[Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]. / Fenómenos de despolarización cortical propagada en los pacientes con lesiones cerebrales traumáticas e isquémicas. Resultados de un estudio piloto.

OBJECTIVES: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy. DESIGN: A descriptive observational study was carried out during 19 months. SETTING: Neurocritical patients. PATIENTS: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment. INTERVENTIONS: A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex. MAIN VARIABLES OF INTEREST: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs. RESULTS: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration. CONCLUSIONS: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI.

[Q fever and endocarditis. Apropos a new case]. / Fiebre Q y endocarditis. A propósito de un nuevo caso.

Endocarditis is the first manifestation of Q fever in its chronic form, generally affecting prosthetic cardiac valves or previously injured valves. Its clinical presentation is an endocarditis with negative culture and there is not agreement with regard to the most adequate antimicrobial treatment and its duration. Frequently, the valve has to be replaced. We present a case of a patient with double aortic lesion, in whom endocarditis by Q fever was diagnosed and treated with doxycycline, initially with success. However, she relapsed one year later, being then resistant to the medical treatment (doxycycline, ciprofloxacine plus rifampicine). It was not possible to replace the valve and the patient died two months later due to cardiac failure.

[Adrenal mass and adrenal insufficiency]. / Masa suprarrenal e insuficiencia suprarrenal.

Primary adrenal insufficiency is a non frequent disease, that is declared in young adults and in the most of the cases is produced from an autoimmune mechanism or a tuberculous disease. The incidence of these forms in the different geographic areas is dependent of degree of irradication of the tuberculosis. We report the case of a patient with latent chronic adrenal insufficiency of tuberculous origin who was affected for an addisonian crisis during an intercurrent infectious disease, which permitted the diagnosis of the addisonian crisis, and Mal of Pott was moreover detected. Evolution with corticosteroid and specific treatment was very favorable.

[Acute acalculous cholecystitis complicating the presentation of cardiac tamponade as the initial manifestation of a pulmonary carcinoma]. / Colecistitis aguda alitiásica complicando la presentación de un taponamiento cardiaco, como manifestación inicial de un carcinoma pulmonar.

The finding of a cardiac tamponade (CT) as initial manifestation of lung cancer is rare, being its most frequent manifestations dyspnea, cough and edemas. The presence of alithiasic acute cholecystitis (AAC) as early manifestation of CT is extremely rare, despite this having being described related to other situations of low cardiac output. We present the case of a patient who underwent emergency surgery due to AAC as a form of presentation of CT, this being the initial manifestation of a pulmonary adenocarcinoma. The histopathological study of the liver and the vesicle were compatible with signs of short evolution venous stasis, and the diagnosis was established through pericardium biopsy and thoracic CAT.

[Langerhans cell granulomatosis with unifocal bone disease and asymptomatic pulmonary infiltration]. / Granulomatosis de células de Langerhans con afectación ósea unifocal e infiltrado pulmonar asintomático.

Langerhans' cell granulomatosis is a usually benign disease, characterized by the proliferation of Langerhans' cell containing S-100 protein. Disease is related with the smoking habit and immunological alterations, and is able to affect any organ in isolated or multisystem form. Diagnosis is provided by biopsy of the lesion and bronchoalveolar lavage if the lung is injured. We present a case of a smoker man with lytic lesion in the skull, which biopsy was diagnostic, and with an asymptomatic interstitial infiltrates lungs, with a restrictive spirometry. Remission was achieved with prednisone (0.75 mg x kg) and stop smoking.