Síndrome demencial reversible secundario a infección crónica del sistema nervioso central por Listeria monocytogenes

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[The safety of the treatment of an acute myocardial infarct by immediate intravenous fibrinolysis in the regional hospital environment]. / Seguridad del tratamiento del infarto agudo de miocardio mediante fibrinólisis intravenosa inmediata en el ámbito hospitalario comarcal.

INTRODUCTION AND OBJECTIVES: Our aim was to evaluate the utility of thrombolytic therapy administered outside tertiary hospital. METHODS: We analyzed 80 consecutive patients with acute myocardial infarction admitted to the emergency area of primary hospital within 24 hours after the onset of symptoms and lastly transported to a coronary care unit (CCU) of a reference hospital. The thrombolytic protocol was performed by medicine department of primary hospital and the CCU of reference hospital. RESULTS: 23 patients without (group A) and 57 with (group B) fibrinolytic therapy (APSAC 50 patients and streptokinase 7 patients) were analyzed. Group A patient were older (mean: 67 +/- 11 vs mean: 62 +/- 10 years; p = 0.01), and arrived later to emergency area (mean 254 +/- 284 vs mean 163 SD 161 min; p = 0.04) and to the coronary care unit (mean 561 +/- 371 vs mean 334 +/- 177 min; p = 0.0002). The guard physician decision to start or not the fibrinolytic therapy, was adequate in 86% of the patients (sensitivity 87%, predictive positive value 95%, specificity 83%). Complications on emergency area or during transport in group B were ventricular fibrillation in 9%, AV block (2-3 degree) in 9%, severe nonsustained ventricular arrhythmia in 11% and transitory hypotension in 23%. No death occurred before CCU admission. In group B, 35% patients was treated within the first 2 hours. The average time gain was 124 min (thrombolysis administration--CCU admission). CONCLUSION: On emergency area of primary hospital, thrombolytic therapy is feasible and safe when administered by well-equipped and well-trained medical emergence area and ambulance staff.

Reliability diagnosis of FAST in allergic rhinitis. Correlation with RAST, nasal provocation and prick test.

Not much data is available on the reliability diagnosis of IgE FAST, in comparison with other "in vitro" and "in vivo" techniques. The motive of this study was to evaluate FAST sensitivity in patients with rhinitic allergies, comparing it with RAST and the prick test. Thirty-four patients, monosensitized in 11 cases for pollen, in 16 for mites and in 7 for moulds were studied. Ten patients with negative nasal provocation were used for the control group. In a total of 133 sera, there was class concordance between FAST and prick test in 59.39% of the cases, with a r = +0.41 and p less than 0.001 correlation coefficient. Corcordance of FAST and RAST for a total of 135 sera was 65.18%. Concordance in those who had nasal positive provocation was 87.65% for FAST, 75.04% for RAST and 92.85% for prick. From our experience with FAST, in patients with allergic rhinitis for the pneumoallergens evaluated, we conclude that this test constitutes an alternative "in vitro" diagnosis in the cases indicated. We found that its advantages were its low cost in the way of human and economical resources, its greater reliability in comparison with RAST, its simple administration and it being harmiess.

Eosinophilic gastroenteritis: a description of a new case with serous affectation.

We discuss a case of a 51 year old female who presented periodic episodes of abdominal pain, nausea and vomitus consisting of food elements and in addition in the last crisis presented ascites and increased abdominal circumference. The laboratory studies performed included the remarkable increase in eosinophils found in peripheral blood and ascitic fluid with the rest of the laboratory findings within the normal limits (biochemical, proteinogram, Igs, urine and stool examination, and negative food provocation test). Radiography demonstrated swelling of the gastric wall at antral level and the small intestinal wall. A gastric sample was taken via endoscopy which established the diagnosis of EG. EG is a disease of still disputable etiopathogenesis. Some think it is mediated by type I hypersensitivity mechanism and others (like our case) mediated by immunologic mechanism different from atopy which on occasions form part of a systemic feature. Regarding the role of eosinophil, it seems to be important as latest studies have found a relation between the degree of cell degranulation and the degree of histologic lesion. From the distinct form of EG (muscular, mucosa, serosa), EG with involvement of the serosa layer is the less frequent. It is usually associated to some other layer (generally muscular) and presenting ascites. Some authors denominate mixed-type EG to these forms whereby important involvement of more than one layer of the digestive tract is demonstrated.

Immunotherapy with standard bacterial and bacterial ribosomal antigens in childhood bronchial asthma.

UNLABELLED: In this study we compared the therapeutic effectiveness of a lyophilized bacterial vaccine (LBV) with that of a vaccine prepared from bacterial ribosomal antigens (ARB) in 150 children with bacterial bronchial asthma. The immunological response of the patients was assessed clinically at 6 months, 1 year and 3 years, by determining the intensity and frequency of the bronchospasm. The serum immunoglobulin levels, the only immunologic parametres studied, were determined at basal conditions and following immunotherapy. CLINICAL RESULTS: after 360 days we detected a better clinical response in those patients who received the ribosomal vaccine (ARB), whereas after 3 years there was no difference in the clinical response between this group of patients and the group who received the bacterial vaccine (LBV). Immunological results: we were not able to show a statistically significant increase in immunoglobulin levels during the three years of immunotherapy with the two vaccines. However, those patients who possessed a deficit in IgG displayed a statistically significant increase in IgG levels after 360 days (t = 3.58, p less than 0.01), and an even greater increase after 1080 days (t = 7.86, p less than 0.001), of treatment with the standard bacterial vaccine. The ribosomal vaccine produced a significant increase in IgG levels (t = 9.59, p less than 0.001) after 1080 days also in patients with a deficit in IgG. In patients with a previous deficit in IgA we did not observe an increase in serum IgA levels during immunotherapy with the bacterial vaccine, but with the ribosomal vaccine these patients displayed significantly higher levels of IgA (t = 13.09, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)