This is a series of case reports presented to the high altitude experts for discussion. It is a contribution to the knowledge of high altitude disease.

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Dear high altitude friends from around the globe:

Hope all is well with you. This is the second case report. Your are invited to make your comments on the diagnosis.

You will learn and teach at the same time. Once we receive all the answers from the high altitude experts around the world in
about two weeks (if there are no problems with the internet, as we have had recently) we will send a follow-up on the case, with our comments.
Please click here to read our comments
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MEDICAL REPORT                          CASE NUMBER : 5233

NAME: M. Z. V.
DATE: July/06/2003
DATE OF INITIAL CONSULTATION: April/27/1998
AGE:  76     SEX: m
BORN IN: LA PAZ    RESIDENT OF LA PAZ: yes  3600 m. above sea level
WEIGHT:  67.5 Kg          HEIGHT: 1.67 cm        BLOOD PRESSURE: 142 / 87 mmHg         PULSE: 60 x'              TEMP: 37. °C _________________________________________________________________________________________________________________
PERSONAL MEDICAL RECORD: Never smoked. Alcoholic beverages: none; drinks  1 cup of coffee per day. Drugs: None. Allergies: None;  Current medication: None; Genito-urinary: None; Gastro-intestinal: None; Other disease: None; Surgery: None; Accidents: None.

FAMILY HISTORY: Father: normal; Mother: normal; Brothers:1 normal; Children: 2 normal.

PHYSICAL EXAMINATION: Head: Normal. Eyes: Normal. Ears: Normal.. Nose: Normal. Throat: Normal.. Neck: Normal Thorax: simetrical. Heart: Normophonetic, rhytmic, heart sounds with no heart murmurs. Lungs: normal breath sounds. Abdomen: Depressible, not painful. Genitals: Normal. Arms: Normal. Legs: Normal.

HISTORY : The patient comes in for a check-up, because he was diagnosed elsewhere with increased polycythemia, and he is worried. He also mentions that he had been diagnosed cholesterol precipitates in the acuous humour of both eyes that make his vision as if it were snowing, when he changes head positions. He brings with him a previous chest x-rays dated july 9th, 1976. He carries on with his life that is normal, walks about two miles a day. He is an active engineer and a previous national chess champion.

LABORATORY TESTS::

Hemogram: Ht = 65%
Hemoglobin 21.7 gm/dl
RBC count of 7.3 million RBC/mm3

Urianalyses: traces of blood.

Blood Gases: pH = 7.41(N=7.38-7.42)
                    PaO2 = 46 mmHg (N=58-62)
                    PaCO2 = 27 mmHg (N=28-32)
                    HCO3 = 16.7 mEq/L (N: 17-21)
                    SaO2 = 84 % (N: 90-92)
                    BD ECF = –6 (N: -5).

In biochemistry Total proteins were 6.8 gm/dl (N: 6.1-7.9),
                        Blood glucose was 102.7 mg/dl (N: 60-110),

He was able to reach the 4th stage of the Bruce protocol on a treadmill test. (normal residents reach 5th stage). No signs of coronary artery insufficiency.
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Please answer these questions before you go on.

1) Ask yourself if this first  chest x-rays  shows you something important that justifies the increased hematocrit.

2)  Do you think that the increased polycythemia will increase with aging or disease progression ?

3)  If you think the hematocrit will not increase, then try to explain why not.

Now click on each of the following links to see the results:

Chest x-rays (posterior-anterior),   (lateral),
Chest x-rays (posterior-anterior),
Electrocardiogram page 1,     electrocardiogram page 2
Oxygen saturation changes and breath-holding (screen1),      (screen2),     (screen3),
The breath holding time was 1 min 50 sec .   Any comments ?
Spirometry,
 

4) What is your diagnostic impression and what should be done ?

5) Do you think this is a case of CMS ?
 

 As usual, if you wish  to keep your opinion anonymous, please let us know.

Our best regards to all of you,
 

Prof. Dr. Gustavo Zubieta-Castillo (Sr)        &         Dr. Gustavo Zubieta-Calleja
High Altitude Pathology Institute (IPPA)
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Please click here to read our comments