Brucellar spinal epidural abscess of cervical location: report of four cases.

Spinal epidural abscesses account for 1 or 2 of every 10,000 hospital admissions, Staphylococcus aureus being the bacterium most frequently involved. Brucellosis is a disorder of worldwide distribution, relatively frequent in South America and in Mediterranean countries in Europe and Africa. Whilst in the USA only 200 cases are reported every year, in Spain it is the most frequent zoonosis. This systemic disease seldom produces spondylodiscitis which in a minority of cases may be complicated by spinal epidural abscesses, in general of lumbar location. The purpose of this article is to analyse 4 cases of brucellar spinal epidural abscess of cervical location and diagnosed in the Province of Teruel, Spain, an endemic area for the disease, through 10 consecutive years (1990-1999). We consider noteworthy the following facts: the first case was a technical employee who acquired the infection in our laboratory of microbiology, the second presented with an extensive purulent collection invading prevertebral and retropharyngeal regions, the third case was cured only with antibiotics without residual deficits. In the fourth case we were not able to demonstrate spondylodiscitis accompanying the epidural abscess at the C2-C6 levels. We discuss especially the epidemiological aspects of brucellosis, the existence of epidural abscess without spondylodiscitis, the clinical manifestations, the diagnosis by means of magnetic resonance imaging, specific serological tests for Brucella, antibiotic treatment and the prognosis of our cases.

[Delay time to arrive at the hospital of 275 patients with acute myocardial infarction. Study form the province of Teruel (1991-1994)]. / Tiempo de demora en acudir al hospital de 275 pacientes con infarto agudo de miocardio. Análisis de la provincia de Teruel (1991-1994).

BACKGROUND: To study the delay time to arrive of the hospital and its relation with any variables, of patients with acute myocardial infarction from the province of Teruel (Spain). PATIENTS AND METHODS: A prospective study was carried out from January 1991 to October 1994. We included patients who were diagnosticated of the acute myocardial infarction (212 men and 63 women). We considered the time between the thoracic pain and their arrive at the urgency service. We based the diagnosis in clinical, electrocardiographic and enzymatic criteria. RESULTS: The mean delay time was 8 h 46 m. The 66.5% arrives before 6 hours. We found no differences between rural or urban patients. The delay time was minor in men than women (7 h 12 m versus 14 h, p = 0.0019), in younger (< 65 years old) than in the older (6 h 3 m versus 10 h 18 m, p = 0.0278), and in those who were admitted to the ICU (7h 16 m versus 20 h 33 m, p = 0.0001). Was longer in patients with arterial hypertension and diabetes. Was minor in patients with dyslipemia and tobacco habit. Many patients to arrive of the hospital by physician order and with own vehicles, it took less time arrive at the hospital than by ambulance (8 h 30 m versus 18 h, p < 0.05). The medium delay in the emergency area was 2 h 35 m. The delay time was longer in patients who died (16 h versus 7h 30 m, p = 0.0018) and in those who present more frequently cardiac failure. CONCLUSIONS: The mean delay time to arrive at the hospital in patients with acute myocardial infarction from the province of Teruel (Spain) in unreasonable and in takes a poor prognosis, so we consider necessary to study the causes of this delay in order to correct them.