Manejo de la deprivación de altas dosis de morfina intratecal en el postoperatorio de paciente sometido a retirada de sistema intratecal por infección. Propuesta de manejo / No disponible

Los pacientes afectos de dolor crónico, portadores de sistemas de liberación de fármacos intratecales, actualmente plantean un desafío de manejo, cuando por razones perioperatorias, nos vemos obligados a interrumpir de forma brusca la administración de dichos fármacos, como el caso clínico que exponemos. en el mismo se aborda la problemática de contrarrestar los efectos de la deprivación de morfina a altas dosis intratecales en un paciente sometido a retirada del sistema intratecal, con una propuesta de manejo y los resultados clínicos observados (AU)

Patients with chronic pain disease, bearers of intrathecal dru release systems, currently pose a challenge of handling, when in the perioperative period, we are forced to discontinue the administration of such drugs, as the clinical case set out sharply. It addresses the problem of countering the effects of the deprivation of high dose of intrathecal morphine in a patient undergoing withdrawal of the intrathecal system, with a proposal for management and clinical outcomes observed (AU)

Angioedema as a single manifestation of carcinoid syndrome in a bronchial carcinoid tumor.

BACKGROUND: The association of bronchial carcinoid tumours with carcinoid syndrome is extremely rare especially in the absence of metastasic disease, and the angioedema is not a typical sign of this syndrome. METHODS AND RESULTS: We report the case of a 39 year-old woman referred to our allergy department with recurrent episodes of angioedema. The aetiological study of angioedema did not show evidence of hypersensitivity to common inhalants, food allergens and latex. C1-inhibitor, C3, C4, C1q, proteinogram and immunoglobulins (IgA, IgG, IgM) all were normal. TSH determination gave normal results, too. Faecal analyses for parasites were negative. The haemogram showed moderate leucocytosis and hypocromic mycrocitic anaemia. The thoracic radiography showed a mediastinal node image in the right paratracheal region. Histology analyses of the samples were diagnostic of a typical carcinoid tumor. Levels of 5-hydroxyindolacetic acid (5-HIIA) were slightly increased. A superior lobectomy was performed and no new episodes of angioedema appeared after surgical intervention. CONCLUSIONS: We report the first case of typical bronchial carcionid tumour, without metastasic disease, with angioedema as a single manifestation of carcinoid syndrome. In our knowledge, only one case of Quincke's edema as part of typical carcinoid syndrome has been reported, in a case of primary midgut carcinoid tumor with metastasic disease to liver. It is very important to include complementary tests, as thoracic radiography, in the routine study of angioedema to reject malignant diseases.

Angioedema as a single manifestation of carcinoid syndrome in a bronchial carcinoid tumor

Background: The association of bronchial carcinoid tumours with carcinoid syndrome is extremely rare especially in the absence of metastasic disease, and the angioedema is not a typical sign of this syndrome. Methods and results: We report the case of a 39 year-old woman referred to our allergy department with recurrent episodes of angioedema. The aetiological study of angioedema did not show evidence of hypersensitivity to common inhalants, food allergens and latex. C1-inhibitor, C3, C4, C1q, proteinogram and immunoglobulins (IgA, IgG, IgM) all were normal. TSH determination gave normal results, too. Faecal analyses for parasites were negative. The haemogram showed moderate leucocytosis and hypocromic mycrocitic anaemia. The thoracic radiography showed a mediastinal node image in the right paratracheal region. Histology analyses of the samples were diagnostic of a typical carcinoid tumor. Levels of 5-hydroxyindolacetic acid (5-HIIA) were slightly increased. A superior lobectomy was performed and no new episodes of angioedema appeared after surgical intervention. Conclusions: We report the first case of typical bronchial carcionid tumour, without metastasic disease, with angioedema as a single manifestation of carcinoid syndrome. In our knowledge, only one case of Quincke's edema as part of typical carcinoid syndrome has been reported, in a case of primary midgut carcinoid tumor with metastasic disease to liver. It is very important to include complementary tests, as thoracic radiography, in the routine study of angioedema to reject malignant diseases (AU)

La presencia de síndrome carcinoide asociado a tumores bronquiales es poco frecuente, sobre todo en ausencia de enfermedad metastásica; y el angioedema no es una manifestación típica de dicho síndrome. Métodos y resultados: Presentamos el caso de una paciente de 39 años de edad con episodios recurrentes de angioedema. En el estudio etiológico de angioedema no se evidenció hipresensibilidad frente a inhalantes, alimentos ni látex. La determinación de fracciones séricas de complemento (C3, C4, C1q y C1-inhibidor) e inmunoglobulinas mostró resultados normales. Los valores de TSH estaban, asímismo, dentro de la normalidad. En análisis de parásitos en heces fue negativo. En el hemograma se apreciaba una leucocitosis moderada y una anemia microcítica e hipocroma. La radiografía de tórax mostraba una imagen nodular mediastínica a nivel paratraqueal derecho. El estudio histológico fue diagnóstico para carcinoide típico. Los niveles de ácido 5-hidroxiindolacético (5-HIIA) en orina de 24 horas, estaban discretamente elevados. A la paciente se le practicó una lobectomía superior derecha, no volviéndose a presentar nuevos episodios de angioedema tras la intervención. Conclusiones: Presentamos el primer caso de tumor carcinoide bronquial típico, sin enfermedad metastásica asociada, con angioedema como única manifestación de síndrome carcinoide. Sólo tenemos conocimiento de un caso de edema angioneurótico de Quincke asociado a síndrome carcinoide en un caso de tumor primario intestinal con metástasis hepáticas. Creemos que es importante incluir determinados exámenes complementarios, como la radiografía de tórax, en el estudio de rutina del angioedema para descartar enfermedades malignas subyacentes (AU)

Allergy to asticot maggots. Identification of allergens.

UNLABELLED: There are some written reports of allergic reactions after contact with Asticot larvae in anglers and occupationally exposed workers. Clinical and immunological studies were performed to confirm the allergens involved in the case of a 12-year-old male who developed respiratory symptoms shortly after contact with Asticot maggots used as fish bait. METHODS AND RESULTS: Aqueous extracts of Asticot maggots were taken for in vivo and in vitro tests. The protein concentration as determined by turbidimetric assay was 1.4 mg/ml. Skin prick test with Asticot extract was positive with an immediate response. Ten atopic and ten nonatopic control subjects did not react to the extract. Specific serum IgE antibodies against Asticot were found in the patient's serum (ELISA). Coomasie staining after SDS-PAGE separation of Asticot extract showed three protein bands of 30, 40 and 60 kDa. IgE immunoblot showed one antigenic band of 60 kDa specifically recognized by the patient's IgE. Specific nasal challenge test with Asticot extract using a Rhinospir 164 rhinomanometer showed immediate response (1/10 w/v), with a 200% increase in nasal resistances from baseline. CONCLUSIONS: One main allergen of MW 60 kDa was specifically recognized by our patient's IgE. There are no previous reports in the literature that characterize the allergens involved in Asticot hypersensitivity. Asticot maggots should be taken into account as a possible causative agent of respiratory symptoms due to a type I hypersensitivity mechanism in anglers who are exposed to emanations of these live fish baits.

Dermatitis alérgica de contacto por el principio activo de un preparado de minoxidil / Allergic contact dermatitis due to minoxidil itself

Introducción: Minoxidil tópico suele utilizarse para tratar la alopecia androgénica. Se calcula una incidencia de dermatitis alérgica de contacto (DAC) por preparados de minoxidil del 1-3,7%. Propilenglicol (usado como vehículo en preparados de minoxidil) es la causa en la mayoría de los casos. Existen muy pocos casos descritos de DAC debida al principio activo del preparado de minoxidil que presentan resultados positivos con los parches de rninoxidil en solución acuosa o vaselina. Material y métodos: Mujer 40 años de edad, no atópica, con lesiones eccematosas en el cuero cabelludo tras una semana de tratamiento con una solución de rninoxidil al 5% por alopecia. Se realizaron pruebas epicutáneas con la fórmula original (minox.idil al 5%, propilenglicol, alcohol de 60º, ácido retinoico al 0,05%), así como con minoxidil al 2% en propilenglicol, mi noxidil al 2% en alcohol de 60º, minoxidil en solución acuosa al 2%, propilenglicol al 10, 20 y 50%, alcohol de 60" y ácido retinoico al 0,05%. Resultados: Se obtuvieron respuestas positivas ( +++) con el preparado original, minoxidil al 2% en propilenglicol y en alcohol de 60", así como con minoxidil al 2% en solución salina ( ++ ). No hubo respuesta con propilenglicol, alcohol ni ácido retinoico. Conclusiones: Presentamos un caso de DAC por el principio activo de un preparado de rninoxidil con un estudio de hipersensibilidad retardada negativo con los vehículos utilizados en su formulación. La mayoría de los casos descritos en la literatura pueden definirse como DAC dependientes del vehículo, con un estudio positivo con minoxidil en diversos vehículos (propilenglicol o alcoholes) y negativo con cada uno de los componentes por separado (AU)

lntroduction: Topical minoxidil solution is used to treat androgenetic alopecia. Allergic contact dermatitis (ACD) has been reported in 1-3.7% of treated patients. Propylene glycol is the causative allergen involved in a majority of cases. There are very few reports of ACD due to rninoxidil itself with positive patch tests reactions in aqueous solutions. Materials and methods: A 40-year-old woman, non atopic, with a history of scalp desquamative dermatitis one week after begining 5% minoxidil solution treatment for baldness. She was patch tested to the original fonnulation (5% minoxidil, propylene glycol, alcohol 60º, retinoic acid 0.05%), and 2% minoxidil in propylene glycol, 2% minoxidil in alcohol (…) (AU)

Allergy to asticot maggots. Identification of allergens

There are some written reports of allergic reactions after contact with Asticot larvae in anglers and occupationally exposed workers. Clinical and immunological studies were performed to confirm the allergens involved in the case of a 12-year-old male who developed respiratory symptoms shortly after contact with Asticot maggots used as fish bait. Methods and results: Aqueous extracts of Asticot maggots were taken for in vivo and in vitro tests. The protein concentration as determined by turbidimetric assay was 1.4 mg/ml. Skin prick test with Asticot extract was positive with an immediate response. Ten atopic and ten nonatopic control subjects did not react to the extract. Specific serum IgE antibodies against Asticot were found in the patient's serum (ELISA). Coomasie staining after SDS-PAGE separation of Asticot extract showed three protein bands of 30, 40 and 60 kDa. IgE immunoblot showed one antigenic band of 60 kDa specifically recognized by the patient's IgE. Specific nasal challenge test with Asticot extract using a Rhinospir 164 rhinomanometer showed immediate response (1/10 w/v), with a 200 % increase in nasal resistances from baseline. Conclusions: One main allergen of MW 60 kDa was specifically recognized by our patient's IgE. There are no previous reports in the literature that characterize the allergens involved in Asticot hypersensitivity. Asticot maggots should be taken into account as a possible causative agent of respiratory symptoms due to a type I hypersensitivity mechanism in anglers who are exposed to emanations of these live fish baits (AU)

Hay publicados algunos casos de reacciones alérgicas tras contacto con larvas de Asticot en pescadores aficionados o en trabajadores expuestos a las mismas por su profesión. Se presentan los estudios clínicos e inmunológicos efectuados para demostrar los alergenos implicados, en este caso de un niño de 12 años de edad con síntomas respiratorios tras el contacto con larvas de Asticot usadas como cebo para la pesca. Métodos y resultados: Se prepararon extractos acuosos de larvas de Asticot para su utilización en los estudios in vivo e in vitro. La concentración proteica del extracto por turbidimetría fue de 1,4 mg/ml. El prick test con extracto de Asticot fue positivo en lectura inmediata, con controles negativos (10 pacientes atópicos y 10 personas no atópicas). Por ELISA se demostró la presencia de IgE sérica específica frente al extracto de Asticot. La tinción con azul de Coomasie tras la separación del extracto de Asticot por electroforesis en SDS-PAGE muestra tres bandas con PM aproximado de 30, 40 y 60 kDa. La inmunotransferencia IgE mostró una banda antigénica de 60 kDa reconocida específicamente por la IgE del paciente. La provocación nasal específica con el extracto produjo una respuesta inmediata con un incremento del 200 por ciento de la resistencia nasal medida con el rinomanómetro Rhinospir 164. Conclusiones: Hemos demostrado un alergeno principal de 60 kDa reconocido de forma específica por la IgE del paciente. No hay trabajos publicados que identifiquen los alergenos implicados en las reacciones de hipersensibilidad por Asticot. Las larvas de Asticot deben ser tenidas en cuenta como posibles agentes etiológicos de reacciones alérgicas en aficionados a la pesca y en quienes estén expuestos a las emanaciones de este tipo de cebos de pesca vivos (AU)