Mediastinitis secundaria a perforación esofágica yatrogénica / No disponible

No disponible

El marcapasos en la Torsade de Pointes: ¿un arma terapéutica o etiológica? / The pacemaker implantation in the Torsade de Pointes: a therapeutic or ethiologic weapon?

La torsade de pointes (TdP) es una causa frecuente de muerte súbita de origen cardiaco, sin embargo, su electrofisiología y tratamiento no están todavía claramente establecidos. Comunicamos el caso de una paciente portadora de marcapasos que presentó varios episodios de taquicardia helicoidal o TdP, que fueron eficazmente corregidos con sobreestimulación cardiaca de su marcapasos y sulfato de magnesio iv. La causa de la prolongación del QT y el inicio de esta arritmia pudo estar favorecido por la estimulación epicárdica de su marcapasos. Queremos incidir en la sobreestimulación cardiaca como tratamiento eficaz de la TdP, y en la necesidad de valorar el riesgobeneficio en la implantación de determinados tipos de marcapasos en pacientes con riesgo de prolongación del intervalo QT y muerte súbita secundaria a TdP (AU)

The Torsade de pointes (TdP) is a frequent cause of sudden death of cardiac origin, however, its electrophysiology and treatment are not still clearly established. We communicate a case of a patient with pacemaker implantation that presented various episodes of Torsade of Pointes (TdP) those were efficiently corrected with overdrive pacing and sulphate of magnesium iv. The cause of the prolonged QT interval and the start of this arrhythmia could be favored by the stimulation in epicardium of its pacemaker. We want to impact in the overdrive pacing as efficient treatment of the TdP, and we must value the risk-benefit in the establishment of determined pacemaker’s types in patients at the risk of prolonged QT interval and secondary sudden death by TdP (AU)

Osteonecrosis de cadera rápidamente progresiva / Rapidly progressive osteonecrosis of the lip

No disponible

Pancreatitis hemorrágica como forma de presentació ninicial de la ruptura de un aneurisma de la arteria esplénica / Hemorragic pancreatitis as an initial clinical presentation of a ruptured splenic artery aneurysm

Los aneurismas de la arteria esplénica son lesiones poco comunes, y la mayoría son asintomáticos. Su diagnóstico precoz es importante porque, en caso de ruptura, la mortalidad es muy elevada. Su presentación clínica puede variar desde una hemorragia digestiva alta por erosión en las vías adyacentes, hasta un shock hipovolémico por ruptura libre en cavidad intraperitoneal. Con cierta frecuencia se observa un fenómeno de doble ruptura, con un leve sangrado inicial contenido en la transcavidad de los epiplones, o bien en estructuras vecinas, entre ellas el páncreas, antes de la hemorragia masiva intraabdominal. Este período "centinela" proporciona una oportunidad valiosa para su diagnóstico y tratamiento quirúrgico urgente. Presentamos el caso de una pancreatitis aguda hemorrágica, como presentación clínica inicial de la rotura de un aneurisma de la arteria esplénica, con un segundo sangrado masivo a cavidad retroperitoneal, provocando un shock hipovolémico (AU)

Taquicardia nodal automática: signo de alarma detoxicidad digitálica grave / Nodal automatic tachycardia: warning sign of posible severe digital toxicity

No disponible

Fractura de ambas cabezas humerales por crisisde tetania hipocalcémica / Bilateral humerus head fracture in hypocalcemic tetanic crisis

No disponible

Fibrilación ventricular por fluosilicato de magnesio / Ventricular fibrillation due to magnesium fluosilicate

La fibrilación ventricular (FV) es la principal arritmia causante de muerte súbita cardíaca y representa un grave problema sociosanitario. En los últimos años se ha experimentado una cierta mejoría en el pronóstico de esta patología, debido principalmente a la preocupación de los países desarrollados en potenciar la accesibilidad en el medio extrahospitalario a equipos de desfibrilación precoz. La principal causa de FV es la isquemia cardíaca, aunque siempre debemos sospechar otros tipos de patologías (alteraciones iónicas, acidosis...). Presentamos un paciente que tras ingesta de un tóxico (fluosilicato de magnesio) desarrolla una hipocalcemia progresiva que le lleva, tras varias horas de evolución, a una parada cardiorrespiratoria por FV (AU)

[Distant metastases in patients with advance laryngeal carcinoma]. / Metástasis a distancia en pacientes con carcinoma de laringe avanzado.

Patients with advanced stage cancer larynx have a higher risk of development of distant metastases which means a bad prognosis. In our study we try to identify risk factors with the idea of involve to all of these patients in more aggressive systemic therapy protocols. Data of 57 patients surgically treated, with squamous pharyngolaryngeal carcinoma, stage III and IV, are evaluated. Advanced T stage or more extensive neck disease more often caused distant metastases (p < 0.05), and also the histological evidence of tumor invasion in three or more cervical nodes (p = 0.02), and poorly differentiated tumors (p < 0.05). Tumor site, surface area in cm, presence of ulceration, and loco-regional uncontrol were not associated with distant metastases.

Metástasis a distancia en pacientes con carcinoma de laringe avanzado / Distant metastases in patients with advance laringeal carcinoma

Los pacientes con carcinoma de laringe en estadios avanzados tienen un alto riesgo de desarrollar metástasis a distancia, lo cual ensombrece considerablemente el pronóstico. En nuestro estudio tratamos de identificar cuáles son los factores de riesgo y planteamos someter a este grupo de pacientes a un tratamiento sistémico más agresivo. Analizamos los datos de 57 pacientes con carcinoma escamoso faringolaríngeo en estadios III y IV, tratados quirúrgicamente. Encontramos que los estadios T avanzados y la afectación cervical ganglionar causan más metástasis (p<0,05), así como la invasión tumoral de 3 o más ganglios (p=0,002), y los tumores pobremente diferenciados (p<0,05). La localización tumoral, su extensión en cm, la presencia de ulceración y la falta de control locoregional no se asociaron con una mayor incidencia de metástasis (AU)

Patients with advanced stage cancer larynx have a higher risk of development of distant metastases which means a bad prognosis. In our study we try to identify risk factors with the idea of involve to all of these patients in more aggressive systemic therapy protocols. Data of 57 patients surgically treated, with squamous pharyngolaryngeal carcinoma, stage III and IV, are evaluated. Advanced T stage or more extensive neck disease more often caused distant metastases (p < 0.05), and also the histological evidence of tumor invasion in three or more cervical nodes (p = 0.02), and poorly differentiated tumors (p < 0.05). Tumor site, surface area in cm, presence of ulceration, and loco-regional uncontrol were not associated with distant metastases (AU)

Trombosis venosa profunda iliofemoral como diagnóstico diferencial en el abdomen agudo / Iliofemoral deep vein thrombosis as a differential diagnosis in acute abdomen

Tanto el dolor abdominal como la trombosis venosa profunda (TVP) de extremidades inferiores, son cuadros habituales en la práctica diaria de un Servicio de Urgencias. La TVP iliofemoral aislada es una entidad poco frecuente, encontrándose el trombo en esta localización en menos del 4 por ciento de los casos. Más infrecuente es que su forma de presentación sea un cuadro de dolor abdominal simulando un abdomen agudo. Entre los factores de riesgo de la TVP en pacientes jóvenes destacan los anticonceptivos orales (ACO). Presentamos un caso de TVP iliofemoral aislada en una paciente de 24 años tomadora de ACO, cuya expresión clínica inicial fue un dolor abdominal agudo (AU)

[Passive smoking and other risk factors associated to the lower respiratory illnesses in sucking infants]. / Tabaquismo pasivo y otros factores de riesgo en las afecciones respiratorias de vías bajas en los lactantes.

OBJECTIVES: We try to evaluate the frequency of lower respiratory illnesses (LRIs), during the first year of life and it's relation to other risk factors, overall passive smoking and modes of feeding. DESIGN: This is a retrospective study in our city. SETTING: Primary Health Care. PATIENTS AND OTHER PARTICIPANTS: The study population is 240 children during the first year of life, born in 1993 and we have collected clinical information about risk factors and LRIs number. MEASUREMENTS AND MAIN RESULTS: A 37% have suffered from at least one episode of LRIs, during the first year of life. The parental smoking appears in 46.6%. The incidence of LRIs was strongly associated with passive smoking (OR = 1.86), exclusive breast-feeding and at least for 5 months (OR = 2.1) and older brothers (OR = 3.12). The number of episodes of LRIs was statistically significative higher in males (males 0.82 +/- 1.67 episodes; females 0.48 +/- 0.67 episodes) (p = 0.0489). CONCLUSIONS: In our report, the risk factors more strongly related with LRIs in suckling infants are passive smoking, older brothers, male sex and less than 5 months of breast feeding.

[Acute otitis media in the first year of life and its relationship with various risk factors]. / Otitis media aguda durante el primer año de vida y su relación con algunos factores de riesgo.

OBJECTIVE: The purpose of the present study was to evaluate the frequency of acute otitis media (OMA) in our city (urban population) during the first year of life and its relationship to some risk factors. PATIENTS AND METHODS: This is a retrospective study of 240 children. We collected information about risk factors (sex, gestational age, birthweight, duration of breastfeeding, older siblings, parental smoking and nursery care). We related these to the number of OMA episodes during the first year of life. RESULTS: Of the infants studied 40% had suffered at least one episode of OMA during the first year of life. There was a higher incidence during winter and spring. Three out of every four episodes occurred after six months of age. The incidence of OMA was strongly associated to whether there were older siblings (odds ratio: 1.98) and to the male sex (odds ratio: 1.98). Children in the breastfed group (exclusive breastfeeding for at least 5 months) have less otitis episodes than the milk-adapted formula group, but the difference was not statistically different (0.41 +/- 0.68 vs 0.69 +/- 1.01 episodes; p = 0.11). CONCLUSIONS: In our report, the only risk factor strongly related with OMA in suckling infants are the presence of older siblings and the male sex. Breastfeeding did not have a protective effect in comparison to commercial formula, although a prospective study might be of interest for further addressing this issue.

[Medicosocial profile of the crucial caregiver. Is he/she an occult patient?]. / Perfil medicosocial del cuidador crucial. Se trata de un paciente oculto?

OBJECTIVE: To determine the prevalence of physical pathology (morbidity felt) and psychological unease (anxiety-depression) in crucial carers for disabled patients, and so establish a profile of them. DESIGN: An observational study. Analysis of two historical cohorts. SETTING: Primary care. Urban health centre. PATIENTS: The exposed cohort was made up of 54 carers for disabled patients, chosen at random from the records at our Centre. The non-exposed cohort (n = 54), matched for age, gender and educational level, was chosen at random from the consulting rooms. MEASUREMENTS AND MAIN RESULTS: By means of a questionnaire, descriptive variables were collected, i.e. the morbidity felt, consumption of medicine, psychological unease (Goldberg's anxiety-depression scale), perception of social support (modified Duke Unl), index of the effort of the carer (IEC) and the profile of the person being cared for. The "typical" carer was a 57-year old woman (CI 95: 54-61), with a low educational level, daughter or wife of the disabled person, who received external help in few cases (11%). Problems of health referred to by carers (Arthralgia, migraines, asthenia, feeling depressed and insomnia), are more frequent (p < 0.001) than in non-carers. 75% took some medication, as against 45% of non-carers (p < 0.001). 83% displayed anxiety and 63% depression, against 36 and 37%, respectively, in the non-exposed cohort. A high IEC implied greater risk of anxiety (p < 0.05) and depression (p < 0.001). CONCLUSIONS: The crucial carer has a greater prevalence of physical and psychological morbidity. A high IEC and a perception of low social support create the conditions for higher anxiety and depression. Caring for the carer needs to be integrated into care for the disabled patient.

[Is general screening for anemia and iron deficiency justified in nursing infants?]. / Está justificado el cribado generalizado de anemia y ferropenia en los lactantes?

OBJECTIVE: To establish the necessity of anemia and iron deficiency screening in breast-feeders in our environment. DESIGN: A crossover study, after data collection from case records. SETTING AND PATIENTS: 93 children of 18 and 24 months living in a urban area. All of them are included in the Healthy Breast-feeder Programme of the Health Center of Teruel city. INTERVENTIONS: Detection in venous blood of hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, transferrin saturation and ferritin in serum. MEASUREMENTS AND MAIN RESULTS: We founded a 1.1% of anemia with iron deficiency and a 3.4% of latent iron deficiency. We detected a total of 5.4% cases of iron deficiency. We didn't find any statistical significance when comparing the haematic values among children who had received different kinds of milk nor in relation with the time in which they got it. We didn't find either any differences when comparing such values among those who had received iron prophylaxis and those in which this treatment was not considered necessary. CONCLUSIONS: Therefore we suggest selective iron prophylaxis for risk groups and laboratory studies only in those with evident signs of anemia or iron deficiency.