RESUMEN
Radiological maxillary sinusitis (RMS) is not an easily diagnosed in Intensive Care Unit (ICU). B-mode ultrasound of paranasal sinuses, validated for the ambulatory patients, was evaluated in a prospective study. One hundred fifty three ultrasound examinations were performed on 30 critically ill patients and compared to CT scan or radiography (Blondeau's view). Two levels of positive echographia are described: positive echographia corresponding with a moderate lesion, cupuliform echographia when the lesion is more significant. Its good predictive negative value when the echographia is negative and its predictive positive value of 100% when the echographia is cupuliform allow to recommend B-mode ultrasound as the best investigation for the diagnosis of maxillary sinusitis in a ICU. Diagnostic ultrasound represents a rapid, painless, innocuous and easily reproducible means of monitoring.
Asunto(s)
Sinusitis Maxilar/diagnóstico por imagen , Humanos , Unidades de Cuidados Intensivos , Estudios Prospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We report a case of wood alcohol (methylated spirits) poisoning in a 40-year-old chronic alcoholic. The initial diagnosis of state of drunkenness was supported by the increased plasma level of ethanol (4.66 g.L-1) obtained with enzymatic method. The confirmation, using gas chromatography (GC), showed an unexpected peak with a retention time at 1.19 min, characteristic of methanol (0.41 g.L-1). The GC analysis of the absorbed beverage revealed a 5% methanol content. The osmolal gap was 115 mOsm.kg-1, with 13 mOsm.kg-1 due to methanol and 90 mOsm.kg-1 to ethanol. Seven hours after the ingestion, the anion gap was at 13 mmol-1. This result reflected the inhibition of methanol oxidation by alcohol-dehydrogenase, when the plasma ethanol concentration was above 1 g.L-1. This concentration was maintained by continuous intravenous administration of (Curéthyl-A) a 95% ethanol containing solution, until methanol concentration decreased below 0.2 g.L-1. The outcome was favourable without neurological and ophthalmological sequelae.
Asunto(s)
Bebidas Alcohólicas/análisis , Intoxicación Alcohólica/complicaciones , Cromatografía de Gases , Metanol/envenenamiento , Equilibrio Ácido-Base , Adulto , Alcohol Deshidrogenasa/antagonistas & inhibidores , Inhibidores Enzimáticos/uso terapéutico , Etanol/sangre , Etanol/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Masculino , Metanol/sangre , Metanol/aislamiento & purificación , Concentración Osmolar , Oxidación-Reducción , Intoxicación/diagnóstico , Intoxicación/tratamiento farmacológicoRESUMEN
We report a case of postoperative apnoea in the recovery room, 25 minutes after tracheal extubation, in a fully awake patient. This event occurred after flushing of an obstructed IV line into which remifentanil had been injected through a 3-way stopcock during anaesthesia. The means for prevention of such an adverse event are discussed.
Asunto(s)
Anestesia General , Anestésicos Intravenosos/efectos adversos , Apnea/inducido químicamente , Intubación Intratraqueal , Piperidinas/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Adulto , Anestésicos Intravenosos/administración & dosificación , Femenino , Humanos , Piperidinas/administración & dosificación , Sala de Recuperación , RemifentaniloRESUMEN
Haemophagocytic syndrome (HM) is a severe disorder with characteristic clinical and biological features. The case of a patient with malignant lymphoma who experienced HM during Herpes virus I pulmonary infection is reported. Main clinical, biologial and pathological findings are described. The risk of underestimation of this disease in patients requiring intensive care as well as the absolute necessity of an early diagnosis are emphasised.
Asunto(s)
Fiebre/etiología , Herpes Simple/complicaciones , Herpesvirus Humano 1 , Histiocitosis de Células no Langerhans/complicaciones , Enfermedades Pulmonares/virología , Linfoma de Células T/complicaciones , Adulto , Cuidados Críticos , Femenino , Herpes Simple/patología , Humanos , Enfermedades Pulmonares/patología , Linfoma de Células T/patología , Macrófagos Alveolares/patología , Fagocitos/patologíaRESUMEN
We report the unusual course of a pulmonary artery catheter through a persistent left-sided superior vena cava. After left subclavian vein cannulation and downward left-sided paramediastinum course, the Swan-Ganz catheter enters the right pulmonary artery. Haemodynamic monitoring was consistent with the diagnosis of septic shock developed by this 56-year-old woman, after cephalic duodenopancreatectomy. Persistent left-sided superior vena cava occurs in 0.5% of the population and 5-10% of patients with congenital heart diseases. It drains into the right atrium through the coronary sinus in 92% of cases and is associated with an absent right superior vena cava in 20% of cases. The left-sided superior vena cava persists when the caudal part of the left anterior cardinal vein does not degenerate. A persistent left superior vena cava may be medically relevant during implantation of pacemaker leads or radiofrequency ablation, during cardiac surgery for placement of a retrograde coronary sinus cardioplegia catheter and during transjugular intrahepatic portosystemic shunt placement.
Asunto(s)
Cateterismo de Swan-Ganz/instrumentación , Vena Cava Superior/anomalías , Angiografía , Femenino , Hemodinámica/fisiología , Humanos , Complicaciones Intraoperatorias , Persona de Mediana Edad , Pancreaticoduodenectomía , Vena Cava Superior/diagnóstico por imagenRESUMEN
We report a case of persisting suprascapular nerve palsy after surgery under general anaesthesia of short duration in a conventional position. Surgical exploration, eight months later, showed a suprascapular notch narrowed by a hypertrophied and calcified superior transverse ligament. Such a lesion and the practice of volley-ball by the patient are in favour of a pre-existing infraclinical neuropathy.