Absence of the superior vena cava: difficulties for pacemaker implantation.

Endocardial pacemaker electrode implantation can be difficult in patients with anomalous superior vena cava (SVC). Venography and CAT scan showed that the patient lacked SVC venous drainage and that systemic veins drained into the inferior vena cava through the azygos vein. A temporary stimulation electrode was placed by puncture of the femoral vein, permanent stimulation by venotomy of the epigastric vein, with the electrode inserted through the external iliac vein.

[The toxic shock syndrome versus the adult Kawasaki syndrome. The diagnostic difficulties]. / Síndrome del shock tóxico frente a síndrome de Kawasaki del adulto. Dificultades diagnósticas.

The case of a 18-year-old woman with the toxic shock syndrome (TSS) associated to a staphylococcal infection in the maxillary sinus is presented. The initial course of the disease was clinically superposed to a Kawasaki syndrome (KS). Both entities, of purely clinical diagnosis, possess many common elements occasionally making differentiation extremely difficult. The clinical data that may orient diagnosis to one of the processes was analyzed. Finally, it is emphasized that the paranasal sinus must be considered as an occult foci in those cases of TSS in which there is no apparent foci of infection.

[Neuroleptic malignant syndrome. Analysis of 9 cases]. / Síndrome neuroléptico maligno. Análisis de 9 casos.

The malignant neuroleptic syndrome (MNS) is an idiosyncratic reaction to neuroleptic drugs. Although it was described in the sixties, it is still a poorly known condition. Controversy still exists about its conceptual frame, and its true incidence is still unknown. We have evaluated 9 cases of MNS seen in a 37 month period. There were 5 females, with a mean age of 50 years. Haloperidol, either single or in association, was the most commonly implicated drug. The estimated frequency of MNS in our population at risk was 1.5%. Eight patients had complications and 5 died from them (55%). We discuss the pathogenetic mechanisms, the conceptual characterization and the current diagnostic criteria. We evaluate the causes of the high mortality in our series. We think that a higher suspicion index of this condition would be desirable, and we recommend early treatment with vigorous supportive measures and drug therapy. We think that prospective studies are required to assess the true incidence of MNS.