[Confirmed and suspected digoxin intoxications]. / Intoxicaciones digitálicas sospechadas y corfimadas.

AIMS: To quantify and analyze suspected and actual digoxin intoxications. METHOD: A drug-use study has been carried out of digoxinaemia requests and results in patients treated chronically with digoxin. RESULTS: Digoxin intoxication (presence of symptoms and typical signs) was suspected in 31.3% of the patients. The percentage analytically confirmed intoxications (digoxinaemia >2 ng/mL) was 16.6%. Sex, age, and dosage had no significant effect in the suspicion or confirmation of digoxin intoxication. Hospitalization and the association of hypokalaemic drugs or those increasing digoxinaemia had no effect in the suspicion of digoxin intoxication. In analytically confirmed intoxications, no significant differences were found between suspected and non-suspected cases. CONCLUSIONS: The suspicion of this intoxications is not usually related with digoxin serum levels, and thus, the toxic limit is imprecise.

Análisis clínico de 91 casos de vasculitis de mediano y pequeño vaso en adultos / Clinical analysis of 91 adults with medium and small sized vessel vasculitis

Fundamento: Analizar las diferencias clínicas y biológicas de las vasculitis de mediano y pequeño vaso. Pacientes y métodos: Estudio descriptivo retrospectivo de 91 casos de vasculitis atendidos en nuestro hospital entre enero de 1991 a marzo de 2001. Se describen las características clínicas y analíticas. Resultados: El 57 por ciento eran varones y la edad media fue de 61,9 ñ 18,6 años (mínima de 17 y máxima de 90). Los síntomas y afectación orgánica fueron: púrpura palpable (89 por ciento), fiebre (36 por ciento), astenia (20 por ciento), artromialgias (19 por ciento), afectación renal (18 por ciento), artritis (16 por ciento), dolor abdominal (16 por ciento), neuropatía (8,7 por ciento), afectación pulmonar (6,5 por ciento). El 24 por ciento mostró varios brotes, clínica prolongada o cronificación del proceso. El 42 por ciento mostró afectación de dos o más órganos o sistemas. Los pacientes con vasculitis consideradas pauci-inmunitarias mostraron mayor astenia (p<0,001), afectación renal y pulmonar (p<0,001 y p<0,01; respectivamente), afectación multiorgánica (p<0,001) y mortalidad relacionada con el proceso (p<0,05). No se encontraron diferencias significativas con respecto al resto de la clínica analizada. Conclusiones: Aunque existe un importante solapamiento clínico entre los distintos tipos de vasculitis, la presencia o ausencia de ciertos datos clínicos y biológicos son de ayuda en la diferenciación y caracterización de las distintas entidades (AU)

Objective: To evaluate the clinical and biological differences between medium sized vessel vasculitis and small vessel vasculitis. Patients and methods: descriptive and retrospective study of 91 patients with vasculitis attended in our hospital from January 1991 to mars 2001. We describe the characteristics of clinical and analytic features. Results: 57% were males. The mean age was 61.9±18.6 years (17 to 90 years). The symptoms and affected organs were: palpable purpura (89%), fever (36%), asthenia (20%), arthromyalgias (19%), nephropaty (18%), arthritis (16%), abdominal pain (16%), neuropathy (8,7%), pulmonary involvement (6,5%). 25% had several episodes, lasting clinical, chronic disease. 42% had evidence of two or more involve organs. The patients with pauci-inmune vasculitis presented more asthenia, nephritis, pulmonary involvement, multi-organic involvement and mortality related to the process. We did not found significant differences respect to the others clinical manifestations analysed. Conclusions: There is a substantial overlap among different vasculitis, the presence or absence of some clinical and biological features can help in the differentiation and characterization of the different entitles (AU)

Intoxicaciones digitálicas sospechadas y confirmadas / Confirmed and suspected digoxin intoxications

Objetivos: Cuantificar y analizar loas intoxicaciones digitálicas y sus sospechas. Método: Se ha realizado un estudio de utilización de medicamentos sobre las peticiones de digoxinemia y los resultados obtenidos en pacientes tratados crónicamente con digoxina. Resultados: Se sospechó intoxicación digitálica (presencia de síntomas y signos propios de la misma) en el 31,3 por ciento de los pacientes y se confirmó analíticamente (digoxinemia > 2 ng/mL) en el 16,6 por ciento. El sexo, la edad y la dosis no influyeron significativamente en la sospecha ni en la confirmación de la intoxicación digitálica. Sí influyeron en las sospechas de intoxicación digitálica, la hospitalización y la asociación de fármacos hipokalemiantes o que eleven la digoxinemia. En las intoxicaciones confirmadas analíticamente no se encontraron diferencias significativas entre las sospechadas y las no sospechadas. Conclusiones: La sospecha de esta intoxicación no suele relacionarse con los niveles plasmáticos de digoxina y, por tanto, su límite tóxico es impreciso. (AU)

Anaphylactic shock following povidone.

OBJECTIVE: To report a patient with an anaphylactic reaction related to povidone administration. CASE SUMMARY: A 37-year-old man with a history of allergic rhinitis presented with urticaria, dyspnea, wheezing, rhinorrhea, and dysphonia 20 minutes after the intraarticular administration of mepivacaine hydrochloride and paramethasone acetate in his right knee. Two months after this episode, he was admitted for controlled provocation tests. Tests on mepivacaine were negative. The preparation of paramethasone contained the excipients benzalkonium chloride, polysorbate 80, and povidone. In vitro tests and provocation were negative with polysorbate 80 and benzalkonium chloride, but positive with povidone. DISCUSSION: Povidone, a mixture of synthetic polymers, is commonly used as an excipient in pharmaceutical products, an additive in food products, and a dispersant and stabilizer in hairsprays. Although it is well tolerated when used topically or parenterally, local and systemic effects have been reported. Furthermore, multiorgan involvement resulting from accumulation of the drug in the reticuloendothelial system has been described. The immunologic properties of povidone have not been explored in humans, but have been in animals. In fact, the capacity of povidone to release histamine and its immunogenicity are proportional to its molecular weight. An immunoglobulin (Ig) E-mediated hypersensitivity reaction in asthma has been reported. In our case, povidone was responsible for the syndrome. However, we cannot determine the exact mechanism. An unspecific histamine release and/or an IgE-mediated hypersensitivity could be involved. CONCLUSIONS: Povidone was responsible for a severe anaphylactic reaction in our patient. The possibility of an iatrogenic adverse effect caused by the excipient but not by the active ingredient should be considered in patients exhibiting similar symptoms. We believe that the excipients used in the preparation of all medicines should be disclosed.