Hemoperitoneo espontáneo masivo en paciente puérpera afecta de neurofibromatosis tipo 1 / Massive spontaneous haemoperitoneum in a post-partum patient with neurofibromatosis type 1

La neurofibromatosis tipo 1 o enfermedad de von Recklinghausen es una enfermedad genética, progresiva y multisistémica que afecta predominantemente a la piel y el sistema nervioso. La alteración vascular es poco frecuente pero puede tener resultados catastróficos. Las pacientes gestantes afectas de esta enfermedad necesitan un seguimiento exhaustivo y multidisciplinar con el objetivo de controlar las posibles alteraciones vasculares sobre todo renales por ser las más frecuentes. Presentamos el caso de una paciente diagnosticada de NF-1 que presentó un hemoperitoneo masivo espontáneo en el postoperatorio tardío de una cesárea electiva. El sangrado espontáneo de grandes vasos es una rara pero potencial complicación letal que puede producirse en pacientes afectos de neurofibromatosis I y que puede precisar de tratamiento quirúrgico urgente

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment

Massive spontaneous haemoperitoneum in a post-partum patient with neurofibromatosis type 1. / Hemoperitoneo espontáneo masivo en paciente puérpera afecta de neurofibromatosis tipo 1.

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a genetic, progressive, multi-system disease that predominantly affects the skin and nervous system. Vascular involvement is rare, but can have catastrophic results. Pregnant patients with this disease need careful, multidisciplinary follow up in order to control possible vascular alterations, which usually affect the kidneys. We present the case of a patient diagnosed with NF-1 who debuted with massive spontaneous hemoperitoneum in the late postoperative period of an elective Cesarean section. Spontaneous bleeding from large vessels is a rare but potentially lethal complication that can occur in patients with NF-1, and may require urgent surgical treatment.

Estudio naturalístico: 100 episodios de agitación psicomotriz consecutivos en urgencias psiquiátricas / A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department

Introducción. La agitación psicomotriz es una situación frecuente en urgencias de psiquiatría con una prevalencia aproximada del 10 %. No hay un consenso total respecto a su manejo; benzodiazepinas, antipsicóticos típicos y, más recientemente, los atípicos han demostrado una eficacia similar. El objetivo del presente estudio es describir las características epidemiológicas y el manejo clínico de los pacientes agitados en la práctica clínica en un servicio de urgencias psiquiátricas.Métodos. Estudio naturalístico de los episodios de agitación psicomotriz recogidos consecutivamente en un servicio de urgencias psiquiátricas. Se recogieron variables demográficas, clínicas y terapéuticas. Las variables de eficacia fueron determinadas mediante la escala Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) y la Agitation-Calmness Evaluation Scale (ACES). Se analizaron variables pragmáticas como la necesidad de sucesivas intervenciones farmacológicas o la necesidad de contención física.Resultados. Fueron incluidos 100 episodios de agitación psicomotriz. La edad media fue de 36,2 años y el 54% eran mujeres. Los diagnósticos más frecuentes fueron de trastorno psicótico (48 %) y de trastorno de la personalidad (24 %). El 39 % requirió contención física y el 52 % aceptó el tratamiento por vía oral. El haloperidol fue el fármaco más utilizado por vía oral y la olanzapina por vía intramuscular.Conclusiones. Una aproximación naturalística permite obtener datos de la práctica real en los servicios de urgencias psiquiátricas. Los estrictos diseños de investigación de los ensayos clínicos de eficacia implican sesgos de selección de la muestra y se suelen alejar de la realidad clínica. Los antipsicóticos atípicos se están convirtiendo en fármacos de primera línea en el tratamiento de la agitación

Introduction. Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in «real-life» in a psychiatric emergency service. Methods. A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. Results. The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. Conclusions. A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

[A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]. / Estudio naturalístico: 100 episodios de agitación psicomotriz consecutivos en urgencias psiquiátricas.

INTRODUCTION: Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service. METHODS: A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. RESULTS: The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. CONCLUSIONS: A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

The use of N-succinyl derivatives in the study of amino acids and peptides by mass spectrometry.

The terminal amino group of amino acids and peptides is blocked as the N-succinyl derivative by reaction with succinic anhydride. The product is then converted to the N,O-permethyl derivative in order to increase its volatility for use in mass spectrometry. The permethylated N-succinyl derivative retains the advantages of the permethylated N-acetyl derivative in regard to ease of preparation on a small scale, volatility and the presence of characteristic fragmentation patterns in their mass spectra. However, peaks in the high mass region are more abundant due to loss of CH3O-from the N-succinyl carbomethoxyl group as well as from the C-terminal carbomethoxyl group. Ions characteristic of the sequence and of individual amino acids are observed, and molecular weight can be determined from the relatively abundant ion at [M--CH3O]+ and from the weak molecular ion.