[Acute methyl parathion poisoning with extrapyramidal manifestations not previously reported]. / Intoxicación aguda por paratión-metílico con manifestaciones extrapiramidales antes no informadas.

A 14-year-old female attempted suicide by ingesting the organophosphate methyl parathion. A severe acute poisoning developed with the characteristic symptomatology: muscarinic, nicotinic and neurologic, as well serum cholinesterase activity decreased 88%. An extrapyramidal syndrome appeared suddenly nine days after the onset with ocular and buccal crisis, neck and trunk dystonic movements, and hypertonia and tremors. The patient improved with the administration of i.v. diphenhydramine. Other causes of toxic extrapyramidalism and organophosphate intermediate syndrome were discarded. Although an absolute causal relationship of the transient extrapyramidal symptomatology to the organophosphate exposure cannot be clearly established in this case, we speculate a possible delayed inhibition of the dopaminergic receptors in the substantia nigra and the basal ganglia.

[Experience in the use of central venous catheterization via subclavian puncture in a pediatric hospital]. / Experiencia en el uso de la cateterización venosa central por punción subclavia en un hospital pediátrico.

OBJECTIVE: To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU. PATIENTS AND METHODS: Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered. RESULTS: 92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter. CONCLUSIONS: Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.

[The treatment of status epilepticus in children]. / Tratamiento del estado epiléptico en niños.

In children the status epilepticus (SE) constitutes a neurological emergency related to a high rate morbi-mortality. The prompt recognition and management are essentially to prevent irreversible neurologic damage. The frequency of SE in emergency rooms and pediatric intensive care units (PICU) is high because of several causes in the group of children less than five years old and particularly in the first year of life. In this paper are analyzed the actual state of drug therapy, general management and prevention of complication to decrease the incidence of severe sequelae in this patients. We suggest a general guide for the pediatrician and intensivist that include monitoring in a PICU for permanent valuation of the patient which result in a better treatment to improve the outcome and survival.