Neumomediastino espontáneo de repetición secundario al síndrome de hiperémesis por cannabis / Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome

El síndrome de hiperémesis por cannabis (SHC) es poco conocido entre los clínicos y se caracteriza por dolor abdominal y vómitos cíclicos, tras un consumo intensivo de cannabis durante años, que no responde al tratamiento con antieméticos pero sí a las duchas de agua muy caliente. Presentamos el caso de un paciente de 24 años, con antecedentes de consumo de cannabis desde los 14 años y un episodio de neumomediastino (NMD), etiquetado como idiopático, el mes anterior, que presentó asociación entre SHC y neumomediastino secundario a los intensos vómitos repetidos del SHC. Se le administró capsaicina tópica y 5 mg de haloperidol endovenoso, permaneciendo 48 h en la Unidad de Corta Estancia de Urgencias. Esta observación clínica aislada podría indicar la necesidad de descartar el SHC como causa de NMD en sujetos jóvenes y, de la misma manera, considerar la presencia de NMD en la exploración clínica de pacientes jóvenes con SHC o en pacientes con patologías en cuya etiología pueda influir el aumento de presión intratorácica

Cannabinoid hyperemesis syndrome (CHS) is little known amongst clinicians and is characterised by abdominal pain and cyclical vomiting, after intense consumption of cannabis over several years. It does not respond to treatment with antiemetics, but does respond to showers in very hot water. We present the case of a 24-year-old patient whose antecedents included cannabis consumption since the age of 14 and an episode of spontaneous idiopathic pneumomediastinum (PM) the previous month, which presented an association of CHS and secondary pneumomediastinum with the intense, repeated vomiting of the CHS. He was given topical capsaicin and 5 mg of intravenous haloperidol, and was kept for 48 hours in the Emergency Short Stay Unit. This isolated clinical observation appears to indicate the need to rule out CHS as the cause of PM in young patients and, similarly, to consider the presence of PM in the clinical exploration of young people with CHS and in patients with pathologies whose aetiology might be influenced by an increase in intrathoracic pressure

[Spontaneuos pneumomediastinum secondary to cannabinoid hyperemesis syndrome]. / Neumomediastino espontáneo de repetición secundario al síndrome.

Cannabinoid hyperemesis syndrome (CHS) is little known amongst clinicians and is characterised by abdominal pain and cyclical vomiting, after intense consumption of cannabis over several years. It does not respond to treatment with antiemetics, but does respond to showers in very hot water. We present the case of a 24-year-old patient whose antecedents included cannabis consumption since the age of 14 and an episode of spontaneous idiopathic pneumomediastinum (PM) the previous month, which presented an association of CHS and secondary pneumomediastinum with the intense, repeated vomiting of the CHS. He was given topical capsaicin and 5 mg of intravenous haloperidol, and was kept for 48 hours in the in A and E Short Stay Unit. This isolated clinical observation appears to indicate the need to rule out CHS as the cause of PM in young patients and, similarly, to consider the presence of PM in the clinical exploration of young people with CHS and in patients with pathologies whose aetiology might be influenced by an increase in intrathoracic pressure.

Comparative tuberculin reactivity to two protein derivatives.

OBJECTIVE: To evaluate the tuberculin reactivity among medical students and the utility of RT-23 (2 tuberculin unit [TU] purified protein derivative [PPD]) produced in Mexico. DESIGN: A blind and comparative study was conducted in a school of medicine using simultaneously RT-23 and an American product (5 TU PPD) randomly assigned to each forearm and read 48 hours later. Ninety eight volunteers were included, 69 from the first year and 29 from the fifth year as medical students. RESULTS: Using 5 TU PPD, 16% of first year students and 41% of fifth grade students were positive (induration > or = 10 mm). The RT-23 worked well and showed a sensitivity of 87% and a specificity of 92%. There was a large difference in the positivity of fifth versus first year students (x2 = 6.00, P = 0.014) with an estimated annual conversion of 5.1%. The high tuberculin conversion rate urges the need to establish preventive and early diagnosis programs for tuberculosis. The utility of RT-23 was found to be comparable to 5 TU PPD in our population.

[Unjustified disposal of transfusion blood because of antibodies against brucella]. / Desecho injustificado de sangre de transfusión por anticuerpos contra Brucella.

OBJECTIVES: To compare the slide microagglutination (SMA) test vs a gold standard test (tube agglutination test: SAT) for the detection of Brucella antibodies in order to evaluate the usefulness of SMA to discard transfusion blood units. DESIGN: Prospective, comparative, cross sectional survey. SETTING: City of Leon, State of Guanajuato, an endemic zone of brucellosis. SAMPLES: 48 sera from blood units discarded for transfusion by three blood banks due to Brucella antibodies detected by SMA and 48 controls of accepted units. METHODS: Determination of Brucella antibodies with the SMA and SAT tests. RESULTS: The 48 control samples were negative with both tests; of the 48 discarded samples, in only seven sera we confirmed a titer > or = 1:80 by SAT; thus, 41 blood units (85%) may have been improperly rejected because the only test used by the blood banks was the SMA. In our hands, the SMA showed a sensitivity and negative predictive value of 100%, a specificity of 81%, and positive predictive value of 29%. CONCLUSIONS: There was a high proportion of improper rejection of blood units for transfusion; Brucella antibodies at any titer detected by SMA should be followed by SAT testing.

Pediatric primary gram-negative nosocomial bacteremia: a possible relationship with infusate contamination.

OBJECTIVE: To evaluate the potential contribution of "extrinsic" contamination of intravenous fluids in hospital bacteremia and infection. DESIGN: Prospective cross-sectional survey of infusate contamination, December 1992 to December 1993. SETTING: A pediatric department (1,500 admissions per year) in a general, urban teaching hospital, serving low-income patients. SAMPLES AND PATIENTS: Infusate samples (0.5 to 1.0 mL) from the injection port used by the staff were taken for cultures from all febrile or septic patients in hospital wards. At least four samples were taken each day; if no febrile or septic patients were available, other patients were sampled at convenience. RESULTS: A 6.8% positive culture rate (87 contaminates in 1,277 infusates) was obtained, without significant differences among the wards. Gram-negative organisms were recovered from 56 samples (62.9%), mainly of the tribe Klebsielleae (56.1%). Coagulase-negative staphylococci were isolated in 30 samples (33.7%). There was no significant difference between the febrile-septic group and the asymptomatic group in the rate of infusate contamination (P = .59). In eight patients, the same organisms were recovered from infusate and blood culture. The overall bacteremia rate was 2.5 per 100 discharges. CONCLUSIONS: Compared to previous reports, higher infusate contamination rates and different organisms (mainly gram-negative) were observed. In hospitals of underdeveloped countries, nosocomial infection control frequently is disregarded. Infusate contamination may be common and could lead to gram-negative bacteremia. In such settings, it seems advisable to perform surveillance studies to identify infusate contamination, because a single infusate contamination could be a signal for an epidemic.

[Pediatric nosocomial bacteremia. Potential usefulness of culturing infusion liquids]. / Bacteriemia nosocomial pediátrica. Utilidad potencial del cultivo de los líquidos de infusión.

Hospital-acquired bacteremia is a common cause of morbidity and mortality, mainly in pediatric units. In a 25 month retrospective study, we analyzed the blood cultures from the Hospital General Regional of the city of Leon, Guanajuato State, Mexico, in order to establish the causal agents of nosocomial bacteremia and infer some associations with contaminated intravenous infusion fluids. In addition we performed a two month study to culture the flasks and intravenous tubing used in our infusions. Five hundred and fifty one blood cultures drawn from August 1990 to September 1992 were analyzed. A total of 135 (24.5%) were positive, most of them (51.8%) with strains of the Klebsielleae tribe (SKT) (Klebsiella, Enterobacter, Serratia). The global incidence of bacteremia in the two year period was 4.3%. In the infusion study, 230 intravenous fluids were cultured, with 68 isolates (30%) most from the SKT tribe. A final consideration is made on the role that inadequate management of intravenous liquids could play in the development of endemic and epidemic nosocomial bacteremia in our hospital, and the eventual utility of making cultures of the i.v. liquids.