RESUMEN
A caesarean section was indicated in a 29-year-old parturient affected by a muscular deficit in myophosphorylase responsible for a type V glycogen storage disease (McArdle disease). This metabolic myopathy had been diagnosed two years previously, whereas the patient already suffered from a hereditary form of dilated cardiomyopathy. The muscular disease was invalidating on the functional level with exercise intolerance. The cardiopathy was little symptomatic but the dysfunction of the left ventricle worsened during the pregnancy with an ejection fraction calculated to 43%. In this case, we report the realization of a general anaesthesia in a patient who had epidural anaesthesia for a previous caesarean section.
Asunto(s)
Anestesia General , Anestesia Obstétrica , Cardiomiopatía Dilatada/complicaciones , Cesárea , Enfermedad del Almacenamiento de Glucógeno Tipo V/complicaciones , Adulto , Cardiomiopatía Dilatada/genética , Femenino , Humanos , Embarazo , Volumen Sistólico , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Following a pulmonary transplantation for cystic fibrosis, 2 patients exhibited a syndrome associating arterial hypertension, headache, visual trouble and generalized seizures. Cerebral magnetic resonance imaging revealed diffuse cortical and subcortical lesions predominantly in posterior regions. The exclusion of alternate diagnoses and the disappearance of the symptoms when the cyclosporine treatment was stopped confirmed the diagnosis of cyclosporine-related reversible posterior encephalopathy syndrome (PRES). Immediate appropriate management resulted in symptom disappearance and regression of radiological images.
Asunto(s)
Encefalopatías/inducido químicamente , Ciclosporina/efectos adversos , Inmunosupresores/efectos adversos , Adulto , Encefalopatías/patología , Cefalea/complicaciones , Humanos , Hipertensión/complicaciones , Trasplante de Pulmón/efectos adversos , Trasplante de Pulmón/inmunología , Imagen por Resonancia Magnética , Masculino , Convulsiones/complicaciones , SíndromeRESUMEN
Deep sternal wound infection is the major infectious complication in patients undergoing cardiac surgery, associated with a high morbidity and mortality rate, and a longer hospital stay. The most common causative pathogen involved is Staphylococcus spp. The management of post sternotomy mediastinitis associates surgical revision and antimicrobial therapy with bactericidal activity in blood, soft tissues, and the sternum. The pre-, per-, and postoperative prevention strategies associate controlling the patient's risk factors (diabetes, obesity, respiratory insufficiency), preparing the patient's skin (body hair, preoperative showering, operating site antiseptic treatment), antimicrobial prophylaxis, environmental control of the operating room and medical devices, indications and adequacy of surgical techniques. Recently published scientific data prove the significant impact of decolonization in patients carrying nasal Staphylococcus aureus, on surgical site infection rate, after cardiac surgery.