La clave estaba en la historia clínica / No disponible

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[Complications related with cocaine abuse that required hospital admission]. / Complicaciones relacionadas con el consumo de cocaína que precisaron ingreso hospitalario.

INTRODUCTION: Although cocaine abuse is an increasingly important medical problem, many manifestations of its toxicity are not well understood. The aim of this study is to review the most serious clinical manifestations related to cocaine abuse. PATIENTS AND METHOD: We reviewed the medical records of all patients over 16 years of age admitted to the hospital from January 1994 to December 2005 where cocaine abuse was recorded in their clinical history. RESULTS: A total of 170 patients, with 188 episodes and 268 pathologic manifestations related to cocaine abuse were included. Thirty two out of the 170 patients (18.8%) were females. Mean age was 33 +/- 11 years, with no significant difference between males and females. A total of 88.8% were smokers, 70% had alcohol abuse and 67.3% had other illegal drug abuses. The more frequent reason for their hospitalization was: pulmonary infection (29.6%), bronchial hyperreactivity (14%), acute psychotic attack related to drugs (12%), ischemic heart disease (10%), infectious endocarditis (7.8%), cerebrovascular disease (8.6%), seizures (6.2%) and severe abdominal complications (2.3%). Eight patients died (6.25%). The association with cocaine was only suspected in 46% of the toxic manifestations. CONCLUSIONS: Several clinical manifestations are associated to cocaine abuse and its consumption causes potentially fatal complications. The integral treatment of these patients could be improved if these complications are kept in mind.

Complicaciones relacionadas con el consumo de cocaína que precisaron ingreso hospitalario / Complications related with cocaine abuse that required hospital admission

Introducción. Aunque la cocaína supone un problema sanitario de importancia creciente, muchos síntomas de su toxicidad no son bien conocidos. El objetivo de este estudio es dar una visión global de las manifestaciones clínicas más graves relacionadas con la cocaína. Pacientes y método. Se revisaron los historiales clínicos de todos los pacientes mayores de 16 años de edad ingresados en nuestro hospital desde el 1 de enero de 1994 hasta el 31 de diciembre de 2005, entre cuyos códigos diagnósticos al alta figuraba el consumo de cocaína. Resultados. Se incluyeron 170 pacientes que sumaron un total de 188 episodios y 268 manifestaciones patológicas relacionadas con la cocaína. De los 170 pacientes, 32 (18,8%) eran mujeres. La edad media fue de 33 ± 11 años y no difirió significativamente entre hombres y mujeres. El 88,8% era fumador, el 70% ingería alcohol en exceso y el 67,3% consumía otras drogas ilegales. El motivo de ingreso más frecuente fue: infección pulmonar (29,6%), hiperreactividad bronquial grave (14%), trastorno psicótico agudo (12%), cardiopatía isquémica (10%), enfermedad cerebrovascular (8,6%), endocarditis bacteriana (7,8%), convulsiones (6,2%) y complicaciones abdominales graves (2,3%). Ocho pacientes fallecieron (6,25%). La asociación con la cocaína sólo se sospechó en un 46% de las manifestaciones clínicas. Conclusiones. El espectro de manifestaciones clínicas asociadas al consumo de cocaína es amplio y causa complicaciones potencialmente fatales. Mejorar su conocimiento por parte de los clínicos puede facilitar el tratamiento integral de estos enfermos (AU)

Introduction. Although cocaine abuse is an increasingly important medical problem, many manifestations of its toxicity are not well understood. The aim of this study is to review the most serious clinical manifestations related to cocaine abuse. Patients and method. We reviewed the medical records of all patients over 16 years of age admitted to the hospital from January 1994 to December 2005 where cocaine abuse was recorded in their clinical history. Results. A total of 170 patients, with 188 episodes and 268 pathologic manifestations related to cocaine abuse were included. Thirty two out of the 170 patients (18.8%) were females. Mean age was 33 ± 11 years, with no significant difference between males and females. A total of 88.8% were smokers, 70% had alcohol abuse and 67.3% had other illegal drug abuses. The more frequent reason for their hospitalization was: pulmonary infection (29.6%), bronchial hyperreactivity (14%), acute psychotic attack related to drugs (12%), ischemic heart disease (10%), infectious endocarditis (7.8%), cerebrovascular disease (8.6%), seizures (6.2%) and severe abdominal complications (2.3%). Eight patients died (6.25%). The association with cocaine was only suspected in 46% of the toxic manifestations. Conclusions. Several clinical manifestations are associated to cocaine abuse and its consumption causes potentially fatal complications. The integral treatment of these patients could be improved if these complications are kept in mind (AU)

Manejo exitoso conservador de prótesis osteoarticular infectada por vía hematógena tardía por Streptococcus pneumoniae / Successful management to protect osteoarticular prosthesis due to Streptococcus pneumoniae infection by means of late hematogenous pathway

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Modeling skull electrical properties.

Accurate representations and measurements of skull electrical conductivity are essential in developing appropriate forward models for applications such as inverse EEG or Electrical Impedance Tomography of the head. Because of its layered structure, it is often assumed that skull is anisotropic, with an anisotropy ratio around 10. However, no detailed investigation of skull anisotropy has been performed. In this paper we investigate four-electrode measurements of conductivities and their relation to tissue anisotropy ratio (ratio of tangential to radial conductivity) in layered or anisotropic biological samples similar to bone. It is shown here that typical values for the thicknesses and radial conductivities of individual skull layers produce tissue with much smaller anisotropy ratios than 10. Moreover, we show that there are very significant differences between the field patterns formed in a three-layered isotropic structure plausible for bone, and those formed assuming that bone is homogeneous and anisotropic. We performed a measurement of conductivity using an electrode configuration sensitive to the distinction between three-layered and homogeneous anisotropic composition and found results consistent with the sample being three-layered. We recommend that the skull be more appropriately represented as three isotropic layers than as homogeneous and anisotropic.

Coagulación intravascular diseminada con localización cutánea exclusiva / Disseminated intravascular coagulation with exclusive cutaneous localization

Se presenta un caso de una paciente de 48 años que ingresa por presentar lesiones purpúricas y equimóticas de bordes netos policíclicos en miembros, orejas y tronco, que evolucionaron hacia la formación de ampollas hemorrágicas y áreas de necrosis sin compromiso del estado general. El cuadro fue interpretado como una CID localizada en piel, a pesar de presentar parámetros biológicos normales, corroborándose el diagnóstico clínico con la biopsia cutánea. Destacamos la importancia diagnostica que asume el estudio histopatológico en aquellos cuadros clínicos compatibles con CID pero con laboratorio normal

Coagulación intravascular diseminada con localización cutánea exclusiva / Disseminated intravascular coagulation with exclusive cutaneous localization

Se presenta un caso de una paciente de 48 años que ingresa por presentar lesiones purpúricas y equimóticas de bordes netos policíclicos en miembros, orejas y tronco, que evolucionaron hacia la formación de ampollas hemorrágicas y áreas de necrosis sin compromiso del estado general. El cuadro fue interpretado como una CID localizada en piel, a pesar de presentar parámetros biológicos normales, corroborándose el diagnóstico clínico con la biopsia cutánea. Destacamos la importancia diagnostica que asume el estudio histopatológico en aquellos cuadros clínicos compatibles con CID pero con laboratorio normal (AU)