Lidocaína endovenosa domiciliaria en cuidados paliativos / Domiciliary endovenous lidocaine treatment in palliative care patients

Introducción:El dolor neuropático es, en numerosas ocasiones, un dolor de difícil manejo que precisa la combinación de diferentes grupos terapéuticos para su control óptimo.Método:La lidocaína es un anestésico local y su uso endovenoso es necesario ocasionalmente para el tratamiento del dolor neuropático; no hay experiencia en su uso domiciliario.Resultados:Realizamos la infusión endovenosa domiciliaria con lidocaína en 2 pacientes con dolor neuropático refractario con mejoría clínica.Conclusiones:La infusión de lidocaína endovenosa en domicilio es una técnica segura y eficaz en pacientes con dolor neuropático. (AU)

Introduction:Neuropathic pain is a often difficult to control pain and is suitable of different therapeutic approaches.Method:Lidocaine is a local anesthesic and its endovenous use is sometimes necessary to control neuropathic pain. There is no reported use of this drug at home.Results:We performed the lidocaine endovenous infusion in two patients with neuropathic pain achieving significant clinical improvement.Conclusions:Endovenous lidocaine infusion at home, is a safe and effective proceeding for patients with neuropathic pain. (AU)

COVID-19 en pacientes en cuidados paliativos: primeros resultados en un hospital comarcal / COVID-19 in palliative care patients: fi rst results in a county hospital

La infección por SARS-CoV-2 es una realidad emergente y urgente. No hay apenas datos sobre la afección en los pacientes en cuidados paliativos por esta infección

SARS-CoV-2 infection is an emergent and urgent reality. Hardly any data are available regarding the condition of patients on palliative care because of this infection

Conspiración de silencio: diferencias en la información al anciano frente al paciente joven / Conspiracy of silence: differences in the information provided to older versus younger patients

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Neoplasia primaria múltiple. Estudio de casos en cuidados paliativos / Multiple primary neoplasm. A cases study in palliative care

El término neoplasia primaria múltiple define a la presencia de dos o más procesos neoplásicos de distinto origen simultáneamente. Existe poca información de los pacientes en cuidados paliativos con esta patología. Presentamos una serie de 10 casos seguidos en nuestra unidad

The term multiple primary neoplasm is defined as the occurrence of two or more neoplastic processes of different origin that develop simultaneously. Information is sparse regarding patients with this condition in the palliative care setting. We report herein a series of 10 consecutive cases seen in our unit

Compensación química y adicción a opioides: a propósito de los excedentes domiciliarios de opiáceos en cuidados paliativos / Chemical compensation and opioid addiction: the point of opioid household surpluses in palliative care

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Metástasis cutáneas y estado de salud percibido / Skin metastasis and perceived quality of life

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Complicaciones focales en salmonelosis, 13 casos entre los años 1996 y 2002 en Galicia, España / Focal complications in salmonelosis: 13 cases among 1996 - 2002 in Galicia, Spain

El género salmonella incluye enterobacterias responsables de numerosos casos de patología infecciosa. Las complicaciones focales son poco frecuentes. Se realizó el estudio retrospectivo entre los años 1996 y 2002 de los casos diagnosticados en el Hospital Clínico de Santiago de Compostela, España. Se diagnosticaron 153 casos como infección por salmonella, de los que 13 (8,5%) presentaron complicaciones. Las edades incluidas fueron entre 17 y 80 años, con una mediana de 37 años, de los que nueve casos (69%) eran hombres y en 7 (54%) no existían factores de riesgo asociados. En 12 pacientes (93%) existía antecedente de gastroenteritis. Los diagnósticos se realizaron por coprocultivo (5 casos), en 6 pacientes (46%) por hemocultivo, en otros 3 casos ambos fueron positivos. Las complicaciones incluyeron absceso esplénico, neumonía, endocarditis, endarteritis, sepsis, hepatitis y artritis reactiva. No existió un claro predominio estacional. El antibiótico pautado fue en 8 pacientes (64%) ciprofloxacino; tres pacientes fueron intervenidos. Dos pacientes fallecieron. En esta serie de casos se concluyó que la prevalencia y morbimortalidad de complicaciones, es elevada. La presentación más habitual es sepsis (4 casos), neumonía (3 casos) y absceso esplénico (2 casos), frente a la osteomuscular o partes blandas (1 caso). Se detectó bacteriemia en un porcentaje elevado de los casos...

Genus salmonella includes enterobacteriaes responsible of a great amount of infectious diseases. Focal complications are not frecuent. We conducted a 5 retrospective study between 1996 and 2002. We included 153 cases with salmonella infection, 13 of which (8, 5%) with ages between 17 and 80 years (median 37) presented focal complications. Nine of the patients were male (69%) and in 7 cases (54%) risk factors were present, 12 (93%) presented previously gastroenteric signs. Microbiological diagnosis established through stool examination (5 cases), in 6 (46%) with blood culture, in other 3 cases, both were positive. Complications included splenic abscess, pneumonia,endocarditis, endarteritis, sepsis, hepatitis and reactive arthritis. No clear seasonal pattern was established. Eight patients (64%) received ciprofloxacin. Three patients were surgically treated. Two patients died. Conclusion: In our series prevalence and morbimortality in focal complications is high. The most common presentation was sepsis (4 cases), pneumonia (3) and splenic abscess (2). Bacteraemia was documented in a high percentage of cases. No seasonal pattern was established...

[Hiccup: review of 24 cases]. / Hipo (singultus): revisión de 24 casos.

BACKGROUND: Although common and usually benign, hiccups can be an extremely uncomfortable disease. There is not much information about persistent and refractory hiccups. AIM: To report clinical features of patients admitted in a hospital due to hiccup. PATIENTS AND METHODS: A retrospective study and prospective follow up of patients admitted for hiccup in Hospital Clínico de Santiago de Compostela between January 1998 and May 2005. RESULTS: Twenty four patients (age 47 to 91 years, 23 males) were studied. Nineteen (79%) were admitted because of persistent hiccups. In twenty one patients, at inverted exclamation markeast one organic etiology was identified, and thirteen patients presented two or more possible associated conditions. The most common possible causes were digestive tract disorders, followed by central nervous system diseases. Twelve patients had a history of exposure to drugs that potentially could cause hiccups, mainly corticosteroids and benzodiazepines. Chlorpromazine was the first choice treatment in 23 patients, but seven required a second line drug. Average hospital stay was 13 days (range 3-90 days). Twelve patients died during follow up. Death occurred during the first three months of follow up in 61%. CONCLUSIONS: Persistent hiccup is often associated with organic conditions, specially advanced tumors of the digestive tract. It is usually associated with a bad prognosis.

Permanent transvenous pacemaker infections: An analysis of 59 cases.

BACKGROUND: Pacemaker infection is a severe process affecting 1-7% of implants. Pulse generator pocket infection is most common. Endocarditis in patients with pacemakers is quite rare. Clinical signs include systemic-related symptoms and severe complications in as many as 40% of cases. The aim of our study was to review our experience and to analyze the epidemiology and treatment of those patients diagnosed as having pacemaker lead endocarditis. METHODS: A retrospective study included all patients diagnosed as having pacemaker endocarditis in our hospital from 1996 to 2002. RESULTS: Fifty-nine patients with pacemaker-related infection were identified, including 39 (66%) with pocket infection. Fever occurred in 25 patients (42%). In 39 patients, a germ was isolated, corresponding to Staphylococcus spp. in 22 (56%). Transthoracic echocardiography demonstrated vegetations in 7 patients (12%), whereas transesophageal echocardiography disclosed abnormal appearances on the pacemaker lead in 10 patients (17%). Ten patients were treated exclusively with antibiotics, while 38 patients required the removal of all infected material. Two patients died. CONCLUSIONS: The diagnosis of endocarditis related to pacemaker infection should be suspected in the presence of fever. High morbidity and mortality are associated with this disease. Prompt treatment, including in some cases removal of the device, is mandatory.

Old Pathogens and old drugs

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[HIV infection in patients aged 50 years or older in the HAART era]. / Infección por VIH en pacientes mayores de 50 años en la etapa TARGA.

There is little information on patients 50 years or older with HIV infection since the start of the HAART era. We performed a descriptive cross-sectional study during 2004 including 28 patients aged 52 to 87 years. Eighteen patients were men (64%) and sexual transmission was the risk factor in 23 (81%). Four patients (14%) fulfilled slow progression criteria and 13 (46%) belonged to the C3 category. Twenty-four patients were on HAART, with optimal adherence. All the patients were receiving HIV-unrelated medications to treat comorbid conditions. Hence, the profile of these patients is as follows: mainly male with sexually transmitted infection, severe immunodeficiency at the diagnosis, and frequent comorbid processes.