Síndrome de Kounis tras la administración de Cefditorén / Kounis syndrome after Cefditorén administration

El síndrome de Kounis fue definido, por primera vez, en 1991, como la aparición simultánea de episodios coronarios agudos y reacciones alérgicas anafilácticas o anafilactoides. Los agentes etiológicos asociados a su aparición son múltiples y los más frecuentes son los fármacos, en especial, los antibióticos. Su diagnóstico es eminentemente clínico, no existe ninguna prueba patognomónica. No hay consenso ni guías de práctica clínica específicas; se recomienda el tratamiento específico para el síndrome coronario agudo enfocado en tratar el vasoespasmo y la anafilaxia, con el agravante de que puede haber contraindicaciones cuando se usan conjuntamente y que dichos fármacos antianginosos pueden desencadenar el cuadro. Se presenta un caso clínico de síndrome de Kounis asociado a cefditorén, el primero descrito en la literatura(AU)

Kounis syndrome was first described in 1991 as the simultaneous occurrence of acute coronary events and allergic anaphylactic or anaphylactoid reactions. Multiple etiologic agents are associated with this syndrome, the most common are drugs, especially antibiotics. Diagnosis is eminently clinical, there are not pathognomonic tests. Consensus and specific clinical practice guidelines are lacking; specific acute coronary syndrome treatment is recommended focusing on vasospasm and anaphylaxis, with the aggravating circumstance that contraindications can be present when used together and such antianginal drugs may trigger the condition. We present a case of Kounis syndrome associated with cefditoren, the first reported in the literature.(AU)

Complicaciones médicas por el consumo de drogas de uso lúdico / Medical complications derived from drug consume

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Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery.

OBJECTIVE: To review the results of the analysis and quantification of the influence of medical factors on the morbidity and mortality associated with emergency surgery for colorectal cancer. PATIENTS AND METHODS: We analyze retrospectively the data for 51 patients who underwent emergency surgery: 34 (67%) to treat acute obstruction and 17 (33%) for perforation. The median follow-up period was 18.5 months (3 to 62 months). RESULTS: The main tumor was located in the right colon in 13 patients (25%), in the left colon in 35 (69%) and in, the rectum in 3 (6%). Primary resection was performed in 94% of the patients: without anastomosis in 35% (18 of 51) and with primary anastomosis in 59% (30 of 51); 6% of the tumors were not resectable. The postoperative morbidity was 41%: 29% (10 of 34) occurring in obstructions and 65% (11 of 17) in perforations. The mortality rate was 14% (9% and 23%, respectively). There were statistically significant associations between mortality and the American Society of Anesthesia grading (p < 0.01) and between both the mortality and morbidity and the score for the acute physiology component of APACHE II (p = 0.01, respectively) and the total APACHE II score (p < 0.01 in both cases). The rate of actuarial disease-free survival was 26% at 36 months. Overall survival was 15% at 62 months. A recurrence rate of 48% (14 of 29) has been recorded. CONCLUSIONS: Emergency surgery for colorectal cancer is associated with a high postoperative morbidity and mortality rate, which correlate with the medical status and, particularly, with the acute physiology score of the APACHE II risk stratification system.