RESUMEN
Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.
Asunto(s)
Adulto , Humanos , Masculino , Acinetobacter baumannii , Infecciones por Acinetobacter/tratamiento farmacológico , Amicacina/administración & dosificación , Antibacterianos/administración & dosificación , Meningitis Bacterianas/tratamiento farmacológico , Sulbactam/administración & dosificación , Infecciones por Acinetobacter/etiología , Craneotomía/efectos adversos , Resultado Fatal , Inyecciones Espinales , Meningitis Bacterianas/etiología , Hemorragia Subaracnoidea/cirugíaRESUMEN
Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin.
Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii , Amicacina/administración & dosificación , Antibacterianos/administración & dosificación , Meningitis Bacterianas/tratamiento farmacológico , Sulbactam/administración & dosificación , Infecciones por Acinetobacter/etiología , Adulto , Craneotomía/efectos adversos , Resultado Fatal , Humanos , Inyecciones Espinales , Masculino , Meningitis Bacterianas/etiología , Hemorragia Subaracnoidea/cirugíaRESUMEN
OBJECTIVE: The aim of this study was to determine the risk factors for postoperative infection after craniotomy, a threat for the vital prognosis, in order to define specific prevention measures. METHOD AND PATIENTS: An open prospective study was made on all adult patients undergoing craniotomy and followed 30 days postoperatively. The infections were defined according to CDCA criteria. The parameters studied were: age, sex, ASA and Glasgow scores, neurosurgical history, the type, the moment and the surface of shaving, antibioprophylaxis, and the type and duration of surgery as well as its emergency level. RESULTS: One hundred and seventy patients were included. Thirty presented with an infection (17.6%), nine with a skull infection, 13 with meningitis, three with empyema, and two with osteitis. The risk factors identified thanks to a univariate analysis were the emergency level of surgery (P < 0.01), duration of surgery >200 min, and duration of stay in ICU >72 h (P < 0.02).
Asunto(s)
Craneotomía , Complicaciones Posoperatorias/epidemiología , Absceso/epidemiología , Adolescente , Adulto , Anciano , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Urgencias Médicas , Empiema/epidemiología , Femenino , Escala de Coma de Glasgow , Humanos , Incidencia , Periodo Intraoperatorio , Tiempo de Internación , Masculino , Meningitis/epidemiología , Persona de Mediana Edad , Marruecos/epidemiología , Osteítis/epidemiología , Estudios Prospectivos , Sala de Recuperación/estadística & datos numéricos , Factores de Riesgo , Dermatosis del Cuero Cabelludo/epidemiología , Enfermedades Cutáneas Infecciosas/epidemiología , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.
Asunto(s)
Angiomiolipoma/complicaciones , Hematoma/etiología , Neoplasias Renales/complicaciones , Anciano , Angiomiolipoma/diagnóstico , Angiomiolipoma/patología , Angiomiolipoma/cirugía , Femenino , Estudios de Seguimiento , Hematoma/diagnóstico , Humanos , Riñón/patología , Neoplasias Renales/diagnóstico , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Nefrectomía , Espacio Retroperitoneal , Rotura Espontánea , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.
Asunto(s)
Donadores Vivos , Nefrectomía/efectos adversos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiologíaRESUMEN
In this study, an uncommon case has been reported of an ectopic pheochromocytoma without the presence of any clinical symptoms. The radiological investigations showed a right retroperitoneal tumor without any kidney involvement. The diagnosis was established by biopsy and subsequent histological findings. In the course of surgery as the large tumor mass was being removed, tachycardia was observed which caused the resection to be performed as rapidly as possible. Once the tumor had been removed, bradycardia occurred, followed by cardiac arrest: although the latter was stabilized after cardiac massage, the patient died one hour after the operative field had been closed. In addition to this case report, the diagnosis, therapeutic strategy and prognosis regarding an ectopically located pheochromocytoma have been discussed.
Asunto(s)
Feocromocitoma/cirugía , Neoplasias Retroperitoneales/cirugía , Biopsia , Bradicardia/etiología , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Feocromocitoma/complicaciones , Feocromocitoma/diagnóstico , Neoplasias Retroperitoneales/complicaciones , Neoplasias Retroperitoneales/diagnósticoRESUMEN
Phaeochromocytoma is a rare tumour that may be discovered incidentally during a surgical operation that can sometimes cause fatal arrhythmias. The authors report 3 cases of phaeochromocytoma presenting in the form of hypertensive crisis and serious arrhythmias following manipulation of the tumour with a fatal outcome in 2 cases. These cases illustrate the severity and complexity of the problems encountered and the importance of preoperative detection of phaeochromocytomas, particularly at the pre-anaesthetic visit.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Complicaciones Intraoperatorias/diagnóstico , Feocromocitoma/diagnóstico , Adulto , Femenino , HumanosRESUMEN
Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.
Asunto(s)
Peritonitis/etiología , Complicaciones Infecciosas del Embarazo , Pielonefritis/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Rotura EspontáneaRESUMEN
OBJECTIVE: To assess the efficacy of an combination of Emla cream and N2O for venous cannulation in children. STUDY DESIGN: Prospective, randomized, double blind trial. PATIENTS: The study included 75 unpremedicated children, aged 3 months to 5 years, ASA physical class I and II, undergoing an elective surgical procedure, randomized into three groups. METHODS: In group I and III, children received Emla cream one hour before entering the theatre. In group II, children received a placebo. Children of group I and III also inhaled 50 vol% nitrous oxide in oxygen and those of groupe II 100 vol% oxygen, 3 min prior and during venous cannulation. A blinded observer recorded the following items: pain assessment with CHEOPS scoring, conditions of venous puncture and behaviour of children. Heart rate, blood pressure and oxygen saturation were assessed at three timepoints: before, 3 min after facial mask application and following venous cannulation. RESULTS: There were non significant differences between the three groups for the conditions of venous cannulation. The CHEOPS score was better in group I (7[4-11]), compared to group II (10[6-13]; P < 0.01) and to group III (9[6-12]; P < 0.01). CONCLUSION: Emla cream combined with nitrous oxide is effective for venous cannulation in providing satisfactory analgesia and in controlling anxiety elicited by the vision of needle.
Asunto(s)
Anestesia por Inhalación , Anestesia Local , Anestésicos Combinados , Anestésicos por Inhalación , Anestésicos Locales , Cateterismo Periférico , Lidocaína , Óxido Nitroso , Prilocaína , Administración Cutánea , Ansiedad/prevención & control , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/psicología , Preescolar , Método Doble Ciego , Femenino , Humanos , Lactante , Combinación Lidocaína y Prilocaína , Masculino , Pomadas , Dimensión del Dolor , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: Fluorescein is widely used in ophthalmology. Side effects related to fluorescein occur frequently but are usually benign (nausea, vomiting, lipothymia). Severe side effects are rare. We report a case of anaphylactic shock due to local application of fluorescein. CASE REPORT: A 70-year-old woman was treated for ocular conjunctivitis with local application of fluorescein. Cardiac arrest occurred due to anaphylactic shock. Resuscitation was successful. DISCUSSION: The gravity of certain complications related to the use of fluorescein underline the importance of adequate resuscitation material and adapted treatment.
Asunto(s)
Anafilaxia/inducido químicamente , Fluoresceínas/efectos adversos , Administración Tópica , Anciano , Conjuntiva , Femenino , Fluoresceínas/administración & dosificación , Humanos , Factores de RiesgoRESUMEN
We report a case of a permanent flaccid paraplegia, with a sensory loss at T12 level, not associated with cerebral damage, subsequent to a cardiac arrest of 15 minutes duration, in a 67-year-old patient, undergoing haemorragic surgery for gangrenous purulent cholecystitis. Besides cardiovascular collapse and subsequent circulatory arrest, possible favouring factors include anatomical anomalies in the territory of anterior spinal artery, surgical posture with hyperlordosis generating venous stasis, emergency haemostatic maneuvers with compression of the arterial territory providing spinal blood supply. Spinal cord lesions are probably more frequent than expected, as the often associated cerebral anoxic encephalopathy impedes their recognition. Only a systematic anatomopathological examination of the spinal cord, in patients who died after a cardiac arrest, would provide the accurate incidence of spinal complications.
Asunto(s)
Paro Cardíaco/complicaciones , Complicaciones Intraoperatorias , Paraplejía/etiología , Anciano , Humanos , Isquemia/etiología , Masculino , Choque Hemorrágico/complicaciones , Médula Espinal/irrigación sanguíneaRESUMEN
OBJECTIVE: To compare the efficacy of oral ondansetron with oral metoclopramide for the prevention of postoperative vomiting and nausea in children undergoing strabismus surgery. STUDY DESIGN: Prospective, randomized, double-blind trial. PATIENTS: Thirty children of physical class 1, age 9 +/- 4 years, scheduled for strabismus surgery, were randomized into two groups (ondansetron and metoclopramide). METHODS: In the ondansetron group, the children received the first oral dose of ondansetron (4 mg) 1 hour before induction of anaesthesia and the other doses 8 and 16 hours later. In the metoclopramide group, children received metoclopramide (5 mg) in the same conditions. Anaesthesia was induced with thiopentone, vecuronium and fentanyl and maintained with halothane and N2O/O2. Patients were evaluated by an independent observer for nausea and emesis in recovery room (0-2 h) and on the ward. The adverse effects of oral ondansetron and metoclopramide were assessed. RESULTS: There were non-significant differences between the two groups for incidence of nausea and vomiting (40% and 53% in ondansetron group versus 33 and 60% in metoclopramide group, respectively. CONCLUSION: Unlike intravenous ondansetron, oral ondansetron is not superior to metoclopramide for the prevention of nausea and vomiting caused by strabismus surgery in children.
Asunto(s)
Antieméticos/farmacología , Náusea/prevención & control , Ondansetrón/farmacología , Complicaciones Posoperatorias/prevención & control , Estrabismo/cirugía , Vómitos/prevención & control , Administración Oral , Adolescente , Niño , Femenino , Humanos , Masculino , Metoclopramida/farmacologíaRESUMEN
This study was carried out to assess the efficacy of oral lorazepam on postoperative nausea and vomiting in patients undergoing thyroid surgery. Twenty-six patients were randomly assigned to two groups, and receiving orally, one hour before induction of anaesthesia, either 2.5 mg of lorazepam (n = 13) or a placebo (n = 13). Lorazepam reduced the incidence and especially the intensity of nausea. The incidence of vomiting in the lorazepam group was significantly lower than in the placebo group (14.5% vs 45%). The use of lorazepam for premedication thus reduces the incidence of postoperative nausea and vomiting. The advantages of this benzodiazepine are its ease of use, low cost and very low incidence of side effects.
Asunto(s)
Ansiolíticos/uso terapéutico , Lorazepam/uso terapéutico , Náusea/prevención & control , Complicaciones Posoperatorias/prevención & control , Vómitos/prevención & control , Adulto , Humanos , Placebos , Medicación PreanestésicaRESUMEN
Phostoxin is a mixture of aluminium phosphide and ammonium carbonate. When exposed to water, it releases phosphorus hydrogen (PH3), a highly-poisonous gas. In Morocco, death rate from suicide due to self-administration of phostoxin pills is high. Clinical signs include abrupt digestive and nervous disorders. Pulmonary oedema or cardiogenic shock dominate early prognosis. Liver and renal damage is secondary. Prevention requires both legal constraints and regulation of sales.
Asunto(s)
Compuestos de Aluminio/envenenamiento , Plaguicidas/envenenamiento , Fosfinas/envenenamiento , Edema Pulmonar/inducido químicamente , Insuficiencia Renal/inducido químicamente , Choque Cardiogénico/inducido químicamente , Enfermedad Aguda , Adulto , Cardiotónicos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Cimetidina/uso terapéutico , Terapia Combinada , Femenino , Humanos , Terapia por Inhalación de Oxígeno , Edema Pulmonar/terapia , Insuficiencia Renal/terapia , Choque Cardiogénico/terapia , Intento de SuicidioRESUMEN
Le tetanos postoperatoire est une affection rare; le but de ce travail est d'en preciser les difficultes diagnostiques et therapeutiques et d'etudier son pronostic. Les auteurs rapportent quatre observations de tetanos postoperatoire; la duree d'incubation est courte: 9 jours en moyenne; et la periode d'invasion est rapide; elle est de 24 a 48 heures. Le trismus est present dans tous les cas. Tous les tableaux sont graves d'emblee. Le traitement a comporte les memes volets que le tetanos commun grave. Trois patients sont decedes: deux complications directes du tetanos et le troisieme par une complication de la reanimation. Le tetanos postoperatoire peut compliquer toute intervention; avec une predisposition de la chirurgie digestive et gynecologique. La porte d'entree est souvent endogene. L'evolution est emaillee de complications inherentes au tetanos et a la reanimation vue la duree de la maldie. Son pronostic est sombre. Un traitement preventif du tetanos est a conseiller chez les sujets a haut risque
RESUMEN
Fatty liver during pregnancy is an acute hepatic disease of unknown origin. We report the case of a 24-year-old woman in whom the diagnosis was made on the basis of the histological examination. The disease did not disturb the normal course of the pregnancy and delivery. In the literature, it is generally suggested that pregnancy must be terminated in cases of acute fatty liver since no favourable outcome has been reported with continued pregnancy. We suggest that, in minor forms, close clinical observation and laboratory monitoring can provide the means of continuing the pregnancy to term.
Asunto(s)
Hígado Graso/terapia , Complicaciones del Embarazo/terapia , Aborto Terapéutico , Enfermedad Aguda , Adulto , Biopsia con Aguja , Hígado Graso/sangre , Hígado Graso/diagnóstico , Femenino , Escala de Coma de Glasgow , Humanos , Pruebas de Función Hepática , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/diagnóstico , Ultrasonografía PrenatalRESUMEN
Nosocomial urinary tract infection is the most frequent nosocomial infection in many care units. Its main risk factor is the presence of a bladder catheter. Prevention is based upon the enforcement of hygiene recommendations which are not always carefully applied everywhere. We report a prospective study concerning 328 patients divided into two gropus. Group I patients (n = 161) had an indwelling bladder catheter. Group II patients (n = 167) had an external urinary drainage by Penilex. The incidence of nosocomial urinary infection was 2.4% in group II versus 26.7% in group I. Thus preventive efficacy of Penilex use appears to be well demonstrated.