Alteración de la actividad de la butirilcolinesterasa en pacientes con enfermedad de Alzheimer tratados con inhibidores de la acetylcolinesterasa / Changes in butyrylcholinesterase activity in patients with Alzheimer disease treated with acetylcholinesterase inhibitors

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Pruebas de coagulación en el tratamiento con drotrecogina alfa activada. ¿Representan los valores obtenidos la realidad clínica? / Coagulation tests during treatment with drotrecogin alpha (activated): Do results reflect the clinical situation?

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[Extrapulmonary tuberculosis in a patient with septic shock]. / Tuberculosis extrapulmonar en un paciente con shock séptico.

A 61-year-old woman who was negative for type 1 human immunodeficiency virus developed vertebral osteomyelitis and skin lesions due to sepsis by Staphylococcus aureus. Microscopic examination of the skin showed alcohol-resistant acid-fast bacilli. A polymerase chain reaction (PCR) assay for Mycobacterium tuberculosis was positive for skin and spinal samples, although the cultures were negative. The diagnosis of M. tuberculosis infection is difficult, particularly when the disease is extrapulmonary. Rapid diagnostic tests that use PCR identify the DNA of the bacillus with greater sensitivity than microscopic examination and can give results within 24 hours of receipt of a sample. We analyze the utility of PCR for diagnosing extrapulmonary tuberculosis.

Tuberculosis extrapulmonar en un paciente con shock séptico / Extrapulmonary tuberculosis in a patient with toxic shock

Una mujer de 61 años, seronegativa para la infección por el virus de la inmunodeficiencia humana tipo 1, desarrolló una osteomielitis vertebral y lesiones cutáneas después de una sepsis por Staphylococcus aureus. La microscopía de la biopsia de la piel mostró bacilos ácido alcohol-resistentes y la técnica de la reacción de la cadena de la polimerasa (PCR) para Mycobacterium tuberculosis fue positiva en las muestras cutánea y vertebral, pero el cultivo fue negativo. El diagnóstico de infección por Mycobacterium tuberculosis es difícil, sobre todo en los casos de tuberculosis extrapulmonar. Los test de diagnóstico rápido como la PCR, identifican el DNA de M. tuberculosis con más sensibilidad que la microscopía y ofrecen el resultado en las 24 horas de recibida la muestra en el laboratorio. Se analiza el valor de la PCR en el diagnóstico de tuberculosis extrapulmonar (AU)

[Intracranial diffusion. A complication of retrobulbar anesthesia]. / Difusión intracraneal. Una complicación de la anestesia retrobulbar.

Retrobulbar anesthesia is considered a safe, effective local-regional technique for ocular surgery. However, local complications that can arise from needle trauma during injection, include retrobulbar hemorrhage, perforation of the ocular globe and occlusion of the artery and/or the central vein of the retina. Systemic complications, such as respiratory arrest, convulsions and cardiovascular collapse, have also been reported, and although they only occur in less than 1% of cases, they are potentially life threatening. We report two cases of intracranial diffusion after retrobulbar anesthesia and describe possible mechanisms that may contribute to its development.

[Propofol in continuous infusion for performing nuclear magnetic resonance in children: an effective alternative to sedation with other drugs]. / Propofol en infusión continua para la realización de resonancia nuclear magnética en niños: una alternativa eficaz a la sedación con otros fármacos.

Sedation is often needed for obtaining nuclear magnetic resonance (NMR) images in children. The aim of this study was to evaluate the efficacy of propofol administered by continuous infusion to non-intubated children for whom our hospital's usual method of sedation (oral chlorohydrate 75 mg/kg at a maximum dose of 2 g plus 4 hours sleep privation the night before) had failed. Deep sedation was induced in 37 ASA I-II children aged 4 and 14 year old, with 2.5 mg/kg propofol followed by 6 mg/kg/h in continuous infusion. An additional dose of 1 mg/kg was administered if the child moved, and the perfusion was reduced to 4 mg/kg if SpO2 fell below 95%. Apnea occurred after induction in 24% (n = 9), 29% (n = 11) required additional doses of propofol, and a tendency to hypercapnia was observed as the imaging procedure progressed. Sedation failed in one child, who required general anesthesia when opisthotonos presented after the induction dose. Awakening was early and satisfactory in all patients, with a score of 2 on the Ramsay scale 15 minutes after NMR. Deep sedation with propofol is a safe and effective method of performing NMR in a child for whom other methods of sedation have failed, provided the child is ASA I-II, monitoring is exhaustive and procedure is carried out by an anesthesiologist.