[Pancreatic pseudocyst, Torulopsis glabrata primary infection. Report of a case]. / Pseudoquiste de páncreas, infección primaria por Torulopsis glabrata. Reporte de un caso.

BACKGROUND: T. glabrata is a saprophyte fungus that has been considered in the past years to be a pathologic agent in the pancreatic pseudocyst. Only three cases have been reported in the world literature. OBJECTIVE: To present a new case of a patient with pancreatic pseudocyst whose primary cause of infection and sepsis was Torulopsis glabrata and to analyze the possible factors that produced the infection. In the same manner, a review of the cases on literature to date was conducted. CASE REPORT: We present the clinical evolution of a post surgical patient with conventional cholecystectomy with biliary duct exploration and biliary duct derivation secondary to choledocholithiasis. This patient developed acute pancreatitis days after an endoscopic retrograde cholangiopancreatography was carried out. The patient received wide-range antibiotics and total parenteral nutrition (TPN). Later, the patient's case was complicated with pancreatic pseudocyst that was act diagnosed and managed initially with antifungus therapy due to an asymptomatic stage and a late report for T. glabrata. CONCLUSIONS: Pancreatobiliary duct instrumentation, in the same manner, prolonged therapy with wide-spectrum antibiotics and with TPN an with the means that had associated as risk factors for T. glabrata infection. Therefore, this fungus could have changed its biologic behavior from commensal to pathogenic. A potentially pathogenic agent in patients receiving this type of therapy and who have pancreatic pseudocyst must be considered to recognize these in the initial stages and begin therapy.

Comparison of high-frequency jet to conventional mechanical ventilation in the treatment of severe smoke inhalation injury.

The pathophysiology of smoke inhalation includes surfactant inhibition and pulmonary vascular injury leading to a high permeability pulmonary oedema. It has been shown in surfactant deficient animal models that methods of ventilation (i.e. high-frequency ventilation - HFV) avoiding a large pressure excursion (i.e. pressure change from end expiration to peak inspiration) improves oxygenation and decreases hyaline membrane formation. Therefore, we compared HFV with conventional mechanical ventilation (CMV) on lung function in an acute animal model of smoke inhalation (SI). Mongrel dogs were anaesthetized, surgically prepared for haemodynamic and blood gas monitoring, and placed on either CMV (n = 6) or HFV (n = 7). Following baseline (BL) measurements both groups were ventilated with wood smoke for 10 min. Ventilator settings were not adjusted from baseline following smoke inhalation in either groups; positive and expiratory pressure (PEEP, approximately 6 mmHg) was added in both groups following smoke exposure. At the conclusion of the study (4 h postsmoke inhalation) lung samples were taken for surfactant function and lung water measurements. Smoke inhalation immediately increased the A-a gradient (CMV-BL = 6.9 +/- 2.4 to CMV-SI = 77.3 +/- 1.9; HFV-BL = 10.5 +/- 2.7; HFV-SI = 72.8 +/- 3.7 mmHg), venous admixture (CMV-BL = 6.9 +/- 2.8 to CMV-SI 69.8 +/- 6.6; HFV-BL = 7 +/- 1.7 to HFV-SI = 60.4 +/- 7.9 per cent) and decreased Pao2 (CMV-BL = 110 +/- 3.4 to CMV-SI = 28 +/- 3.5; HFV-BL = 103 +/- 3.6 to HFV-SI = 31 +/- 1.7 mmHg) to a similar level in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)