Loxoscelismo cutáneo / Cutaneous loxoscelism

El loxoscelismo es un cuadro tóxico producido por el veneno que inoculan con su mordedura las arañas del género Loxosceles (“arañas pardas”o “del rincón”). Dicho cuadro puede presentarse bajo dos formas clínicas: loxoscelismo cutáneo y loxoscelismo cutáneo- visceral. En España se encuentra la especie Loxosceles rufescens a la que se le han atribuido dos casos de loxoscelismo cutáneo pero ninguno cutáneo-visceral, mucho más grave y potencialmente mortal. El loxoscelismo cutáneo se inicia con prurito, posteriormente dolor intenso y evolución a una forma edematosa, de mejor pronóstico, o a una necrosante, como el caso que exponemos a continuación, que evolucionó a gangrena seca y requirió de la amputación de un dedo. El diagnóstico es eminentemente clínico. El tratamiento consiste en analgésicos, antihistamínicos, corticoides sistémicos, antibióticos de amplio espectro y dapsona en casos graves. La administración del suero antiloxosceles no se recomienda en nuestro país (AU)

Loxoscelism is a toxic disease produced by the poison inoculated through the bite of a spider belonging to the gender Loxosceles ("brown spider" or "corner spider"). This clinical condition may appear under two different clinical forms: cutaneous loxoscelism and viscerocutaneous loxoscelism. In Spain, the species Loxosceles rufescens has been involved in two cases of cutaneous loxoscelism but not in cases of viscerocutaneous loxoscelism, a much more severe and potentially fatal disease. The cutaneous loxoscelism begins with a burning and stinging sensation, which changes gradually either to an edematous form with intense pain and edema, with better prognosis, or to a more severe form with necrosis, as occurred in the present case, which finally developed dry gangrene and required the amputation of a finger. Usually, the diagnosis is clinical. The treatment includes analgesic and antihistaminic drugs, steroid medication, broad-spectrum antibiotics and dapsone in some of the more severe. The administration of the serum antivenin is not recommended in our country (AU)

[Design and evaluation of an educational course for mothers of pregnant adolescents]. / Diseño y evaluación de un curso educativo dirigido a madres de adolescentes embarazadas.

This article is the continuation of a previous investigation about educational necessities in perinatal health of pregnant adolescent mothers. Now we present the design and evaluation of an Educational Course for that group. The theoretical mark of the Course corresponds to the education of adults, under the focus of the grupal learning. The content included gineco obstetrics topics, prevention of perinatal risks and the analysis of the social and cultural enviroment. As evaluation instrument, a self-applicable questionnaire of thirteen open questions was built on four aspects: family dynamics, utility of the course, utility of the information and behavior of the pregnant adolescents. A sample of 101 mothers of pregnant adolescents participated of the study from January 1999 to May 2000. The results indicate that the family dynamics was modified favorably in 88% of the cases soon after the attendance of mothers like adolescents to their respective courses, although some factors related with the father show a lack of commitment about the family situation. The 100% of the mothers considered important the attendance to the course because it is an educational instrument, so much for pregnant daughters as for themselves. The Course propitiated the exchange of preventive information between them in 87% of the cases. 97% of the mothers informed changes in their daughter's attitudes soon after her attendance to the course.

[Aspergillus endocarditis. Report of a case treated surgically with success]. / Endocarditis por aspergillus. Informe de un caso tratado quirúrgicamente con éxito.

A 42 year old man without history of rheumatic heart disease was admitted to the hospital with severe aortic insufficiency and heart failure. There were no clinical data of an infectious disease. The bidimensional echocardiogram showed vegetations involving the aortic valve leaflets. With the diagnosis of acute aortic insufficiency caused by infective endocarditis the patient was submitted to surgery. During surgery the existence of endocarditis secondary to a mycotic agent was demonstrated. The fungus was latter identified as aspergillus fumigatus. The postoperative course was uneventful. The good results obtained in this case confirm recent reports advising an urgent surgical approach of cases of infective endocarditis secondary to mycotic agents, and support the view that echocardiography may be a valuable tool in the diagnosis of this entity.

Endocarditis por aspergillus. Informe de un caso tratado quirurgicamente con exito. / Aspergillus endocarditis. Report of a case surgically treated with success

Se informa el caso de un paciente del sexo masculino de 42 anos de edad, quien sufrio endocarditis de la valvula aortica producida por aspergillus fumigatus. La forma de presentacion fue una insuficiencia aortica severa e insuficiencia cardiaca. El cuadro clinico no mostro las manifestaciones habituales de endocarditis y el diagnostico se sospecho ante la presencia de insuficiencia aortica aguda, confirmandose despues con ecocardiografia y cultivo del tejido valvular extirpado.Se manejo quirurgicamente en forma temprana con resultados satisfactorios. Un ano despues de la cirugia se mantenia asintomatico y en clase funcional I. Los resultados obtenidos en este enfermo, apoyan lo expresado en la literatura en cuanto a que la endocarditis por hongos debe manejarse quirurgicamente en forma temprana, especialmente ante el descubrimiento ecocardiografico de vegetaciones de gran tamano