[Efficacy of an intervention in smoking cessation in patients with myocardial infarction]. / Eficacia de una intervención para dejar de fumar en pacientes con infarto de miocardio.

BACKGROUND: The aim of this study was to evaluate the efficacy of an structured intervention based on a medical advice versus to the ordinary anti-tobacco advice in patients with miocardial infarction who are attended in an Intensive Care Unit (ICU). PATIENTS AND METHODS: 90 patients were randomly selected to receive either the specific intervention (intervention group) or the ordinary advice (control group). The medical advice was given during the ICU hospitalization and during the second, the third and the fourth week. One year later the smoking habit was evaluated. RESULTS: After one year 26 patients of the intervention group and 31 patients of the control group had stopped smoking (RR = 0.88 [CI 95% RR] 0.57 to 1.37). CONCLUSIONS: The percentage of patients who stop smoking after a miocardial infarction is high. The structured medical counselling was not effective to reduce the number of smokers at one year.

[Exclusion causes to thrombolytic treatment in myocardial infarction]. / Causas de exclusión de tratamiento trombolítico en el infarto de miocardio.

BACKGROUND: Only one third of patients who have suffered a myocardial infarction can benefit from thrombolytic treatment in the daily clinic practice. The aim of this study is to know the percentage of patients who were treated in a General Hospital and the main exclusion causes to receive thrombolytic treatment. METHODS: A descriptive study in patients with infarction who were admitted to the Critical Care Unit of a 550 beds Hospital between September-95 and August-96. RESULTS: 188 patients were admitted with suspicion of myocardial infarction. The 50.53% of them received thrombolytic treatment. The main exclusion causes to receive this treatment were: delay of the patient (18.10%), normal ECG or descended ST (16.50%), contraindications (8%), patient's refusal to receive treatment (0.53%) an uncertain indication of therapy (6.40%). CONCLUSIONS: A high percentage of patients received thrombolytic therapy, maybe because these drugs can be used until 12 hours the infarction and they haven't limit of age.

[Delayed thrombolytic administration in myocardial infarction;]. / Demora en la administración de trombolíticos en el infarto de miocardio.

BACKGROUND: The aim of the study is to know whether the patients with acute myocardial infarction (AMI) who consulted an extrahospitalary physician before the hospital arrival delayed their admission to the critical care unit (CCU), and whether their probability to receive early thrombolytic therapy was smaller than that of the patients who cam directly to hospital. PATIENTS AND METHODS: A descriptive study in patients with AMI was performed during 1995. The following variables were studied: age, sex, town of residence, previous AMI, consultation to an extrahospitalary physician, delay time in the admission to the CCU, and whether thrombolytic treatment was performed. Comparison of proportions, Student-Fisher t-test, or Mann-Whitney U-test were used, according to the case. A multiple logistic regression was used to study the independent effect of the previous consult to an extrahospitalary physician on the chance for early thrombolytic treatment. RESULTS: A hundred and eighteen patients (79.7% males) were studied. The mean age was 63 years-old. Nine point five per cent of the patients had suffered a previous AMI and 54.2% received thrombolytic treatment. Delay to hospital arrival was the main exclusion reason to receive this treatment. The mean age of patients who consulted an extrahospitalary physician (n = 69) was 5 years older, their hospital arrival were 100 min later (difference of medians) (p < 0.001), were admitted to the CCU 124 min later (p < 0.02) and ran a higher risk to arrive to CCU after 3 hours from the onset of symptoms (odds ratio [OR]: 3.3; confidence interval [IC] 95%: 1.2 to 9.2) than those who cam directly to hospital. CONCLUSIONS: The patients with AMI who consult an extrahospitalary physician delay their admission to the CCU and have a less chance to receive early thrombolytic therapy in the first 3 hours of evolution.

[Carbon tetrachloride poisoning]. / Intoxicación por tetracloruro de carbono.

Cases of severe acute carbon tetrachloride poisoning are sporadically described in Spain. We report the cases of three patients that inhaled toxic vapour of carbon tetrachloride that they used as a solvent during their working activity. They developed hepatic disfunction and one of them acute renal failure. The interval between the labour exposure and the medical care was higher than 24 hours. All the patients received N-acetylcysteine treatment (300 mg/kg) and oxygen. The patient ith renal failure recurred hemodialysis. The basic aspects of diagnosis and treatment are commented.

[Cardiopulmonary resuscitation in a general hospital]. / Reanimación cardiopulmonar en un hospital general.

The study presents a plan that is based on transferring the survival chain philosophy in hospital environments that directs the modern cardiopulmonary revival (CPR). The plan is based on an alarm system, starting the basic CPR by the nurse that identifies the sudden death, the fast arrival of the intensive care doctor, a nurse supervisor (who carries the defibrillator monitor to the scene) and the doctor responsible for the patient. During the first two years of performance (June 1993 to June 1995) 99 cases occurred with 73 confirmed stoppages. In 95% of the cases the alarm was tended in less than 5 minutes. Twenty one patients (33%) recovered their pulse and seven (11%) were sent home with a good brain recovery. The authors believe that appliances like the one introduced are useful in order to achieve efficient results in the CPR within the hospital.

[Familial thyroid medullary carcinoma without associated neoplasms]. / Carcinoma medular de tiroides familiar sin neoplasias asociadas.

Each of three patients with thyroid medullary carcinoma (TMC) presents the tumor as a family feature. Most of them have other associated endocrinous neoplasias. Through the study of baseline plasmatic calcitonin and after stimulus with calcium and pentagastrin, patients with silent TMC can be detected. We present the results of the study of a family including 70 members and with hereditary TMC, between 1988 and 1992. Six new cases of TMC were diagnosed starting from the case index. Their average age was 31.7 years. Five of them underwent surgery. None of them had other associated endocrinous neoplasias, which is extremely rare. In addition, we present data on the postoperative follow-up of the patients, two of which had high calcitonin and CEA levels.

[Fatal poisoning with paraquat: report of a new case]. / Intoxicación letal por paraquat: aportación de un nuevo caso.

Intoxication with paraquat has been rarely described in our country. We present a case of a 66-years-old man admitted to our hospital five hours after an accidental ingestion of a sip of paraquat. Despite therapy with gastric lavage, Füller's Soil, Magnesium Sulphate, liquids and hemoperfusion, the patient developed Multiple Organic Failure and died 48 hours after his hospitalization. Plasmatic levels of the herbicide were very high. Typical clinical data, prognosis factors and therapeutical management of this intoxication are described.