Afectación cerebrovascular isquémico-hemorrágica en pacientes con covid-19 / Ischemic-hemorrhagic stroke in patients with Covid-19

La infección por el coronavirus asociada al síndrome de distrés respiratorio agudo severo (SARS-CoV-2) produce un síndrome clínico denominado mundialmente covid-19 que ha generado 5.940.441 infectados y 362.813 muertes hasta mayo de 20201. En estadios moderados y severos de la infección se produce una reacción sistémica del organismo caracterizada por la hiperinflamación, tormenta de citocinas y elevación de biomarcadores de daño miocárdico. Además, se ha sugerido la relación entre covid-19 y manifestaciones neurológicas. Recientes autopsias sugieren microangiopatía trombótica en múltiples órganos. Presentamos la descripción de 2 casos de pacientes con covid-19 severo, ingresados en Reanimación, que presentaron afectación cerebrovascular y fallecieron posteriormente. Se recomienda estrictamente la aplicación de profilaxis farmacológica antitrombótica en los pacientes afectados por covid-19 ingresados en cuidados críticos y se sugiere administrar dosis profilácticas por encima de la media

Coronavirus associated severe acute respiratory syndrome (SARS-CoV-2) causes a worldwide syndrome called Covid-19 that has caused 5,940,441 infections and 362,813 deaths until May 2020. In moderate and severe stages of the infection a generalized swelling, cytokine storm and an increment of the heart damage biomarkers occur. In addition, a relation between Covid-19 and neurological symptoms have been suggested. The results of autopsies suggest thrombotic microangiopathy in multiple organs. We present 2 cases of patients infected with severe Covid-19 that were hospitalized in the Reanimation Unit that presented cerebrovascular symptoms and died afterwards. A high dose prophylaxis with antithrombotic medication is recommended in patients affected by moderate to severe Covid-19

Ischemic-hemorrhagic stroke in patients with Covid-19. / Afectación cerebrovascular isquémico-hemorrágica en pacientes con covid-19.

Coronavirus associated severe acute respiratory syndrome (SARS-CoV-2) causes a worldwide syndrome called Covid-19 that has caused 5,940,441 infections and 362,813 deaths until May 2020. In moderate and severe stages of the infection a generalized swelling, cytokine storm and an increment of the heart damage biomarkers occur. In addition, a relation between Covid-19 and neurological symptoms have been suggested. The results of autopsies suggest thrombotic microangiopathy in multiple organs. We present 2 cases of patients infected with severe Covid-19 that were hospitalized in the Reanimation Unit that presented cerebrovascular symptoms and died afterwards. A high dose prophylaxis with antithrombotic medication is recommended in patients affected by moderate to severe Covid-19.

Endocarditis infecciosa sobre válvula nativa por Escherichia coli resistente a ampicilina en el postoperatorio de una nefrectomía radical derecha por pielonefritis xantogranulomatosa / Native valve infective endocarditis due to ampicillin-resistant Escherichia coli in the postoperative period of a right radical nephrectomy due to xanthogranulomatous pyelonephritis

La endocarditis infecciosa (EI) debida a Escherichia coli es una enfermedad rara, aunque cada vez más frecuente. La fiebre persistente en pacientes sépticos a pesar de un tratamiento adecuado plantea la necesidad de considerar la EI como diagnóstico diferencial. Presentamos el caso de un paciente varón de 36 años al que se le practica una nefrectomía radical derecha por diagnóstico de pielonefritis xantogranulomatosa, presentando en el postoperatorio un estado de shock séptico con fiebre persistente de hasta 41°C. Ante el hallazgo de un soplo de nueva aparición se le diagnostica EI mitroaórtica mediante ecocardiograma transesofágico (ETE) teniendo que someterse a cirugía cardiaca para sustitución valvular. Tras múltiples complicaciones postoperatorias es dado de alta exitosamente

Infective endocarditis (IE) due to Escherichia coli is a rare disease, although increasingly frequent. Persistent fever in septic patients despite adequate treatment raises the need to consider IE as a differential diagnosis. We present the case of a 36-year-old male patient who underwent a radical right nephrectomy as a result of diagnosis of xanthogranulomatous pyelonephritis, presenting in the postoperative period a state of septic shock with persistent fever of 41°C. Given the finding of a new-onset murmur, he was diagnosed with a mitroaortic IE by means of a transesophageal echocardiogram (TEE), having to undergo cardiac surgery for valve replacement. After multiple postoperative complications, he is successfully discharged

Native valve infective endocarditis due to ampicillin-resistant Escherichia coli in the postoperative period of a right radical nephrectomy due to xanthogranulomatous pyelonephritis. / Endocarditis infecciosa sobre válvula nativa por Escherichia coli resistente a ampicilina en el postoperatorio de una nefrectomía radical derecha por pielonefritis xantogranulomatosa.

Infective endocarditis (IE) due to Escherichia coli is a rare disease, although increasingly frequent. Persistent fever in septic patients despite adequate treatment raises the need to consider IE as a differential diagnosis. We present the case of a 36-year-old male patient who underwent a radical right nephrectomy as a result of diagnosis of xanthogranulomatous pyelonephritis, presenting in the postoperative period a state of septic shock with persistent fever of 41°C. Given the finding of a new-onset murmur, he was diagnosed with a mitroaortic IE by means of a transesophageal echocardiogram (TEE), having to undergo cardiac surgery for valve replacement. After multiple postoperative complications, he is successfully discharged.

Parálisis diafragmática unilateral tras colecistectomía laparoscópica / Unilateral diaphragmatic paralysis after laparoscopic cholecystectomy

La colecistectomía laparoscópica supone hoy en día el tratamiento gold estándar de la patología aguda de la vía biliar. A pesar de las numerosas ventajas que presenta respecto a la cirugía abierta clásica, no está exenta de complicaciones. Presentamos el caso de un paciente varón de 82 años que tras el diagnóstico de colecistitis gangrenosa es intervenido de urgencia de colecistectomía laparoscópica, presentando en las primeras 24h del postoperatorio un episodio de insuficiencia respiratoria aguda, motivo por el cual ingresa en reanimación. Los estudios realizados a posteriori mostraron una parálisis del hemidiafragma derecho, probablemente relacionada con la cirugía

Laparoscopic cholecystectomy is currently the gold standard treatment for acute biliary tract pathology. Despite its many advantages compared to open surgery, it is not without complications. We present the case of an 82-year-old man who, after a diagnosis of gangrenous cholecystitis, underwent urgent laparoscopic cholecystectomy. During the first 24hours after the surgery, he had an episode of acute respiratory failure, for which he was admitted to the critical care unit. Studies performed later showed paralysis of the right diaphragm that was probably related to the surgery

Unilateral diaphragmatic paralysis after laparoscopic cholecystectomy. / Parálisis diafragmática unilateral tras colecistectomía laparoscópica.

Laparoscopic cholecystectomy is currently the gold standard treatment for acute biliary tract pathology. Despite its many advantages compared to open surgery, it is not without complications. We present the case of an 82-year-old man who, after a diagnosis of gangrenous cholecystitis, underwent urgent laparoscopic cholecystectomy. During the first 24hours after the surgery, he had an episode of acute respiratory failure, for which he was admitted to the critical care unit. Studies performed later showed paralysis of the right diaphragm that was probably related to the surgery.