Robinson T Steinberg J Paridon S Bazzarre T A Statement for Health Proffesionals From the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association Circulation 2002 106 Stamler J Stamler R Neaton JD Blood pressure, systolic and diastolic, and cardiovascular risks: US population data Arch Intern Med 1993 153 Kannel WB Blood pressure as a cardiovascular risk factor: prevention and treatment JAM 1996 275 van den Hoogen PCW Feskens EJM Nagelkerke NJD Menotti A Nissinen A Kromhout D The relation between blood pressure and mortality due to coronary heart disease among men in differents parts of the world N Engl J Med 2000 342 Strandberg TE Salomaa VV Vanhanen HT Pitkälä K Blood pressure and mortality during a 32-year-follow-up J Hypertens 2001 19 Hansson L Zanchetti A Carruthers SG Dahlöf B Elmfeldt D Julios S Ménard J Rahn KH Wedel H Westerling S Effects of intensive blood- pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial Lancet 1998 351 Joint National Comitee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JNC VI Arch Intern Med 1997 155 Vasan RS Larson MG Leip EP Evans JC O´Donnell CJ Kannel WB Levy D Impact of high-normal blood pressure on the risk of cardiovascular disease N Engl J Med 2001 345 Lew¡ngton S Clarke R Qizilbash N Peto R Collins R Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies Lancet 2002 360 Wolf-Maier K Cooper RS Banegas JR Giampaoli S Hense HW Joffres M Hypertension Prevalence and Blood Pressure Levels in 6 European Countries, Canada and the United States JAMA 2003 298 Bakris GL Mensah GA Pathogenesis and Clinical Physiology of Hypertension Curr Probl Cardiol 2003 28 Furgchtott RF Zawadzki JV The obligatory role of endothelial cells in the relaxation or arterial smooth muscle by acetylcholine Nature 1980 288 Palmer RMJ Ferrige AG Moncada S Nitric oxide accounts for the biological activity of endothelium-derived relaxing factor Nature 1987 327 Lyons D Webster J Benjamin N Angiotensin II: Adrenergic sympa- thetic constrictor action in humans Circulation 1995 91 Henrion D Laher I Laporte R Bevan JA Angiotensin II amplifies arterial contractile response to norepinephrine without increasing Ca++ influx: role of protein kinase C J Pharmacol Exp Ther 1992 261 Gaedeke J Noble N Border W Angiotensina II e insuficiencia renal progresiva Curr Hypertens Repor Ed Esp 2003 2 Ruiz-Ortega M Lorenzo O Rupérez M Estaban V Suzuki Y Mezzano S Plaza JJ Egido J Role of the Renin-Angiotensin System in Vascular Disease: Expanding the Field Hypertension 2001 38 Danser AH Schalekamp MA Bax WA van den Brink AM Saxena PR Riegger GAJ Angiotensin-converting-enzyme in the human heart: Effect of the deletion/insertion polymorphism Circulation 1995 92 Ueda S Elliot HL Morton JJ Connel JMC Enhanced pressor response to angiotensin I in normotensive men with the deletion genotype (DD) for angiotensin-converting enzyme Hypertension 1995 25 Castellano M Muiesan ML Rizzoni D Beschi M Pasini G Cinelli A Angiontensin-converting enzyme I/D polymorphism and arterial wall thickness in a general population: The Vorbano Study Circulation 1995 91 Chadwichk IG O´Toole L Morice AH Wilfred YW Jackson PR Ramsay LE Pressor and hormonal responses to angiotensin I infusion in healthy subjects of different angiontensin-converting enzyme genotypes J Cardiovasc Pharmacol 1997 29 Ruiz-Ortega M Lorenzo O Suzuki Y Ruperez M Egido J Proinflammatory actions of angiotensin II Curr Opin Nephrol Hypertens 2001 10 Zhou M-S Schulman I Raij L Nitric Oxide, Angiotensin II and Hypertension Sem in Nephrol 2004 24366-378 Rigat B Hubert C Alhenc-Gelas F Cambien F Corvol P Soubrier F An insertion/deletion polymorphism in the angiotensin I-converting enzyme gene accounting for half the variance of serum enzyme levels J Clin Invest 1990 86 Sharma P Fatibene J Ferraro F Jia H Monteith S Brown C A genome-wide search for susceptibility loci to human essential hypertension Hypertension 2000 35 Dzau VJ Bernstein K Celermajer D Cohen J Dahlöf B Deanfield J The relevance of tissue angiotensin-converting enzyme: manifestations in mechanistic and endpoint data Am J Cardiol 2001 88 ^ssuppl Pfohl M Koch M Prescod S Haase KK Haring HU Karsch KR Angiotensin I-converting enzyme polymorphism, coronary artery disease and myocardial infarction: an angiographically controlled study Eur Heart J 1999 20 de Lange M Spector T Andrew T Genome-wide scan for blood pressure suggest linkage to chromosome 11, and replication of loci on 16, 17, and 22 Hypertension 2004 44 Williams RR Hunt SC Hasstedt SJ Hopkins PN Wu LL Berry TD Stults BM Barlow GK Schumacher MC Lifton RP Lalouel JM Are the interactions between genetic and environmental factors predisposing to high blood pressure? Hypertension 1991 18 ^sI McIntyre M Bhor D Dominiczak A Endotelial function in hipertensión: The role of the superoxide anion Hipertensión 1999 34 Granger DN Vowinkel T Petnehazy: Modulation of the inflammatory response in cardiovascular disease Hypertension 2004 43 Zalba G San José G Moreno M Fortuño M Fortuño A Beaumont F Díez J Oxidative stress in arterial hypertension: Role of NAD(P)H oxidase Hypertension 2001 38 Miyamoto Y Saito Y Kajiyama N Yoshimura M Shimasaki Y Nakayama M Endotelial nitric oxide synthase gene is positively associated with essential hypertensio Hypertension 1998 32 Lacy F Kailasam MT O´Connor DT Schimd-Schöenbein GW Parmer RJ Plasma hydrogen peroxide production in human essential hypertension: Role of heredity, gender and ethnicity Hypertension 2000 36 Lüscher T Barton M Endothelins and endothelin receptor antagonists: Therapeutic considerations for a novel class of cardiovascular drugs Circ 2000 102 Tiret L Poirier O Hallet V The Lys198Asn polymorphism in the endothelin-1 gene is associated with blood pressure in overweight people Hypertension 1999 33 Schiffrin E Role of endothelin-1 in hypertension Hypertension 1999 34 Elijovich F Laffer CL Gavras H Bresnahan MR Schiffrin EL Regulation of plasma endothelin by SALT in salt-sensitive hypertension Hypertension 1999 33
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300004 Fiebre amarilla: un peligro latente Yglesias-Rosales Marvin Rodríguez-González Andrea Rojas-Montero Manuel ,Clínica Marcial Fallas ,Caja Costarricense de Seguro Social Area de Salud Alajuela Oeste ,Caja Costarricense de Seguro Social Hospital San Juan de Dios 07 2005 2005 47 118 125

La fiebre amarilla es una zoonosis, aguda, febril que se encuentra catalogada como una fiebre hemorrágica potencialmente mortal. Es causada por un arbovirus y transmitida por un artrópodo del cual se conocen dos modalidades epidemiológicas, con un área endémica que corresponde a la mayoría de América del Sur y parte del continente africano. En Costa Rica la última epidemia de fiebre amarilla ocurrió a principios de los años cincuenta. La fisiopatología de la fiebre amarilla no es bien conocida. La mayoría de las infecciones son sintomáticas, y tienen una alta mortalidad que varia según la epidemia. El diagnóstico se confirma de forma definitiva con la serología y aunque éste examen no se realiza en el país, las muestras de los casos sospechosos son enviadas a laboratorios panameños. Con base en su gran mortalidad y a la ausencia de un tratamiento específico, es obvio que el camino a seguir en el manejo de la fiebre amarilla es la prevención mediante las vacunaciones masivas en las áreas endémicas y grupos de riesgo, así como el control del vector. La fiebre amarilla sigue siendo una entidad que afecta considerablemente la salud pública en varios países del mundo; Costa Rica reúne un conjunto de condiciones que facilitarían su aparición y propagación, por lo que es una patología cuyas características convendría mantener en mente

Yellow fever is an acute febrile zoonosis, catalogued as a hemorrhagic fever that is potentially deadly. It is caused by an arbovirus and transmitted by an arthropod; there are two known epidemiologic modalities, and it has an endemic area that comprises most of South America and part of the African continent. In Costa Rica the last outbreak of yellow fever was in the fifties. The physiopathology of yellow fever is not well known. Most of the infections are symptomatic and have a high mortality that varies from outbreak to outbreak. The diagnosis is definitely confirmed by serology and although this test isn’t performed in Costa Rica, the suspicious samples are sent to Panamanian labs. Taking into consideration its high mortality and the lack of specific treatment, it’s obvious that the only way to deal with yellow fever is to get rid of the vector and prevention with massive vaccination in endemic areas. Yellow fever continues to be an entity that considerably affects public health in several countries; Costa Rica has quite a few conditions that will ease its appearance and dissemination, that’s why this is a disease which’s characteristics are convenient to keep handy

 Arbovirus fiebre amarilla Costa Rica zoonosis fiebre hemorrágica Arbovirus yellow fever zoonosis haemorragic fever Renan A La fiebre amarilla en Yucatán durante las épocas precolombina y colonial Biomédica 2000 11 Mc Carthy M A century of the US army yellow fever research Lancet 2001 357 Strano A Dooley J Isaac K Manual sobre la fiebre amarilla y su diagnostico diferencial histopatológico Manual sobre la fiebre amarilla y su diagnostico diferencial histopatológico 1975 Trejos A Romero A Clínica de la fiebre amarilla en Costa Rica Rev Biol Trop 1954 Monath T Yellow fever: an update Lancet Infect Dis 2001 1 Mutebi J Wang H Li L Bryant J Barrett A Phylogenetic and evolutionary relationships among yellow fever virus isolates in Africa J Virol 2001 Gubler D Aedes albopticus in Africa Lancet Infect Dis 2003 13 Van der Stuyft P Gianella A Pirard M Cespedes J Lora J Peredo C Urbanization of yellow fever in Santa Cruz, Bolivia Lancet 1999 353 Monath T Facing up to re-emergence of urban yellow fever Lancet 1999 353 Guías para la vigilancia, prevención y control de la fiebre amarilla Guías para la vigilancia, prevención y control de la fiebre amarilla 1981 Organización Panamericana de la Salud Velandia M Fiebre Amarilla Selvática, Colombia 2003 Fiebre Amarilla Selvática, Colombia 2003 2003 Instituto Nacional de Salud Reiter P Cordellier R Ouma J Cropp B Savage H Sanders E First recorded outbreak of yellow fever in Kenya 1992-1993 Am. J Trop Med Hyg 1998 59 Thonnon J Fontenille D Tall A Diallo M Renaudinean Y Baudez B Re-emergence of yellow fever in Senegal in 1995 Am. J Trop Med Hyg 1998 59 Monath T Brinker K Chandler F Kemp G Cropp B Pathophysiologic correlations in a rhesus monkey model of yellow fever Am J Trop Med Hyg 1981 30 Monath T Yellow fever: a medically neglected disease. Report on a seminar Rev Infect Dis 1987 9 Fauci A Braunwald E Isselbacher K Wilson J Harrison, Principios de Medicina Interna Harrison, Principios de Medicina Interna 1998 Editorial Mc Graw-Hill Internacional WHO. Epidemiological bulletin Marc h 19 1 Vasconcelos P Diagnosis of viral disease Lancet 2003 361 Campbell G Marfin A Lanciotti R Gubler D West Nile virus Lancet Infect Dis 2002 2 Monath T Ballinger M Miller B Salaun J Detection of yellow fever viral RNA by nucleic acid hybridization and viral antigen by immunocytochemistry in fixed human liver tissues Am J Trop Med Hyg 1989 40 Gubler D Dengue and dengue hemorrhagic fever Clin Microbiol Rev 1998 11 Guzmán M Kourí G Dengue: an update Lancet Infect Dis 2002 2 Tierney L McPhee S Papadakis M Current Medical Diagnosis & Treatment 2002 Current Medical Diagnosis & Treatment 2002 2002 Lange Medical Books/ McGraw-Hill Berhman R Kliegman R Jenson H Nelson, Tratado de Pediatría: México Nelson, Tratado de Pediatría: México 2001 Editorial McGraw-Hill Interamericana Mortimer P Yellow fever vaccine BMJ 2002 439 Monath T Nichols R Archambault W Moore L Marchesani R Tian J Comparative safety and immunogenicity of two yellow fever 17d vaccines (arilvax and yf-vax) in a phase III multicenter, double-blind clinical trial Am. J Trop Med Hyg 2002 66 Lang J Zuckerman J Clarke P Barrett P Kirkpatrick C Blondeau C Comparison of the immunogenicity and safety of two 17d yellow fever vaccines Am. J Trop Med Hyg 1999 60 Peter G Hall C Halsey N Marcy S Pickering L Red Book, Enfermedades Infecciosas en Pediatría. Argentina Red Book, Enfermedades Infecciosas en Pediatría. Argentina 1999 Editorial Medica Panamericana Yellow Fever Vaccine: Recommendations of the Advisory Committee on Immunizations Practices MMWR 2002 51 RR-17 Sibailly T Wiktor S Tsai T Cropp B Ekpini E Adjorlolo-Johnson G Poor antibody response to yellow fever vaccination in children infected with human immunodeficiency virus type 1 Pediatr Infect Dis J 1997 16 Robert E Vial T Schaefer C Arnon J Reuvers M Exposure to yellow fever vaccine in early pregnancy Vaccine 1999 17 Tsai T Raul R Lynberg M Letson G Congenital yellow fever virus infection after immunization in pregnancy J Infect Dis 1993 168 Martin M Tsai T Cropp B Chang G Holmes D Tseng J Fever and multisystem organ failure associated with 17d-204 yellow fever vaccination: a report of four cases Lancet 2001 358 Chan R Penney D Little D Carter I Roberts J Rawlinson W Hepatitis and death following vaccination with 17d-204 yellow fever vaccine Lancet 2001 358 Vasconcelos P Luna E Galler R Silva L Coimbra T Barros V Serious adverse events associated with yellow fever 17dd vaccine Brazil: a report of two cases Lancet 2001 358 Jennings A Gibson C Miller B Mathews J Mitchell C Roehrig J Analysis of a yellow fever virus isolated from a fatal case of vaccine-associated human encephalitis J Infect Dis 1994 169 International Travel and Heath. Switzerland International Travel and Heath. Switzerland 2005 WHO International Heath Regulations (1969): third annotated edition, Geneva, World Health Organization International Heath Regulations (1969): third annotated edition, Geneva, World Health Organization 1983 Conclusions and recommendations of the technical advisory group on vaccine preventable diseases, Municipalities: Improving Immunization Services, of the Pan American Health Organization 2002 Conclusions and recommendations of the technical advisory group on vaccine preventable diseases, Municipalities: Improving Immunization Services, of the Pan American Health Organization 2002 2002 PAHO
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300005 Respuesta a los diferentes esquemas terapéuticos empleados en el tratamiento de la nefropatía lúpica García-Torres Viviana Vargas-Marín Jorge García-Sancho Hernán ,Caja Costarricense de Seguro Social Hospital México ,Caja Costarricense de Seguro Social Hospital México 07 2005 2005 47 126 132

Justificación y Objetivo: La nefritis lúpica es considerada como el prototipo de las glomeru-lonefritis mediadas por complejos inmunes. Existe gran variedad de manifestaciones clínicas y cambios histológicos asociados con esta patología. Los pacientes que la padecen tienen un elevado riesgo de deterioro progresivo de la función renal como resultado de la interacción de mecanismos inmunológicos y esclerosantes crónicos de lesión renal. El monitoreo de parámetros serológicos, la excreción renal de proteínas, y especialmente el sedimento urinario facilita el reconocimiento del pronóstico y el tratamiento de este desorden. Se realizó la presente investigación para comparar la respuesta de los pacientes diagnosticados con nefritis lúpica a los diferentes esquemas terapéuticos empleados en el tratamiento de esta patología, en el Servicio de Reumatología del Hospital México. Métodos: Se realizó un análisis retrospectivo tranversal de tipo descriptivo en el que se incluyeron los expedientes clínicos de pacientes diagnosticados con nefropatía lúpica en la Consulta Externa del Servicio de Reumatología del Hospital México en el período de tiempo comprendido entre 1990-1999. Se realizó una comparación de la respuesta a los diferentes regímenes terapéuticos empleados para el tratamiento en cada paciente. Resultados: La población de pacientes diagnosticados con nefropatía lúpica en los años mencionados fue de un total de 65. El sexo femenino predominó en una proporción de 5 a 1. El grupo de edad más frecuente fue el de los 20 a 40 años. El hallazgo histológico más frecuente en las biopsias renales fue la nefropatía lúpica clase IV. De los distintos esquemas terapéuticos, el más utilizado fue el de prednisona más ciclofosfamida, correspondiendo a un 52,31% del total, y fue con este esquema con el único que se obtuvo mejoría en la totalidad de los parámetros analizados luego del empleo del mismo. La ciclofosfamida fue el medicamento que presentó mayor número de efectos adversos. Conclusión: Se comprueba mediante este estudio la mayor eficacia en el tratamiento de las complicaciones de los pacientes con nefropatía lúpica cuando se utiliza el esquema medicamentoso de prednisona más ciclofosfamida

AIM: Lupus nephritis is considered the prototype for immune complex- mediated glomerulonephritis. There is a great variety of clinical manifestations and histologyc changes associated with this disorder. Patients are at high risk of progressive decline of renal function as a result of organ injury secondary to the interaction of immune and chronic sclerosing mechanisms. Monitoring activity parameters, renal protein excretion, and urinary sediment, make it easier for the recognition of the prognosis and treatment of this disease. This investigation was made in order to compare the response of patients diagnosed with lupus nephritis to the different therapeutic regimens used for the treatment of this entity at the Rheumatology Service of the Hospital Mexico. Methods: A retrospective, cross sectional study was made, of the clinical files of patients diagnosed with lupus nephritis at seen the Rheumatology Service of the Hospital Mexico from 1990 to 1999. A comparison was made of the response to the different therapeutic regimens used for treatment in each patient. Results: There were 65 patients diagnosed with lupus nephritis, with a female/male ratio was of 5/1. The majority of the group was from 20 to 40 years. The most common hystologic finding on renal biopses was type IV lupus nephritis. From all the therapeutic regimens, the one that included prednisone and cyclophosphamide was more frequently used than any other (52,3%). The use of this regimen showed improvement in all of the analyzed clinical parameters. Cyclophosphamide was the drug that produced more adverse effects. The use of prednisone-cyclophosphamide demonstrated major efficacy in the treatment of patients with lupus nephritis

 Lupus Eritematoso Sistémico Glomerulonefritis Lúpica tratamiento prednisona azatioprina ciclofosfamida Systemic Lupus Erythematosus Lupus Nephritis treatment Prednisone azatioprina cyclophosphamide Mok CC Wong RWS Lai KN Treatment of severe proliferative lupus nephritis: the current state Ann Rheum Dis 2003 62 Klippel JH Weyand CM Wortmann RL Primer on the rheumatic diseases Primer on the rheumatic diseases 1997 Atlanta Arthritis Foundation Pedrosa MF Beaumont GH Sánchez JL Mola EM Marqués AO García PB Manual de enfermedades reumáticas Manual de enfermedades reumáticas 1996 Sociedad Española de Reumatología Kuiper-Geertsma DG Derksen RH Newer drugs for the treatment of lupus nephritis Drugs 2003 63 Hübscher O Lupus como uno de los temas centrales del Congreso Anual del Colegio Americano de Reumatología: Publicaciones de ALUA Lupus como uno de los temas centrales del Congreso Anual del Colegio Americano de Reumatología: Publicaciones de ALUA 1997 N ov Mok CC Lai KN Mycophenolate Mofetil in lupus glomerulonephritis Am J Kidney Dis 2002 40 Hejaili FF Moist LM Clark WF Treatment of lupus nephritis Drugs 2003 63 Tumlin JA Lupus nephritis: novel immunosuppresive modalities and future directions Semin Nephrol 1999 19 Elizondo PM Introducción a la reumatología Introducción a la reumatología 1997 Sociedad Mexicana de Reumatología Fauci AS Branwald E Isselbacher KJ Wilson JD Martin JB Kasper DL Harrison: Principios de Medicina Interna Harrison: Principios de Medicina Interna 1998 Mc Graw-Hill Balcells A La clínica y el laboratorio La clínica y el laboratorio 1997 Masson Pirani CL Pollak VE The natural history of the renal manifestations of systemic lupus erythematosus J Am Soc Nephrol 1997 63 Chan TM Li FK Tang CS Wong RW Fang GX Ji YL Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis N Engl J Med 2000 343 Austin HA Boumpas DT Treatment of lupus nephritis Semin Nephrol 1996 16 Steinberg AD Gourley M Cyclophosphamide in lupus nephritis J Rheumatol 1995 22 Fox DA Mc Cune WJ Inmmunosupressive drug therapy of systemic lupus erythematosus Rheum Dis Clin North Am 1994 20 Balow JE Boumpas DT Fessler BJ Austin HA Management of lupus nephritis Kidney Int 1996 49 Falk RJ Treatment of lupus nephritis: A work in progress N Engl J Med 2000 343 Berden JM Lupus nephritis Kidney Int 1997 52 Kelley WN Harris ED Ruddy S Sledge CB Textbook of rheumatology Textbook of rheumatology 1993 Philadelphia W.B. Saunders Company Donadio JV Glassock RJ Immunosupressive drug therapy in lupus nephritis Am J Kidney Dis 1993 21
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300006 Cuidado intensivo en un hospital regional: Características demográficas y mortalidad Salas-Segura Donato A ,Hospital Tony Facio Castro 07 2005 2005 47 133 136

Objetivo: Describir las principales características de la población ingresada a la Unidad de Cuidado Intensivo, Hospital Tony Facio Castro de Limón. Materiales y métodos: Se recabó la información de todos los pacientes ingresados a la Unidad de Cuidado Intensivo del Hospital Tony Facio, durante un período de 6 meses. Los datos fueron almacenados y procesados en una base creada en SPSS 11.0. Resultados: Se estudiaron un total de 155 pacientes, 82 (53%) eran hombres, 113 ingresaron del área de medicina, 34 al área quirúrgica y 8 a la ginecobstétrica. La estancia promedio fue de 5,22 días. La mayoría de los pacientes (30%) ingresaron por síndrome coronario agudo. La mortalidad general fue del 15,5% (24 pacientes), y la causa principal fue shock séptico. Conclusión: Se presentan los primeros datos publicados en el país sobre las características demográficas de la población que ingresa a una unidad de cuidado intensivo

Objective: To describe a poblation admitted to Intensive Care Unit of the Tony Facio Hospital of Limón Materials and methods: Information about all patients admitted to Intensive care unit during 6 months period was gathering. A data base in SPSS 11.0 was created to process all information. Results: A total of one hundred fifty five patients were studied, 82 (53%) were men, 113 were admitted to medicine area, 34 to surgical area and 8 to obstetrics area. Mean length of stay was 5, 22 days. Most patients (30%) have the diagnosis of acute coronary syndrome. General mortality was 15, 5 % (24 patients), septic shock was the most important causes of death. Conclusion: First data about national intensive care unit’s demographics facts are show

 Unidad de cuidado intensivo estadísticas mortalidad Intensive care unit stadistics mortality Cerón U Esponda J Sierra A Cerón U Bases de datos en la unidades de terapia intensiva Bases de datos en la unidades de terapia intensiva 2001 McGraw-Hill Interamericana Marik P Hedman L What’s in a day?: Determining intensive care unit length of stay Crit Care Med 2000 28 Angus D Barnato A Linde-Zwirble WT Weissfeld LA Watson S Rickert T Use of intensive care at the end of life in the United States: An epidemiologic study Crit Care Med 2004 32 Gatt S Pregnancy, delivery and the intensive care unit: need, out-come and management Curr Opin Anaesthesiol 2003 16 Romo H Kajdacsy-Balla AC Vincent JL Effect of patient sex on intensive care unit survival Arch Intern Med 2004 164 Rocker G Cook D Sjokvist P Weaver B Finfer S McDonald E Clinician predictions of intensive care unit mortality Crit Care Med 2004 32 5 Keenan SP Dodek P Chan K Hogg R Craib KJP Anis AH Spinelli J Intensive care unit admission has minimal impact on long-term mortality Crit Care Med 2002 30 Finkielman JD Morales IJ Peters SG Keegan MT Ensminger SA Lymp JF Afessa B Mortality rate and length of stay of patients admitted to the intensive care unit in July Crit Care Med 2004 32 Glance LG Osler TM Dick A Rating the quality of intensive care units: Is it a function of the intensive care unit scoring system? Crit Care Med 2002 30 Cerón U Esponda J Borboya M Paul-Vásquez J Valor predictivo de los sistemas de calificación de gravedad: comparación de cuatro modelos en tres unidades de terapia intensiva mexicanas incluidas en la base de datos multicéntricas de terapia intensiva Rev Mex Med Crit y Ter Int 2000 14 Cerón U Esponda J Borboya M Paul-Vásquez J Rendimiento clínico y costo-efectividad de tres unidades de terapia intensiva mexicanas incluidas en la base de datos multicéntricas de terapia intensiva Rev Mex Med Crit y Ter Int 2000 14 41 Weber R Kane SL Oriolo VA Saul M Skledar SJ Dasta JF Impact of intensive care unit (ICU) drug use on hospital cost: A descriptive analysis, with recommendations for optimizing ICU pharmacotherapy Crit Care Med 2003 31 ^sSuppl Rosemberg A Recent innovations in intensive care unit risk-prediction models Curr Opin Crit Care 2002 8 Cook DA Steiner SH Cook RJ Farewell VT Morton AP Monitoring the evolutionary process of quality: Risk-adjusted charting to track outcomes in intensive care Crit Care Med 2003 31 Combes A Costa M Trouillet JL Baudot J Mokhtari M Gilbert C Chastre J Morbidity, mortality, and quality of life outcomes of patients requiring 14 days of mechanical ventilation Crit Care Med 2003 31
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300007 Enfermedad de Castleman. Reporte de 14 casos de 1990-2002 en el "Hospital Dr. Rafael Angel Calderón Guardia", dos con presentación inusual y revisión de literatura Fiedler-Velásquez Eduardo Gourzong- Taylor Charles Goyenaga-Hernández Pedro López-Castro Jairo ,Hospital Dr. Rafael Ángel Calderón Guardia ,Hospital Dr. Rafael Ángel Calderón Guardia 07 2005 2005 47 137 143

La enfermedad de Castleman (hamartoma linfoideo, linfoma gigante benigno, hiperplasia angiofolicular de los nódulos linfáticos) es un transtorno linfoproliferativo raro, de curso usualmente benigno de etiología desconocida y pobremente entendido. Resulta de un crecimiento no regulado del tejido linfático y puede manifestarse clínicamente en 2 formas, localizada y diseminada o multicéntrica, con 3 variantes histopatológicas, vascular hialino, plasmocelular y mixto o transicional. Usualmente la forma vascular hialina tiene una evolución clínica benigna manifestada solamente por adenopatías, en cambio, la forma plasmocelular o mixta puede manifestar alteraciones físicas y de laboratorio, tales como fiebre, pérdida de peso, anemia e hiper-globulinemia. Las 2 últimas condiciones clínicas pueden resultar en transformación maligna similar al linfoma de Hodgkin. Revisamos la base de datos del Servicio de Patología de nuestro hospital y encontramos 14 casos reportados desde enero de 1990 hasta enero del 2002, 2 mostraron presentación inusual

Castleman’s disease is a rare lymphoproliferative disorder. Its etiology is unknown and its course is usually benign. It is secondary to an irregular growth of lymphatic tissue and it can exhibirt 2 forms: a localized and a disseminated or multicentric. Histopathologically there are 3 forms: hialine vascular, plasma cell and mixed or transitional. The first type usually has a benign clinical course and is characterized by adenomegalies, the plasma cell or mixed forms, however, may exhibit clinical or laboratory anomalies, such as fever, weight loss, anemia and hyperglobulinemia. The latter forms may evolve to Hodgkin lymphoma. We found 14 cases at the Calderon Guardia Hospital Pathology Department data base (1990-2002). The clinical course of 2 patients is presented

 enfermedad de Castleman trastorno linfoproliferativo comportamiento clínico Castleman¢s disease lymphoproliferative disorder Castleman B Iverson L Menendez Vp Localizad mediastinal lymph node hyperplasia Cancer 1956 9 Séller AR Hochholzer Castleman B Hyaline vascular and plasma cell types of giant lymph node hyperplasia of the mediastinum and other locations Cancer 1972 29 Davis B Bagg A Milmoe G CT and Mr Appearance of Castleman¢s diasease of the neck AJR 1999 1973 Hoor TT Hewan-Lowe K Miller J Moss M A transitional variant of Castleman¢s disease presenting as a chylous pleural effusion Chest 1999 115 Blankeship M Rowlett J Timby J Roth R Jones R Giant lymph node hyperplasia (Castleman¢s Disease) presenting with chylous pleural effusion Chest 1997 Hashimoto H Jun Ichi I Kironaka M Sakaki T Intracranial Castlema¢s disease of solitary form. Case report J Neuro surg 1999 90 Gangopadhyay K Zeyad M Kfoury H Pathologic Quiz Case Arch Otolaryngol Head Neck Surg 1997 123 Chim Ch Lam K Chan K Castleman disease with kaposi sarcoma and glomerulonephritis Am J Med 1999 107 Suwannaroj S Elkis S McMurray R Systemic lupus erythematosus and Castleman¢s Disease J Reumatol 1999 26 Dhingra H Sondhi D Fleischman J Ayinla R Chawla K Rosner F Castleman¢s disease and superior vena cava thrombi: A rare presentation and review of the literature Mount Sinai J Med 2001 68 Belec L Mohamed AS Authier FJ Hallouin MC Soe AM Cotigny S Gaulard P Gherardi RK Human herpesvirus 8 infection in patients with POEMS syndrome associate multicentric Castleman¢s disease Blood 1993 93 Papo T Soubrier M Marcelin AG Calvez V Wechsler B Huraux JM Pitte JC Cacoub P Human herpesvirus 8 infection, Castleman¢s disease and POEMS syndrome Br J Haematol 1999 104 Tohda S Murakami N Nara N Human herpesvirus 8 Dna in HIV-negative Japanese patients with multicentric Castleman¢s disease and related disease Inter J Mol Med 2001 8 Yoshizaki K Matsuda T Nishimoto N Kuritani T Yaeho L Aozasa K Nakahata T Kawai H Tagoh H Komori T Kishimoto S Hirano T Kishimoto T Pathogenic significance of interleukin-6 in Castleman¢s disease Blood 1989 74 Hsu S-M Waldrom JA Xie S-S Barlolgie B Expression of inter-leukin-6 in Castleman¢s disease Hum Pathol 1993 24 Soulier J Grollet L Oksenhendler E Cacoub P Cazals-Hatem D Babinet P d¢ Agay MF Clauvel JP Raphael M Degos L sigaux F Kaposi¢s sarcoma- associated herpesvirus-like DNA sequences in multicentric Castleman¢s disease Blood 1995 86 Chang Y Cesarman E Pessin MS Lee F Culpepper J Knowles Dm Moore PS Identification of hipesvirus-like DNA sequences in AIDS-associated Kaposi¢s sarcoma Science 1994 266 Gerald W Kostianovasky M Rosai J Development of vascular neoplasia in Castleman¢s disease: Report of seven cases Am J Surg Pathol 1990 14 Torres V MJ López J Melero MC Vivanco M JL Peralta I ML Nieto Del Rincón J Pérez Campos Anemia ferropénica refractaria al tratamiento oral con hierro, como forma de presentación de la enfermedad de Castleman An Esp Pediatr 1999 51 Veldhuis GJ Van Der Leest AHD de Wolf JthM de Vries EGE Vellenga E A case of localized Castleman¢s disease with systemic involvement: treta and pathogenic aspects Ann Hematol 1996 73 Frizzera G Castleman¢s disease: More questions than answers Hum Pathol 1985 16 Gaba AR Stenin RS Sweet DL Variakojis D Multicentric giat lymph node hyperplasia Am J Clin Pathol 1978 Frizzera G Banks PM Massarelli G Rosai J A systemic lymphopro-liferative disorder with morphologic features of Castleman¢s disease: Pathological findings in 15 patients Am J Surg Pathol 1983 7 Frizzera G Castleman¢s disease and related disorders Semin Diagn Pahtol 1988 5 Issacson PG Castleman¢s disease Histopathology 1989 14 Moon WK Im JG Han MC Castleman¢s of the mediastinum: MR imagin features Clin Radiol 1994 49 Bowne W Lewis J Fillipina D Niesvizky R Brooks A Burt M Brennan M The management of unicentric and multicentric Castleman¢s Disease: A report of 16 cases and a review of the literature Am Can Soc 1999 85 Peterson BA Frizzera G Multicentric Castleman¢s disease Semin Oncol 1993 20 Herrada J Cabanillas F Lawrence R Manning J Puhg J The clinical behavoir of localized and multicentric Castleman disease Ann Intern Med 1988 128 Lchant NA Sun Nora CJ Ledon LA Oseas RS Prince HE Multicentric angiofollicular lymph node hyperplasia (Castleman¢s disease) followed by Kaposi¢s sarcoma in two homosexual males with acquired immunodeficiency syndrome (AIDS) Am J Clin Pathol 1985 83 Oksenhendler E Duarte M Soulier J Cacoub P Welker Y Cadranel J Multicentric Castleman¢s disease in HIV infection: a clinical and pathological study of 20 patients AIDS 1996 10 Lowenthal DA Filippa DAA Richardson ME Bertoni M Straus DJ Generalized lymphadenopathy with morphologic features of Castleman’s disease in a HIV positive man Cancer 1978
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300008 Guías para el tratamiento de la dislipidemia en pacientes con VIH/SIDA que reciben TARGA Hasbum Benhard Solano Antonio León María Paz Boza Ricardo , 07 2005 2005 47 144 147

La dislipidemia es una de las complicaciones más frecuentes en los pacientes infectados por el VIH que reciben tratamiento antiretroviral. Su manejo se ve complicado por las interacciones entre algunos de las terapias hipolipemiantes y los inhibidores de proteasa. Estas guías buscan facilitar el abordaje de estos casos tanto en el diagnóstico, su clasificación y manejo no farmacológico como farmacológico

Lipid disorders are one of the most frequent complications of HIV positive patients receiving antiretroviral treatment. The intervention of these patients is difficult, especially due to the interactions among some lipid lowering drugs and protease inhibitors. The guides presented here are facilitate the diagnosis, classification an aimed to intervention of these patients

 VIH dislipidemia estatinas fibratos riesgo cardiovascular HIV dyslipidemia statins fibrates cardiovascular risk Dronda F Riesgo vascular en pacientes con infección crónica por el VIH - 1:controversias con implicaciones terapéuticas, clínicas y pronósticas Enferm Infecc Microbiol Clin 2004 22 Henry K Melroe H Huebsch J Severe premature coronary artery disease with protease inhibitors ( letter ) Lancet 1998 351 Bozzette SA Ake CF Tam HK Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection N Engl J Med 2003 348 Grinspoon S Carr A Cardiovascular risk and body - fat abnormalities in HIV - infected adults N Engl J Med 2005 352 Mauss S Stechel J Willers R Differentiating hyperlipidaemia associated with antiretroviral therapy AIDS 2003 17 Gallant JE Staszewski AL Pozniak E Efficacy and safety of Tenofovir DF vs Stavudine in combination therapy in antiretroviral-naïve patients: a 3 - year randomized trial JAMA 2004 292 Yeni PG Hammer MS Hirsch MS Treatment for adult HIV infection: 2004 recommendations of the International AIDS Society - USA Panel JAMA 2004 292 Dubé MP Stein JH Aberg JA Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)- Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group Clin Infect Dis 2003 37 Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 2001 285 Grundy SM Cleeman JI Bairey Merz N Implications of recent clinical trials for the National Cholestrol Education Program Adult Treatment Panel III Guidelines Circulation 2004 110
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300009 Carcinoma ameloblástico de la mandíbula Lazo- Valladares Angel Otero Diana , 07 2005 2005 47 148 150

El concepto de carcinoma intraóseo primario es exclusivo de la mandíbula y maxila, ya que se origina de componentes ondontogénicos. El carcinoma ameloblástico es una lesión sumamente infrecuente, que puede aparecer de novo o asociado a una lesión previa, como un quiste odontogénico o un ameloblastoma. El diagnóstico se establece cuando se encuentran elementos histológicos de ameloblastoma, que alternan con áreas de epitelio histológicamente malignas, con independencia de que existan metástasis. Esto lo diferencia del también infrecuente ameloblastoma metastático, en el cual se encuentra un ameloblastoma con histología benigna, que inesperadamente mestatiza. La importancia de esta diferenciación radica en el pronóstico, ya que el carcinoma ameloblástico es una lesión muy agresiva, de crecimiento rápido, que tiende a provocar un gran efecto de masa, que tiene alta tasa de recidiva y mortalidad, contrario al ameloblastoma metastásico, caso en que el paciente puede sobrevivir muchos años tras la aparición de la metástasis. Con el presente caso se ilustran algunos aspectos importantes sobre el comportamiento biológico del ameloblastoma, como su elevado potencial de recurrencia, el daño que puede provocar por extensión directa y ciertas complicaciones metabólicas que, aunque infrecuentes, puede asociar. Además, permite diferenciar clínica e histológicamente la rara transformación maligna que este puede presentar, lo mismo que la importancia de la clasificación adecuada de los carcinomas odontogénicos

The concept of primary intraosseus carcinoma is exclusive of the mandible and maxilla because it originates from odontogenic components. The ameloblastic carcinoma is a very rare lesion that can appear de novo or arise form a previous lesion as an odontogenic cyst or ameloblastoma. The diagnosis is established when it is found histologic elements of an ameloblastoma together with histologically malignant epithelium, regardless of the presence of metastasis. This makes it different from the more common metastatic ameloblastoma in which the ameloblastoma has benign morphology and unexpectedly gives rise to a metastasis.This difference is of importance because the ameloblastic carcinoma is a very aggressive lesion, of rapid growth that gives mass effect, high recurrence rate and high mortality; while with the metastasic ameloblastoma the patient can survive several years after the metastasis appears. With this case several important aspects about the biologic behavior of ameloblastomas are discussed, such as its high recurrence rate, its local aggressiveness and certain-metabolic complications that may occur. Besides it illustrates the clinical and histological difference between the rare malignant transformation of ameloblastomas and the importance of its adequate classification

 Carcinoma ameloblástico mandíbula caso clínico ameloblastic carcinoma faw clínical care Cox Darren Muller Susan Carlson Grant Murria Douglas Ameloblastic carcinoma ex- ameloblastoma of the mandible with malignancy-associated hypercalcemia Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000 90 Gardner David Denver Colo Some current concepts on the pathology of ameloblastomas Oral surg Oral Med Oral Pathol Endod 1996 82 Lau Stephen Tideman Henk Wu PC Ameloblastic carcinoma of the jaws Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 85 Müller Susan DeRose Patricia Cohen Cynthia DNA ploidy of ameloblastoma ans ameloblastic carcinoma of the jaws Arch Pathol Lab Med 1993 117 Sastre Jesús Muñoz Mario Naval Luis Magdalena Adrados Ameloblastic carcinoma of the maxilla: report of a case J Oral and Maxillofac Surg 2002 60 Slootweg P J Müller H Malignant ameloblastoma or ameloblastic carcinoma Oral Surgery 1984 57 Vigneswaran Nadarajah Expression patterns of epithelial differentiation antigens and lectin binding sites in ameloblastomas: a comparison with basal cell carcinomas Human Pathology 1993 24
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300010 Fibrosis retroperitoneal Orlich-Castelán Claudio Gutiérrez-Góngora Jaime , 07 2005 2005 47 151 153

Se reporta el caso de una mujer de 61 años de edad, con antecedente de tuberculosis pélvica en la adolescencia, que se presentó con insuficiencia renal aguda y dolor lumbar y a quien se le diagnosticó fibrosis retroperitoneal. Se revisa la bibliografía reciente y los principales aspectos de esta enfermedad

Retroperitoneal fibrosis. is an uncommon disease complicated by ureteral entrapment causing hydronephrosis and obstructive renal failure. We herein report a case recently diagnosed at our institution and review the literature on this topic

 fibrosis retroperitoneal insuficiencia renal tuberculosis pélvica retroperitoneal fibrosis kidney failure pelvic tuberculosis Nicholson B Theodorescu D Gillenwater J Diseases of the retroperitoneum Diseases of the retroperitoneum 2-25 Fourth Philadelphia Lippincott Williams and Wilkins Co Katz R Golijanin D Pode D Shapiro D Primary and postoperative Retroperitoneal Fibrosis Urol 2002 5 Seth A Ansari M.S Trikha V Mittal R Retroperitoneal Fibrosis: a rare complication of Pott s disease J. of Urol 2001 166 Utz D Myers Utz Retroperitoneal Fibrosis Retroperitoneal Fibrosis 1977 3-20 Fourth Philadelphia W.B. Saunders Co Kardar A.H Kattan S Lindstedt E Hanash K La terapia con esteroides para la fibrosis retroperitoneal: la dosis y la duración J. of Urol 2002 168
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300011 Tuberculomas cerebrales en una paciente joven Poutvinski Vladimir Rojas- Solano José Fuchs- Cordon José , 07 2005 2005 47 154 157

La tuberculosis del SNC representa cerca del 5% de los casos de tuberculosis extrapulmonar, y la meningitis es el cuadro clínico más frecuente. Una forma poco común de presentación en nuestro medio son los tuberculomas. Se refiere el caso de una paciente de 30 años de edad, hospitalizada para estudio por múltiples masas intracerebrales. Se descartaron la toxoplasmosis y la neurocisticercosis debido a la falta de respuesta al tratamiento específico, tampoco se encontró lesión tumoral primaria que sustentara una metástasis. No se llegó al diagnóstico etiológico por la imposibilidad de realizar una biopsia. Tras 5 meses, la paciente reingresa con una pleuritis por M. tuberculosis, que sugirió tuberculomas como causa de las lesiones intracerebrales. Este diagnóstico presuntivo se confirmó con una excelente respuesta a antifímicos, con desaparición de las masas intracerebrales al cuarto mes de tratamiento. El caso demuestra que es importante considerar los tuberculomas en el diagnóstico diferencial de las masas intracerebrales

Tuberculosis of the central nervous system accounts for approximately 5% of all cases of extrapulmonary tuberculosis, mainly in the form of meningitis. Tuberculomas are uncommon entities. We present the case of a 37 year old woman with intracerebral lesions. Toxoplasmosis and neurocysticercosis were considered as possible etiologies, but specific treatment administration did not produce any results. There were no data suggesting a metastatic origin. Biopsy was unavailable. Five months later the patient developed tuberculous pleuritis wich suggested that intracerebral lesions could be tuberculomas. This diagnosis was confirmed by the results of antituberculous treatment the: intracerebral lesions disappeared on the fourth month of therapy. This case shows that tuberculomas should be kept in mind in the differential diagnosis of intracerebral masses

 tuberculosis sistema nervioso central tuberculomas Martínez HR Tuberculosis del sistema nervioso central: Conceptos actuales Revista Mexicana de Neurociencia 2000 1 Zurger A Lowy FD Tuberculosis of the central nervous system: From Scheld WM, Whitley RJ. Infections of the central nervous system Tuberculosis of the central nervous system: From Scheld WM, Whitley RJ. Infections of the central nervous system 1991 Raven Press Garcia-Monco JC Central nervous system tuberculosis Neurol Clin 1999 17 Pratibha Singhi, Sunit Singhi: Central nervous system tuberculosis Curr Treat Opt Infect Dis 2001 3 Bagga A Kalra V Ghai OP Intracranial tuberculoma: Evaluation and treatment Clin Pediatr 1988 27 Jinkins JR Computed tomography of intracranial tuberculosis Neuroradiology 1991 33 DeAngelis LM Intracranial tuberculoma: Case report and review of the literature Neurology 1981 31 Whiteman ML Neuroimaging of central nervous system tuberculosis in HIV-infected patients Neuroimaging Clin N Am 1997 7 Gupta RK Jena A Singh AK Role of magnetic resonance (MR) in the diagnosis and management of intracranial tuberculomas Clin Radiol 1990 41 Ünal A Sutlas PN Kirbas D Case report: intracerebral tuberculoma misdiagnosed as toxoplasmosis J Neurol Sciences (Turkish) 2004 23 3 Harder E Al-Kawi MZ Carney P Intracranial tuberculoma: Conservative management Am J Med 1983 74 Frieden TR Sterling TR Munsiff SS Watt CJ Dye C Tuberculosis Lancet 2003 362 Ravindra Kumar Garg Tuberculosis of the central nervous system Postgrad Med J 1999 75
S0001-600220050003 Acta Médica Costarricense Acta méd. costarric 0001-6002 Colegio de Médicos y Cirujanos de Costa Rica S0001-60022005000300012 Costa Rica en el Exterior , 07 2005 2005 47 158 158