Absorción sistémica de tacrolimus tópico en enfermedad de Crohn metastásica con úlceras cutáneas / Systemic absorption of topical tacrolimus in metastatic Crohn disease with skin ulcers

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Probable interaction between trazodone and carbamazepine.

The need to maintain long-term treatment of chronic pathologies makes the appearance of interactions possible when such therapies incorporate other drugs to deal with the aggravation of the same or other intercurrent pathologies. A case is presented in which the addition of trazodone to a chronic treatment with carbamazepine (CBZ) is associated with symptoms typical for intoxication by this antiepileptic, accompanied by a raised serum concentration. When the trazodone was suspended, these symptoms lessened and the concentration of CBZ decreased progressively, suggesting a probable interaction between the 2 drugs.

[Sacral root neuromodulation as treatment for fecal incontinence. Preliminary results]. / Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal. Resultados preliminares.

We present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compared to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 +/- 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 +/- 2.54 (p = 0.0031), and 75.01% of patients could delay defecation above fifteen minutes (p = 0.0018). We also describe the surgical technique and its indications, and finally review the various therapeutical options for FI and show our algorithm for this condition. SRN is an effective technique for the treatment of FI in properly selected patients with no response to medical therapies (including biofeedback) or anatomic correction (sphincteroplasty), with efficacy, little morbidity, and a short hospital stay.

Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

INTRODUCTION: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

[Treatment of proctalgia fugax with botulinum toxin: results in 5 patients]. / Tratamiento de la proctalgia fugax con toxina botulínica: resultados en 5 pacientes.

INTRODUCTION: Proctalgia fugax can be defined as transitory but recurrent anal pain. Although its etiology remains unknown, an internal anal sphincter spasm seems to be the most likely, so that the different treatments focus on reducing the pressure of the internal anal sphincter. This study is aimed at evaluating the effectiveness of botulinum A toxin in the treatment of proctalgia fugax. PATIENTS AND METHODS: Prospective clinical trial of patients with proctalgia fugax treated with botulinum A toxin at the Outpatient Clinic attached to the Coloproctogy Unit, University Hospital of Elche, from January 1999 to January 2002. The patients included in the study underwent rectal digital examination, anuscopy, rectoscopy, anal manometry and ultrasonography, barium enema and pelvic CT scan to rule out any organic cause for anal pain. The treatment consisted of 25 IU of botulinum A toxin, with a supplementary dose of 50 IU in those patients with persistence of anal pain episodes within the next two months. The patients were reviewed on the first week, second month, sixth month and first and second year. Anal pain was measured by the patients, using a linear analogue scale from 0 to 10, and continence was assessed at every visit using the Cleveland Continence Grading Scale. RESULTS: Five patients were recluted for the study, with a predominance of females (4 vs. 1). Mean age was 45 years. Length of symptoms prior to the treatment was 13 months (range: 6-18 months). Only one female patient required a second dose of botulinum A toxin to handle the anal pain. All the patients healed and remained free of pain up to finishing the follow-up. There were no local complications. Anal manometry showed an increased MRP (mean resting pressure) in comparison to a control group of patients (114 mmHg vs. 66 mmHg; p < 0.001) that restore to normal values after the treatment (75.65 mmHg). As for the MSP (mean squeeze pressure), it showed no difference with respect to the control group nor did it vary after the treatment. CONCLUSION: Botulinum A toxin offers a high rate of healing with no associate morbidity in the treatment of proctalgia fugax.

Útero gigante / Giant uterus

Presentamos el caso clínico de una mujer de43 años con aumento del perímetro abdominalde un año de evolución. El volumen del abdomenfue notorio en los últimos meses adquiriendouna consistencia dura y acompañándosede pérdida de 10kgr. de peso. Ante tal tumoraciónabdominal gigante y con sospecha de probableorigen mesentérico, sin poder definir origenni naturaleza, se decidió extirpación quirúrgicadel tumor, encontrando una gran tumoraciónabdominal dependiente de útero, tratándosede un útero gigante de 5.250 kilogramoscon un único mioma

We report on the case of a 43-year-old female;;patient who complained of progressive increase;;in abdominal perimeter during the last year,;;along with weight loss of approximately 10 kg.;;On clinical examination there was abdominal;;tenderness. CT scan revealed a great abdominal;;mass, apparently spawning from the mesenterium.;;At surgery, the tumor was found to stem;;from the uterus, and weightened 5.25 kgr. The;;histopathological report informed of myoma

Esfinterotomía lateral interna abierta con anestesia local como gold standard en el tratamiento de la fisura anal crónica. Estudio prospectivo clínico y manométrico a largo plazo / No disponible

Introducción: la fisura anal crónica sigue siendo uno de los problemas proctológicos más frecuentes e incapacitantes en la población occidental actual. La esfinterotomía lateral interna abierta es una de las opciones terapéuticas descritas y aceptadas como tratamiento de elección de la fisura anal crónica, ya que reduce la hipertonía esfinteriana (mecanismo etiopatogénico fundamental de la fisura), permitiendo por tanto, disminuir la proctalgia y así la curación de la fisura. Material y métodos: realizamos un estudio prospectivo de 120 pacientes intervenidos por fisura anal crónica con esfinterotomía lateral interna abierta con anestesia local (20 cc mepivacaína al 2%) tratados ambulatoriamente en la consulta de la Unidad de Proctología entre los años 1998-2001. No se requirió estudios preoperatorios, preparación con enemas, profilaxis antibiótica, accesos venosos, ingreso ni observación hospitalaria. Los pacientes fueron revisados a la 1a semana, 2o mes, 6o mes y al año. Resultados: complicaciones precoces (1a semana): 3 hematoma-equimosis de la herida (2,5%), 3 hemorragias autolimitadas (2,5%). No encontramos trombosis hemorroidales, fístulas, abscesos perianales ni mortalidad. Complicaciones tardías (2o mes): 9 pacientes con incontinencia (7,5%) y 3 pacientes (2,5%) con recurrencia de la fisura. Al 6o mes, la incontinencia disminuyó al 5% (6 pacientes), y aparecieron 3 pacientes más con recurren- cia de la fisura (2,5%). Al año se mantuvo la tasa de incontinencia del 5% (a gases y líquidos) y aparecieron otros 3 pacientes con recurrencia de la fisura (2,5%). Recurrencia global del 7,5%. Los hallazgos en la manometría fueron, PMB (presión máxima basal) pre-tratamiento similar a la PMB en pacientes con recurren- cia de la fisura, así como la PMB del grupo control similar a la PMB de pacientes con curación. La PMB en pacientes incontinentes fue más baja que la PMB en pacientes continentes (55 ± 7 frente a 80,7 ± 21). La diferencia entre la PMCV (presión máxima de contracción voluntaria) en pacientes incontinentes y pacientes continentes no fue estadísticamente significativa. Conclusiones: la esfinterotomía lateral interna abierta con anestesia local tiene una tasa de curación a largo plazo y unos índices de morbilidad equiparables a otras técnicas, por lo que puede ser considerada como un tratamiento adecuado y eficaz para esta patología (AU)

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Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures. A prospective clinical and manometric study.

BACKGROUND: Chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures), decreases anal pain, and allows the fissure to heal. MATERIAL AND METHODS: We carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. RESULTS: Early complications: 3 hematoma-ecchymosis of the wound (2.5%), 3 self-limited hemorrhage events (2.5%). No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5%) within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP) in incontinent patients was lower than in continent patients (55 +/- 7 mmHg versus 80.7 +/- 21 mmHg). The difference in mean squeeze pressure (MSP) between incontinent patients and continent patients was not statistically significant. CONCLUSIONS: Open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.

[Calculating how long phenytoin intoxication lasts]. / Cálculo de la duración de una intoxicación por fenitoína.

INTRODUCTION: We report a case of intoxication with phenytoin (DPH), in which the actual time required for it to disappear was compared with that estimated using linear regression. CASE REPORT: A 23-year-old female with tonic-clonic seizures, receiving chronic therapy with DPH 300 mg/day. The patient came to hospital because of tremors, balance disorders, vomiting and headaches. Neurologically, she presented horizontal nystagmus in the two extreme gazes, generalised hyperreflexia and ataxic gait. Cranial CAT scan and cerebrospinal fluid were both normal. Serum concentration of DPH was found to be 60.2 mg/L. When DPH concentration is >8-10 mg/L, its rate of elimination diminishes disproportionately and the risk of toxicity increases. Use of mathematical methods makes it possible to calculate the time required for a toxic concentration to come down to therapeutic values. In our patient the DPH took 204 hours to drop below the toxic level (20 mg/L), whereas by using a linear regression with only two different concentrations a figure of 155 hours was obtained. CONCLUSIONS: The method employed here can be useful as a quick, simple and easily applicable way of estimating the time a toxic concentration of DPH takes to return to a normal level.

[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)

Cálculo de la duración de una intoxicación por fenitoína / Calculating how long phenytoin intoxication lasts

Introducción. Se presenta una intoxicación por fenitoína (DPH), en la que se comparó el tiempo real que transcurrió hasta su desaparición con el estimado mediante una regresión lineal. Caso clínico. Mujer de 23 años, con crisis tonicoclónicas, en tratamiento crónico con 300 mg/día de DPH. Acudió al hospital por temblor, trastornos del equilibrio, vómitos y cefalea. Neurológicamente, presentaba nistagmo horizontal en ambas miradas extremas, hiperreflexia generalizada y marcha atáxica. La TAC craneal y la analítica de líquido cefalorraquídeo fueron normales. La concentración sérica de DPH era de 60,2 mg/L. Cuando la concentración de DPH es superior a 8-10 mg/L, su eliminación disminuye desproporcionadamente y aumenta el riesgo de toxicidad. Mediante métodos matemáticos se puede calcular el tiempo necesario para que una concentración tóxica disminuya hasta los valores terapéuticos. En nuestra paciente transcurrieron 204 horas hasta que la DPH se situó por debajo del límite tóxico (20 mg/L), mientras que con el empleo de una regresión lineal con sólo dos concentraciones diferentes se obtuvo una cifra de 155 horas. Conclusiones. El método utilizado puede servir como una aproximación sencilla, rápida y de fácil aplicación para estimar el tiempo que una concentración tóxica de DPH tarda en volver a la normalidad Introducción. Se presenta una intoxicación por fenitoína (DPH), en la que se comparó el tiempo real que transcurrió hasta su desaparición con el estimado mediante una regresión lineal. Caso clínico. Mujer de 23 años, con crisis tonicoclónicas, en tratamiento crónico con 300 mg/día de DPH. Acudió al hospital por temblor, trastornos del equilibrio, vómitos y cefalea. Neurológicamente, presentaba nistagmo horizontal en ambas miradas extremas, hiperreflexia generalizada y marcha atáxica. La TAC craneal y la analítica de líquido cefalorraquídeo fueron normales. La concentración sérica de DPH era de 60,2 mg/L. Cuando la concentración de DPH es superior a 8-10 mg/L, su eliminación disminuye desproporcionadamente y aumenta el riesgo de toxicidad. Mediante métodos matemáticos se puede calcular el tiempo necesario para que una concentración tóxica disminuya hasta los valores terapéuticos. En nuestra paciente transcurrieron 204 horas hasta que la DPH se situó por debajo del límite tóxico (20 mg/L), mientras que con el empleo de una regresión lineal con sólo dos concentraciones diferentes se obtuvo una cifra de 155 horas. Conclusiones. El método utilizado puede servir como una aproximación sencilla, rápida y de fácil aplicación para estimar el tiempo que una concentración tóxica de DPH tarda en volver a la normalidad (AU)

Introduction. We report a case of intoxication with phenytoin (DPH), in which the actual time required for it to disappear was compared with that estimated using linear regression. Case report. A 23-year-old female with tonic-clonic seizures, receiving chronic therapy with DPH 300 mg/day. The patient came to hospital because of tremors, balance disorders, vomiting and headaches. Neurologically, she presented horizontal nystagmus in the two extreme gazes, generalised hyperreflexia and ataxic gait. Cranial CAT scan and cerebrospinal fluid were both normal. Serum concentration of DPH was found to be 60.2 mg/L. When DPH concentration is > 8-10 mg/L, its rate of elimination diminishes disproportionately and the risk of toxicity increases. Use of mathematical methods makes it possible to calculate the time required for a toxic concentration to come down to therapeutic values. In our patient the DPH took 204 hours to drop below the toxic level (20 mg/L), whereas by using a linear regression with only two different concentrations a figure of 155 hours was obtained. Conclusions. The method employed here can be useful as a quick, simple and easily applicable way of estimating the time a toxic concentration of DPH takes to return to a normal level (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)

[Can treatment associated with ticlopidine and nifedipine increase serum levels of phenobarbital?]. / ¿Puede el tratamiento asociado con ticlopidina y nifedipina aumentar los niveles séricos de fenobarbital?

INTRODUCTION: We report a case in which the association between ticlopidine, nifedipine and phenobarbital was linked with a higher than expected phenobarbital concentration in serum, which suggested a possible interaction between these drugs. CASE REPORT: A 67 year old male who received treatment with phenobarbital, digoxin, nifedipine, ticlopidine, paroxetine and clorazepate dipotassium. The first control of the level of phenobarbital in serum was performed without any symptoms or signs of toxicity or ineffectiveness. A phenobarbital concentration in serum of 21.4 mg/L was obtained, with a serum level/dosage ratio of 16.7. DISCUSSION: The serum level/dosage ratio of phenobarbital that was found in this case is almost twice as high as expected. In the absence of other factors that can explain this finding, we believe that two drugs (ticlopidine and nifedipine) may be involved in an interaction with phenobarbital. CONCLUSIONS: The high value of the serum level/dosage ratio that was found makes it advisable to monitor the concentrations of phenobarbital in serum in treatment associated with ticlopidine or nifedipine, especially when adjusting the dosage, beginning or ending treatment with these drugs.

¿Puede el tratamiento asociado con ticlopidina y nifedipina aumentar los niveles séricos de fenobarbital? / Can treatment associated with ticlopidine and nifedipine increase serum levels of phenobarbital?

Introducción. Describimos un caso en que la asociación de ticlopidina, nifedipina y fenobarbital se asoció con una concentración sérica de fenobarbital mayor que la previsible, que sugirió una posible interacción entre estos fármacos. Caso clínico. Varón de 67 años en tratamiento con fenobarbital, digoxina, nifedipina, ticlopidina, paroxetina y cloracepato dipotásico. Se realizó el primer control del nivel sérico de fenobarbital, sin ningún síntoma o signo de toxicidad o ineficacia. Se obtuvo una concentración sérica de fenobarbital de 21,4 mg/L, con un índice nivel sérico/dosis de 16,7. Discusión. El índice nivel sérico/dosis de fenobarbital que se encontró en este caso es casi el doble que el previsible. En ausencia de otros factores que puedan explicar este resultado, creemos que dos fármacos (ticlopidina y nifedipina) pueden estar implicados en una interacción con fenobarbital. Conclusiones. El alto valor del índice nivel sérico/dosis que se encontró hace aconsejable monitorizar las concentraciones séricas de fenobarbital en el tratamiento asociado con ticlopidina o nifedipina, especialmente al ajustar las dosis, iniciar o suspender el tratamiento con estos fármacos (AU)

Introduction. We report a case in which the association between ticlopidine, nifedipine and phenobarbital was linked with a higher than expected phenobarbital concentration in serum, which suggested a possible interaction between these drugs. Case report. A 67-year-old male who received treatment with phenobarbital, digoxin, nifedipine, ticlopidine, paroxetine and clorazepate dipotassium. The first control of the level of phenobarbital in serum was performed without any symptoms or signs of toxicity or ineffectiveness. A phenobarbital concentration in serum of 21.4 mg/L was obtained, with a serum level/dosage ratio of 16.7. Discussion. The serum level/dosage ratio of phenobarbital that was found in this case is almost twice as high as expected. In the absence of other factors that can explain this finding, we believe that two drugs (ticlopidine and nifedipine) may be involved in an interaction with phenobarbital. Conclusions. The high value of the serum level/dosage ratio that was found makes it advisable to monitor the concentrations of phenobarbital in serum in treatment associated with ticlopidine or nifedipine, especially when adjusting the dosage, beginning or ending treatment with these drugs (AU)

Estudio de utilización de la profilaxis tromboembólica venosa en cirugía de cadera / Study of the use of venous thromboembolic prophylaxis in hip surgery

Objetivo. Cuantificar la profilaxis tromboembólica en la cirugía de cadera y determinar su calidad. Diseño experimental. Estudio retrospectivo de utilización de medicamentos, del tipo indicación-prescripción. Las variables principales fueron: realización o no de tromboprofilaxis, tipo de la misma (fármaco, dosis y tiempo) y cualidad (correcta, incorrecta y dudosa).Resultados. La profilaxis tromboembólica se indicó en el 91,3 por ciento de los pacientes (p < 0,05). Los fármacos utilizados más frecuentemente fueron las heparinas de bajo peso molecular (p < 0,001). La calidad de la profilaxis fue incorrecta en el 63,3 por ciento (p < 0,001), dudosa en el 28,3 por ciento y correcta en el 8,4 por ciento. Conclusiones. Los cirujanos ortopédicos conocen la indicación de tromboprofilaxis en los pacientes operados de cadera y la prescriben, aunque no siguen unánimemente las recomendaciones aceptadas internacionalmente para su realización (AU)

[Possible gabapentin phenytoin interaction]. / Posible interacción gabapentina fenitoína.

INTRODUCTION: We report a possible case of gabapentin induced phenytoin toxicity. CASE REPORT: White man, 26 years old, chronically treated with phenytoin (for the past 4 years) and gabapentin (for the past 17 months). He was seen after complaining of dysarthria, ataxia and vertigo for the past 3 months, although having noted slight dizziness and a general, though undefined, indisposition from the start of taking gabapentin. The total and free serum levels of phenytoin found were clearly toxic. Gabapentin was discontinued definitively, and phenytoin for the next 7 days. The clinical symptoms had disappeared completely and phenytoin returned to within therapeutic levels. According to the criteria of causation it can be considered a possible adverse reaction caused by phenytoin related to incorporation of gabapentin. The mechanisms of this possible drug interaction are discussed, with emphasis on cytochrome P450 metabolism. CONCLUSION: The present case is a warning of the possible interaction of a drug (gabapentin) not contemplated when starting or when monitoring an antiepileptic treatment.

Posible interacción gabapentina-fenitoína / Possible gabapentin-phenytoin interaction

Introducción. Se presenta un caso de toxicidad por fenitoína posiblemente inducida por gabapentina. Caso clínico. Varón de raza blanca, 26 años, en tratamiento crónico con fenitoína (desde cuatro años antes) y gabapentina (desde hace 17 meses), que acude a la consulta por un cuadro de disartria, ataxia y vértigo desde hacía tres meses, aunque notaba mareos ligeros y malestar general impreciso desde que comenzó a tomar gabapentina. Los niveles séricos de fenitoína total y libre fueron claramente tóxicos. Se suspendió definitivamente la gabapentina y, durante siete días, la fenitoína. Los síntomas clínicos que motivaron la consulta desaparecieron completamente y los niveles de fenitoína disminuyeron hasta valores incluidos dentro del intervalo terapéutico. En relación a la causalidad de esta intoxicación, se puede considerar una posible reacción adversa causada por fenitoína relacionada con la asociación de gabapentina al tratamiento. Se discuten los mecanismos implicados en esta posible interacción, con énfasis en el metabolismo por el citocromo P450. Conclusiones. El presente caso alerta sobre la posible interacción de un fármaco, la gabapentina, en la cual no se piensa cuando se instaura o se hace el seguimiento de un tratamiento antiepiléptico (AU)

[Thromboembolism prevention in acute myocardial infarction]. / Profilaxis tromboembólica en infarto agudo de miocardio.

The objectives were to identify risk factors for vein thromboembolic disease (VTD) among patients with acute myocardial infarction (AMI) and to analyse both quantitatively and qualitatively the performed thromboembolic prophylaxis. A cross-sectional study was carried out with all inpatients at the Coronary Unit at our hospital during 1998. The risk factors for thromboembolism included: inmobilization (79.2%), heart failure (33.2%) and age over 70 years (31%). VTD prophylaxis was performed in 86.9% of the time. Non-fractioned heparin (NFH) and low molecular weight heparins (LMWH), mostly nadroparine, were the most commonly used drugs at admission and at discharge, respectively. Overdosage and underdosage for NFH and LMWH, respectively, were observed. That patients received or not VTD prophylaxis was not influenced by thromboembolic risk factors.