[Discrepancy between clinical and radiologic manifestations of an epidural hematoma after catheterization]. / Discordancia clínico-radiológica y resolución espontánea de un hematoma postcateterización epidural.

Neuraxial techniques are considered safe if certain guidelines are followed, but they are not risk free. We report the case of an 81-year-old woman with an invasive bladder tumor who underwent radical cystectomy with a Bricker-type procedure. General anesthesia was used and epidural analgesia was also provided for surgical and postoperative pain management. Late in the postoperative recovery period a large epidural hematoma was diagnosed based on radiologic signs of spinal cord compression, in the absence of symptoms other than mild and progressive back pain that developed after extubation. The surgeon decided against emergency surgery to reduce compression. Symptoms resolved gradually, and a magnetic resonance image 45 days after discharge confirmed that the hematoma was smaller. In addition to the usual safety recommendations for epidural anesthesia with regard to drugs that alter hemostasis, it is important to bear in mind circumstances that have pharmacokinetic repercussions and that increase risk. Lower back pain can be a warning sign. Some cases may resolve spontaneously.

Discordancia clínico-radiológica y resolución espontáneade un hematoma postcateterización epidural / Discrepancy between clinical and radiologic manifestations of an epidural hematoma after catheterization

Las técnicas neuroaxiales se consideran seguras si serespetan ciertas recomendaciones, pero no están exentasde riesgos.Presentamos el caso de una mujer de 81 años intervenidade neoplasia vesical infiltrante, mediante cistectomíaradical tipo Bricker. Se empleó anestesia generaly analgesia epidural intra y postoperatoria. En el postoperatoriotardío se diagnosticó un hematoma epiduralextenso con signos de radiológicos de compresión medular,en ausencia de síntomas neurológicos compresivos.Tan sólo manifestó una dorsalgia leve tras la extubación,que progresó durante el postoperatorio. Se desestimóla cirugía descompresiva urgente. La clínica remitióprogresivamente. La RM a los 45 días del altamostró el hematoma en resolución.En la anestesia epidural, además del seguimiento delas recomendaciones de seguridad respecto a los fármacosque alteran la hemostasia, hay que considerar circunstanciasque alteren su cinética y la adición progresivade factores de riesgo. La dorsolumbalgia puede serun signo de alerta. Algunos casos pueden resolverse demanera espontánea (AU)

Neuraxial techniques are considered safe if certainguidelines are followed, but they are not risk free. Wereport the case of an 81-year-old woman with aninvasive bladder tumor who underwent radicalcystectomy with a Bricker-type procedure. Generalanesthesia was used and epidural analgesia was alsoprovided for surgical and postoperative painmanagement. Late in the postoperative recovery perioda large epidural hematoma was diagnosed based onradiologic signs of spinal cord compression, in theabsence of symptoms other than mild and progressiveback pain that developed after extubation. The surgeondecided against emergency surgery to reducecompression. Symptoms resolved gradually, and amagnetic resonance image 45 days after dischargeconfirmed that the hematoma was smaller. In additionto the usual safety recommendations for epiduralanesthesia with regard to drugs that alter hemostasis, itis important to bear in mind circumstances that havepharmacokinetic repercussions and that increase risk.Lower back pain can be a warning sign. Some casesmay resolve spontaneously (AU)

Serum trypsin levels in acute pancreatic and non-pancreatic abdominal conditions.

Serum trypsin levels have been estimated by radioimmunoassay in 26 healthy controls (248 +/- 94.9 micrograms/l; mean +/- s.d.), 12 patients with chronic renal failure (1100 +/- 584 micrograms/l), 34 with acute pancreatitis (1399 +/- 618 micrograms/l) and 23 with acute non-pancreatic abdominal conditions. Mean serum trypsin in acute pancreatitis and in chronic renal failure was significantly higher than in control group (P less than 0.001). Serum trypsin levels were well above the upper limit of normality in all patients with acute pancreatitis and in all but one with chronic renal failure. Serum trypsin was markedly raised in one patient with a traumatic haemoperitoneum and in one of the 11 with peptic ulcer perforation, and moderately raised in 3 of the 6 with acute cholecystitis. Determination of serum trypsin seems to be a specific test for acute pancreatitis, provided renal failure has been excluded. However, the authors suggest it should be prospectively measured in a larger series of acute non-pancreatic abdominal conditions.