Acute necrotizing myopathy and podophyllin toxicity. Report of a fatal case.

A 21 year old male ingested podophyllin in a suicide attempt. The disorder was marked by seizures, coma, peripheral neuropathy, renal failure and acute necrotizing myopathy, an unusual finding. The coma and systemic disturbances resolved within three weeks. The myopathy resolved in 7 weeks, demonstrating a high capacity of muscle recuperation. The sensorimotor peripheral neuropathy persisted until the patient's death 9 weeks after the ingestion, due to septicemia. This report confirms the transient central neurotoxicity of podophyllin and persistent peripheral neurotoxicity of podophyllin, and describes a reversible necrotizing myopathy associated to mitochondrial abnormalities, a still unreported feature of podophyllin toxicity.

Comparative study of intensive care unit (ICU) performance.

It is possible to evaluate ICU performance using severity-of-illness systems, but are these systems objective enough to draw comparison between different units? A software was developed to allow data collection and calculation of the score APACHE II [1] and administrative hospital indicators. To provide homogeneity, all data were collected following the same protocol and verified by one author.

[A cardiac lesion secondary to paraquat]. / Lesão cardíaca secundária ao paraquat.

PURPOSE: To evaluate cardiac alterations secondary to exogenous intoxication by paraquat. METHODS: We performed analysis of clinical and laboratory data of 25 patients with acute paraquat poisoning admitted in our ICU from November 1983 to January 1991. RESULTS: There were purposeful overdoses in 24 cases (96%). The mortality rate was 56%. The lung involvement was 96%, renal was 92%, gastrointestinal tract was 72%, hepatic was 56%, and cardiac involvement was 40%. CONCLUSION: Cardiac involvement due to paraquat is frequent (40%). The clinical picture of this involvement has a wide spectrum, ranging from minimal changes in the ECG to acute and extensive myocardial necrosis.

[Electrocardiographic changes in accidental hypothermia]. / Alterações eletrocardiográficas na hipotermia acidental.

PURPOSE: Electrocardiographic alterations were evaluated in a group of accidental hypothermia patients, and correlated with values of core temperature, pH and plasmatic concentrations of Na+, K+ and Cl-. METHODS: Conventional 12-lead surface electrocardiograms were obtained in a group of 32 patients with accidental hypothermia after involuntary cold exposure. Cardiac arrhythmias, QRS configuration, ST-T segment and T wave alterations were analyzed. pH, Na+, K+ and Cl- serum concentrations were simultaneously measured. Electrocardiogram and electrolyte abnormalities were then correlated with the core temperature. RESULTS: Twenty-eight patients had abnormal electrocardiogram (90.6%). Sinus bradycardia and idioventricular rhythm were observed in 11 and 3 patients respectively. QT interval enlargement was found in 24 patients and Osborn wave in 28 cases. Altered T waves expressing an abnormal repolarization were observed in 23 cases. A significant negative correlation was obtained when J wave amplitude was correlated with core temperature levels. CONCLUSION: Hypothermia produces electrocardiographic abnormalities characterized by Osborn waves. Other minor findings include sinus bradycardia, idioventricular rhythm and long QT intervals.

Recorrência de infarto do miocárdio no lupus eritematoso sistêmico. Apresentação de um caso e revisão da literatura / Recurrence of myocardial infarction in systemic lupus erythematosus. Report of a case an review of the literature

Os autores relatam o caso de uma paciente jovem com lupus eritematoso sistemico, que apresentou 2 episodios de infarto agudo do miocardio no intervalo de 5 meses. No primeiro episodio, as provas laboratoriais foram compativeis com atividade lupica e no episodio seguinte nao se demonstrou atividade. Na cinecoronarioventriculografia as arterias coronarias eram normais, constatando-se a presenca de aneurisma apical importante. Os testes para pesquisa de espasmo coronario, pela prova de gelo, e a perfusao do miocardio, inferida pela dosagem do lactato no seio coronario, foram normais. A controversia dos achados clinicos e laboratoriais observados no presente relato motivaram a revisao da literatura pertinente

Artrite psoriatica infantil. / Juvenile psoriatic arthritis

Os autores descrevem um caso de artrite psoriatica infantil, entidade de baixa prevalencia na infancia, correspondendo a 2% do total de artrite psoriatica. Tecem consideracoes sobre o caso e discutem seus principais aspectos epidemiologicos, clinicos e laboratoriais