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2.
Angiol. (Barcelona) ; 74(3): 131-134, May-Jun. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-209047

RESUMO

Introducción: presentamos un caso inusual de rotura aórtica múltiple secundaria a espondilodiscitis por Staphylococcus aureus sensible a meticilina. Caso clínico: varón de 71 años que ingresa en nuestro hospital para el estudio programado de una espondilodiscitis T7-T8 refractaria a tratamiento empírico antibiótico. El decimoquinto día de su ingreso el paciente presenta una hematemesis masiva con dos paradas cardiorrespiratorias. Tras ser reanimado en dos ocasiones, se realiza una endoscopia en el quirófano que sugiere la presencia de una fístula aortoentérica primaria. A su vez, en una tomografía computarizada de seguimiento se evidencia sangrado activo en la aorta torácica. Realizamos una angiografía diagnóstica en la que apreciamos tres puntos de ruptura aórtica. Se precisa la implantación de endoprótesis cubiertas para el control del sangrado: un dispositivo en la aorta torácica (Gore C-TAG®) y otro a nivel abdominal (Aortic Begraft®). Discusión: la aortitis es una complicación poco común de la espondilodiscitis con una tasa alta de mortalidad. Un alto índice de sospecha es clave para su temprano diagnóstico y tratamiento. La antibioterapia es obligatoria y el tratamiento endovascular puede usarse como terapia puente en emergencias. Es un procedimiento rápido que permite la estabilización hemodinámica del paciente antes de una cirugía abierta aórtica definitiva.(AU)


Introduction: we present an unusual case with multiple aortic ruptures secondary to methicillin-sensitive Staphylococcus aureus thoracic spondylodiscitis. Case report: the patient was a 71-year-old man admitted to our hospital for scheduled study of an infectious spondylodiscitis D7-D8 refractory to empirical antibiotic therapy. Fifteen days after admission, the patient began with massive hematemesis. After being resuscitated from two cardiac arrests, an endoscopy was carried out in the operating room suggesting presence of a primary aortoenteric fistula and, at the same time, in a follow-up computed tomography an active bleeding in thoracic aorta was shown. We performed a diagnostic angiography; three different sites of rupture were observed and two covered endogfrats were placed for bleeding control of thoracic and abdominal aorta: one device in thoracic aorta (Gore C-TAG®) and another one in abdominal aorta (Aortic Begraft®). Discussion: aortitis is an uncommon complication of spondylodiscitis, with a high mortality rate. A high index of suspicion is key to its diagnosis and prompt treatment. Antibiotherapy is mandatory and endovascular treatment can be used as a bridge therapy in emergency, it is a fast procedure that can secure hemodynamical stabilization prior to definitive aortic open repair.(AU)


Assuntos
Humanos , Masculino , Idoso , Pacientes Internados , Resultado do Tratamento , Exame Físico , Avaliação de Sintomas , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Ruptura Aórtica/terapia , Hematemese , Próteses e Implantes , Sistema Cardiovascular , Vasos Linfáticos/anatomia & histologia , Vasos Sanguíneos/anatomia & histologia , Sistema Linfático , Discite/complicações , Discite/diagnóstico , Discite/cirurgia , Parada Cardíaca
6.
Nutr. hosp ; 37(6): 1281-1284, nov.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198318

RESUMO

INTRODUCCIÓN: la nutrición parenteral (NP) es una modalidad de soporte nutricional con posibles complicaciones, en parte asociadas al catéter venoso central (CVC). El quilotórax consiste en el derrame de líquido linfático de origen intestinal en el espacio pleural. CASO CLÍNICO: varón de 57 años ingresado para colecistectomía. Presenta un postoperatorio complicado que requiere reposo digestivo y NP. Posteriormente presenta disnea y dolor torácico con derrame pleural bilateral y pericárdico. Inicialmente se interpretó como un quilotórax, por su aspecto lechoso y su contenido en triglicéridos. La TC confirmó la malposición del CVC con salida de NP a nivel del tronco venoso innominado. Fue intervenido quirúrgicamente, realizándose un lavado del mediastino anterior y la reparación de la perforación. La evolución posterior fue favorable. DISCUSIÓN: la extravasación de la NP al espacio pleural es una complicación infrecuente pero posible de la administración de NP por vía central. Por tanto, debe tenerse en cuenta en el diagnóstico diferencial


INTRODUCTION: parenteral nutrition (PN) is commonly used as a nutritional support option. It may cause complications, partly due to a central venous access. Chylothorax is an accumulation of lymphatic fluid in the pleural space. CASE REPORT: a 57-year-old man was admitted for cholecystectomy. A complicated postoperative period required PN. Cardiorespiratory symptoms started while receiving PN, and a bilateral pleural and pericardial effusion was identified. It was initially interpreted as chylothorax due to its milky appearance and high triglyceride content. A CT scan confirmed a malposition of the CVC with PN leakage at the level of the innominate venous trunk. It was surgically repaired. DISCUSSION: parenteral nutrition leakage is an unusual complication of PN. It should be included in the differential diagnosis of pleural effusion


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral Total/efeitos adversos , Quilotórax/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Esternotomia/métodos , Quilotórax/complicações , Complicações Pós-Operatórias , Dispneia/complicações , Dor no Peito/etiologia , Hematemese/complicações , Diagnóstico Diferencial , Radiografia Torácica
13.
Rev. esp. enferm. dig ; 111(3): 182-188, mar. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-189823

RESUMO

Background: upper gastrointestinal bleeding (UGIB) is one of the main causes of hospital admission in gastroenterology departments and is associated with a significant morbidity and mortality. Rebleeding after initial endoscopic therapy occurs in 10-20% of cases and therefore, there is a need to define predictive factors for rebleeding. Aim: the aim of our study was to analyze risk factors and outcomes in a population of patients who suffered a rebleed. Methods: five hundred and seven patients with gastrointestinal bleeding were included. Clinical and biochemical data, as well as procedures and outcome six months after admission, were all collected. Documented clinical outcome included in-hospital and six-month delayed mortality, rebleeding and six-month delayed hemorrhagic and cardiovascular events. Results: according to a logistic regression analysis, high creatinine levels were independent risk factors for rebleeding of non-variceal and variceal UGIB. In non-variceal UGIB, tachycardia was an independent risk factor, whereas albumin levels were an independent protective factor. Rebleeding was associated with in-hospital mortality (29.5% vs 5.5%; p < 0.0001). In contrast, rebleeding was not related to six-month delayed mortality or delayed cardiovascular and hemorrhagic events. Conclusions: tachycardia and high creatinine and albumin levels were independent factors associated with rebleeding, suggestive of a potential predictive role of these parameters. The incorporation of these variables into predictive scores may provide improved results for patients with UGIB. Further validation in prospective studies is required


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hemorragia Gastrointestinal/epidemiologia , Creatinina/análise , Albumina Sérica/análise , Melena/epidemiologia , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/complicações , Recidiva , Prognóstico , Biomarcadores/análise , Taquicardia/epidemiologia , Hematemese/epidemiologia , Estudos Prospectivos
15.
Acta pediatr. esp ; 76(9/10): e144-e147, sept.-oct. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-177424

RESUMO

La gastroenteritis eosinofílica representa una patología emergente y pertenece a un espectro reconocido de enfermedades digestivas eosinofílicas. Puede aparecer a cualquier edad y con sintomatología diversa. Su diagnóstico positivo es histológico, aunque no hay una definición precisa. Presentamos un caso atípico de un lactante de 2 meses de edad con una gastroenteritis eosinofílica manifestada por una hemorragia digestiva grave


Eosinophilic gastroenteritis is an emergent disease and belongs to a group of eosinfilic digestive illness. It is characterized by various unspecific symptoms. Histological study confirms the diagnostic even if there is not until now a clear definition about histological criteria. We present an infant of 2 months with eosinophilic gastroenteritis revealed by a severe digestive bleeding


Assuntos
Humanos , Masculino , Lactente , Gastroenterite/etiologia , Hematemese/complicações , Hemorragia Gastrointestinal/complicações , Eosinofilia/patologia , Gastroenterite/patologia , Úlcera Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Endoscopia/métodos
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