[Transient global amnesia after general anaesthesia]. / Amnesia global transitoria en el contexto de una anestesia general.

Transient global amnesia is a neurological syndrome in which there is a sudden and brief inability to form new memories, as well as an intense retrograde amnesia. However, awareness, personal identity and attention remain intact. It is an uncommon condition seen after an anaesthetic procedure. There are several aetiopathogenic hypotheses (epileptic, migrainous or ischaemic origin) and triggering factors (pain, anxiety, temperature changes, exercise, Valsalva manoeuvres, diagnostic tests or certain drugs). We describe the case of a patient with a high level of pre-operative anxiety who suffered an episode of transient global amnesia after undergoing otolaryngology surgery. With an acute and continued amnesia after general anaesthesia, the first thing that must be done is to establish a suitable differencial diagnosis, which should include transient global amnesia, as this is mainly an exclusion diagnosis. Preoperative anxiety may be a triggering factor to take into account in this condition, with anxiolytic treatment prior to the surgery being important.

[Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke]. / Influencia de la curva de aprendizaje y del código ictus extrahospitalario en el tratamiento trombolítico del ictus agudo.

INTRODUCTION: We present the experience for thrombolytic treatment using recombinant tisular plasminogen activator (rt-PA) at a university hospital. We analyze the influence of individual and collective acquired experience and of the activation of an out-of-hospital stroke code (OSC) on the delays to onset of treatment, number of patients treated and outcome. METHOD: Prospective register of patients with ischemic stroke treated with rt-PA within the period 1/2004- 12/2006. Comparison of results between patients treated during the three years of study and based on the individual experience of the neurologist who applies the treatment and on the patients treated with or without activation of OSC. RESULTS: A total of 87 patients were treated (mean age: 66.6 +/- 13.7). Door-to-needle time was 79 +/- 21 min in 2004, 64 +/-22 in 2005 and 63 +/- 26 in 2006 (p=0.003). Experienced neurologists started thrombolysis sooner (door-to-needle time: 62 +/- 22 min vs 75 +/- 27, p=0.03). Activation of the ESC reduced door-to-needle time (53 +/ 17 min vs 65 +/- 21; p=0.032) and door-to-computed tomography scan time (21 +/- 10 min vs 29 +/-24; p=0.016). There were no differences in outcome in the different groups. CONCLUSIONS: Individual and collective acquired experience and the activation of an OSC can lower in-hospital delays. This contributes to increasing the number of patients eligible for thrombolysis. Thrombolytic therapy is safe and effective even when it is applied by inexperienced neurologists if strict guidelines are followed.

[Endometrioid carcinoma of the prostate: a histogenetic dilemma with therapeutic implications]. / Carcinoma endometrioide de la próstata: un dilema histogenético con implicaciones terapéuticas.

An additional case of endometrioid carcinoma of the prostate is presented. We discuss the origin and significance of this controversial and uncommon tumor type. The different histogenic hypotheses that have been put forward not only imply a distinct embryologic conception but also an appropriate therapeutic approach. The good results achieved by antiandrogen therapy in the case reported herein have prompted us to consider this treatment modality as a valid adjunct to surgery.

Amnesia global transitoria en el contexto de una anestesia general / Transient global amnesia after general anaesthesia

La amnesia global transitoria es un síndrome neurológico en el que se produce una pérdida abrupta y pasajera de la capacidad para crear nuevos recuerdos, así como una amnesia retrógrada de intensidad variable, permaneciendo, sin embargo, preservadas la conciencia, la identidad personal y la atención. Se trata de una entidad poco frecuente tras un proceso anestésico. Existen distintas hipótesis etiopatogénicas (base epiléptica, migrañosa o isquémica) y desencadenantes (dolor, la ansiedad, los cambios de temperatura, el ejercicio, las maniobras de Valsalva, las pruebas diagnósticas o determinados medicamentos). Describimos el caso de una paciente con alto grado de ansiedad preoperatoria que sufrió un episodio de amnesia global transitoria tras una intervención quirúrgica otorrinolaringológica. Ante un episodio de amnesia aguda y mantenida tras una anestesia general debemos plantear, en primer lugar, un adecuado diagnóstico diferencial que incluya la amnesia global transitoria, puesto que, en la mayoría de los casos, se trata de un diagnóstico de exclusión. La ansiedad preoperatoria puede ser un desencadenante a tener en cuenta en esta entidad, siendo importante el tratamiento ansiolítico previo a la intervención(AU)

Transient global amnesia is a neurological syndrome in which there is a sudden and brief inability to form new memories, as well as an intense retrograde amnesia. However, awareness, personal identity and attention remain intact. It is an uncommon condition seen after an anaesthetic procedure. There are several aetiopathogenic hypotheses (epileptic, migrainous or ischaemic origin) and triggering factors (pain, anxiety, temperature changes, exercise, Valsalva manoeuvres, diagnostic tests or certain drugs). We describe the case of a patient with a high level of pre-operative anxiety who suffered an episode of transient global amnesia after undergoing otolaryngology surgery. With an acute and continued amnesia after general anaesthesia, the first thing that must be done is to establish a suitable differencial diagnosis, which should include transient global amnesia, as this is mainly an exclusion diagnosis. Preoperative anxiety may be a triggering factor to take into account in this condition, with anxiolytic treatment prior to the surgery being important(AU)

Influencia de la curva de aprendizaje y del código ictus extrahospitalario en el tratamiento trombolítico del ictus agudo / Influence of the experience and of out-of-hospital stroke code in thrombolytic treatment of acute stroke

Introducción. Se presenta la experiencia en el tratamientodel ictus isquémico con activador del plasminógeno tisularrecombinante (rt-PA) en un hospital universitario. Seevalúa la influencia de la curva de aprendizaje, individual ycolectiva, y de la activación del código ictus extrahospitalario(CIE) en las demoras hasta el inicio del tratamiento, en elnúmero de pacientes tratados y en su evolución.Método. Registro prospectivo de pacientes con ictus isquémicotratados con rt-PA entre enero de 2004 y diciembrede 2006. Análisis comparativo entre los pacientes tratadosen los 3 años del estudio y en función de la experienciadel neurólogo que aplica el tratamiento, así como en pacientestratados con o sin activación del CIE.Resultados. Se trataron 87 pacientes (66,6±13,7 años).El tiempo puerta-aguja fue de 79±21 min en 2004, 64±22 minen 2005 y 63±26 min en 2006 (p=0,003). Los neurólogoscon experiencia aplicaron el tratamiento más rápido (tiempopuerta-aguja: 62±22 frente a 75±27 min; p=0,03). La activacióndel CIE redujo el tiempo puerta-aguja (53±17 frentea 65±21 min; p=0,032) y el tiempo puerta-tomografíacomputarizada (21±10 frente a 29±24 min; p=0,016). Nohubo diferencias en la evolución de los pacientes en los distintosgrupos.Conclusión. La experiencia adquirida y la activación delCIE disminuyen las demoras intrahospitalarias, contribuyendoa aumentar el número de pacientes tratados con trombólisis.El tratamiento trombolítico es seguro y eficaz, inclusosi se aplica por neurólogos sin experiencia si se siguencriterios estrictos (AU)

Introduction. We present the experience for thrombolytictreatment using recombinant tisular plasminogenactivator (rt-PA) at a university hospital. We analyze theinfluence of individual and collective acquired experienceand of the activation of an out-of-hospital stroke code(OSC) on the delays to onset of treatment, number ofpatients treated and outcome.Method. Prospective register of patients with ischemicstroke treated with rt-PA within the period 1/2004-12/2006. Comparison of results between patients treatedduring the three years of study and based on the individualexperience of the neurologist who applies the treatmentand on the patients treated with or without activationof OSC.Results. A total of 87 patients were treated (meanage: 66.6±13.7). Door-to-needle time was 79±21 min in2004, 64±22 in 2005 and 63±26 in 2006 (p=0.003).Experienced neurologists started thrombolysis sooner(door-to-needle time: 62±22 min vs 75±27, p=0.03).Activation of the ESC reduced door-to-needle time (53±17 min vs 65±21; p=0.032) and door-to-computed tomographyscan time (21±10 min vs 29±24; p=0.016). Therewere no differences in outcome in the different groups.Conclusions. Individual and collective acquired experienceand the activation of an OSC can lower in-hospitaldelays. This contributes to increasing the number of patientseligible for thrombolysis. Thrombolytic therapy issafe and effective even when it is applied by inexperiencedneurologists if strict guidelines are followed (AU)

Encefalopatía aguda secundaria al tratamiento con disulfiram / Acute encephalopathy secondary to treatment with disulfiram

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