The profile evolution of acute severe poisoning in Spain.

About 5% of the patients admitted to emergency departments with poisonings are seriously ill and need admission to intensive care units (ICUs). This paper presents the result of three multicentric studies carried out in Spain during the last ten years. A study was made of 6 ICUs in 1980, 41 in 1987 and 15 in 1990 with a total of 596 patients. The average age (36) remained stable throughout, but the number of female cases decreased each time. The most frequent cause (79%) was attempted suicide. The products used most frequently were therapeutic drugs (82, 71 and 58%) followed by drugs of abuse, and then agricultural, household and industrial products. We observed a progressive decrease in barbiturates (54, 15 and 2%) and an increase in benzodiazepines and cyclic antidepressants. Therapeutic methods used were mostly gastric lavage (64%), activated charcoal (35%), forced diuresis (43%), extracorporeal therapy (11%) and antidotes. The mortality rate fluctuated between 6.4 and 9.1%, being significantly higher with poisoning by non-therapeutic drugs. In conclusion, the most common poisoning admitted to our ICUs was by psychoactive drugs in suicide attempts. We observed the under-use of activated charcoal and an excessive usage of kidney and extracorporeal methods. The prognosis was worse for poisonings with non-therapeutic drugs.

Tc-99m HMPAO labeled platelets in the detection of left ventricular thrombosis post acute myocardial infarction.

A left ventricular thrombosis post acute myocardial infarction was detected with Tc-99m HMPAO labeled platelet imaging. The left ventricular thrombosis was already detected on early scans, which allowed for a precise diagnosis during the first 6 hours of the study.

[Percutaneous and surgical gastrostomies: our clinical experience in enteral nutrition]. / Gastrostomía percutánea y quirúrgica: experiencia clínica en nutrición enteral.

Percutaneous gastrostomy (PG) was performed on 18 patients and 11 patients were subjected to surgical gastrostomy (SG) in the HCU of Zaragoza from October 1990 to November 1991. Involvement of the high digestive tract was the most common finding: 11 patients had CA of the oesophagus and stomach, 2 suffered from extrinsic pressure of the oesophagus due to metastatic adenopathy of a lung and breast tumour and 9 patients had CA of the larynx with total dysphagia. Another less common indication in our series, although still of great importance, was a severe involvement of the CMS, which made oral nutrition impossible due to functional dysphagia. Due to the long-term nature of this pathology, feeding by nasogastric tube was not considered. This was the case of 4 patients. The duration of enteral nutritional in the patients' home was 112.8 +/- 61 days with PG and 37 +/- 26 days with SG (p: 0.007). The incidence of complications was 33% in PG and 73% in SG, and for both techniques, the most common complication was blockage of the tube. Percutaneous gastrostomy is a simple technique, with no surgical risks involved, but with the benefits of traditional surgical techniques which, despite the small number of cases recorded, has very few complications both with regard to placing and afterwards, and also enables the patient to receive nutrients earlier than would be the case with traditional surgical techniques during prolonged periods at the patient's home.

[Changes in nutritional and biochemical parameters in septic patients undergoing total parenteral nutrition. Their relationship with mortality]. / Evolución de parámetros nutricionales y bioquímicos en pacientes sépticos bajo NPT. Su relación con la mortalidad.

The response of 24 septic patients admitted into the ICU to total parenteral nutrition was studied, and the course of the parameters evaluated from non-surviving (14) and surviving patients was compared. Serum glucose, triglyceride, albumin, transferrin, prealbumin, RBP, zinc levels and CD4/CD8 ratio were measured at 48 hours, 4 days and 8 days after the onset of parenteral nutrition. Overall, a significant increase in prealbumin (p less than 0.01) and RBP (p less than 0.05) levels were the only findings to parenteral nutrition response. When the non-surviving and surviving groups were compared, the former showed a significant increase in serum triglyceride (p less than 0.001), while a significant increase in serum transferrin and CD4/CD8 ratio (p less than 0.01) was observed in the latter.

[Experience with an enteral diet with fiber and a high fat content in ICU patients with glucose intolerance]. / Experiencia con una dieta enteral con fibra y alto contenido en grasas en pacientes de UCI con intolerancia a la glucosa.

The use of EN in diabetics is problematic due to the rapid absorption of the nutrients and difficulties in controlling glycemia. The purpose of this study is to evaluate the clinical tolerance and effects of a special diet for patients unable to tolerate glucose on glycemia and insulin requirements, containing 50% of its caloric intake in the form of fats (mainly monounsaturated fatty acids) and a high fibre content. This diet was used on a group of Intensive Care patients with stress diabetes, comparing it to a high protein diet in terms of Nitrogen Balance and evolution of circulating proteins. 35 patients admitted to Intensive Care with traumas or sepsis were studied. The patients received EN for a period of 14 days. They were divided into two groups at random. Group A received a high protein diet and Group B the special diet for patients with intolerance to glucose. In Group A, the levels of glycemia and insulin requirements were significantly higher than those of Group B. There were no significant differences in albumin, transferrin, prealbumin and RBP levels in both groups. Cholesterol levels remained normal, although on day 14 they were higher in Group B patients. Group A patients had higher triglyceride levels. The nitrogen balance was only higher on days 6 and 7 in Group A patients, with and accumulated Balance for the 14 days of 11.54 +/- 3.5 g. In Group A compared to 6.24 +/- 2.63 g. in Group B. Clinical tolerance to the diet was satisfactory, with the usual problems in critical patients.

[Comparative study of 2 antithrombotic regimens in 75 patients with coronary endoprostheses]. / Estudio comparativo de dos pautas antitrombóticas en 75 pacientes portadores de endoprótesis coronaria.

PURPOSE: To compare systemic anticoagulation with antiaggregation in patients with coronary stent, with regard to subacute occlusion, mean hospital staying and haemorrhagic complications. PATIENTS AND METHODS: Seventy-five patients with coronary stent were treated with one of two different antithrombotic protocols. A group comprised of 34 patients (group A) received sodium heparin and acenocoumarin, plus acetylsalicylic acid (325 mg) and dipyridamole (225 mg). The remaining 41 patients (group B) were given antiplatelet agents, namely ticlopidine (125-250 mg) and aspirin (125 mg). RESULTS: One case of group A (2.9%) showed thrombosis due to stent occlusion. No thrombotic complications were seen in the patients with antiplatelet drugs. Haemorrhagic complications were present in 11 group A patients (32.3%), and blood transfusion was necessary in 3 of them. Hemorrhage was present in 9 cases of group B (21.8%), and none of them needed blood transfusion. The mean number of days to achieve INR > 2 was 3.06 (1-11) in group and 2.02 (1-5) in group B. CONCLUSIONS: Antiplatelet regimes appear as a good choice in coronary stent, in spite of the fact that the primary indication seems that of group A.