Anales De Medicina Interna最新文献

Objective: VEIA study is an evolutional registry of acute poisonings (AP) attended in the Emergency Room of the Doce de Octubre Hospital in Madrid (Spain) in a whole year (1979, 1985, 1990, 1994,1997 and 2000). We present the 2004 study and compare the results with the previous years.

Methods and results: Methodology has been identical across VEIA STUDY. Of 1508 AP, 610 are suicide attempts (IAVIS), 319 ethylic, (IAVE), and 218 by illicit drugs (IAVD). Of the 2,259 toxics involved, 48% are medications (50% benzodiacepines) alcohol 25% and illicit drugs 13%.

Conclusions: There is an important increase (34%) of cases and the incidence surpasses all published in our country. There are no gender differences nor in the whole neither the Health Area Census, but there are differences in IAVIS, IAVE and IAVD. IAVIS increase in 35%. Benzodiacepines poisoning increases two-fold as well as antidepressive drugs do in women. In men also increase, but in a minor extent. Acetaminophen remains the same in 23%. NSAID's, adjuvants and myorelaxants increase in women as do also alcohol and other poisons that almost equal men's. There are 13 cases of IAVIS in patients with alimentary disorders. Among men, a quarter are illicit drug abusers. In IAVE, the group without alcoholism grows and the total decreases. Illicit drugs duplicate the number of the former year. Cocaine supposes already 2/3 of the cases, MDMA ascends to 22 cases and they appear new substances as glue, without doubt as an effect of immigration and ketamine. Finally 205 household accidents and 57 industrial injuries complete the series.

Malnutrition increases post surgical morbimortality, hospital stance and economical costs. Possibilities of nutritional intervention in surgical patients are important. Early enteral nutrition is better than total parenteral nutrition in patients under surgery. Periroperaoty nutritional support must be administrated to patients with severe or middle undernutrition and will be under surgery, during 7-14 days before surgical intervention, if this intervention could be delayed. Total parenteral nutrition will be not used regularly in patients under mayor digestive surgical procedures. Inmunonutrition has been demonstrated useful in surgical patients. Evidence demonstrates that inmunotritional formulas decrease incidence of infections, hospital stance and time of ventilation in patients in UCI wards. New research areas have been explored in this topic area, carbohydrate utility in presurgical patients and probiotic in enteral formulas.

Necrotizing fascitiis due to Streptococcus Pyogenes has a high mortality rate. Detection of the infection before it developes to the streptococcal toxic shock syndrome is quite challenging and its one of the main goals of its management because at this final stage the treatment is in most of the cases ineffective. In a secuence of events of the progression of the infection to shock, renal failure occurs before hipotension very often. We report the case of a 38-year-old patient affected by a fulminant necrotizing fascitiis by Streptococcus Pyogenes which presented at admission with lower leg cellulitis and acute renal failure.

Objective: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital.

Methods: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly.

Results: 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus.

Conclusions: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.

The optic neuromyelitis or syndrome of Devic is an inflammatory and autoimmune illness of the central nervous system. It is characterized by attacks of optic neuritis and myelitis, being able to produce blindness, great neurological disability and even the short term death. Until the moment an effective treatment doesn't exist, the therapy is centred in the treatment of the acute attacks, the medical prevention of the complications and the rehabilitation. This article is a revision of this not very common illness, considering that its prevalence in our country has gone in increase. We compare between the optic neuromyelitis and the multiple sclerosis, being based on the main ones characteristic clinical-epidemic that distinguishes these two pathologies, considered by many clinical variants of oneself illness.

Suppurative thrombophlebitisis a very infrequent complication of the central venous catheterization. The majority of the cases are produced by species of staphylococci. A 22-year-old colombian-woman, student, without toxic habits was admitted because of temporary left astrocytoma (grade II). Nine days after implementing a catheter in the right subclavian vein she presented high fever (39.5 degrees C), shivers, progressive right side neck swelling and odinofagia. She had leukocytosis (26,300 cells/microl) and normal cerebrospinal fluid. After withdrawing the catheter, Staphylococcus aureus was isolated in the tip of the catheter and in four bottles of blood cultures. A neck CT demonstrated expansion and absence of contrast in the right internal jugular vein. The patient evolved satisfactorily with cloxacillin, gentamycin and low molecular weight heparin.