[Acute confusional syndrome associated with obstructive sleep apnea aggravated by acidosis secondary to oral acetazolamide treatment]. / Síndrome confusional agudo asociado a apnea-hipopnea obstructiva del sueño y agravado por acidosis metabólica secundaria a acetazolamida oral.

Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn. During the admission examination infectious, toxic, and neurologic causes, or those related to metabolic or heart disease were ruled out. Arterial blood gases measured during one of the nighttime episodes of acute confusional syndrome showed mild hypoxia and hypercapnia with mixed acidosis. Signs and symptoms suggestive of OSAS had been developing over the months prior to admission, with snoring, sleep apnea, and moderate daytime drowsiness. Polysomnography demonstrated severe OSAS with an apnea-hypopnea index of 38. Mean arterial oxygen saturation was 83%; time oxygen saturation remained below 90% was 44%. The attending physician ordered the withdrawal of oral acetazolamide, which was considered the cause of the metabolic component of acidosis. Treatment with continuous positive airway pressure was initiated at 9 cm H2O, after a titration polysomnographic study. The patient continued to improve.OSAS, for which very effective treatment is available, should be included among diseases that may trigger acute confusional syndrome.

Psicosis aguda como forma de presentación de un carcinoma pulmonar de célula pequeña

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Infection caused by Nocardia farcinica: case report and review.

Nocardia farcinica is a rare Nocardia species causing localised and disseminated infections. A case of Nocardia farcinica infection is presented, and 52 cases previously reported in the literature are reviewed. The hosts usually had predisposing conditions (85%), and acquired the infection through the respiratory tract or skin; the infection then often spread to the brain, kidney, joints, bones and eyes. Pulmonary or pleural infections (43%), brain abscesses (30%) and wound infections (15%) which failed to respond to conventional antimicrobial therapy were the more frequent forms of infection. Nocardia farcinica was frequently isolated from pus (100% of samples), bronchial secretions (41%) and biopsy specimens (63%), but isolation from blood and urine, as in the case presented here, is rare. Antibiotic therapy was adequate in 61% of the patients in whom it was specified, the agents most frequently given being trimethoprim-sulfamethoxazole (54%), amikacin combined with imipenem (7%) and amoxicillin-clavulanate (7%). The high mortality (31%) can be attributed to the severe underlying diseases present, difficulties encountered in identifying the pathogen, inappropriate therapy and late initiation of therapy. Although an infrequent pathogen, Nocardia farcinica should be kept in mind as a cause of infection especially in immunosuppressed patients with indolent infections not responding to third-generation cephalosporins.

Two-dimensional immunoelectrophoresis of histoplasmin and a purified polysaccharide-protein antigen of Histoplasma capsulatum.

Crude histoplasmin and a polysaccharide-protein complex (PPC-histo) antigens obtained from culture filtrates of Histoplasma capsulatum were analyzed by single and tandem two-dimensional immunoelectrophoresis (TD-IEP) using a rabbit hyperimmune anti-histoplasmin polyvalent serum. Single TD-IEP showed 14 arc precipitates for histoplasmin. Continuity of arcs 2, 6, and 7, and 9 and 10 was observed, suggesting a different polymeric configuration of the same antigen. This was also confirmed in tandem TD-IEP of histoplasmin with homologous (PPC-histo) and heterologous PPC's from Blastomyces dermatitidis, Paracoccidioides brasiliensis and Coccidioides immitis. Tandem TD-IEP of histoplasmin and PPC-histo displayed a similar antigenic pattern to histoplasmin alone, being arcs 1 and 3 more evident and apparently present only in histoplasmin and PPC-histo. Tandem TD-IEP showed common antigens among the other heterologous fungal purified antigens, and seems useful to observe the multiplicity of antigens present in fungal preparations and to identify those precipitates (arcs 1 and 3) that are predominant in the purified preparation.

[Multiple familial polyposis. Report of 4 cases and association with mucinous adenocarcinoma of the colon]. / Poliposis familiar múltiple. Informe de cuatro casos y asociación con adenocarcinoma mucinoso de colon.

Four cases of familial polyposis coli (FPC), seen at Dr. Manuel Gea González General Hospital from 1985 to 1987, are presented. Three females and one male, with ages ranging between 23 and 52 years, are presented. The clinical picture included bloody feces, polyp prolapse, and a maxillary osteoma. In 3 cases the correct preoperative diagnosis was made by rectosigmoidoscopy, biopsy and barium enema. In one patient, urgently operated on, the diagnosis was postoperatively made by colonoscopy. The adenocarcinoma of the colon appeared associated with FPC in three cases (one of the mucinous variety). One total coloproctectomy and two abdominal colectomies with ileorectal anastomosis were performed. One patient operated on because of bowel obstruction was treated by right hemicolectomy. This case developed abdominal carcinomatosis afterwards. One woman died; another one was lost during follow-up, and the other one had no complications. The association of FPC and mucinous adenocarcinoma of the colon is reported for the first time.

[Ileosigmoid volvulus. A case report]. / Vólvulo íleosigmoideo. Informe de un caso.

This is a case report of an ileosigmoid volvulus in a 68 year old man. The patient had emergency surgery for an acute abdominal condition. Intraoperative diagnosis of an ileosigmoid knot was made and it was necessary to resect the necrotic portion of the ilium, with ilioiliostomy, and to resect the gangrenous section of the sigmoid colon, end colostomy, and Hartmann pouch. Eleven weeks later, a colosigmoidostomy was realized. The evolution of the patient was satisfactory. The literature about ileosigmoid volvulus is reviewed.