[Intravenous PGE-1 in peripheral vascular obstructive disease: use over a 6-month period]. / La PGE-1 intravenosa en la enfermedad vascular periférica obstructiva: experiencia de uso en un periodo de 6 meses.

OBJECTIVE: The main goal of this study is to assess PGE-1 use by measuring and stratifying its effectiveness according to patient condition, using clinical parameters. Standard therapy consists of intravenous infusion for 21 days. MATERIAL AND METHODS: A revision of 30 medical records was carried out on 28 men and 2 women with a mean age of 69.71 -- SD 14.84 -- years who had been treated with PGE1. Twenty-six patients had a diagnosis of chronic arterial ischemia (6 Grade I-II, 20 Grade III-IV), and 4 of diabetic gangrene. The following clinical parameters were measured both before and after therapy -- pain, distal perfusion, and necrotic lesions according to TASC (Transatlantic Inter-Society Consensus). RESULTS: Before treatment onset, 30 patients had pain and decreased distal perfusion, and 20 patients had necrotic lesions. Six patients discontinued therapy because of lesion worsening. After 21 days of treatment 18 patients continued to have pain and decreased distal perfusion, and 16 still had necrotic lesions. Stratifying results by diagnosis, those 6 patients diagnosed with grade I-II chronic arterial ischemia experienced improvement in the three clinical parameters being considered -- absence of pain and improved distal perfusion and necrotic lesions. CONCLUSIONS: PGE1 is a beneficial medication, and optimal results are obtained when it is used in early peripheral vascular disease.

La PGE-1 intravenosa en la enfermedad vascular periférica obstructiva: experiencia de uso en un periodo de 6 meses / Intravenous PGE-1 in peripheral vascular obstructive disease: use over a 6-month period

Objetivo: El principal objetivo de este trabajo es la evaluación en el uso de PGE-1, midiendo su efectividad y estratificándola de acuerdo a la patología del paciente mediante parámetros clínicos siendo el tratamiento estándar de 21 días en infusión intravenosa. Material y métodos: Se ha procedido a la revisión de treinta historias clínicas 28 varones y 2 mujeres con una edad media de 69,71 SD 14,84 años que iniciaron tratamiento con PGE1. Veintiséis pacientes presentaban diagnóstico de isquemia arterial crónica (6 grado I-II, 20 grado III-IV) y 4 de gangrena diabética. Antes y después del tratamiento se midieron los parámetros clínicos dolor, perfusión distal y lesiones necróticas según el TASC (Consenso Trans-atlántico Inter-society).Resultados: Previo al inicio del tratamiento, 30 pacientes manifestaban dolor con una disminución de la perfusión distal y 20 presentaban lesiones necróticas. A 6 pacientes, les fue suspendido la terapia por un empeoramiento de las lesiones. Tras 21 días de tratamiento, 18 permanecían con dolor y la perfusión distal estaba disminuida y 16 continuaban con lesiones necróticas. Estratificando los resultados en función del diagnóstico, los 6 pacientes diagnosticados con isquemia arterial crónica grado I-II son los que presentaron mejoría de los tres parámetros clínicos, ausencia de dolor y una mejora de la perfusión distal y de las lesiones necróticas. Conclusiones: La PGE1 es un medicamento beneficioso, obteniéndose resultados clínicos óptimos, cuando se usa en estadios iniciales de la enfermedad vascular periférica obstructiva. (AU)

[Suicidal attempt with colchicine]. / Intento autolítico con colchicina.

Colchicine is an alkaloid that has been successfully used for a long time in the treatment of acute gout episodes. It's efficacy lies in its inhibition of inflammation cell migration and in the action of specific cytokines, as well as of the production of lactic acid and deposition of uric acid in affected tissues. Colchicine toxicity is rare but may entail highly negative consequences for health unless a rapid gastric decontamination with stomach lavage and active carbon is carried out, and adequate support measures are taken as wellas appropriate hydration and electrolyte replacement. We present the case of a patient who was admitted to hospital after ingesting colchicine with suicidal intention. Colchicine inhibits cell division, which explains its distinct toxicity stages. The lack of proportion existing between ingested dose and clinical impact may result from concomitant treatment with other drugs or from peculiarities in its metabolism.

Hyperglycemia induced by megestrol acetate in a patient with AIDS.

OBJECTIVE: To report a case of hyperglycemia induced by megestrol acetate in a patient with AIDS. CASE SUMMARY: A 28-year-old man with AIDS developed hyperglycemia requiring insulin therapy 5 days after beginning megestrol therapy. The hyperglycemia resolved with discontinuation of the agent and treatment with insulin, and recurred 2 years later, when megestrol acetate treatment was rechallenged. In this case the patient had developed hyperglycemia and pancreatitis 1 year before, related to pentamidine therapy. DISCUSSION: To our knowledge this is the first reported case of hyperglycemia that was induced by megestrol acetate as early as 5 days after beginning therapy and confirmed by rechallenge. The mechanism of action is unclear. CONCLUSIONS: Clinicians caring for patients with AIDS-related cachexia should be aware that megestrol acetate can cause a severe but reversible hyperglycemic state.