Síndrome de Ogilvie: manejo actual a propósito de un caso

Objetivo: Dar a conocer las últimas recomendaciones para la sospecha, el diagnóstico y el tratamiento médico y quirúrgico del síndrome de Ogilvie. Material y método: Estudio descriptivo, retrospectivo, observacional; en formato de caso clínico y revisión de la literatura actual, a través de PubMed, Scielo y otros motores de búsqueda de artículos científicos. Discusión y Conclusiones: La seudoobstrucción colónica aguda o síndrome de Ogilvie consiste en un íleo adinámico severo y dilatación masiva de asas del colon en ausencia de obstrucción mecánica. Se presenta, principalmente, en pacientes postquirúrgicos o severamente enfermos. Tienen riesgo de perforación aproximado del 3% y una mortalidad del 50%, la mayoría de los pacientes responden al manejo médico conservador. La descompresión colonoscópica puede ser necesaria en pacientes que no responden al tratamiento médico de soporte y a la descompresión farmacológica con neostigmina. Distintos grados de isquemia y/o perforación colónica obligan la reso-lución quirúrgica urgente en algunos casos, lo que define la morbimortalidad. Es importante la sospecha clínica de este síndrome para evitar complicaciones posiblemente fatales.

Objective: To present the latest recommendations for the suspicion, diagnosis and medical and surgical treatment of Ogilvie syndrome. Materials and methods: Descriptive, retrospective, observational study; in clinical case format and review of the current literature, through PubMed, Scielo and other search engines for scientific articles Discussion and Conclusions: Acute colonic pseudo-obstruction or Ogilvie syndrome consists of a severe adynamic ileus and massive dilatation of the colonic loops in the absence of mechanical obstruction. It occurs in post-surgical or severely ill patients. They have a risk of perforation of approximately 3% and a mortality of 50%, most patients respond to conservative medical management. Colonoscopic decompression may be necessary in patients who do not respond to supportive medical treatment and drug decompression with neostigmine. Different degrees of colonic ischemia and / or perforation require urgent surgical resolution in some cases, which defines morbidity and mortality. Clinical suspicion of this syndrome is important to avoid possibly fatal complications.

Hiperactividad simpática paroxística: una entidad subdiagnosticada: caso clínico / Paroxysmal sympathetic hyperactivity: report of one case

Paroxysmal sympathetic hyperactivity may appear after brain injury. Its clinical manifestations are sporadic and self-limited crisis of arterial hypertension, hyperthermia, tachycardia, hyperhidrosis, muscle tension, sialorrhea and mydriasis. These subside with the administration of morphine and beta-blockers. It may be caused by a dysautonomia leading to increased levels of catecholamines due to the lack of brain regulation. We report a 19 years-old man with a history of illicit drug and alcohol consumption, with a secondary axonal injury due to a cranioencephalic trauma. During hospitalization, he had recurrent, self-limited episodes of dysautonomia. An infectious cause was discarded. When morphine was administrated suspecting the presence of pain, the crisis subsided, which helped to establish the diagnosis of paroxysmal sympathetic hyperactivity.

Depresión adulta y experiencias infantiles adversas: evidencia de un subtipo depresivo complejo en consultantes de la atención primaria en Chile / Association between adverse childhood experiences with depression in adults consulting in primary care

Background: Traumatic experiences during childhood may influence the development of mental disorders during adulthood. Aim: To determine clinical and psychosocial variables that are associated with a higher frequency of adverse childhood experiences (ACE) in patients who consult for depression in Primary Health Care clinics in Chile. Material and Methods: A socio-demographic interview, the mini international neuropsychiatric interview (MINI), a screening for ACE, a questionnaire for partner violence (PV), the Life Experiences Survey (LES) and the Hamilton Rating Scale for Depression (HRDS) were applied to 394 patients with major depression (87% women). Results: Eighty two percent of patients had experienced at least one ACE and 43% of them reported three or more. Positive correlations were observed between the number of ACE and severity of depressive symptoms (r = 0.19; p < 0.01), psychiatric comorbidities (r = 0.23; p < 0.01), partner violence events (r = 0.31; p < 0.01), vital stressful events (r = 0.12; p < 0.01), number of depressive episodes (r = 0.16; p < 0.01), duration of the longer depressive episode (r = 0.12; p < 0.05) and suicidal tendency according to HDRS (r = 0.16; p < 0.01). An inverse correlation was observed between frequency of ACE and age at the first depressive episode (r = -0.12; p < 0.05). Conclusions: These data are consistent with the hypothesis that early trauma is associated with more severe and complex depressive episodes during adulthood.