La Tesis se encuentra estructurada en CUATRO (04) CAPÍTULOS, presenta SIETE (07) Conclusiones, TRES (03) Sugerencias, CUARENTA Y CINCO (45) Referencias Bibliográficas y documentos de Anexos, haciendo un total de CIENTO TREINTA Y OCHO (138) Páginas sin contar la carátula, Dedicatoria, Tabla de Contenidos, Lista de Tablas, Lista de Figuras, Introducción. El primer capítulo se trata el Planteamiento Teórico de la investigación, en el segundo capítulo Marco Teórico, en el tercer capítulo Procedimiento Metodológico de la investigación, en el cuarto capítulo Presentación de los Resultados, finalmente las Conclusiones, Sugerencias, Referencias Bibliográficas y por último Anexos. Con el trabajo de investigación se pretende establecer como la motivación extrínseca se relaciona con el desempeño laboral de los trabajadores de la Municipalidad distrital de Miraflores. Donde se c...

We present a case of a 35 year-old woman who had multiple bony fractures, short size, left xyphoescoliosis, blue sclerae, functional limitation of the hips, dentinogenesis imperfecta, severe osteoporosis and conduction hypoacusia. We review the types of osteogenesis imperfecta, clinical presentation, differential diagnosis, treatment and prognosis.

Rapunzel syndrome is a rare form of gastric trichobezoar extending to the bowel. It is composed of hair, mucus and decaying food particles. We report the case of an 18 year-old girl who was admitted to our institution with past history of irregular treatment of major depression during the previous year and history of five months of nauseas, vomiting and 15 kg weight loss. On examination findings included abdominal tumor mass, distention and pain. She presented severe anemia and the gastroduodenal x-rays showed gastric filling defects. Diagnosis was confirmed by gastroscopy and gastrotomy revealed a large tricobezoar with duodenal projection, that was removed. She did not present complications on discharge.

We present the case of a multiparous and obese woman of 59 years with partial hypopituitarism having an empty sella syndrome. We describe the clinical, radiological and biochemical findings. The diagnosis of empty sella was confirmed by computarized tomography. The levels of thyroxine, cortisol and growth hormone were decreased, with pituitary hyporresponsiveness to hypoglicemia induced with insulin. The replacement therapy was successful.

We report the case of a 27 year-old patient with acute lymphoblastic leukemia who presented severe lactic acidosis as a metabolic complication. She presented with severe malnutrition, marked anemia and consuming syndrome. There was no reticuloendothelial system compromise and an initial myelogram was normal. These factors delayed the diagnosis and forced the extent of the differential diagnosis. The suspicion of lactic acidosis-associated hematologic neoplasia needed reassessing the case with new myelogram to establish the diagnosis.

Marfan’s syndrome is an autosomal dominant inheritance disorder that affects many body systems (skeletal, ocular, cardiovascular, cutaneous, pulmonary, abdominal, neurological). Marfan’s syndrome etiology is unknown, but recent genetic studies have linked this disorder to an extracellular microfibrillar defect located on chromosome 15q15-q21,3. Marfan’s syndrome characteristics require a multidisciplinary approach to patient care. We report a case of sporadic Marfan’s syndrome and review the clinical manifestations, the newly Ghent Criteria required for diagnosis, and management strategies, including follow-up, risk-factors modification, genetic counseling, and surgery in selected patients.