Outbreak of multiresistant Acinetobacter baumannii in a polyvalent intensive care unit: clinical, epidemiological analysis and PFGE-printing evolution.

An outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) occurred over the course of a 27-week period in our adult polyvalent intensive care unit (ICU). Twenty-one patients were affected, and 72 strains were identified from different clinical samples. The strains were resistant to all antibiotics except for colistin and ampicillin/sulbactam. Forty-nine MRAB strains collected from 18 patients were analysed by pulsed-field gel electrophoresis (PFGE). This analysis revealed four highly-related PFGE types (genetic similarity index >90%) termed 1, 2, 3 and 4, that were isolated in 13, seven, one, and three patients, respectively. A single PFGE type was identified from five of ten patients with successive isolation of MRAB; in the other five patients, two or three PFGE types were detected. This suggested phased evolution of PFGE types 2, 3 and 4 from PFGE type 1. Global mortality was high (13 patients; 62%). Non-survivors had higher APACHE II scores than survivors on the date that MRAB was isolated (OR = 1.57; 95% CI [1.02, 2.44]). The outbreak was controlled after implementation of an extensive infection control program.

[Syncope due to parapharyngeal space lesions syncope-syndrome]. / Síncope secundario a síndrome del espacio parafaríngeo.

The clinic association between tumors in the neck and syncopal attacks has been well documented but uncommon. The pathogenesis of this type of syncope has been attributed to an specific sinus node disfunction and several diseases that affect pacemaker activity, cardiac output and blood supply to the brain are able to produce it. The most common reflex cardiovascular sindromes linked to the IX nerve are carotid sinus syndrome and glossopharyngeal neuralgia-asystole syndrome. Some patients with a pathological involvement of the parapharyngeal space also suffers from syncope but the clinical picture of these patients differs so greatly from the other two syndromes, which suggests specific aetiological, clinical and therapeutical features so the term "parapharyngeal space lesiones syncope-syndrome" has been proposed for this entity. We report a case of a patient with a neck tumor in the parapharyngeal space with syncope as the major symptom.

[ST elevation and tension pneumothorax]. / Elevación del ST y neumotórax a tensión.

We present a case of a sixty-nine-year-old male admitted to the hospital because of an acute respiratory failure that needed intubation and mechanical ventilation. Shortly after several attempts of right and left (the last one successful) subclavian vein cannulation (the last one successful) he developed a bilateral tension pneumothorax with important hemodynamic repercussion, a critical hypoxia and an ST elevation in inferior leads. Other more typical electrocardiographic changes could be observed: decrease in QRS amplitude and diminishing of precordial R voltage. After removing the air of the right pleural space, all the electrocardiographic signs disappeared returning to normal without electric or enzymatic assay of myocardial necrosis.

[ST-segment and myocardial enzymes evolution during myocardial infarction after fibrinolysis therapy and its relation with postinfarction angina, Killip class and mortality in intensive unit care]. / Evolución del segmento ST y las enzimas cardíacas en el infarto agudo de miocardio con fibrinólisis y su relación con la angina postinfarto, el índice de Killip y la mortalidad durante el ingreso en cuidados intensivos.

INTRODUCTION: The prognostic value of enzyme peaks, the sum of the ST segment and reperfusion arrythmias during myocardial infarction remains unclear. AIM: The aim of this study was to relate the early enzymatic peaks, the sum of the ST segment and reperfusion arrythmias after thrombolytic therapy with postinfarction angina, Killip class and mortality during the acute phase of myocardial infarction. PATIENTS AND METHODS: Of 187 patients receiving fibrinolytic therapy, 169 were consecutively and prospectively included in the study. The following myocardial enzymes were determined: CK, MB, TGO, LDH. Electrocardiograms were performed prior to and 2, 6, 12 and 24 hours after the administration of the fibrinolytic drug. RESULTS: The mean age of the patients was 60.12 +/- 11.3 years, with 138 (81.7%) being males. Myocardial infarction was anterior in 74 (43.7%) and inferior in 95 cases (56.3%). Reperfusion arrythmias were observed in 65 cases (38.5%). One hundred thirty-one (77.5%) were Killip class I, 12 (7.1%) presented postinfarction angina, and 8 (4.7%) died. A peak was observed in MB at 6 hours in cases of anterior myocardial infarction and the sum of the ST segment decreased less than 50% in the first 2 hours. No statistically significant correlation was observed between the enzymatic peaks, the reperfusion arrythmias, Killip class, postinfarction angina or early mortality. The greater the ST segment sum, the greater the severity according to the Killip class. On multivariate analysis no model was found to be related to postinfarction angina. However, age was related to mortality and sex and age were associated with heart failure. CONCLUSIONS: In our population, the variables studied were not found to be useful to determine the prognosis during the early phase of acute myocardial infarction.

[Tension pneumothorax as a complication of colonoscopy]. / Neumotórax a tensión como complicación de colonoscopia.

The appearance of complications is not frequent following lower gastric endoscopy, and even less so in those which carry the risk of death. Within the low incidence, perforation is the second in frequency of appearance, following hemorrhage. Herein we present the case of a patient who developed acute respiratory failure on developing hypertensive pneumothorax secondary to colon perforation during therapeutic colonoscopy. The mechanism of production, the clinical manifestations and the treatment of this complication are reviewed.

[Diffuse erythema with lung and inguinal masses as the initial manifestation of a large cell neuroendocrine tumor of the lung]. / Eritema generalizado, masa pulmonar e inguinal como forma de presentación de un carcinoma neuroendocrino pulmonar de células grandes.

Large cell neuroendocrine carcinoma of the lung is defined as poorly differentiated and high-grade neuroendocrine tumor that is morphologically and biologically between atypical carcinoid and small cell lung carcinoma. The prognosis of this type of tumor is poor, specially in advanced disease. We report on a case with atypical presentation, with high blood levels of histamine as a previously unreported association, and IV stage, in which the diagnosis was made after biopsy of an inguinal mass.

[Parapharyngeal space tumor syncope syndrome]. / Síndrome del síncope del tumor del espacio parafaríngeo.

There are several causes of syncopal attacks because of carotid sinus alterations. Recently parapharyngeal tumours have been implicated in its etiology. We reported a man with a cavum tumour who had several syncopes and an haemodynamical angina because of severe bradyarrhythmias. Implicated clinical entities in parapharyngeal space lesions syncope-syndrome, its physiopathological characteristics and differential diagnosis are discussed.