Paraparesia espástica tropical importada / Imported tropical spastic paraparesis

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[Electrocardiography and echocardiography aspects of hypertrophic myocardiopathy in pediatrics]. / Aspectos electrocardiográficos y ecocardiográficos de la miocardiopatía hipertrófica en edad pediátrica.

Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease, characterized by asymmetric hypertrophy of the left and/or right ventricle with disarray of myocardial fibers. In order to know its clinical and electrocardiographic manifestation in the pediatric age group, we made a retrospective study of 24 cases from 1986 to 1995. There were: 15 girls and 9 boys, with a mean age of 6 years (age range: 1 month to 17 years). Clinical manifestations were dyspnea (71%), syncope (42%) and palpitations (42%). Physical examination disclosed an aortic systolic murmur in all patients, a mitral regurgitation in 42% and physical signs of congestive heart failure in 54% of patients. Chest X rays showed cardiac enlargement in 71% and pulmonary capillary hypertension in 42%. The most frequent ECG abnormalities were: a prolonged time in the intrinsecoid deflection onset on leads corresponding to the affected region, more or less deep and clean Q waves on leads aVF, aVL, V5 and V6, as well as supraventricular and ventricular rhythm disturbances in 11 patients (46%) with and without congestive heart failure. Bidimensional echocardiography confirmed antero-septal hypertrophy in all patients. The mortality rate was 17%. HCM is rare disease in the pediatric age group. Mortality increases when congestive heart failure and arrhythmias are present. Treatment must be individualized in all cases.

Prevention of catheter sepsis: the hub.

The prevention of catheter sepsis lies in a sound understanding of the routes through which catheters get contaminated. The catheter hub has been recognized as a portal for microorganisms causing catheter sepsis, particularly in central venous catheters inserted for > 1 wk. Bacteria and fungi may reach the internal surface of the catheter connector during manipulation by hospital staff and then colonize the entire lumen of the catheter. Endoluminal contamination has diagnostic, therapeutic, and preventive implications. Some traditional preventive approaches (site care, subcutaneous cuffs and tunnels, maximal aseptic barriers at the time of catheter insertion, and external antiseptic or antibiotic coating) may fail because they focus solely on the skin as a source of bacteria. Hub-related catheter sepsis can be prevented by aseptic hub manipulation, appropriate junction protection, and by reducing the number of catheter lumens, side ports, three-way stopcocks, and changes of the infusion sets. Needleless systems must be evaluated in terms of their safety in preventing endoluminal contamination. A new disinfecting catheter hub incorporating an antiseptic barrier has been developed and reduced hub-related catheter sepsis by more than 90%. The endoluminal route of intravascular catheter contamination must be taken into account when designing strategies for the diagnosis and prevention of catheter-related sepsis.

[Information on opiate and cocaine consumption in the emergency room clinical records: validity and reliability]. / Información sobre el consumo de opioides y cocaína en la anamnesis de urgencias: validez y fiabilidad.

BACKGROUND: Data on drug consumption obtained from emergency room clinical records have been used for various epidemiological purposes. However the validity and reliability of these data remain unknown. This paper assesses the reliability and validity of an Emergency Room Toxicological Register (HMR) which has collected information on drug misuse from emergency room clinical records since 1979, and examines the implications for epidemiological applications. SUBJECTS AND METHODS: An Emergency Room Survey (ERS) was carried out in a Barcelona Hospital including opiate or cocaine users identified by the physician and a systematic sample of other patients age 15 to 49 years old. Data on clinical records of interviewed patients were also reviewed. Episodes from identified drug users (686) and HMR (676) for the same study period were linked and validity and reliability were analyzed. RESULTS: Sensitivity ranged between 63 and 86%, and specificity was 98%, Kappa index higher than 0.72 and intraclass correlation coefficient was 0.99. CONCLUSIONS: Information about drug users included in emergency room clinical records proved to be valid as an information system for drug use surveillance. However data about patterns of less heavy users, as cocaine use, are underreported.

[A unique medical experience: the 1992 Barcelona Olympic Games]. / Una experiencia médica única: los Juegos Olímpicos de Barcelona 1992.

BACKGROUND: The request for medical attention derived from Olympic Games is variable, with few previously published experiences and thus, the estimations made by the organizers are difficult. METHODS: The health care program established during the 1992 Olympic Games held in Barcelona is described and the clinical cases attended are reported. RESULTS: The number of persons accredited by the Barcelona Olympic Committee was 132,286. Health care attendance was provided in the sports installations, the olympic villages of the journalists and athletes, olympic family hotels, press centers and the International Youth Camp. A Polyclinic was in operation in the Olympic Village with a 24 hour Emergency Department. A total of 15,552 visits were made, 524 of which were sent to the Emergency Department of the Olympic Hospital (Hospital del Mar in Barcelona). Three hundred twenty visits were programed in the Out Patient Departments of the Hospital and a total of 81 patients were admitted to the hospital with a mean stay of 3.9 days. The most common medical problems encountered were those related with the locomotor system. CONCLUSIONS: The health care program designed for the Barcelona 1992 Olympic Games was adequate to attend the health care demand required.

Simultaneous human immunodeficiency virus and Hepatitis C infection following a needlestick injury.

Needlestick injuries to health professionals at the Hospital del Mar, Barcelona since 1987 have been prospectively studied; a total of 296 such accidents in 286 subjects have been registered. We report the first case to our knowledge of simultaneous human immunodeficiency virus (HIV) and hepatitis C (HCV) infection in a nurse who suffered a needlestick injury after a blood sampling. Forty-four days after the accident she had symptoms and laboratory findings of acute hepatitis. Subsequent laboratory tests showed elevation in the aminotransferases and antibodies against HIV. The seroconversion to HCV was not detected until 109 days after the injury. The precise sequence of clinical and biological events of this case of simultaneous HIV and HCV infection is reported.

Pathogenesis and prevention of catheter-related septicemia.

Intravascular catheters are contaminated by bacterial flora present on the patient's own skin or on the hands of the personnel manipulating the catheter-tubing junction. In the former case, contamination is more often extraluminal and often leads to CRS soon after catheter insertion. In the second circumstance, contamination preferentially involves the endoluminal route and results in bacteremia after the initial 10 to 14 days of catheter use. Effective prevention relies on thorough aseptic technique during insertion of the catheter or manipulation of its hub. Further studies are required to define the best means of achieving permanent sterilization of the insertion site. New hub designs should reduce the risk of hub contamination and CRS in prolonged intravascular catheterizations.

[A new electrocardiographic algorithm for localizing accessory pathways using only the polarity of the QRS complex]. / Un nuevo algoritmo electrocardiográfico para la localización de las vías accesorias utilizando únicamente la polaridad del complejo QRS.

From 250 consecutive patients who underwent radiofrequency ablation of accessory pathways, we studied 102 patients with successful ablation of a single overt accessory pathway. All patients had manifested preexcitation on a baseline 12 lead electrocardiogram. None of this patients had additional congenital or acquired cardiac abnormalities which could have affected the QRS morphology. A new algorithm for localizing the AP site was developed, based only on the polarity of the QRS complexes in DIII, V1 and V2, without analysis of the delta wave. We could localize the accessory pathway in five sites with 88% of probability of success. This simplify the electrocardiographic analysis of Wolff Parkinson White and improvement the results of radiofrequency ablation.

Psychotropic drug consumption and other factors associated with heroin overdose.

In clinical or forensic practice there are few studies assessing which risk factors are associated with heroin overdoses. A series of 76 consecutive non-fatal heroin overdoses were compared to 22 consecutive subjects who self-injected heroin within 1 h before admission to the emergency room. Whereas blood levels of alcohol and IgE and urinary cocaine metabolite levels were similar in both groups, higher benzodiazepine plasma levels were detected in the heroin overdose group. The assessment of methadone, dextropropoxyphene, amphetamines and cannabis in urine analysis did not show differences between both groups. The interview revealed that only 48% of subjects in the heroin overdose group self-administered the last dose of heroin before admission in the usual setting as compared to 100% of subjects in the non-overdose group. The application of a log-linear regression model identified self-injection of heroin in an unusual place and plasma concentrations of total morphine and benzodiazepines as risk factors for heroin overdose.

[Identification of patients at risk of malignant arrhythmia in the 1st year after myocardial infarction]. / Identificación de los pacientes con riesgo de arritmias malignas en el primer año postinfarto del miocardio.

Two hundred twenty two consecutive patients with acute myocardial infarction were followed for one year. We evaluated the usefulness of late potentials, the spectral analysis, heart rate variability, infarct-related coronary artery, ejection fraction, arrhythmias during Holter monitoring and other clinical variables as risk markers for developing of ventricular arrhythmias and/or sudden death. Twenty four patients (10.8%) had late arrhythmic events: sudden death in 7, sustained ventricular tachycardia in 15 and unexplained syncope in 2. Late potentials had high sensitivity (94%) and negative predictive value (99%), followed by an occluded related-infarct coronary artery (75% sensitivity and 96% negative predictive value). Complex ventricular arrhythmias during Holter monitoring was the test with the highest specificity (92%). A combination of late potentials plus an occluded infarct-related coronary artery or late potentials plus ejection fraction showed 100% sensitivity with 100% negative predictive value. Of the 16 studied variables, 5 had independent and significative value as a predictor of arrhythmic events, these are, according to the relative risk: late potentials (20.2), ejection fraction less than 40% (12.1), complex arrhythmias during Holter monitoring (7.5), the presence of an occluded infarct-related coronary artery (6.4) and anterior myocardial infarction localization (4.5). We consider, that with a combination of simple methods of assessment, we can select a subgroup of survivors of an acute myocardial infarction at high risk of developing ventricular arrhythmias and sudden death, which also identifies patients with low risk for these complications.

[Vector cardiographic evaluation of monomorphic ventricular tachycardia; its relation to the type of cardiopathy, vagal tonus and the prevalence of late potentials]. / Evaluación vecto-espacial de la taquicardia ventricular monomórfica; relación con el tipo de cardiopatía, tono vagal y prevalencia de potenciales tardíos.

The most common cause of sudden death is malignant ventricular arrhytHmia. In order to identify the predictive value of the vectospatial evaluation in the surface electrocardiogram during a monomorphic ventricular tachycardia (MVT), and the equilibrium state of AutonomOus Nervous System (ANS), 89 patients of both sexes were studied with mean age of 47 +/- 16.2 years. They were grouped as follows: Group I included 43 patients (P), with a coronary heart disease; Group II (n = 24P) with a noncoronary myocardiopathy and Group III (n = 22P) with unknown origin MVT (Cryptogenic). Relationship between QRS configuration in the frontal plane (QRSf) during MVT episode with transverse plane, cardiac position in the chest X-rays, presence and duration of late potentials (LPs) in their two types of analysis (time domain and spectral mapping by high-resolution electrocardiogram), heart rate variability and ejection fraction by echocardiography were determined in all patients. The QRSf configuration with left bundle-branch block (LBBB) was the most common in group I, the sustained MVT (SMVT) + LBBB was associated with both prevalence and duration of late potentials (p = 0.005), low-rate heart variability and ejection fraction < 40%. SMVT + LBBB was the most common type in group III and if it has shown and inferior axis, an elevated rate of LPs (+) was seen. Situation that oriented to an arrhythmogenic right ventricular dysplasia. Low amplitude signals with short duration in the time domain were seen in group I with LBBB; and with SMVT + RBBB in group II. We suggest that vectospatial evaluation of QRSf during a MVT is a greater importance in the risk stratification for sudden death and it can guide to anatomic origin and the diagnosis-therapeutic approach.

[Clinical effectiveness of naloxone in acute ethanol intoxication]. / Eficacia clínica de la naloxona en la intoxicación etílica aguda.

The first articles trying to link the effects of ethyl alcohol with those of opiates appeared in 1970. The first case of reversion from ethylic coma due to naloxone was described in 1978. Since then, many authors have reported different results related to the effectiveness of opiate antagonists in this clinical situation, without any of the studies showing a beneficial effect from its use. The purpose of the present study is to perform a double-blinded clinical trial with placebo to evaluate naloxone's clinical effectiveness in severe ethylic intoxication, using the Glasgow test (GT) to measure the level of consciousness. Treatment was randomly assigned to 38 patients of whom 18 received 2 mg of naloxone and 20 a placebo. Among the results, it was found that the best approximation of the level of alcoholemia responsible for ethylic coma, without the involvement of other toxic psychotropes, was made using the Glasgow test, especially in patients who are occasional drinkers. It was shown that naloxone indeed lacks effectiveness in ethylic coma, raising the level of consciousness only one or two points in the Glasgow test for the 15 to 45 minutes after its administration and primarily in the group of patients with the lowest levels of consciousness.

[Exhaustion syndromes in a popular marathon]. / Síndromes por agotamiento en una maratón popular.

The clinical characteristics of seven healthy subjects who required hospital care for an exhaustion syndrome due to extenuated physical exercise during participation in a public marathon are presented. All the patients were used to practising sports activities and in all the cases the symptoms of exhaustion appeared in the last few kilometers of the race. The most frequent symptom found in all the patients was lipothymia with falling to the ground followed by gastrointestinal manifestations, muscle cramping and fever. Upon analysis the signs of rhabdomyolysis and others suggestive of dehydration were observed in all the cases. Leukocytosis was observed in four and hypopotassemia in two. Evolution was good in all the cases with rest and hydroelectrolytic reposition. Finally, the preventive measures to avoid heat stroke and exhaustion syndromes in public marathons are reported.