RESUMEN
Surgical patients with pulmonary hypertension present a significant challenge to the anesthesiologist. Continuous perioperative monitoring of pulmonary artery (PA) pressure is recommended and most often accomplished with a PA catheter. Placement of a PA catheter may be difficult or contraindicated, and in these cases, transesophageal echocardiography is a useful alternative to monitor dynamic PA physiology. In this case, we used intraoperative transesophageal echocardiography to detect changes in peak PA pressure and guide clinical treatment in a patient with pulmonary hypertension and an extensive PA aneurysm undergoing partial nephrectomy.
Asunto(s)
Aneurisma/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Monitoreo Intraoperatorio/métodos , Nefrectomía/métodos , Arteria Pulmonar/diagnóstico por imagen , Aneurisma/cirugía , Femenino , Humanos , Persona de Mediana Edad , Nefrectomía/efectos adversos , Arteria Pulmonar/cirugíaRESUMEN
Radiofrequency (RF) scanning is an increasingly popular method of detecting retained surgical items. RF systems are generally regarded as safe but have the potential to cause electrical interference with pacemakers. This may lead to serious adverse events, including asystole. We present a case of an RF system used with a temporary pacemaker resulting in asystole. With the use of RF devices becoming widespread, it is important for all operating room personnel to recognize the potential for pacemaker interference from RF scanning devices and the requirements for asynchronous pacing when these devices are in use.
Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Marcapaso Artificial , Ondas de Radio/efectos adversos , Enfermedad de la Arteria Coronaria/fisiopatología , Electrocardiografía , Campos Electromagnéticos , Falla de Equipo , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Dedos/irrigación sanguínea , Isquemia/etiología , Enfermedades Profesionales/etiología , Enfermedades Vasculares Periféricas/etiología , Arteria Cubital , Traumatismos de la Mano/complicaciones , Humanos , Isquemia/diagnóstico , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/diagnóstico , Enfermedades Vasculares Periféricas/diagnóstico , SíndromeRESUMEN
A 62-year-old Caucasian woman, with remote history of painful skin blistering and hypertrichosis, recent history of travel to Mexico and increased alcohol consumption, presented with progressively worsening jaundice and fatigue. Physical examination was remarkable for severe generalised jaundice, scleral icterus and erythematous facial blistering and scarring. Laboratory workup revealed markedly elevated total and direct bilirubin, mildly elevated transaminases, severe iron overload and increased urine coproporphyrin. Porphyria cutanea tarda was diagnosed, and she was treated with supportive measures including hydration and alcohol cessation. Pathology of her liver demonstrated mild iron overload and severe fatty infiltration. Hospital follow-up revealed complete resolution of jaundice and fatigue and near-normalisation of liver function tests.
Asunto(s)
Consumo de Bebidas Alcohólicas , Hierro/toxicidad , Hepatopatías/fisiopatología , Luz Solar , Diagnóstico Diferencial , Femenino , Humanos , Hepatopatías/complicaciones , Hepatopatías/diagnóstico , Hepatopatías/terapia , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
A man in his late 50s with a history of membranoproliferative glomerulonephritis presented with fever and mild dyspnoea. He was HIV-negative and had been on corticosteroids as immunosuppression for 6 months prior to tapering them off 1 week before presentation. He was not taking prophylaxis for Pneumocystis jirovecii pneumonia. After unsuccessful treatment for community-acquired pneumonia, his condition worsened and he required intubation and mechanical ventilation. Full respiratory workup including bronchoscopy revealed P jirovecii as a source for the patient's infection. He was treated successfully with a 21-day course of trimethoprim-sulfamethoxazole and eventually weaned off the ventilator. He has had no complications to date. In our review of this case and the existing literature, we believe that proper utilisation of prophylaxis for pneumocystis pneumonia may have prevented our patient's transfer to intensive care unit. In our article, we discuss this issue and explore current evidence for prophylaxis.
Asunto(s)
Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/microbiología , Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Broncoscopía , Diagnóstico Diferencial , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/prevención & control , Respiración Artificial , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
BACKGROUND: Several sports medicine reviews have highlighted a 3- to 6-month time frame for return to play after splenic lacerations. These reviews are based on several well-defined grading scales for splenic injury based on computed tomography (CT). None of the articles suggest that serial CT scanning is necessary for follow-up; some even indicate that it has no role in the management of these injuries. HYPOTHESIS: With proper follow-up and possibly the use of serial CT scanning or other imaging modalities, it may be possible for athletes to safely return to play sooner than what current guidelines recommend. STUDY DESIGN: The authors present 2 cases of professional hockey players who both suffered grade III splenic lacerations while playing. METHODS: Both players were treated conservatively and monitored with serial CT scanning until radiographic and clinical findings suggested complete healing. RESULTS: Both players were able to return to full-contact professional hockey within 2 months after suffering grade III splenic lacerations. Neither athlete suffered any complications after his return. CONCLUSIONS: With CT scanning, 2 athletes were able to return to play earlier (2 months) than previously recommended (3-6 months) without compromising their safety. CLINICAL RELEVANCE: Additional cases must be examined before outlining more definitive recommendations regarding splenic lacerations in sports, but it is possible that elite athletes may return to play sooner than what the current literature recommends.
RESUMEN
This case report presents a teenage patient who initially was thought to have a sports-related injury but ultimately was diagnosed with a primary soft tissue tumor. A previously healthy 16-year-old softball player presented with a history of left knee joint line pain, clicking, and swelling. The patient was presumed to have a lateral meniscus tear. However, magnetic resonance imaging demonstrated an intra-articular mass. Arthroscopy revealed a 2.5- × 1.5-cm firm pedicular mass in the lateral joint. Histological exam demonstrated localized pigmented villonodular synovitis. The patient healed uneventfully and returned to sporting activities. This report re-emphasizes the possibility that "sports tumors" can mimic symptoms of a meniscal tear in young athletes.