Documento de Consenso sobre "Tratamiento Antimicrobiano de la Faringoamigdalitis" / Consensus document re " Pharyngoamigdalitis antimicrobial therapy protocols"

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Documento de consenso sobre tratamiento antimicrobiano de la faringoamigdalitis / Consensus statement on antimicrobial of pharyngo-tosillitis

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Abdomen agudo por rotura diferida de diafragma / Acute abdomen due delayed diaphragmatic rupture

La rotura traumática del diafragma es una lesión poco frecuente que puede pasar desapercibida a menos que exista un elevado índice de sospecha. En el intervalo entre la rotura y la herniación del contenido abdominal hacia la cavidad torácica, los síntomas y signos son inespecíficos y las pruebas diagnósticas como la radiografía de tórax pueden ser normales. Presentamos un caso de manifestación tardía de una rotura diafragmática izquierda secundaria a un traumatismo torácico en accidente de tráfico. El paciente pedeció la estrangulación del segmento herniado del estómago en el tórax. Se revisa el mecanismo de la lesión y las técnicas diagnósticas de imagen (AU)

[Record of neurological emergencies at a tertiary care hospital]. / Registro de urgencias neurológicas en un hospital de tercer nivel.

INTRODUCTION AND OBJECTIVE: There is a progressive increase in the demand for multidisciplinary attention from the Emergency Medical Services. The objective of this study was to determine the proportion of neurological conditions in the total hospital emergency workload, their demographic composition and medical needs. PATIENTS AND METHODS: We present an observational study of a cohort of histories of neurological emergencies at a tertiary hospital during a period of one year. RESULTS: On analysis of all emergencies, 1,592 were neurological conditions. The duty neurologist was consulted in 87.9% of the cases. The average age was 59, and the majority were women (56.3%). Maximum demand was between 14.00 and 19.59 hours. Monday was the day of the week when most were seen. The commonest causes of consultation were change in strength or language, headache and epileptic crises. The complementary investigation done most frequently was a blood test. Cerebral CT scan were done in 31.9% of the patients. The diagnoses most often made, as a group, were cerebrovascular disease followed by epilepsy and headache. The majority of the patients were referred to Primary Care Centres or for neurological consultation. When the patients were grouped according to the specialties with doctors on duty, the second largest group were seen by the emergency neurologist at our hospital. CONCLUSION: In view of the above results, we consider the presence of a neurologist in the Emergency Department to be fully justified.

Early single dose therapy with ofloxacin for empirical treatment of acute gastroenteritis: a randomised, placebo-controlled double-blind clinical trial.

This study is a double-blind, placebo-controlled, randomised clinical trial to evaluate the clinical and microbiological efficacy and safety of single dose ofloxacin for acute diarrhoea. Eligible patients were 16 years of age or older with a history of acute diarrhoea lasting no more than 48 h; 117 patients were randomised and 97.4% (114/117) were evaluable for efficacy. Of these, 58% were suspected to have ingested contaminated foods. Enteric pathogens were isolated in 61.5% of the patients, Salmonella enteritidis being reported in 87.5%. The patients received either a single 400 mg dose of ofloxacin, or placebo. The average duration of diarrhoea was 2.56 +/- 2.21 days in the ofloxacin group and 3.41 +/- 2.5 in the placebo group (P = 0.117). The average duration of fever was 0.63 +/- 0.95 days in the ofloxacin group and 1.05 +/- 0.96 in the placebo group (P = 0.02). Symptoms remained unchanged for more than 48 h in only 7% of the patients who received ofloxacin, compared with 12% in the placebo group (P = 0.485). Only 32% of patients in the ofloxacin group remained culture positive after 48 h compared with 59% in the placebo group (P = 0.0018). These represent a relative risk reduction (RRR) for stool clearance of 45.5% and absolute risk reduction (ARR) of 27% (95% Cl, 8-44.7), with a number of patients needed to treat (NNT) of 3.7 (95%, 2.7-11.3). After 15 days, 23.3% of patients in the ofloxacin group had a positive culture compared with 28.9% in the placebo (P = 0.63). This represents an RRR of 19%, an ARR of 5.6% and a NNT of 17.8. Adverse events in the ofloxacin group were observed in only one patient who reported headache and in one patient in the placebo group who developed a rash. In summary, empirical treatment with a single dose of ofloxacin in acute diarrhoea did not reduce the intensity or duration of symptoms (except possibly length of fever). It was notable however that stool cultures became negative for S. enteritidis by 48 h, with no relapse after 2 weeks of follow-up.

Abscess caused by Salmonella enteritidis within a glioblastoma multiforme.

Focal intracranial infections due to Salmonella species are rare. We report a case of brain abscess caused by Salmonella enteritidis within a glioblastoma multiforme.