[Headache in a short-stay unit. A retrospective study of 140 cases]. / Cefalea en una unidad de estancia corta. Estudio retrospectivo de 140 casos.

OBJECTIVE: Our objective was to study those patients that warranted admission to our Short-Stay Unit (Observation Unit) with an incoming diagnosis of headache so as to determine the characteristics of the headache, analyze complementary explorations and their use and to establish the causes of the problem. PATIENTS AND METHODS: A retrospective review of the clinical history of patients admitted for headache between 1992 and 1997 was done, recording specific data according to pre-set objectives. RESULTS: One hundred forty patients were admitted with headache (2% of total admittance to the Unit. Sixty-one percent were males. Seventy cases were between 11 and 15 years old. The most frequent accompanying symptoms were vomiting (61%), fever (31%) and various concurrent infections (21%). Seventy-two cases (51%) presented an evolution of less than 24 hours before admittance. Frontal headache was the most common localization, 30.6% of the patients were awaken by the pain and 32% calmed with analgesics. CAT scan/70%) and skull X-ray (59%) were the most used complementary explorations. Ten CAT scans and 3 X-rays showed anomalies. Evolution was favorable in most cases. The most frequent diagnoses were headache associated with infections (31%), tension headaches (29%) and migraine (21%). Fourteen percent were non-specific headaches. A central nervous system tumor was diagnosed in 6 patients, where 5 showed papilledema on initial exploration. CONCLUSIONS: Headache, especially in adolescents, is a common cause of consultations to the emergency room. When not accompanied by other symptoms it is not usually precluding a severe disease. In an emergency room exploration, a complete neurological exam must be undergone, including retinal exam, leaving further complementary exams for those cases where the patient history suggests an organic alteration.

[Routes of endotracheal colonization in patients with mechanical ventilation]. / Rutas de colonización traqueal en pacientes sometidos a ventilación mecánica.

OBJECTIVE: We prospectively evaluated the frequency and route of endotracheal colonization in intubated children in order to know what microorganisms, either by primary infection or through previous colonization of oropharynx and/or stomach and progression towards the lower respiratory tract, are responsible for these infections. PATIENTS AND METHODS: Oropharyngeal, tracheal and gastric samples of 43 patients were collected for culture at the moment of intubation and at 24-h intervals for 4 days. The colonization route for each endotracheal microorganism was classified depending on the initial isolation site. Isolated microorganisms were considered as belonging to the same strain if the biochemical pattern and antibiogram were identical. RESULTS: Of the patients studied, 84% presented positive cultures the first day. Tracheal colonization was detected at day 1 in 22 patients (51%) and in 35 (82%) at the end of the study. A colonization sequence was seen in 18 patients (41%). The microorganisms most frequently isolated were S. aureus, P. aeuruginosa and C. albicans. CONCLUSIONS: The mechanisms of tracheal colonization in intubated children is similar to adults. Oropharynx colonization is the key antecedent. Prophylaxis measures should avoid the proliferation at the oropharyngeal and/or gastric level.