Parálisis facial alternobárica: a propósito de un caso y revisión de la literatura / Alternobaric facial palsy: case report and literature review

La parálisis o paresia facial alternobárica es una neuropraxia del séptimo nervio cra-neal debido a cambios de presión. Se produce en el contexto de una disfunción de la trompa de Eustaquio, una dehiscencia canal del nervio facial y cambios en la presión atmosférica. Se considera una rara complicación de barotrauma. Su prevalencia es difícil de estimar y, probablemente, se encuentre subreportada. La forma de presentación más habitual incluye paresia facial, plenitud aural, hipoacusia, otalgia, parestesias faciales y linguales. La mayoría de los episodios son transitorios, con una duración entre minutos y algunas horas, con recuperación posterior completa. Entre los diagnósticos diferenciales se encuentran causas periféricas y centrales de paresia facial, las cuales hay que sospechar ante la persistencia de los síntomas en el tiempo o ante la presencia de otros signos o síntomas neurológicos. La evaluación inicial debe incluir un examen otoneurológico completo. La tomografía computarizada de hueso temporal favorece la visualización de posibles dehiscencias del canal del facial. La prevención de nuevos episodios incluye la práctica de ecualización efectiva, la resolución de la disfunción de la trompa de Eustaquio y en algunos casos específicos, métodos alternativos de ventilación del oído medio como la colocación de tubos de ventilación. Una vez instalada la parálisis facial, si no se produce recuperación espontánea, el uso de corticoides es una opción. Se presenta un caso de paresia facial alternobárica recurrente y una revisión de literatura.

Alternobaric facial palsy or paralysis is a neuropraxia of the seventh cranial nerve due to pressure changes. It occurs in the context of Eustachian tube dysfunction, facial nerve canal dehiscence, and changes in atmospheric pressure. It is considered a rare complication of barotrauma. Its prevalence is difficult to estimated, and this condition is probably underreported. The most common form of presentation includes facial weakness, ear fullness or pressure, hearing loss, otalgia, facial and lingual paresthesias. Most episodes are transient, lasting from minutes to a few hours, with a subsequent complete recovery. Among the possible differential diagnoses are peripheral and central causes of facial paralysis, which must be suspected due to the persistence of symptoms over time or the presence of other neurological signs or symptoms. The initial evaluation should include a complete otoneurological examination. Computed tomography of the temporal bone is useful for the visualization of facial canal dehiscence. Prevention of further episodes includes practicing effective equalization, Eustachian tube dysfunction treatment, and in certain specific cases, alternative middle ear ventilation methods such as tympanostomy tubes. Once facial paralysis is established, if spontaneous recovery does not occur, the use of corticosteroids is considered an option. A case of recurrent alternobaric facial paresis and a review of the literature are presented.

Remoción extracorpórea de CO2 en un paciente con estatus asmático que evoluciona con barotrauma / Extracorporeal CO2 Removal in a Patient with Status Asthmaticus who Evolved with Barotrauma

RESUMEN Paciente varón de 20 años, con diagnóstico de asma conocida, llegó al departamento de emergencias de un hospital de su localidad con historia de disnea 1 d antes de la admisión. Posteriormente, se torna taquicárdico, taquipneico y cianótico, por lo que fue intubado de emergencia. En la UCI del hospital general de tercer nivel, presentó bron coespasmo grave, presiones de vía aérea elevadas durante la ventilación mecánica e hipoperfusión grave. Recibió cristaloides y norepinefrina como resucitación. Al tercer día, presentó enfisema subcutáneo, neumotórax e hipercapnia con acidosis mixta. Se decidió utilizar ventilación mecánica ultraprotectora asociada con Novalung®. Con esta estrategia, logramos reducir las presiones de la vía aérea, la PEEPi, la potencia mecánica (PM) resistiva y mejorar la hipercapnia y la acidosis. El paciente permaneció 10 d en Novalung® y mostró buena evolución posterior. Finalmente, es extubado, dado de alta de la UCI y salió del hospital en buenas condiciones.

ABSTRACT A 20-year-old male with known asthma arrived at the emergency department in the first hospital with story of shortness of breath 1 day before admission. He suddenly became tachycardic, tachypneic and cyanotic, for which he was intubated. In the tertiary care general hospital ICU, he showed severe bronchospasm, high airway pressures during mechanical ventilation (MV) and severe hypoperfusion. He received crystalloids and norepinephrine. On the third day, he developed subcutaneous emphysema, pneumo thorax and hypercapnia with mixed acidosis. We decided to use ultra-protective me chanical ventilation concomitant with Novalung®. With this strategy, we could reduce airway pressures, PEEPi, resistive mechanical power and improve hypercapnia and acidosis. The patient stayed for 10 days in Novalung® and showed good evolution. He was later extubated and discharged of ICU, leaving the hospital in good conditions.

El buceo recreativo y la otorrinolaringología: ¿qué sabemos y deberíamos saber? / Recreational diving and otolaryngology: what do we know and should we know?

El buceo recreativo es una práctica cada vez más popular en la población mundial, sin embargo, no está exenta de riesgos. A medida que transcurre una inmersión, el buzo es susceptible a una serie de cambios de presión que afectan las distintas cavidades que contienen aire dentro del cuerpo humano, tales como el oído, cavidades paranasales y los pulmones. Existe un gran espectro de patologías asociadas al buceo, explicándose la mayoría de ellas por el barotrauma asociado, cuya gravedad depende de la magnitud del daño asociado, pudiendo presentar desde manifestaciones a nivel local, así como también a nivel sistémico. Las patologías otológicas suelen ser las más frecuentes y el principal motivo de consulta en este tipo de pacientes. Sin embargo, las afecciones otoneurológicas, rinosinusales, de vía aérea y sistémicas pueden ser comunes dependiendo de cada perfil de buceo. Actualmente no existen recomendaciones locales sobre esta práctica, por lo que el conocimiento de la fisiología, fisiopatología y el tratamiento de las patologías otorrinolaringológicas asociadas deben ser conocidas a medida que este deporte se vuelve cada vez más popular. Se realizó una revisión de la literatura sobre las distintas afecciones otorrinolaringológicas con el fin de sistematizarlas y elaborar recomendaciones para establecer una práctica segura.

Recreational diving is an increasingly popular practice in the world; however, it is not without risks. As a dive progresses, the diver is susceptible to a series of pressure changes that affect the air-containing cavities, such as the ear, paranasal cavities, and lungs. There is a large spectrum of pathologies associated with diving, most of them being explained by associated barotrauma, the severity of which depends on the magnitude of the associated damage, could present local manifestations, as well as at systemic level. Otological pathologies are usually the most frequent and the main reason for consultation in this type of patients, however, otoneurological, rhinosinusal, airway and systemic conditions can be common depending on each diving profile. Currently there are no local recommendations on this practice, therefore, knowledge of the physiology, pathophysiology and treatment of associated otorhinolaryngological pathologies should be known as this sport becomes increasingly popular. A review of the literature on the different ear, nose and throat conditions was carried out in order to systematize them and develop recommendations to establish a safe practice.

Barogenic perforation of the esophagus: An unusual manifestation / Perforación barogénica del esófago: una presentación inusual

Abstract Introduction: Typically, when esophageal perforation secondary to barotrauma is mentioned as the causal pathophysiological mechanism of perforation, the literature refers to spontaneous esophageal perforation or Boerhaave syndrome as an entity. It involves the longitudinal and transmural rupture of the esophagus (previously healthy) secondary to an abrupt increase in intraluminal esophageal pressure, frequently triggered during vomiting. However, in the medical literature, some reports list mechanisms of barotrauma other than this entity. Case report: A 64-year-old female patient with a history of surgically managed gastric adenocarcinoma (total gastrectomy and esophagoenteral anastomosis) presented with stenosis of the esophagojejunal anastomosis, which required an endoscopic dilatation protocol with a CRETM balloon. The third session of endoscopic dilation was held; in removing the endoscope, we identified a deep esophageal laceration with a 4 cm long perforation at the level of the middle esophagus (8 cm proximal to the dilated anastomosis), suspecting the mechanism of barotrauma as the causal agent. She required urgent transfer to the operating room, where we performed thoracoscopic esophagectomy, broad-spectrum empiric antimicrobial coverage, and enteral nutrition by advanced tube during in-hospital surveillance. The control esophagram at seven days showed a small leak over the anastomotic area, which was managed conservatively. Imaging control at 14 days showed a decrease in the size of the leak, with good evolution and tolerance to the oral route. The patient was later discharged.

Resumen Introducción: típicamente, cuando se menciona la perforación esofágica secundaria a barotrauma como el mecanismo fisiopatológico causal de la perforación, la literatura se refiere a la perforación esofágica espontánea o síndrome de Boerhaave como entidad, la cual hace referencia a la ruptura longitudinal y transmural del esófago (previamente sano) secundaria a un aumento abrupto de la presión intraluminal esofágica, que se desencadena frecuentemente durante el vómito. Sin embargo, en la literatura médica existen algunos reportes que mencionan otros mecanismos de barotrauma diferentes a esta entidad. Reporte de caso: se presenta el caso de una paciente de 64 años con antecedente de adenocarcinoma gástrico manejado quirúrgicamente (gastrectomía total y anastomosis esofagoenteral), quien presentaba estenosis de anastomosis esofagoyeyunal, que requirió un protocolo de dilatación endoscópica con balón CRETM. Se llevó a una tercera sesión de dilatación endoscópica, en la que durante la extracción del endoscopio se identificó una laceración esofágica profunda con perforación de 4 cm de longitud a nivel del esófago medio (8 cm proximal a anastomosis dilatada), y se sospechó del mecanismo de barotrauma como agente causal. Requirió traslado urgente a sala de cirugía, en la que se realizó esofagorrafia por toracoscopia, cubrimiento antimicrobiano empírico de amplio espectro y nutrición enteral por sonda avanzada durante la vigilancia intrahospitalaria. El esofagograma de control a los 7 días mostró una pequeña fuga sobre el área anastomótica, la cual se manejó de manera conservadora. El control imagenológico a los 14 días evidenció una disminución del tamaño de la fuga, con una evolución satisfactoria y tolerancia a la vía oral, y posteriormente se dio el egreso.

Barotrauma y barodontalgia en la aviación / Barotrauma and barodontalgia in Aviation / Barotrauma e barodontalgia na aviação

Introducción: se ha estudiado ampliamente la importancia de los cambios de presión y sus consecuencias en el cuerpo humano. De esto se desprenden dos conceptos importantes: el barotrauma que se define como el daño producido por cambios en la presión atmosférica; y la barodontalgia que se define como el dolor dentario producido por variaciones de presión barométrica, por ejemplo cuando existen gases atrapados en restauraciones o en la cámara pulpar y/o conducto radicular. Estos conceptos se fundamentan en las leyes de los gases: la Ley de Difusión Gaseosa, la Ley de Dalton, la Ley de Boyle, la Ley de Charles y la Ley de Henry. Discusión: el estudio y prevención de la barodontalgia es de suma importancia, ya que aunque no tiene alta prevalencia entre los aviadores, su aparición es súbita y de alta intensidad, lo que puede provocar en el piloto una incapacidad física y mental, que aumenta el riesgo de accidentes. Conclusiones: en esta revisión, se reúnen las estrategias recomendadas para prevenir su aparición.

Introduction: the importance of pressure changes and their consequences on the human body has been widely studied. Two important concepts arise from this: barotrauma, which is defined as the damage produced by changes in atmospheric pressure; and barodontalgia, which is defined as dental pain produced by variations in barometric pressure, for example when gases are trapped in restorations or in the pulp chamber and/or root canal. These concepts are based on the gas laws: the Law of Gaseous Diffusion, Dalton's Law, Boyle's Law, Charles' Law and Henry's Law. Discusion: the study and prevention of barodontalgia is of utmost importance, since although it is not highly prevalent among aviators, its onset is sudden and of high intensity, which can cause physical and mental incapacity in the pilot, increasing the risk of accidents. Conclusions: this review brings together the recommended strategies to prevent its occurrence.

Introducão: a importância das mudanças de pressão e suas conseqüências sobre o corpo humano têm sido amplamente estudadas. Dois conceitos importantes podem ser derivados disto: barotrauma, que é definido como o dano produzido por mudanças na pressão atmosférica; e barodontalgia, que é definida como a dor dental produzida por variações na pressão barométrica, por exemplo, quando os gases estão presos em restaurações ou na câmara de polpa e/ou canal radicular. Estes conceitos são baseados nas leis do gás: a Lei de Difusão Gasosa, a Lei de Dalton, a Lei de Boyle, a Lei de Charles e a Lei de Henry. Discusion: o estudo e prevenção da barodontia é de suma importância, pois embora não seja muito prevalente entre os aviadores, seu início é repentino e de alta intensidade, o que pode causar incapacidade física e mental no piloto, aumentando o risco de acidentes. Conclusões: esta revisão reúne as estratégias recomendadas para evitar sua ocorrência.

Evaluando el riesgo de fracasar con el tratamiento con cánula nasal de alto flujo en insuficiencia respiratoria por SARS COV2. Utilidad del Índice de ROX / Assessing the risk of failure with high-flow nasal cannula treatment in respiratory failure in SARS COV2. Utility of the ROX Index

El tratamiento de la insuficiencia respiratoria hipoxémica, con oxigenación mediante cánula nasal de alto flujo CNAF, tiene muchas ventajas. El sistema de humidificación caliente mejora la función mucociliar y la movilización de secreciones. En segundo lugar, el alto flujo logrado por la cánula nasal, puede mejorar la oxigenación, generar una presión positiva de bajo nivel, (efecto PEEP) en las vías respiratorias, reducir la frecuencia respiratoria, atenuar la resistencia inspiratoria y asegurar una FiO2 constante. Tercero, la CNAF permite que el paciente se alimente por vía oral, hable y tosa, lo que hace que sea mucho más cómodo que la oxigenación por mascara (1). Por último, no aumenta el riesgo de complicaciones propias de la ventilación mecánica invasiva, como la neumonía, barotrauma o traqueítis.

Treatment of hypoxemic respiratory failure with high-flow nasal cannula oxygenation has many advantages. The heated humidification system improves mucociliary function and secretion mobilization. Second, the high flow achieved by the nasal cannula can improve oxygenation, generate a low-level positive pressure (PEEP effect) in the airways, reduce respiratory rate, attenuate inspiratory resistance, and ensure constant FiO2. Third, HFNC allows the patient to feed orally, talk, and cough, making it much more comfortable than mask oxygenation (1). Lastly, it does not increase the risk of complications typical of invasive mechanical ventilation, such as pneumonia, barotrauma or tracheitis.

Perforación duodenal por barotrauma durante colangiopancreatografía retrógrada endoscópica: caso clínico / Duodenal perforation due to barotrauma during endoscopic retrograde cholangiopancreatography: clinical case

Resumen Introducción: La perforación duodenal secundaria a la colangiopancreatografía retrógrada endoscópica (CPRE) es una complicación infrecuente y más aún cuando su mecanismo lesional es por barotrauma. La inyección de aire a alta presión produce un neumoretroperitoneo, cuya extensión y evolución lesional es incierta. Caso Clínico: Se comunica el caso de un hombre joven que sufrió una perforación duodenal durante una CPRE, su manejo quirúrgico y evolución. Discusión: El diagnóstico clínico-imagenológico suele ser precoz y claro si se detecta la lesión durante el procedimiento. El manejo terapéutico conservador o quirúrgico de esta entidad depende de varios factores que se analizan en el presente estudio.

Introduction: Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication and even more if the mechanism of injury is secondary to barotrauma. The injection of high-pressure-air produces a pneumo-retroperitoneum, the extent and lesional evolution of which is uncertain. Clinical Case: We report the case of a young man who suffered a duodenal perforation during an ERCP, his surgical management and evolution. Discussion: The clinical-imaging diagnosis is usually early and clear if the lesion is detected during the procedure. Its conservative or surgical management will depends on several factors that are analyzed in the present study.

Comparación de 3 modos de ventilación mecánica en colecistectomía laparoscópica / Comparison of 3 mechanical ventilation modes in laparoscopic cholecystectomy

Resumen: El modo ventilatorio asistido durante un procedimiento laparoscópico aún es controversial. Objetivo: Comparar la dinámica ventilatoria según el modo de ventilación asistida: por ventilación controlada por volumen (VCV), controlada por presión (VCP) o por presión con garantía de volumen (VCP-GV), en anestesia para colecistectomía laparoscópica. Material y métodos: 21 pacientes adultos manejados con una de las tres modalidades (7 por grupo). Se analizó durante el procedimiento (a la intubación, la insuflación de CO2 intraabdominal y resolución), su frecuencia respiratoria, el volumen espiratorio, CO2 al final de la espiración (EtCO2), presión pico vía aérea, presión media pulmonar, distensibilidad, saturación de oxígeno y volumen minuto respiratorio. Resultados: Posterior a la intubación, no hubo diferencias clínicas importantes en las mediciones entre los modos de ventilación. A la insuflación los pacientes con modo VCP incrementaron su frecuencia respiratoria, pero conservaron su presión pico; contra aquéllos en modo VCV y VCP-GV que incrementaron su presión pico con escasa reducción de su frecuencia respiratoria. Las otras variables no se modificaron durante el procedimiento y no hubo diferencias entre los modos ventilatorios. Conclusión: Los tres modos de ventilación permitieron un buen control ventilatorio con pocas diferencias respecto a parámetros basales, pero sugerimos que el modo VCP previene mejor los aumentos en la presión pico.

Abstract: The assisted ventilatory mode during a laparoscopic procedure is still controversial. Objective: To compare ventilatory dynamics according to the assisted ventilation mode: by volume-controlled ventilation (VCV), pressure-controlled (PCV) or by pressure with volume guarantee (PVC-VG), in general anesthesia for laparoscopic cholecystectomy. Material and methods: 21 adult patients managed with one of the three modalities (seven per group). Their respiratory rate, minute expiratory volume, end tidal CO2 (EtCO2), peak airway pressure, mean pulmonary pressure, compliance, oxygen saturation and minute respiratory volume were analyzed during the procedure (at intubation, abdominal CO2 insufflation and resolution). Results: After intubation there were no clinical differences in measurements between ventilation modes. On insufflation, patients with PCV mode increased their respiratory rate, but kept their peak pressure; against those in VCV and PCV-VG mode who increased their peak pressure with little reduction in their respiratory rate. The other variables were not modified during the procedure and there were no differences between the ventilatory modes. Conclusion: The three modes of ventilation allowed a good ventilatory control, but we suggest the PCV since it prevents an increase in peak pressure.

Barotrauma en COVID-19: Asociación de neumotórax y uso de cánula nasal de alto flujo / Barotrauma in COVID-19: Association between pneumothorax and high flow nasal cannula use

La cánula nasal de alto flujo (CNAF) es una alternativa en la oxigenoterapia de pacientes en insuficiencia respiratoria aguda hipoxémica, especialmente en contexto de pandemia por SARS-CoV-2. Existen muchos beneficios, con distintos niveles de evidencia y muy pocos efectos adversos reportados a su uso descritos en adultos. Se presenta el caso de un paciente con enfermedad pulmonar obstructiva crónica, que cursando con una neumonía grave por SARS-CoV-2, mientras recibía terapia con CNAF, desarrolló un neumotórax. Esta complicación asociada a la terapia con CNAF es poco reportada en la literatura, lo que motiva este reporte.

High Flow Nasal Cannula (HFNC) is an alternative to deliver oxygen in patients with hypoxemic acute respiratory failure, especially in the context of SARS-CoV-2 outbreak. There are plenty of benefits described, with different evidence levels and very few adverse effects published in adults until now. We report the case of a patient with chronic obstructive pulmonary disease, presenting with SARS-CoV-2 severe pneumonia that while receiving oxygen with HFNC developed pneumothorax. This complication associated with HFNC has not been commonly described, which motivates this report.

Hematoma subperiosteal orbitário secundário a barotrauma em aviação civil / Orbital subperiosteal hematoma secondary to barotrauma in civil aviation

RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.

ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.

A case of pulmonary barotrauma complicated with cerebral arterial air embolism in a diver / 中华劳动卫生职业病杂志

Pulmonary barotrauma is a kind of disease caused by the injury of lung tissue or blood vessel when the gas pressure of lung is too high or too lower than the external pressure of the body, which causes the air to enter the blood vessel and adjacent tissue. It could be happened in the escape of the divers with the light diving equipment or the sailors from submarine. Generally, the decompression chamber was used to treating the disease, and the minimum air pressure of 0.5 MPa recompression therapeutic schedule was used to selecting. In November 2019, a patient with pulmonary barotrauma combined with cerebral arterial gas embolism caused by improper underwater escape with light diving equipment was admitted to the General Hospital of Eastern War Zone. He was treated with 0.12 MPa oxygen inhalation recompression scheme in the oxygen chamber pressurized with air. 7 days later, the patient recovered and discharged.

Embolismo cerebral durante vuelo comercial: reporte de caso / Cerebral embolism during commercial flight: case report

RESUMEN Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.

ABSTRACT We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.

Review of Human Physiology in the Underwater Environment

Since before centuries, human tries hard to explore underwater and in 1940’s human-introduced an important and revolutionary gear i.e. scuba that allowed human-made long interaction in the underwater world. Since diving using pressure gas under pressure environment, it should be considered to remember gas law (Boyle’s law). The gas law gives a clear understanding of physiological consequences related to diving diseases such as barotrauma or condition in which tissue or organ is damage due to gas pressure. The organ which has direct effect related to compression and expansion of gas were lungs, ear, and sinus. These organs were common and potentially fatigue injury for a diver. In this article we shall review the history of scuba diving, physical stress caused underwater environment, physiology adaptation of lung, ear, and sinus, and diving disease.

Enfermedad descompresiva grave en buzo aficionado / Severe decompressive illness in amateur diver

RESUMEN Paciente masculino de 23 años de edad, buzo aficionado, que ingresó en el Hospital Militar "Dr. Joaquín Castillo Duany", con historia de haber realizado inmersiones profundas, dos días consecutivos, con escape a superficie sin realizar las paradas de descompresión establecidas, a la salida de la segunda inmersión. Comenzó a presentar de forma brusca calambres, pérdida total de la fuerza muscular en miembros inferiores y disminución de la fuerza muscular en miembros superiores, así como falta de aire, opresión torácica, relajación de esfínter anal y vesical e intranquilidad. Se diagnosticó enfermedad descompresiva grave o tipo II y barotrauma pulmonar. Fue reportado grave e ingresado en sala de terapia intensiva. Se realizó tratamiento recompresivo de urgencia. La evolución clínica resultó favorable sin peligro para la vida; aunque con secuelas neurológicas invalidantes(AU)

ABSTRACT We present a 23-year-old male patient, amateur diver, who came to Dr. Joaquín Castillo Duany Militar Hospital complaining of sudden cramps, total loss of muscle strength in lower limbs, decreased muscle strength in upper limbs, shortness of breath, chest tightness, anal and bladder sphincter relaxation and restlessness. He had done deep-sea dives in two consecutive days, with escape to the surface but not performing required decompression stops at the exit of the second dive. His diagnosis was severe decompression sickness or type II and pulmonary barotrauma. He is reported as severe and admitted to the intensive care unit. Urgent recompression treatment was performed. The clinical evolution was favorable without danger to life although with disabling neurological sequelae(AU)

Clinical analysis of severe community-acquired pneumonia complicated with mediastinal emphysema after renal transplantation (report of 9 cases) / 器官移植

Objective To investigate the clinical treatment and outcomes of severe community-acquired pneumonia (CAP) complicated with mediastinal emphysema after renal transplantation. Methods Clinical data of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation were retrospectively analyzed. The acute physiology and chronic health evaluationⅡ(APACHEⅡ) and oxygenation index were recorded when the patients were admitted to the intensive care unit (ICU). The complications of mediastinal emphysema and corresponding treatment were observed. The treatment course during the ICU, mortality rate in ICU, ICU stay time and hospital stay time were recorded. All patients underwent pathogenic examinations. Results The APACHEⅡ score of9 patients with severe CAP complicated with mediastinal emphysema after renal transplantation was 14 (8-21) scores and the oxygenation index was 150 (133-189) mmHg. Among 9 patients, 3 cases were infected by bacteria alone, 3 cases were infected by bacterial infection combined with viral infection, 1 case was infected by mycobacterium tuberculosis complicated with other bacterial infection and 1 case was viral infection. No pathogenic evidence was detected in the remaining 1 patient. Mediastinal emphysema complicated with subcutaneous emphysema occurred in 7 cases and pneumothorax occurred in 6 cases. Treatment methods included anti-infection, modified immunosuppressive program, mediastinal drainage, thoracic closed drainage, subcutaneous incision and extracorporeal membrane oxygenation (ECMO) treatment. Six patients received invasive mechanical ventilation (IMV), 2 received non-invasive positive pressure ventilation (NIV) and 1 received high-flow nasal oxygen cannula (HFNC). Among 9 patients, the mortality rate in ICU was 6/9, the remaining 3 patients were recovered and discharged, the ICU stay time was 26 (17-40) d, and the total hospital stay time was 27-61 d. Conclusions Mediastinal emphysema is a serious complication of patients presenting with severe CAP after renal transplantation with a high mortality rate. For these patients, imaging evaluation, timely drainage and full sedation should be strengthened, and ECMO treatment should be delivered when necessary.

Lesiones pulmonares quísticas en el neonato: no todo es enfermedad congénita pulmonar. Reporte de caso / Cystic lung lesions in neonate: they do not always represent pulmonary congenital disease. Case report

Resumen Los quistes pulmonares unilaterales son un hallazgo inusual en neonatos, desde el punto de vista del radiólogo es difícil distinguir los quistes pulmonares congénitos de los adquiridos. El diagnóstico definitivo es histológico. Se presenta un recién nacido prematuro de 28 semanas con síndrome de dificultad respiratoria en relación con múltiples quistes pulmonares. Las radiografías iniciales del tórax mostraron un quiste pulmonar solitario izquierdo. Requirió de forma escalonada asistencia respiratoria, junto con rayos X seriados donde se observa la presencia de neumotórax y el aumento del tamaño de la lesión quística inicial con presencia de nuevos quistes. La tomografía computarizada confirmó la presencia del quiste solitario del lóbulo inferior izquierdo y varias colecciones de gas intersticial con puntos centrales de tejidos blandos con relación a enfisema pulmonar intersticial y se planteó como diagnóstico diferencial malformación adenomatoidea quística. La lesión fue extirpada quirúrgicamente en vista del deterioro clínico. La histología confirmo la presencia de enfisema pulmonar intersticial persistente. MÉD.UIS. 2018;31(1):65-70.

Abstract Unilateral pulmonary cysts are an unusual finding in neonates, from the point of view of the radiologist it is difficult to distinguish congenital pulmonary cysts from those acquired. The definitive diagnosis is histological. A 28-week premature neonate with respiratory distress syndrome is present in relation to multiple pulmonary cysts. The initial chest X-rays showed a solitary left pulmonary cyst. It required a staggered respiratory assistance, along with serial X-rays where the presence of pneumothorax and the increase in the size of the initial cystic lesion with the presence of new cysts was observed. Computed tomography confirmed the presence of solitary left lower lobe cyst and several collections of interstitial gas with central soft tissue points in relation to interstitial pulmonary emphysema and was raised as a differential diagnostic cystic adenomatoidea malformation. The lesion was surgically removed in view of clinical deterioration. Histology confirmed the presence of persistent interstitial pulmonary emphysema. MÉD.UIS. 2018;31(1):65-70.

Stomach Perforation Caused by Ingesting Liquid Nitrogen: A Case Report on the Effect of a Dangerous Snack

We report our experience with a case of stomach perforation after accidental ingestion of liquid nitrogen. A 13-year-old boy ate a snack at an amusement park and began to complain of sudden onset of severe abdominal pain with shortness of breath. It was determined that the snack he had ingested had been cooled with liquid nitrogen. A computed tomography scan of the abdomen and a chest X-ray showed a large volume of pneumoperitoneum. During surgery, a 4-cm perforation of the angularis incisura of the stomach was identified. Primary repair and omentopexy was performed. The patient was discharged without postoperative complications.

Colorectal injury by compressed air: the rule of conservative therapy / Lesão colorretal por ar comprimido: a regra da terapia conservadora

ABSTRACT We are reporting a case of colorectal injury caused by a jet of compressed air directed from a distance towards the anus. The patient mentioned that it happened accidentally while his colleague was cleaning his clothes using compressed air. The patient presented with acute abdominal pain and distension. A contrast CT study did not show any free air or leakage. The patient was treated conservatively, progressed well and was discharged from the hospital on the fourth day.

RESUMO Descrevemos um caso de lesão colorretal causada por um jato de ar comprimido direcionado para o ânus, a certa distância. O paciente mencionou que o ocorrido foi acidental, enquanto um colega estava limpando suas roupas com ar comprimido. O paciente se apresentou com dores abdominais agudas e distensão. Um estudo de TC contrastado não demonstrou ar livre, nem vazamento. O paciente foi tratado conservadoramente, teve boa evolução e recebeu alta hospitalar no quarto dia.

Compound effects of inhaling pure oxygen and lifting height on ear baric function in a hypobaric chamber / 解放军医学杂志

Objective To compare the ear baric function between 4000m altitude chamber test with inhaling air and 6900m altitude chamber test with inhaling pure oxygen.Methods Eleven healthy male volunteers attended two tests as two groups by self-comparison. As the air group the volunteers inhaled air at 4000m, while as the pure oxygen group they inhaled pure oxygen at 6900m altitude, and the time interval between the two tests was more than two weeks. During the test, the volunteers breathed air or pure oxygen at random for 1h, and then were exposed at a speed of 20m/s to the target altitude for 5min. Hereafter they were sent back to the ground at the same speed. The changes of subjective symptoms, degree of tympanic congestion, acoustic immitance index and pure-tone auditory threshold were recorded before and after the test. The acoustic impedance index and pure-tone threshold were statistically analyzed.ResultsFour volunteers (4 ears) in air group and 7 volunteers (7 ears) in pure oxygen group reported ear pain in altitude chamber exposures, respectively. The pain-triggering altitude was higher in the pure oxygen group. Immediately after tests, there were 3 (3 ears) and 5 volunteers (5 ears) with Ⅲ degree congestion of the tympanic membrane in the two groups respectively. Four volunteers (6 ears) developed gradually aggravated hemorrhages after altitude exposure. And the tympanic membrane congestion difference between groups was statistically significant at 3 and 24h after tests (P<0.01). The type A tympanogram appeared in 11 (15 ears) and 11 (14 ears) volunteers respectively immediately after tests. The increase of static compliance value was significantly greater in pure oxygen group than in air group immediately after tests (P<0.05), the decrease of middle ear pressure was more significant in pure oxygen group than in air group at 3 and 24h after tests (P<0.05). Both the two altitude exposure tests resulted in eustachian tube dysfunction. At 3 and 24h after the tests, the increase of individual frequency pure-tone threshold was significantly higher in pure oxygen group than in air group (P<0.05).Conclusion Breathing pure oxygen and lifting height could increase the screening degree of ear baric function test in hypobaric chamber, and have greater influence on degree of tympanic congestion, acoustic immittance and pure-tone auditory threshold in 24 hours.

Rectal perforation by compressed air

As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injury from its improper use. However, damage of large intestine caused by compressed air is uncommon. Herein a case of pneumatic rupture of the rectum is described. The patient was admitted to the Emergency Room complaining of abdominal pain and distension. His colleague triggered a compressed air nozzle over his buttock. On arrival, vital signs were stable but physical examination revealed peritoneal irritation and marked distension of the abdomen. Computed tomography showed a large volume of air in the peritoneal cavity and subcutaneous emphysema at the perineum. A rectal perforation was found at laparotomy and the Hartmann procedure was performed.