Food allergy as a cause of rhinitis and/or asthma.

We studied the histories of patients who had visited our Department during the last 5 years, presenting food allergy with exclusively respiratory symptoms (18.5%). We studied the correlation between IgE levels and the histamine release test and the type of food implicated. Seventy-seven percent of patients presented sensitization to one food, and 23% presented polysensitization. We found that foods such as snails and eggs have a strong predilection for the bronchial tree as the shock organ. High total IgE was found in 85.2% of patients. The histamine release test was positive in 66% of cases. We conclude that this is a highly sensitive method for the in vitro diagnosis of food allergy.     

Serum concentration of calcium and calcitonin in hyperthyroidism caused by Graves' disease]

Serum calcium and calcitonin were determined in 13 patients (12 women and 1 man), ages ranging from 30 to 40 years, with clinical diagnosis of hyperthyroidism due to Graves' Disease, confirmed by serum determinations of T3 and T4, with the purpose of establishing the relationship that these two substances may have in this pathology. The results obtained showed a decrease in seric calcium concentration in relation to a control group (10.02 +/-) 0.48 vs 11.49 +/- 0.28 mg/dl; p less than 0.005) and an increase in calcitonin concentration (193.6 +/- 8.62 vs 116.7 +/- 7.61 pg/ml; p less than 0.0001). We also found a significative negative association (r = -0.69; p less than 0.01) between these two compounds in the group of patients with hyperthyroidism, not being found in the control group.     

Effectiveness of health education for puerperae

A survey was conducted in early 1985 among 366 new mothers at 3 hospitals in Pinar del Rio, Cuba, to assess their level of health information regarding the care of newborns. The 11 study variables included breastfeeding, weaning, bathing the newborn, care of clothing and equipment for the baby, well baby visits, vaccination, accidents and safety, parent-child relations, sex education, and the puerperium. The level of information on these topics was generally low and was adequate only for breastfeeding. The information deficit was not related to urban or rural residence, parity, or educational level. The lack of knowledge of new mothers was attributed to the lack of motivation of health personnel at all levels to provide health education, inadequate use of existing information channels, and a lack of emphasis on health education within the general educational system.     

Comparative, Clinico-Epidemiologic Study of Schistosoma mansoni Infections in Travellers and Immigrants in Spain

The study presented here aimed to contrast the marked clinical differences in the presentation of Schistosoma mansoni-induced infection between immigrants and travellers entering Spain from endemic regions, and to elucidate the therapeutic implications of these infections. A total of 200 African immigrants and 80 travellers with schistosomiasis were included in the study. Among the immigrants, 25 patients were diagnosed with Schistosoma mansoni infection; 15 presented with nonspecific symptoms, and 10 were asymptomatic. Hepatosplenomegaly was observed in nine. Among the travellers, 14 were diagnosed with Schistosoma mansoni infection; four were asymptomatic, four had Katayama syndrome, four had diarrhoea, and two had prostatitis. All of the patients were treated with praziquantel. Patients diagnosed with Katayama syndrome received praziquantel and dexamethasone for 3 days, with the praziquantel treatment being repeated at 3–4 weeks. The significant differences observed in the clinical presentation of Schistosoma mansoni-induced infection, indicate that a well-differentiated therapeutic strategy is required when this infection is diagnosed in a non-immune (traveller) or a semi-immune (immigrant) patient. Electronic Publication     

Pleural effusion in patients infected with the human immunodeficiency virus

In order to analyze the etiology, cytological and biochemical characteristics, and outcome of pleural disease in patients infected with HIV, the medical records of 86 HIV-positive patients with pleural effusion were reviewed. Controls were 106 HIV-negative patients with parapneumonic or tuberculous effusion. Most HIV-positive patients were intravenous drug abusers (95.3%). Pleural effusions in HIV-positive patients were caused by infections in 76 (89.4%) cases. Parapneumonic effusion was diagnosed in 59 patients and tuberculous pleuritis in 15 patients.Staphylococcus aureus was the most frequently isolated bacteria. Parameters for differentiating complicated cases of parapneumonic exudate from uncomplicated cases, such as pleural fluid pH<7.20 (sensitivity 80% vs. 84.3%), pleural fluid glucose<35 mg/dl (sensitivity 45% vs. 56.25%) pleural fluid LDH > 1600 Ul/l (sensitivity 85% vs. 62.50%), showed similar sensitivity in HIV-positive and HIV-negative patients. Monocytes in pleural fluid were significantly decreased in tuberculous pleuritis in HIV-positive patients (506±425 vs. 1014±1196 monocytes/ml, p<0.05). No significant differences were detected in the outcome of HIV-positive and HIV-negative patients with pleural disease. It can be concluded that the pleural effusion was of predominantly infectious etiology in HIV-positive patients from populations with a high prevalence of intravenous drug abuse. Neither the biochemical parameters in pleural fluid nor the outcome differed significantly between HIV-positive and HIV-negative patients.     

Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy

Summary:  Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro-clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. In refractory SE, general anesthesia may be required. Propofol and thiopental represent first line agents in this setting, after careful assessment of potential risks and benefits.     

Linitis plástica primaria rectal

Primary linitis plastica of the rectum is an infrequent and unusual rectal carcinoma. We report a new case that presented clinically as a haemorrhoidal syndrome. We comment on the characteristics--clinical picture and histopathology--of this uncommon presentation of rectal tumour, as well as its clinical history and prognosis taking into account that the literature consulted indicated the unusualness of primary linitis plastica of the rectum.     

Hospital utilization and increasing old age in the user of care?]

Data are presented on hospital stay for the population 65 years-old and over, measured in percentage over the total for Spain, for the 1978 to 1988 period, by gender, for each province and autonomous region (Comunidad Autónoma). The country's total for the last available year was 35%. Except in Baleares and Murcia, the proportion of hospital stays increased in all Regions, especially in Navarra, where it increased from 23% to 51%. After adjusting for age, the increase in the proportion of hospital stays in the study population was due to an increase in utilization per person. The proportion, which was 13.3% in 1978, raised to 23.8% in 1988, with an adjusted value of 21.3%.