Neurocisticercosis asintomática: A propósito de un caso / Asymptomatic neurocysticercosis: Apropos one case

La neurocisticercosis es una parasitosis de Sistema Nervioso Central endémica de países en vías de desarrollo que, debido a la inmigración, está aumentando su incidencia en países desarrollados. La clínica más frecuente es la epilepsia seguida de cefaleas o alteraciones neurológicas. Para su diagnóstico son necesarias pruebas de neuroimagen e investigación epidemiológica. El tratamiento, en los casos indicados, se basa en antiparasitarios asociados a corticoides, antiepilépticos y a veces cirugía. Presentamos el caso de un paciente sudamericano con neurocisticercosis asintomática que se diagnosticó gracias a las imágenes típicas que presentaba en la TAC y a la sospecha epidemiológica. Se decidió seguimiento clínico del paciente ya que no existía evidencia a favor de iniciar su tratamiento

Neurocysicercosis is a parasitic disease of the Central Nervous System endemic in undeveloped countries but it is increasing its incidence in developed countries due to immigration. Seizures are the most frequent clinical presentation followed by headache and neurological impairment. Neuroimaging and epidemiological search are needed to diagnosis. Treatments, in indicated cases, consist of antiparasitic and sometimes surgery. We report a case of a patient neurocysticercosis diagnosed by typical images in CT and epidemiological suspicion. Clinical following without treatment was decided because there is no evidence in favour of using antiparastic drugs in these patients

Miocardiopatía hipertrófica obstructiva portadora de desfibrilador automático y marcapasos bicameral: manejo anestésico con ocasión de cirugía laparoscópica y cesárea / Obstructive hypertrophic cardiomyopathy carrier of desfibrillator and dual-chamber pacing: anesthetic management for laparoscopic surgery and caesarean

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Varón con infecciones respiratorias de repetición / Recurrent respiratory infections in man

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Una complicación grave de la sinusitis / Severe sinusitis complication

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Valor diagnostico del apendicolito ante sospecha de apendicitis / Diagnostic value of apendicolito in apendicitis

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Nuevos indicadores en el reconocimiento profesional: autoridad y decisión / No disponible

La profesión de matronas reúne una serie de competencias de amplio alcance: desde la salud reproductiva, hasta el diagnóstico y el asesoramiento a la madre. Esta amplitud de responsabilidades profesionales no cuenta con un reconocimiento profesional, retributivo y decisional acorde con lo que abarcan. Analizar esta profesión en relación con otras incidiría en aumentar su visibilidad y neutralizar jerarquías, máxime en organizaciones sanitarias que pretenden cumplir con los parámetros de calidad (AU)

Midwife’ s profession consists of a series of different wide competences: from reproductive health to diagnosis and mother’s counselling. This wide range of professional responsebilities has not the professional, financial compensation, and decision making recognition it deserves, in accordance with the scope of the midwife’ s performance. To analyse this profession comparing it to others would enhance its value and neutralize staff categories, mainly in health organizations which intend to conform to quality parameters (AU)

[Trends of hospital infections at an oncology center, 1986-1996]. / Tendencias de infecciones intrahospitalarias en un centro oncológico, 1986-1996.

OBJECTIVE: To describe the results of ten years of nosocomial infection (NI) surveillance in an oncology center. MATERIAL AND METHODS: This is a descriptive study of the Infection Control and Surveillance Program Committee at the Instituto Nacional de Cancerología, conducted in 1997. From June 1986 to December 1996, we surveyed 62,733 hospital discharge records. Criteria used to classify nosocomial infections were those outlined in 1972 by the Centers for Disease Control and Prevention, Atlanta (GA). Survey data were collected through review of microbiology chart records and of hospital chart records of febrile patients, patients receiving antibiotics, and patients visited after surgery. We calculated the rates of NI as the number of infections/100 discharges. RESULTS: The rate of NI per 100 discharges was 4.4 in 1986, 7.7 in 1987, 8.1 in 1988, 5.9 in 1989, 4.6 in 1990, 5.1 in 1991, 4.3 in 1992, 5.4 in 1993, 7.6 in 1994, 7.1 in 1995 and 8.5 in 1996. Escherichia coli was the microorganism most frequently isolated. From 1987, an increase of almost seven times in fungi isolations as well as enterococci was observed. CONCLUSIONS: An increasing trend in NI rates was observed in the last four years, probably related to multiple factors such as improved surveillance (better reporting) and a real increase in the frequency of NI.

Experience of an intravenous therapy team at the Instituto Nacional de Cancerología (Mexico) with a long-lasting, low-cost silastic venous catheter.

Means of vascular access are fundamental in the management of cancer. However, since current intravenous devices for long-term treatment are expensive and necessitate a high degree of education among medical personnel, in developing countries they are impractical for use in most of the population. We describe the use of a nontunneled, low-cost, long-lasting Silastic catheter (LLSC), cared for by an intravenous therapy team (IVTT), in 462 patients with cancer. The rate of infectious complications was 0.66 infections per 1,000 catheter-days, which is as low as that reported in association with other catheters in developed countries. Neutropenia and skin and/or soft-tissue infections were significant risk factors associated with LLSC-related infections. We believe that use of this catheter may be an alternative for patients with cancer who need chemotherapy, as long as an IVTT is established for its care. Our experience could be useful for practitioners in countries with similar socioeconomic characteristics.

Administration of the antimycotic agents fluconazole and itraconazole to leukaemia patients: a comparative pharmacokinetic study.

This report presents the results of a randomized parallel design comparative study of the serum concentrations of fluconazole and itraconazole after administration of 100 mg orally to patients with leukaemia. Each group consisted of ten patients. The antimycotic drugs were administered with a standard breakfast immediately before the start of chemotherapy (day one) and on days eight and fifteen. No significant differences (p > 0.05; ANOVA) in the pharmacokinetic parameters of fluconazole (AUC, Cmax, Tmax) were found during the three days of the trial. It is concluded that there is no clinically important pharmacokinetic interaction between fluconazole and the chemotherapeutic agents given to this group of patients. A pharmacokinetic interaction between fluconazole and the fever suffered by some of the patients also seems unlikely. No significant differences (p < 0.05; ANOVA) in the pharmacokinetic parameters of itraconazole (AUC, Cmax, Tmax) were found during the three days of the trial, although the statistical power of the data was low. The significantly greater variability of all pharmacokinetic parameters for itraconazole than for fluconazole and the sharp increases and decreases in AUC during the course of the trial found for some patients in the itraconazole group suggest the need for caution in this group of patients.

Primary B cell lymphoma of the rectum in a patient coinfected with HIV-1 and HTLV-I.

This report describes a clinical case of a large cell, immunoblastic plasmacytoid malignant B-cell lymphoma of the rectum in an AIDS patient coinfected with HTLV-I. The malignant cells showed clonal genetic rearrangement of the HC (JH) and LCK genes. Infection by EBV was demonstrated serologically and with slot blots using genomic DNA of the cancer cells. Southern blot analysis with DNA extracted from the lymphoma cells were negative for HTLV-I. The patient received seven cycles of VACO-B which induced complete but transient clinical remission of the tumor. The final outcome of the patient is unknown.

High incidence of subclavian dialysis catheter-related bacteremias.

This retrospective cohort study reviews the incidence of bacteremia in 48 patients undergoing hemodialysis using subclavian vein dialysis catheters (SDC) as temporary vascular access. Twelve (25%) of these patients had catheter-related bacteremia, and the most frequently isolated organisms were coagulase-negative staphylococci. Three patients developed right-sided endocarditis and one of them died due to pulmonary embolism. The presence of possible risk factors for SDC-related bacteremia, including duration of catheterization and number of hemodialysis procedures, were not statistically different when patients with and without bacteremia were compared, with the exception of a significantly lower incidence of bacteremia among those patients receiving antibiotic therapy at the time of catheter insertion. The use of resterilized catheters was not a risk factor. Specific guidelines for SDC insertion and care were established and followed, after which the infection frequency was reduced to 7.5% (1 episode per 45.5 patient-weeks of catheter use) in this high-risk population.

Pancuronium in caesarean section and its placental transfer.

Pancuronium bromide was used in 49 patients undergoing repeat elective Caesarean section. In 26 patients who received only pancuronium 0.1 mg kg-1, pancuronium was detected in all umbilical venous or arterial samples (0.12 micrograms ml-1). In 23 other patiets who received suxamethonium 1.0 mg kg-1 followed by pancuronium 0.05 mg kg-1, pancuronium was detected in fetal blood 2 min after injection; the concentration of pancuronium in umbilical venous or arterial samples in 14 subjects was 0.08 micrograms ml-1, and less than 0.05 micrograms ml-1 in nine subjects. There was no evidence that such concentrations of pancuronium were detrimental to the fetus. The use of suxamethonium before pancuronium resulted in reduction of pancuronium dosage, induction-delivery time, and fetal concentrations of pancuronium, and was associated with better condition of the neonate.