Severe Clostridium difficile colitis as potential late complication associated with COVID-19.

Spain has been one of the most affected countries by the COVID-19 outbreak. After the high impact of the pandemic, a wide clinical spectrum of late complications associated with COVID-19 are being observed. We report a case of a severe Clostridium difficile colitis in a post-treatment and recovered COVID-19 patient. A 64-year-woman with a one-month hospital admission for severe bilateral pneumonia associated with COVID-19 and 10 days after discharge presented with diarrhoea and abdominal pain. Severe C. difficile-associated colitis is diagnosed according to clinical features and CT findings. An urgent pancolectomy was performed due to her bad response to conservative treatment. Later evolution slowly improved to recovery. C. difficile-associated colitis is one of the most common hospital-acquired infections. Significant patient-related risk factors for C. difficile infection are antibiotic exposure, older age, and hospitalisation. Initial therapeutic recommendations in our country included administration broad-spectrum antibiotics to all patients with bilateral pneumonia associated with SARS-CoV-2. These antibiotics are strongly associated with C. difficile infection. Our patient developed a serious complication of C. difficile due to the use of broad-spectrum antibiotics. The appearance of late digestive symptoms in patients diagnosed and treated for COVID-19 should alert clinicians to the possibility of C. difficile infection. The updated criteria for severe colitis and severe C. difficile infection should be considered to ensure an early effective treatment for the complication.

Oxigenación por membrana extracorpórea / Extracorporeal membrane oxygenation

Las siglas ECMO (que significa oxigenación por membrana extracorpórea) se conocen internacionalmente como una forma de soporte cardiorrespiratorio prolongado con circulación extracorpórea. Él uso de ELMO se reserva para aquellas situaciones reversibles con fallo respiratorio o cardiorrespiratorio grave con falta de respuesta al tratamiento convencional o respuesta insuficiente. En España, y tras algunos casos aislados notificados de circulación extracorpórea prolongada, se inició el programa de ELMO en octubre de 1997 en el Hospital General Universitario "Gregorio Marañón" de Madrid, habiéndose tratado hasta la actualidad 64 pacientes neonatales y pediátricos (año 2002).En este trabajo realizamos una revisión de las indicaciones, riesgos y resultados de esta útil y novedosa técnica (AU)

Ultrasound of the elbow.

This article describes the use of ultrasound (US) in the evaluation of the elbow. US is able to visualize several abnormalities affecting tendons, muscles, ligaments and bursae around the elbow joint as well as to delineate the nature of soft-tissue swelling, such as a space-occupying lesion or synovial enlargement. Occult fractures, osteophytes and intra-articular loose bodies can be depicted with this technique as well. At the cubital tunnel, US allows accurate imaging of the ulnar nerve and to document changes that occur in compressive syndromes. Over other imaging modalities, US offers several key advantages, including cost effectiveness, availability and ability to perform a dynamic examination of tendon movement and joint motion. With continued experience, it is likely that the use of US will increase further with regards to evaluation of soft-tissue abnormalities of the elbow.

[Hemodynamic changes during laparoscopic surgery. Preliminary study]. / Alteraciones hemodinámicas durante la cirugía laparoscópica. Estudio preliminar.

The haemodynamic changes produced by laparoscopic surgery in children have been evaluated. A transesophageal echocardiographic study on 13 patients (7 males and 6 females, 10.8 +/- 2.7 years old) has been performed before, during and after peritoneal CO2 gas insufflation. A change on the Doppler waves pattern of the infradiaphragmatic veins along with an increase in blood flow velocity were observed. Pulmonary veins suffered minimal changes showing an increase on either the systolic pressure and on atrial contraction. Diastolic retrograde flow in aorta reflected an increase in peripheral vascular resistance. Cardiac output increased minimally. All haemodynamic changes returned to basal after gas peritoneal desufflation. These data show that laparoscopic surgery could produce important cardiac derangements in children with ventricular dysfunction or in patients presenting left ventricular outlet obstruction. In these patients laparoscopic surgery might be precluded.

Bronchoesophageal fistula secondary to aspiration of tongue adhesion button in a child with glossoptosis.

A newborn boy with obstructive apnea secondary to glossoptosis was treated by securing his tongue to his lower lip. Soon after, the button that served for posterior fixation became detached and was thought to have been evacuated via the digestive tract. Twenty-two months later the infant presented with pneumonia involving the right lower lobe and hemoptysis, causing an acute respiratory distress syndrome (ARDS). After mechanical ventilation was started marked gastric distention was observed. Esophagography and bronchography revealed a fistula between the right main stem bronchus and the esophagus. During surgical repair the plastic fixation button was found in the bronchial orifice of the fistula. Despite surgical correction of the fistula the child died of refractory respiratory failure.

Onfalocele gigante: caso clinico. / Giant omphalocele: clinical case

1. Se presenta un caso de hepato-onfalocele gigante, con diagnostico antenatal por ecografia, permitiendo el manejo obstetrico, neonatal y quirurgico adecuado. 2. Se hacen consideraciones sobre la patogenia, diagnostico, tratamiento y pronostico de dicha anomalia congenita