[Acute aortic dissection]. / Disección aórtica aguda.

OBJECTIVE: Acute aortic dissection is a medical emergency associated with high rates of mortality. Despite recent diagnostic advances, prompt and accurate diagnosis is difficult. We present a review of the a medical emergency service experience to diagnosis, factors associated to prompt diagnosis and inhospital evolution. MATERIAL AND METHOD: We studied 86 consecutive patients who had aortic dissections, to assess the presentation, management, and outcome. RESULTS: Mean age 61.9 +/- 12.5 years, 80% male. Hypertension was the most common predisposing factor (65% of patients overall). Chest pain was the most common initial complaint (58%). The initial clinical impression was aortic dissection in 56% of patients overall. Computed tomography was diagnostic in 96% when used. 62% underwent surgery. Overall in-hospital mortality was 28%. CONCLUSIONS: Acute aortic dissection presents with a wide range of manifestations. A high clinical index of suspicion and a prompt computed tomography should to improve recognition of aortic dissection.

[Diabetic ketoacidosis in an emergency department]. / Cetoacidosis diabética en un departamento de Urgencias.

OBJECTIVE: We study clinical data and differences in the patients with Diabetic Ketoacidosis (CAD) attended in an Emergency Department (ED). METHODS: We described 15 patients with criteria for diagnosis of CAD during a 12-month period. We value prospectively clinical data, precipitating factors, diagnosis associated, previous diagnosed diabetes, complications, mortality and use of and intensive care unit (UCI). We comparing groups according two characteristics: age group and prior diagnosis of diabetes mellitus.

[Fixed-dosage combinations in the treatment of hypertension]. / Combinaciones en dosis fija para el tratamiento de la hipertensión.

The antihypertensive treatment with a single agent is not useful for the arterial pressure control in a significant number of patients. In such cases, combined treatment or drug substitution are recommended (sequential or substitutive monotherapy). In the last years, the fixed dose combinations in one single pharmaceutical preparation have proliferated. These associations must fulfill a number of conditions in order to be considered rational, as for instance the compatibility of its pharmacokinetic features, properly dosing, the absence of new secondary effects and the high efficiency showed in most of patients. The advantages of these combinations are the comfort and easiness of the therapeutic schema, antihypertensive action strengthening, less secondary effects when dose is reduced, and perhaps a synergism in the protection of target organs. The most popular combinations are: potassium sparing diuretic plus thiazide, diuretic plus beta block, diuretic plus ACEI, or calcium antagonist plus ACEI.

[Emergency department observation and short term unit]. / Unidad de Observación y Corta Estancia de Medicina en el Servicio de Urgencias.

BACKGROUND: An emergency department observation and short term unit is analyzed, and the conditions appropriate for it. METHODS: Four hundred patients admitted consecutively were evaluated. Demographic, and clinical data, complementary tests performed, diagnosis, destination and revisits to the emergency department were analyzed. RESULTS: The 57% of the patients were over 65 years. Complementary tests were performed in all patients. 42% were discharged home without hospitalization, being syncope, intoxication and epilepsy the most common diagnosis. The 1.8% of the patients no hospitalized revisted to emergency department during the next 72 hours. CONCLUSION: Emergency department observation and short term units can reduce hospitalization and health care costs and improve the quality of medical care through extended evaluation and treatment.

[Malignant neuroleptic syndrome]. / Síndrome neuroléptico maligno.

Neuroleptic Malignant Syndrome (NMS) is a rare disease characterized by hyperthermia, altered level of consciousness, autonomic dysfunction and muscular rigidity in relation to treatment with different drugs. We describe ten patients with Neuroleptic Malignant Syndrome in our Hospital. The mean age was 48 +/- 18 and females were majority (70%). Haloperidol, alone or with another farms, was relation with NMS in the 90% of the cases. Mortality became the 20% and it was relation with respiratory failure and delayed on admission in Intensive Care Unit (UCI). We remarked the importance to have a high suspicious index for attending of this disease by a precocious and intensive treatment.

[Charcot-Marie-Tooth disease, dilated myocardiopathy and cardiac conduction disorders]. / Enfermedad de Charcot-Marie-Tooth, miocardiopatía dilatada y trastornos de la conducción cardiaca.

We describe the case of two brothers with Charcot-Marie-Tooth disease, dilated cardiomyopathy and disorders in the cardiac conduction. We review the literature in order to find physiological grounds for these associations. Despite the absence of consolidated data on this question, the genetic grounds could play some role here. In this sense, our cases contribute with the novelty that the disease affects two brothers. This has never been described before and could contribute, along with future observations, to clarify some etiopathogenic aspects of the disease.

[Rhabdomyolysis in acute intoxications]. / Rabdomiolisis en intoxicaciones agudas.

The development of rhabdomyolysis is a complications of acute intoxications, although its actual incidences is unknown. We had studied the frequency and differential characteristics of the patients with such complications. A prospective study was conducted with 200 patients admitted to a General Hospital from an urban area due to acute intoxication, recording the etiology of the intoxication, motivation and analytical characteristics of the patients with rhabdomyolysis compared to their patients without rhabdomyolysis. The incidence of rhabdomyolysis was 7.7%. Among the patients with rhabdomyolysis, ludic motivation (59%) and etiology associated to drug abuse (heroin 30%, cocaine 24%) were more frequent compared to the patients without rhabdomyolysis. Twenty per cent of the patients consuming cocaine and 17% of the patients consuming heroin developed rhabdomyolysis. Acute rhabdomyolysis was, thus, a significant complication of acute intoxications, associated to the consumption of illegal drugs and, at least in our cases, with a good evolution regarding the renal function.