[Intermittent asphyxia syndrome caused by a bronchial cast in the subglottic region]. / Síndrome asfíctico intermitente provocado por molde bronquial en zona subglótica.

We report the case of an intensive care unit patient with acute respiratory failure caused by severe community-acquired pneumonia with empyema. She required orotracheal intubation and mechanical ventilation. Following extubation the patient s condition improved until the onset of several choking episodes caused by a dislodged laryngotracheal cast in the subglottic region. We discuss the differential diagnosis of upper airway obstructions and of the entities related to bronchial cast formation, in particular the clinical and pathophysiological features of plastic bronchitis and the treatment options available.

Síndrome asfíctico intermitente provocado por molde bronquial en zona subglótica / Intermittent asphyxia syndrome caused by bronchial cast in the subglottic region

Se presenta el caso de una paciente ingresada en la unidad de cuidados intensivos por insuficiencia respiratoria aguda secundaria a una neumonía comunitaria grave con empiema, que requirió intubación orotraqueal y ventilación mecánica. Tras su extubación cursó con buena evolución hasta presentar varios episodios de crisis asfícticas intermitentes secundarias a una obstrucción por el desplazamiento de un molde laringotraqueal en la zona subglótica. Se discute el diagnóstico diferencial de las obstrucciones respiratorias de la vía aérea superior, así como el de las entidades relacionadas con la formación de moldes bronquiales, con especial atención a las bronquitis plásticas, sus características clínicas, fisiopatológicas y posibilidades terapéuticas

We report the case of an intensive care unit patient with acute respiratory failure caused by severe community-acquired pneumonia with empyema. She required orotracheal intubation and mechanical ventilation. Following extubation the patient´s condition improved until the onset of several choking episodes caused by a dislodged laryngotracheal cast in the subglottic region. We discuss the differential diagnosis of upper airway obstructions and of the entities related to bronchial cast formation, in particular the clinical and pathophysiological features of plastic bronchitis and the treatment options available

[Acute respiratory distress syndrome caused by pulmonary nocardiosis in a patient with systemic lupus erythematosus]. / Síndrome de distrés respiratorio agudo provocado por nocardiosis pulmonar en un paciente con lupus eritematoso sistémico.

Nocardia is a gram-positive bacillus that infects mainly immunodepressed patients. Its association with lupus erythematosus has been described only occasionally and we have found no reports in the literature of an association between lupus and acute respiratory distress syndrome due to pulmonary nocardiosis. We present such a case and discuss the mechanisms that make this lung infection so virulent as well as its epidemiological and microbiological characteristics, clinical presentation, diagnosis, and treatment.

Síndrome de distrés respiratorio agudo provocado por nocardiosis pulmonar en un paciente con lupus eritematoso sistémico / Acute respiratory distress syndrome caused by pulmonary nocardiosis in a patient with systemic lupus erythematosus

Nocardia es una bacilo grampositivo que infecta principalmente a pacientes inmunodeprimidos. Su asociación con el lupus eritematoso sistémico se ha descrito pocas veces, y en la bibliografía médica revisada no hemos encontrado ningún caso asociado al síndrome de distrés respiratorio agudo por una nocardiosis pulmonar. A partir de un caso clínico se realiza una descripción de los mecanismos de virulencia de esta bacteria, así como de las características epidemiológicas, microbiológicas, forma de presentación clínica y procedimientos diagnósticos y terapéuticos de esta entidad

Nocardia is a gram-positive bacillus that infects mainly immunodepressed patients. Its association with lupus erythematosus has been described only occasionally and we have found no reports in the literature of an association between lupus and acute respiratory distress syndrome due to pulmonary nocardiosis. We present such a case and discuss the mechanisms that make this lung infection so virulent as well as its epidemiological and microbiological characteristics, clinical presentation, diagnosis, and treatment

Neumonía asiática/síndrome respiratorio agudo severo.Epidemia en un mundo globalizado / On SARS: epidemics in the context of globalization

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[Axillo-subclavian effort thrombosis: main characteristics]. / Trombosis de esfuerzo axilosubclavia. Características más relevantes.

OBJECTIVE: Effort related thrombosis of the axillo-subclavian vein is a disabling disorder that occurs primarily in healthy young individuals. The aim of this study is to show our experience in diagnosis and therapy of this entity. METHODS: During a 5 years period (1994 to 1998) we studied 7 patients (6 woman and 1 man), with an average age of 26 years old. All patients underwent Doppler ultrasound examinations and, later, venography of the affected upper extremity. All of them were treated at the outset with systemic infusion of fibrinolytic agents. RESULTS: Only one patient manifested successfully clinic outcome. Five patients were treated with surgical decompression resulting in excellent function. One patient refused surgical treatment, and he was treated with warfarin sodium showing a poor clinic response. CONCLUSION: Although systemic fibrinolytic therapy can restore axillo-subclavian vein patency, surgical approach is necessary to relieve the external compression.

Trombosis de esfuerzo axilosubclavia. Características más relevantes / Effort thrombosis of the axillosubclavian vein: mains characteristics

Objetivo: La trombosis de esfuerzo axilosubclavia es una enfermedad discapacitante que aparece en individuos jóvenes y sanos. Mostramos nuestra experiencia, tanto en el diagnóstico como en el tratamiento en esta entidad. Pacientes y métodos: Durante un periodo de 5 años (1994 al 1998) hemos estudiado 7 pacientes (6 mujeres y 1 hombre) con una media de edad de 26 años. En todos los pacientes se realizó ecodoppler y flebografía posteriormente. En todos ellos se instauró tratamiento con fibrinolíticos sistémicos. Resultados: Sólo en un caso hubo evolución favorable. De los 6 restantes, 5 fueron intervenidos quirúrgicamente con buenos resultados. Un paciente se negó a este tratamiento y se utilizaron anticoagulantes orales con mala evolución clínico-radiológica. Conclusiones: Aunque los fibrinolíticos sistémicos pueden restaurar la permeabilidad de la vena axilosubclavia, la resección de la primera costilla es necesaria para evitar la compresión extrínseca (AU)

[Acute lung injury as initial manifestation of diffuse alveolar hemorrhage]. / Daño pulmonar agudo como manifestación inicial de hemorragia alveolar difusa.

OBJECTIVE: To determine clinical features and outcome in hospitalized patients with acute lung injury secondary to diffuse pulmonary hemorrhage (DPH). PATIENTS AND METHOD: Eight adult patients suffering DPH and acute lung injury were undergone to diagnosis procedure and following. RESULTS: Two cases of idiopathic pulmonary hemosiderosis, two cases of systemic lupus erythematous, two cases of Goodpasture's syndrome, one case of idiopathic rapidly progressive glomerulonephritis and one of periarteritis nodosa were diagnosed. Treatment was methylprednisolone in all cases; besides, three cases required ventilatory support, and one immunosuppressive therapy, plasmapheresis and hemodialysis. One patient died and three of them suffered relapse with satisfactory outcome. CONCLUSION: We remark the presence of acute lung injury as an initial feature of DPH in our experience and the importance of a prompt diagnosis of the underlying disease.

Daño pulmonar agudo como manifestación inicial de hemorragia alveolar difusa / Acute lung injury as an initial feature of diffuse pulmonary hemorrhage

Objetivo: determinar los hallazgos clínicos y la evolución de pacientes hospitalizados por insuficiencia respiratoria aguda secundaria a hemorragia alveolar difusa (HAD). Pacientes y Método: Ocho adultos afectos de HAD y daño pulmonar agudo, sometidos a protocolo diagnóstico y seguimiento evolutivo. Resultados: Se diagnosticaron 2 casos de hemosiderosis pulmonar primaria (HPP), 2 lupus eritematoso sistémico (LES), 2 síndrome de Goodpasture (GP), un caso de glomerulonefritis rápidamente progresiva idiopática (GNRP) y una panarteritis nodosa microscópica (PAN). Todos los pacientes se trataron con metilprednisolona; además 3 de ellos necesitaron ventilación mecánica (VM) y uno inmunosupresores (IS), plasmaféresis (PF) y hemodiálisis (HD). Un paciente falleció y tres, a pesar de recidivar la HAD, evolucionaron favorablemente. Conclusión: Destacamos la presencia de daño pulmonar agudo como síntoma de inicio de HAD y la importancia de un diagnóstico rápido de la enfermedad subyacente (AU)

[Pneumothorax due to drug inhalation]. / Neumotórax por inhalación de drogas.

Two cases of spontaneous pneumothorax after repeated inhalation of cocaine and forced aspiration of marijuana smoke, respectively, are presented. The absence of pneumomediastinum and associated subcutaneous emphysema in both cases is stressed. Inspiratory manipulations against resistance are assessed as potential etiological factors, although the coexistence of other pneumothorax predisposing factors seems to be necessary.

[Legionellosis at intensive care units: study of 30 cases]. / Legionelosis en cuidados intensivos: estudio de 30 casos.

A prospective study during 44 months has been carried out in order to establish the incidence of pneumonia due to Legionella sp. in our hospital's intensive care unit (ICU). Thirty cases of legionellosis were diagnosed (22.2% of the studied pneumonias) two of them were acquired in the ICU and 76.6% were caused by L. pneumophila serotype. The most evident symptomatology was intense dyspnea, neurological disorders, acute respiratory and renal failure. The biochemical alterations, most commonly encountered were increased liver enzymes, hypoxemia, hypoalbuminemia, increased urea, creatinine and hematuria. As a consequence of this severe disease, the mortality rate was high (13 out of 30 cases).