Hallazgos de neuroimagen en una serie de 14 pacientes con cefalea tratados con parche hemático epidural / Neuroimaging findings in a series of 14 patients witch headache for spontaneous intracranial hypotension treated with epidural blood patch

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Bacteriemia por Salmonella enteritidis como debut clínico de síndrome de inmunodeficiencia adquirida / Salmonella enteritidis bacteraemia as clinical onset of acquired immune deficiency syndrome

Presentamos un caso de una paciente de 38 años, que acudió a urgencias por cuadro de insuficiencia respiratoria aguda severa y fue ingresada en la Unidad de Cuidados Críticos con la sospecha diagnóstica inicial de neumonía adquirida en la comunidad producida por gérmenes atípicos, que se complicó con un síndrome de distrés respiratorio agudo. Este pudo ser tratado con ventilación mecánica no invasiva. A las 48h de su ingreso se informó del crecimiento de bacilos gramnegativos en los hemocultivos, identificados posteriormente como Salmonella enteritidis. Esta información, unida a la linfopenia que presentaba la paciente, sugería un estado de inmunodepresión, por lo que se realizaron pruebas serológicas que resultaron positivas para VIH. Fueron instaurados tratamientos antimicrobianos basados en los hallazgos microbiológicos y la evolución clínica de la paciente fue favorable(AU)

The case is presented of a 38 year-old patient who was admitted in the Emergency Department due to a severe acute respiratory failure and who was transferred to the Critical Care Unit with a suspected initial diagnosis of community acquired pneumonia caused by an atypical microorganism, which was complicated with an acute respiratory distress syndrome. This was able to be treated with non-invasive mechanical ventilation. At 48hours after admission, the growth of Gram negative bacilli in the blood culture was reported, which was subsequently identified as Salmonella enteritidis. This information, along with the lymphopenia suffered by the patient, suggested an immunodepressed state, thus serological tests were performed which showed positive for HIV. Antibiotic treatment was started based on the microbiological findings, with a favourable clinical outcome for the patient(AU)

[Salmonella enteritidis bacteraemia as clinical onset of acquired immune deficiency syndrome]. / Bacteriemia por Salmonella enteritidis como debut clínico de síndrome de inmunodeficiencia adquirida.

The case is presented of a 38 year-old patient who was admitted in the Emergency Department due to a severe acute respiratory failure and who was transferred to the Critical Care Unit with a suspected initial diagnosis of community acquired pneumonia caused by an atypical microorganism, which was complicated with an acute respiratory distress syndrome. This was able to be treated with non-invasive mechanical ventilation. At 48 hours after admission, the growth of Gram negative bacilli in the blood culture was reported, which was subsequently identified as Salmonella enteritidis. This information, along with the lymphopenia suffered by the patient, suggested an immunodepressed state, thus serological tests were performed which showed positive for HIV. Antibiotic treatment was started based on the microbiological findings, with a favourable clinical outcome for the patient.

[Pulmonary torsion complicating lobectomy: report of 2 cases]. / Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos.

We report 2 cases of pulmonary torsion discovered during the early postoperative recovery of patients who had undergone lobectomy. Early diagnosis, based on chest radiography and confirmed by computed tomography, meant we were able to avoid major surgical resection and the development of further complications. Pulmonary torsion is a rare but potentially serious abnormality. Prompt diagnosis is the key to preventing tissue injury and complications such as necrotizing pneumonitis, thromboembolic disease, or septic shock. Among the diagnostic tests that can be carried out if there is good reason to suspect torsion, we emphasize simple chest radiography and fiberoptic bronchoscopy, supported by computed tomography or arteriography, even though a firm diagnosis requires surgical exploration of the affected lung. Definitive treatments range from reversing the torsion and securing the lung to resecting the lung if the parenchymal tissue has been fully compromised.

Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos / Pulmonary torsion complicating lobectomy: report of 2 cases

Descripción de dos casos de torsión pulmonar enpacientes intervenidos de lobectomía por neoplasia pulmonar.Se muestran dos pacientes que sufrieron complicaciónde torsión de lóbulo pulmonar tras realizarselobectomía pulmonar aparecida en el postoperatorioinmediato. Se realizó el diagnóstico precoz mediante unaradiografía del tórax y la confirmación mediante unTAC, que indicó la toracotomía la cual evitó mayorresección quirúrgica y aparición de otras complicaciones.La torsión pulmonar es una alteración infrecuentepero de potencial gravedad. El diagnóstico precoz es devital importancia para evitar el compromiso tisular yprevenir complicaciones como neumonitis necrotizante,enfermedad tromboembólica o shock séptico. Entre laspruebas diagnósticas que pueden llevar a la alta sospechadiagnóstica destacamos la radiología simple de tóraxy fibrobroncoscopia, apoyadas por la tomografía axial ola arteriografía, aunque el diagnóstico definitivo es laexploración quirúrgica del parénquima afecto. El tratamientodefinitivo abarca desde la simple detorsión y fijacióndel pulmón, hasta resección pulmonar o neumonectomíasi el compromiso tisular es completo(AU)

We report 2 cases of pulmonary torsion discoveredduring the early postoperative recovery of patients whohad undergone lobectomy. Early diagnosis, based onchest radiography and confirmed by computedtomography, meant we were able to avoid major surgicalresection and the development of further complications.Pulmonary torsion is a rare but potentially seriousabnormality. Prompt diagnosis is the key to preventingtissue injury and complications such as necrotizingpneumonitis, thromboembolic disease, or septic shock.Among the diagnostic tests that can be carried out ifthere is good reason to suspect torsion, we emphasizesimple chest radiography and fiberoptic bronchoscopy,supported by computed tomography or arteriography,even though a firm diagnosis requires surgicalexploration of the affected lung. Definitive treatmentsrange from reversing the torsion and securing the lungto resecting the lung if the parenchymal tissue has beenfully compromised(AU)

Rigidez de descerebración transitoria en el contexto de hipoxemia y administración de propofol, midazolamflumacenilo y remifentanilo-naloxona / No disponible

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Cefalea postpunción dural tras anestesia subaracnoidea en un programa de cirugía mayor ambulatoria / No disponible

Objetivo: Evaluar la incidencia de cefalea postpunción dural en pacientes sometidos a cirugía mayor ambulatoria bajo anestesia espinal intradural. Material y métodos: Estudio retrospectivo y descriptivo de9.992 pacientes intervenidos en un periodo de 9 años. Se cuantifican la relación de CPPD-tipo de aguja empleada, así como el consumo de agujas espinales por año de estudio. Se valoró por las consultas e ingresos al Servicio de Urgencias de los casos de CPPD según criterios de Jones. El método estadístico empleado fue la t de Student para las variables cuantitativas y la (..) (AU)

Objective: To evaluate the ratio of headaches after dural puncture (PDPH) in patients undergoing intradural spinal anaesthesia for ambulatory surgery. Material and methods: We undertook a retrospective and descriptive study of 9,992 patients over a period of 9 years. The relationship between PDPH and the type of needle used, as well as the consumption of spinal needles per year of study, were quantified. We evaluated the number of cases of PDPH through the consultations and admissions to the Emergency Service according to the Jones’ criteria. The statistical methods used were: Student’s t test for the quantitative variables and chi-squared test of frequencies for the qualitative variables. Results: The incidence of PDPH was 0.60%. The average age of PDPH appearance was 43.12 ± 15.62 years, with a predominance of the feminine sex (63,3%). The incidence of PDPH when using a 22-G Quincke type needle was superior, with statistically significant differences, with respect to the rest of needles. The PDPH was severe in 58% of the cases. The evolution of the migraine in most of the cases (91%) was benign with medical treatment. Conclusions: The progressive reduction in the number of days of hospitalization, accentuated, in the last years, with the new organizational models for surgical assistance has lead to the appearance, in primary medicine, of clinical problems usually found only in hospitalized patients. The PDPH is characterized bya front occipital headache that gets worse when in the upright position in surgical patients undergoing spinal anaesthesia, and is benign and self-limited when treated with conventional medication (AU)

[Acute opiate tolerance and postoperative hyperalgesia after a brief infusion of remifentanil managed with multimodal analgesia]. / Tolerancia aguda a opioides e hiperalgesia postoperatoria tras breve infusión de remifentanilo controlados con analgesia multimodal.

Postoperative analgesia may be complicated by the occurrence of acute opiate tolerance and hyperalgesia. We present the case of a patient who underwent gynecological surgery that was complicated by intense pain in the immediate postoperative period. The pain was attributed to the development of acute opiate tolerance caused by the brief infusion of a high dose of remifentanil. The opiate tolerance was complicated by tactile hyperalgesia at the site of the surgical wound. Pain management with the usual dose of nonsteroidal anti-inflammatory drugs associated with a high dose of morphine (50 mg administered in less than 2 hours) produced no analgesic or adverse effects. The pain was finally brought under control by epidural perfusion of ropivacaine and fentanyl and subsequently maintained with multimodal analgesia.