[Aseptic meningitis after intradural anesthesia]. / Meningitis aséptica tras anestesia intradural.

We report a case of aseptic meningitis after intradural anesthesia in a 70-year-old male. Clinical features developed 4 hours after surgery, and they consisted of high fever, severe headache, drowsiness and temporospatial disorientation, without signs of meningeal irritation. The analysis of cerebrospinal fluid (CSF) showed pleocytosis, normal biochemical findings, and absence of microorganisms both in Gram stain and in culture. The outcome was favorable, and the clinical features disappeared within 48 hours without antibiotic therapy.

[HELLP syndrome and its complications during preeclampsia-eclampsia]. / Síndrome HELLP y sus complicaciones durante la preeclampsia-eclampsia.

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a rare complication that can appear during and/or after pregnancy in patients with preeclampsia or eclampsia. As the syndrome can have serious complications, early diagnosis is important for management. We describe a patient with HELLP syndrome who developed one of its unusual but severe complications: ruptured liver capsule.

[Comparative study of the treatment of postoperative pain in function of the surgical service]. / Estudio comparativo del tratamiento del dolor postoperatorio en función del servicio quirúrgico.

HYPOTHESIS AND OBJECTIVES: A high level of pain has been observed among surgical patients and it has been suggested that surgical specialty may be an important factor in pain, although no relation has been conclusively demonstrated. In this study we compared the characteristics of postoperative pain and pain treatment given in several surgical services. PATIENTS AND METHODS: We studied 249 patients in orthopedic surgery and traumatology (OST, n = 95), general surgery (GS, n = 66), gynecology and obstetrics (GO, n = 51), urology (URO, n = 16), vascular surgery (VS, n = 9), ophthalmology (OPH, n = 7), otorhinolaryngology (ORL, n = 5). The characteristics of analgesic treatment (type of prescription, drug, route, dose and compliance) were recorded, as were degree of pain expressed on a visual analog scale and a verbal assessment scale 24 h after surgery, and level of patient satisfaction with the analgesic treatment. RESULTS: Thirty percent of the patients reported moderate to unbearable pain the day after surgery. Severe pain was most common in OST patients. Analgesics, mainly diclofenac (52%) and pethidine (36%), were prescribed by protocol for 93% of patients. Although there were differences among the various services, compliance with diclofenac prescription was better; compliance was high among GO patients for both drugs. Over half the patients reported having had severe or unbearable pain during the hours following surgery. Most said relief was sufficient or high (55%) with treatment and described themselves as satisfied or very satisfied (62%) with the analgesic received. Surgery on extremities was the most painful and generated the greatest dissatisfaction. CONCLUSIONS: This study suggests that type of surgery may condition the prevalence of and severity of postoperative pain. Although type of surgery and location are important factors, there are sufficient differences and deficiencies in treatment to explain, at least partly, the variation observed.

[Fondaparinux as an alternative anticoagulant in heparin-induced thrombocytopenia in the patient with a ventricular assist device]. / Fondaparinux como alternativa a la anticoagulación en una paciente con dispositivo de asistencia ventricular y trombocitopenia inducida por heparina.

Heparin-induced thrombocytopenia is a reaction associated with the use of this drug. It occurs in up to 3% of patients treated for at least 5 days. Its treatment is to stop the heparin, and according to patient needs, replace it with another anticoagulant. We present a patient who, after a heart transplant, and the need for a ventricular assist device, required anticoagulation. The patient developed heparin-induced thrombocytopenia. Heparin was stopped and anticoagulation was replaced by fondaparinux. The peri-operative complications and the management of the coagulation are described.

[Postoperative cortical blindness after right upper lung lobectomy]. / Ceguera cortical postoperatoria tras lobectomía pulmonar superior derecha.

Changes in vision after non-ophthalmic surgery are a serious complication that can have devastating consequences due to its potential irreversibility. This not only leads to medical problems, but also legal ones. Many causes that affect sight during the peri-operative period have been identified, whether due to optic nerve damage or of extra-ocular origin (in the neuro-optic pathways and/or cerebral cortex). AU these may have a multifactorial origin, and there is still controversy as regards it pathogenesis and treatment. We present the case of a thoracic surgery patient who had a bilateral amaurosis in the post-operative period, which had a favourable outcome.

Fondaparinux como alternativa a la anticoagulación en una paciente con dispositivo de asistencia ventricular y trombocitopenia inducida por heparina / Fondaparinux as an alternative anticoagulant in heparin-induced thrombocytopenia in the patient with a ventricular assist device

La trombocitopenia inducida por heparina es una reacción asociada al tratamiento con dicho fármaco. Se da hasta en el 3% de los pacientes tratados al menos 5 días. Su tratamiento es la suspensión, y si el paciente lo precisa, sustitución por otro anticoagulante. Presentamos el caso de un paciente trasplantado de corazón y con dispositivo de asistencia ventricular derecho que desarrolló trombocitopenia inducida por heparina en el postoperatorio. Se describe el manejo de la anticoagulación con fondaparinux. Se describen las complicaciones perioperatorias y el manejo de la anticoagulación (AU)

Heparin-induced thrombocytopenia is a reaction associated with the use of this drug. It occurs in up to 3% of patients treated for at least 5 days. Its treatment is to stop the heparin, and according to patient needs, replace it with another anticoagulant.We present a patient who, after a heart transplant, and the need for a ventricular assist device, required anticoagulation. The patient developed heparin-induced thrombocytopenia. Heparin was stopped and anticoagulation was replaced by fondaparinux. The peri-operative complications and the management of the coagulation are described (AU)