Nuevas estrategias de monitorización hemodinámica con el monitor PiCCO / New strategies of hemodynamic monitoring using the PiCCO monitor

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[Coexistence of syringomyelia and extramedullary intradural meningioma]. / Coexistencia de siringomielia y meningioma intradural extramedular.

INTRODUCTION: The coexistence of non-communicating syringomyelia with extramedullary intradural tumours in surgical series is extremely rare. CASE REPORT: We report the case of a 68-year-old female who had been suffering from predominantly proximal asymmetrical progressive paraparesis, with no involvement of the sphincters; the clinical exploration revealed a band of thermal hypaesthesia D7-D8. Magnetic resonance imaging (MRI), following the administration of gadolinium, confirmed the coexistence of an extramedullary intradural expansive lesion, which had features suggesting it could be a meningioma, and a dorsal syringomyelia. The cavity involved two medullary segments situated above the tumour and there were no associated anomalies at the junction of the medulla and upper spinal cord. Following complete resection of the tumour, which was diagnosed histologically as being a transitional meningioma with abundant psammoma bodies, the patient recovered the ability to walk independently. CONCLUSIONS: MRI with contrast is the best diagnostic means available for the detection and delimitation of the two components in this rare association, although its capacity to detect signs suggesting turbulences in the intracavity fluid, especially in small cavities, has still to be confirmed. The variations in the size and situation of the cavity with respect to the seat of the tumour, and the fact that progress is seldom monitored with MRI in the cases published to date, do not allow us to identify the pathogenic mechanism responsible for this association or to suggest the best type of shunt to prevent a possible expansion of the syringomyelic cavity.

[Tonsillar mast cell infiltration and allergic tonsillitis]. / Infiltración mastocitaria amigdalar y amigdalitis alérgica.

We report the case of a seven year-old boy bearing of exudative acute tonsillitis after strawberry ingestion with no previous infectious history. After having diagnosed it as hypersensitivity type I, this patient began to suffer repetitive episodes of exudative and purulent tonsillitis, related to cool drinks and direct manipulation of tonsils. These were hyperplastic and Staphylococcus sp. and Streptococcus sp. were isolated in them. The episodes were shortened by the use of corticosteroids. Tonsillectomy was the definitive therapy. Biopsy informed of mast cells infiltration in germinal centers of both palatine tonsils.

Infiltración mastocitaria amigdalar y amigdalitis alérgica / Tonsillar mast cell infiltration and allergic tonsillitis

Presentamos el caso de un niño de siete años de edad en el que se detectó un episodio de amigdalitis aguda exudativa tras la ingestión de fresas sin antecedentes infecciosos. Una vez diagnosticado el cuadro como hipersensibilidad tipo I, el paciente comenzó a presentar episodios repetitivos exudativos y pultáceos en relación con la ingesta de bebidas frías y la manipulación directa de las amígdalas. Estas eran hiperplásicas y en ellas se aisló Staphylococcus sp. y Streptococcus sp. Estos cuadros eran rápidamente yugulados mediante corticosteroides. La amigdalectomía fue el tratamiento definitivo. La biopsia de la pieza informó de infiltración por mastocitos en los centros germinales de ambas amígdalas palatinas. (AU)

We report the case of a seven year-old boy bearing of exudative acute tonsillitis after strawberry ingestion with no previous infectious history. After having diagnosed it as hypersensitivity type I, this patient began to suffer repetitive episodes of exudative and purulent tonsillitis, related to cool drinks and direct manipulation of tonsils. These were hyperplastic and Staphylococcus sp. and Streptococcus sp. were isolated in them. The episodes were shortened by the use of corticosteroids. Tonsillectomy was the definitive therapy. Biopsy informed of mast cells infiltration in germinal centers of both palatine tonsils (AU)