Respuesta a la TEC en un caso de trastorno explosivo intermitente refractario / Effect of ECT on a case of intermitent explosive disorder, refractory of pharmacological treatments

Introducción: El trastorno explosivo intermitente se manifiesta como una historia de episodios de pérdida de control de impulsos agresivos, con violencia o destrucción de la propiedad. El caso que presentamos tuvo una evolución atípica, por su gravedad clínica, la asociación con clínica obsesivo-compulsiva y su refractariedad a los tratamientos convencionales. Caso clínico: Se trata de un paciente varón de 35 años, que presentaba desde los 18 años crisis de agitación muy importantes, con destrucción de objetos, ante mínimas contrariedades. Presentaba, además, sintomatología obsesivo-compulsiva, con rituales de limpieza y perfeccionismo. El tratamiento farmacológico con potenciadores de la vía serotoninérgica, clozapina y diversos eutimizantes, resultó inefectivo. Finalmente, la asociación de la terapia electro-convulsiva logró controlar los episodios de agitación. Conclusiones: La literatura acerca del tratamiento con TEC de este síndrome se limita a series de casos. La gravedad clínica del caso motivó que se pautara dicha técnica, con buen resultado

Introduction: IED (intermittent explosive disorder) is a condition which makes people lash out violently for no reason; the person loses control suddenly and brakes or smashes something. The reported case showed atypical evolution due to its clinical condition such as an obsessive compulsive behavior and its resistance to common treatment. Clinical case: Since age eighteen, a thirty five-year old man had disproportionate reactions to any provocation, also showing obsessive compulsive symptoms characterized by repeated patterns of cleaning and perfectionism. He was treated pharmacologically with serotonin reuptake inhibitors (SRI), clozapine (antipsychotic) and other mood-stabilizers, thus resulting ineffective. Electro-convulsive therapy (ECT) finally controlled the violent outbursts. Conclusion: Information including ECT on this type of disorder limits to certain cases. The seriousness of the case encouraged specialists to employ this technique resulting in successful outcome (AU)

[Acute epiglottitis caused by Haemophilus influenzae type b in children: presentation of 21 cases]. / Epiglotitis aguda por Haemophilus influenzae tipo b en niños: presentación de 21 casos.

BACKGROUND: The aim of this paper is to review the epidemiological, clinical and therapeutical characteristics of Haemophilus influenzae type b (Hib) epiglottitis in children at a time when an efficient and safe vaccination is available. METHODS: The clinical histories of 21 children admitted to Children's Hospital La Fe (1971-1996) with a clinical diagnosis of epiglottitis and isolation of the microorganism in blood cultures (20 cases) and surface culture of the epiglotis (one case) are reviewed. RESULTS: The annual average was 4/100,000 children under 5 years of age. Evolution prior to diagnosis was > 12 hours in 52.4% of the cases. More males were affected (52.4% vs 47.6%). All the children except one (95.2%) were under 5 years of age; 81% were under 3 years of age and 1 child was 6 years and 8 months old. Respiratory distress (100%) and fever > or = 38 degrees C (85.7%) were the most common clinical manifestations. General health was affected in 71.4% of the cases and 66.7% had leucocytosis on admission. The clinical diagnosis was confirmed by direct visualization of the epiglotis in 76.1% of the cases. Hib was isolated in blood culture in 20 cases (95.2%). The strains produced beta-lactamases and were ampicillin-resistant in 57.1%. 19 children (90.5%) required endotracheal intubation. Initial empiric antibiotic therapy was third generation cephalosporins (cefotaxime or ceftriaxone) alone or combined with ampicillin. One child died (4.8%). CONCLUSIONS: Pediatricians must still be aware of this serious infection in order to diagnosis and treat it as early as possible.

Non-immunological hydrops fetalis and intrapericardial teratoma: case report and review.

A large intrapericardial teratoma was found at necropsy in a 38-week stillborn fetus, in which prenatal diagnosis of hydrops fetalis and an echogenic cardiac mass had been made. Clinical and pathological data are reported. In utero intrapericardial teratomata lead to different outcomes depending on whether fetal hydrops is associated. When generalized fetal hydrops is not present, the outcome is good, even in cases with large pericardial effusions. When generalized fetal hydrops occurs, it often results in a poor outcome. In our literature review, we have found eight perinatal deaths in nine similar cases reported.