Thallium poisoning presenting with abdominal colic, paresthesia, and irritability.

A case of acute thallium poisoning presenting with sudden abdominal pain, paraesthesiae and irritability is described. The peripheral nervous system was later affected along with loss of hair and the development of streaks (Mee's lines) on the nails of the hands and feet. The diagnosis was established by thallium assays of blood and urine. Thallium was undetectable in the blood by day 70. The manifestations cleared in six months with symptomatic treatment only. We review the characteristics and differential diagnosis of thallium poisoning and stress the importance of a high index of clinical suspicion.

Clinical significance of anaerobic bacteremias in a general hospital. A prospective study from 1988 to 1992.

A prospective study was designed to investigate anaerobic bacteremias and evaluate their incidence and significance in a general hospital. One or more blood cultures positive for anaerobic microorganisms were analyzed from each of a total of 61 patients hospitalized between January 1988 and April 1992, in accordance with an established protocol. The clinical repercussions of bacteremia were also analyzed. Two percent of blood cultures were positive for anaerobes, with an incidence of 0.6 cases per 1000 hospitalized patients. The most frequently isolated anaerobes were Bacteroides fragilis and Clostridium perfringens. Intraabdominal disease was the route of entry in 50% of the patients. A death rate of 37.3% was mostly attributed to B. fragilis. Hospitalization in the surgical department, nosocomial acquisition, previous surgery, critical initial clinical status and the presence of complications were significantly associated with increased death rates. No significant differences were found in the clinical course between patients whose antibiotic treatment was judged adequate and those for whom it was considered inadequate. The frequency and incidence of anaerobic bacteremia was low in our hospital. The well-known clinical and epidemiological characteristics of these infections facilitates their prompt diagnosis and empirical treatment with antibiotics of proven effectiveness against anaerobes.

[Subglottal stenosis as the initial manifestation in Wegener's disease]. / Estenosis subglótica como primera manifestación de la enfermedad de Wegener.

A 21-year-old man with 3-month history of hoarseness and dyspnea was suspected to have Wegener's granulomatosis with initially appearing in the trachea. In spite of unspecific biopsies, the clinicopathological picture and the high titles of anticytoplasmic autoantibodies (ACPA) confirmed the diagnosis. The early treatment with cyclophosphamide impeded the evolution to graver systemic forms of the disease.