[Eagle's syndrome: Presentation of a case in the Primary Care clinic]. / Síndrome de Eagle. Presentación de un caso en la consulta de atención primaria.

Eagle's syndrome is rare condition described in 1937 by W. Eagle, and is secondary to the elongation of the styloid process and/or calcification of the stylohyoid ligament. Although it occurs asymptomatically in the majority of cases, the pressure exerted by this alternative structure from an anatomical point of view against the neighbouring areas can trigger a great variety of symptoms. It is often wrongly diagnosed, leading to multiple interconsultations with different professionals. This means that the professional must take it into account in those cases of pain in the maxillofacial region without any clear aetiology. The case is presented of a 63year-old patient in whom the only symptom was an invalidating occipital neuralgia, with visits to numerous physicians. A 3-dimension cone beam computed tomography (CBCT) confirmed the clinical suspicion. The treatment consisted of partial resection of both styloid processes.

Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism.

Essentials In venous thromboembolism (VTE), it is uncertain if enoxaparin should be given twice or once daily. We compared the 15- and 30-day outcomes in VTE patients on enoxaparin twice vs. once daily. Patients on enoxaparin once daily had fewer major bleeds and deaths than those on twice daily. The rate of VTE recurrences was similar in both subgroups. SUMMARY: Background In patients with acute venous thromboembolism (VTE), it is uncertain whether enoxaparin should be administered twice or once daily. Methods We used the RIETE Registry data to compare the 15- and 30-day rates of VTE recurrence, major bleeding and death between patients receiving enoxaparin twice daily and those receiving it once daily. We used propensity score matching to adjust for confounding variables. Results The study included 4730 patients: 3786 (80%) received enoxaparin twice daily and 944 once daily. During the first 15 days, patients on enoxaparin once daily had a trend towards more VTE recurrences (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.55-5.88), fewer major bleeds (OR, 0.42; 95% CI, 0.17-1.08) and fewer deaths (OR, 0.32; 95% CI, 0.13-0.78) than those on enoxaparin twice daily. At day 30, patients on enoxaparin once daily had more VTE recurrences (OR, 2.5; 95% CI, 1.03-5.88), fewer major bleeds (OR, 0.40; 95% CI, 0.17-0.94) and fewer deaths (OR, 0.58; 95% CI, 0.33-1.00). On propensity analysis, patients on enoxaparin once daily had fewer major bleeds at 15 (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88) and at 30 days (HR, 0.16; 95% CI, 0.04-0.68) and also fewer deaths at 15 (HR, 0.37; 95% CI, 0.14-0.99) and at 30 days (HR, 0.19; 95% CI, 0.07-0.54) than those on enoxaparin twice daily. Conclusions Our findings confirm that enoxaparin prescribed once daily results in fewer major bleeds than enoxaparin twice daily, as suggested in a meta-analysis of controlled clinical trials.

Estudio de un protocolo de desintoxicación rápida en pacientes dependientes de opiáceos en una unidad de cuidados intensivos: resultados preliminares / Study of an ultrashort opiate detoxification protocol in an intensive care unit: preliminary results

Objetivo. Valorar la aplicación de un protocolo de desintoxicación en pacientes dependientes de opiáceos realizado en una unidad de cuidados intensivos (UCI). Métodos. Estudio abierto, prospectivo, realizado en pacientes seleccionados adictos a opiáceos (heroína, metadona, morfina o codeína) según criterios DSM-III o CIE-10.Tras el ingreso en la unidad de desintoxicación hospitalaria (UDH) y en el servicio de cuidados intensivos (UCI) recibían tratamiento farmacológico con agonistas -2-adrenérgicos, antagonistas opiáceos, atropina y sedación controlada con midazolam durante 6 h. Se valoró el síndrome de abstinencia a opiáceos (SAO) y el estado de sedación. El procesamiento estadístico se realizó mediante el paquete SPSS. Resultados. Se han estudiado 20 pacientes dependientes de opiáceos sometidos a una pauta de desintoxicación ultracorta. Todos los pacientes terminaron la desintoxicación sin complicaciones graves en el período establecido. Un caso fue considerado fracaso al obtener una sedación insuficiente. Conclusiones. La desintoxicación rápida a opiáceos puede ser una técnica eficaz y segura. Las posibles complicaciones de este método, por el elevado riesgo intrínseco que conlleva, parecen aconsejar que estos tratamientos sean instaurados en un servicio de cuidados intensivos. La selección de pacientes puede mejorar los resultados (AU)

Acute eosinophilic pneumonia associated with antidepressant agents.

Acute eosinophilic pneumonia is a severe syndrome characterized by fever, lung infiltrates, blood eosinophilia and respiratory failure. We describe a case of acute eosinophilic pneumonia associated with clomipramine and sertraline. A 40-year-old woman was admitted to the emergency department with 37.9 degrees C and respiratory rate of 35 respirations per minute. Blood analysis showed PaO2 = 57.6 mm Hg and HCO3- = 21.7 mmol/l and 12.2% eosinophils. Chest X-ray showed infiltrates in both lower lobes. She was taking clomipramine 25 mg bid for the last 4 weeks and sertraline 50 mg/day for the last week. Other causes of acute eosinophilic pneumonia such as parasitic and fungal infections or collagen diseases were discarded. Both antidepressant were stopped and the patient became afebrile and asymptomatic. A week later the patient was discharged from hospital. Physicians should be aware of this adverse antidepresant reaction which may result in severe pulmonary symptoms.

[The diagnosis of sleep apnea syndrome with a portable device. Our experience with 100 cases]. / El diagnóstico del síndrome de apnea del sueño con un equipo portátil. Nuestra experiencia con 100 casos.

UNLABELLED: Portable devices might be an alternative method to diagnose patients suspected for obstructive sleep apnea syndrome (OSAS). We have analized one hundred patients consecutively referred to our especialized out-patient clinic for sleep breathing disorders. We have used a previously validated portable device-Polygraphics CNS-which records thoracoabdominal movement, nasobuccal airflow, ECG, oxymetry, body position, and continuous positive airway pressure (CPAP). Sixty patients showed an apnea/hypopnea index (AHI) > 15. Seven patients showed an AHI > 10f plus symptoms suggestive of OSAS. Two patients had an AHI between 5-10 and very high suspicion for OSAS; a subsequent CPAP treatment showed the disappearance of respiratory events and an evident improvement in oxymetric records. Twenty two patients showed an AHI < 5. Nine patients could not be classified and other diagnostic method were deemed necessary. CONCLUSION: A previously validated cardiorrespiratory portable polygraphic device was useful in most cases for taking diagnostic decisions in OSAS.