Management of methomyl poisoning.

Eleven patients who suffered methomyl poisoning were admitted to the intensive care unit. All of them showed cholinergic symptoms similar to that produced by organophosphate insecticides but of lesser intensity. Plasma cholinesterase activity was normal in four patients and moderately lower in the remainder (always above 32%). All of the patients showed miosis and none presented with bradycardia. No complications were detected in the acute stage or on further examination a month later. The treatment applied was: (1) gastric lavage or washing the skin; (2) the administration of activated charcoal; (3) small doses of atropine according to symptoms (average of total dose 4.3 mg). All of the patients recovered within 24-48 h. In conclusion, we can assume that methomyl poisoning does not produce serious complications if moderate surveillance is assumed. Only small doses of atropine are required to counteract symptoms.

[Experience with a protocol of systematic postfibrinolysis angioplasty in acute myocardial infarct]. / Experiencia con un protocolo de angioplastia sistemática posfibrinólisis en el infarto agudo de miocardio.

Two hundred twenty one patients admitted for AMI in the CCU, and treated with systemic thrombolysis with streptokinase have been retrospectively analysed and divided in two groups: the first 98 patients (group A) were included in a research protocol: The following 123 patients (group B) represent the clinical application of thrombolytic therapy in our unit. In group A coronary arteriography in the first 48 hours (84 patients), and PTCA to the infarct related artery with significant stenosis (39 patients) were performed systematically. In group B, 54 patients had coronary arteriography PTCA was restricted to 12 patients with symptomatic ischemia. No significant differences in base line clinical parameters were detected between groups A and B. Total hospital mortality was 5% and similar in both groups. Reinfarction rate was greater in group A, 13% than in group B, 5%, but not significantly different. Reinfarction was related to PTCA (chi 2 test p less than 0.05). The incidence of post infarction angina was related to the existence of more than one diseased vessel. These data suggest that protocol PTCA post thrombolysis is not effective in reducing post infarction ischemia or mortality.

[The importance of thrombin and its inhibition in unstable angina. Nonfractionated heparin, hirudin and defractionated heparins]. / Importancia de la trombina y su inhibición en la angina inestable. Heparina no fraccionada, hirudinas y heparinas fraccionadas.

Atheroma plaque rupture with liberation of tissue factor activates the coagulation cascade and plateletes, leading to the formation of intracoronary thrombi in many patients with acute coronary syndromes. In this process, tissue factor, thrombin, Factor Xa and fibrin play a major role. This review analyses the clinical efficacy of the antithrombotic drugs: fractionated heparin, low molecular or fractionated heparins, direct thrombin inhibitors, specific Xa factor inhibitors and inhibitors of the tissue factor pathway in patients with unstable angina and non-Q wave myocardial infarction. Enoxaparin, a low molecular weight fractionated heparin, has shown to be associated with a greater clinical efficacy, superior to that achieved with conventional heparin anticoagulation or treatment with aspirin, and probably should be considered as the antithrombotic of choice. Present clinical research should be aimed at the identification of patients with greater benefit, new treatment protocols with other antithrombotic drugs and the efficacy in special situations such as invasive coronary interventions or the association with other drug like, thrombolytic agents or new antiplatelet antiaggregants.

[LDL apheresis using a double filtration technique. Results after a 6-to-12 month follow-up in patients with refractory hyperlipemia and ischemic heart disease]. / LDL-aféresis con método de doble filtración. Resultados obtenidos en el seguimiento a 6 y 12 meses en 5 pacientes con hiperlipemia refracteria y cardiopatía isquémica.

METHODS: Five patients with a family history of hypercholesterolemia were treated for one year with double filtered technique of LDL-apheresis: heterozygotic in four patient and homozygotic in one. All patients presented documented cardiovascular disease and had been treated unsuccessfully with lipid lowering drugs. RESULTS: Plasmatic cholesterol was significantly reduced from 463.8 +/- 60.9 mg/dl to 326.36 +/- 36 mg/dl at 6 months after treatment and 347.56 +/- 68.1 mg/dl at 12 months (p < 0.05). LDL was also reduced from 407.92 +/- 69.39 mg/dl to 294.04 +/- 62.02 mg/dl and 296.6 +/- 82.42 mg/dl respectively (p < 0.05) and Apo B was reduced from 291.84 +/- 28.97 mg/dl to 224.5 +/- 47.11 mg/dl at 6 and 12 months respectively, without significant modifications of other lipidic parameters and without adverse events. CONCLUSIONS: LDL-apheresis is a therapeutic approach effective in the reduction of total plasmatic cholesterol, in conjunction with to LDL and APO B in patients refractory to lipid lowering agents.

[Longitudinal dissociation of the bundle of His and infra-His block]. / Disociación longitudinal del haz de His y bloqueo infrahisiano.

A case with advanced supra-His block and escape pacemaker at the proximal His block with longitudinal dissociation of the bundle of His is presented. These alterations caused a complete left bundle branch block and prolonged HV interval obtaining the normalization of the QRS after distal His extrasystole. We comment on the differential diagnosis between first degree intra-His and infra-His blocks.