Los antídotos en su lucha contra las intoxicaciones: a propósito de una intoxicación aguda por arsénico / No disponible

El arsénico es un metal que se encuentra ampliamente distribuido por la naturaleza. Actualmente la mayoría de las intoxicaciones, tanto agudas como crónicas, se ven en el medio laboral, pudiendo darse casos de intoxicación no industrial, a partir de la contaminación de productos domésticos o alimenticios por desechos industriales con arsénico o sus derivados. Sin embargo son excepcionales las intoxicaciones suicidas como el caso que nosotros describimos u homicidas por vía digestiva. En estos casos el tratamiento antídoto, basado en la reactividad química que poseen los agentes quelantes para formar complejos atóxicos e hidrosolubles que se eliminan por la orina, es vital para poder evitar las graves consecuencias incluso letales de dicha intoxicación aguda(AU)

Arsenic is a metal that is widely distributed in nature. Nowadays, most of the poisonings, both acute and chronic, can be seen in the work environment, with some cases of non-industrial contamination reported, caused by contamination of domestic or food products from industrial wastes containing arsenic or its derivatives. Even though, cases of self-poisoning via the digestive tract like the one we describe, or homicide, are exceptional. In these cases, antidotes based on the chemical reactivity owned by the chelating agents to form a non-toxic and water-soluble complex that can be eliminated in urine, are vital to avoid serious or even lethal consequences caused by acute poisoning(AU)

Coma mixedematoso en una herniorrafia urgente / No disponible

No disponible

Tratamietno de coagulopatía secundaria a la cirugía de un aneurisma esplénico roto / Treatment of a coagulopathysecondary to surgery for a rupture splenic aneurysm

Introducción. La rotura de los aneurismas de arteria esplénica produce una hemorragia masiva abdominal con una mortalidad de hasta el 75%. Con frecuencia, agrava la hemorragia una coagulopatía de etiología multifactorial. Caso clínico. Mujer de 40 años que acudió al hospital por dolor abdominal agudo e hipotensión. En la ecografía había un importante hemoperitoneo. En el quirófano, la arteria esplçenica presentaba un aneurisma roto de 3 cm de diámetro, que se excluyó mediante ligadura. A pesar del control de la hemorragia masiva y las múltiples transfusiones intraoperatorias, persistía un sangrado difuso que no tenía origen en un vaso principal. Se atribuyó a una coagulopatía secundaria y se trató mediante un packing abdominal, con compresas y repetida inyección intravenosa del factor VII recombinante activado. Al segundo día se reintervino para retirar el packing y no se detectó un sangrado activo. Se le dio el alta domiciliaria a los 43 días. Conclusión. La rotura de los aneurismas de arteria esplénica se asocia frequentemente con una coagulopatía multifactorial, cuyo tratamiento puede requerir medidas hemostáticas extraordinarias. En este caso, la realización de un packing abdominal y la administración de factores activadores de la cascada de coagulación permitieron controlas satisfactoriamente esta complicación

Introduction. The rupture of splenic artery aneurysms gives rise to a massive abdominal hamorrhage with a mortality rate of up to 75%. The haemorrhage is often exacerbated by a coagulopathy with a multifactorial aetiology. Case report. A 40-year-old woman who went to hospital with acute abdominal pain and hypotension. Ultrasound imaging showed an important hemoperitoneum. In the operating theatre, the splenic cartery presented a ruptured aneurysm with a diameter of 3 cm, which was excluded by means of ligation. Despite controlling the massive haemorrhage and the numerous transfusion that the patient was given during the operation, there was still some diffuse bleeding that did not have its origin in a major vessel. It was attributed to a secondary coagulopathy and was treated by abdominal packing, with absorbent pads and repeated intravenous injections of activated recombinant factor VII. On the second day, a new operation was performed to remove the packing and no active bleeding was detected. After 43 days in hospital the patient returned home. Conclusions. Rupture of splenic artery aneuryms is often associated with a multifactorial coagulopathy, which may require extraordinary haemostatic measures to treat it. In this case, carrying out abdominal packing and administering factors to activate the clotting cascade made it possible to control this complication satisfactorily

Lineage-specific chimaerism quantification after T-cell depleted peripheral blood stem cell transplantation.

Patients that receive a T-cell depleted (TCD) hematopoietic stem cell transplantation (SCT) show higher risk of graft failure/rejection and of disease relapse than those that receive unmanipulated grafts. The purpose of the present investigation was to analyze the usefulness of chimaerism quantification in bone marrow (BM), peripheral blood (PB), and leukocyte lineages such as T lymphocytes (CD3+,both CD4+ and CD8+), B lymphocytes (CD19+) and myeloid cells (CD15+), for the early detection of graft failure/rejection episodes and disease relapse after TCD-PBSCT. Two of the ten (2/10) patients included in the study showed stable complete chimaerism (CC). The other 8/10 patients showed decreasing mixed chimaerism (MC) and 7 of them had either graft failure (n = 1)/rejection (n = 3) or disease relapse (n = 3). In two patients relapsed from chronic myeloid leukemia, MC was observed in BM and PB, with higher percentages of autologous cells in BM, as well as in leukocyte lineages, with higher percentages of recipient cells in the myeloid lineage than in lymphocytes. Combined analysis of chimaerism and minimal residual disease allowed early diagnosis of relapse and successful rescue therapy with donor leukocyte infusions (DLI), before the onset of hematological relapse. Chimaerism analysis allowed early diagnosis of incipient graft rejection in 3 patients. These patients showed MC both in BM and PB, with greater percentages of recipient cells in PB. Analysis of leukocyte lineages showed higher percentages of autologous cells in T lymphocytes (mainly CD8+) than in B or myeloid cells. Two of these patients were successfully treated with DLI and recovered normal PB counts and BM cellularity, as well as CC. The graft versus recipient hemopoiesis effect harbored by the donor immunocompetent cells infused seems useful forthe treatment of graft rejection, provided that an early diagnosis is made.