Successful treatment for a case of near-fatal secondary adrenal insufficiency / Tratamiento exitoso de una caso de insuficiencia adrenal secundaria casi fatal

A thirty-six-year old female with shock was found to be unconsciousness a few days after developing a respiratory infection. Her past medical history included autoimmune hypothyroidism. Her state of shock was not controlled by massive fluid resuscitation with a vasopressor and antibiotics. However, an infusion of 250 mg methylprednisolone dramatically improved her shock state. Further examination indicated secondary acute adrenal insufficiency. Adrenal insufficiency may complicate other endocrine disorders. Accordingly, a physician should consider hypoadrenocorticism, when patients are in a state ofrefractory shock in spite ofmassive infusion with a vasopressor, especially in patients with other endocrine disorders.

Una mujer de treinta y seis años en shock fue hallada inconsciente unos dias después de desarrollar una infección respiratoria. Los antecedentes en su historia clinica incluian hipotiroidismo autoinmune. Su estado de shock no fue controlado por la reanimación con liquidos masiva con un vasopresor y antibióticos. Sin embargo, una infusion de 250 mg metilprednisolona habia mejorado considerablemente su estado de shock. Un examen mas detenido indicó insuficiencia adrenal aguda secundaria. La insuficiencia adrenal puede complicar otros trastornos endocrinos. En consecuencia, un médico debe considerar la posibilidad de hipoadrenocorticismo, cuando los pacientes se encuentran en estado de shock refractario a pesar de una infusion masiva con un vasopresor, especialmente en el caso pacientes con otros trastornos endocrinos.

A case of pulmonary oedema induced by suffocation / Un caso de edema pulmonar inducido por sofocación

A 57-year old female civilian was suffocated by an intruder. The victim (experienced severe dyspnoea) but violently resisted the assault. Two hours after this event, on admission to a Trauma Centre, she demonstrated left facial swelling with low percutaneous oxygen saturation. Chest X-ray and computed tomography demonstrated pulmonary oedema. This improved dramatically within a short time and she was discharged on the 5th hospital day. Pulmonary oedema induced by suffocation has been reported only rarely. The possible mechan-isms by which pulmonary oedema might form after the relief of airway obstruction are discussed.

Una ciudadana de 57 años fue sofocada por un intruso. La víctima experimentó una disnea severa, pero resistió violentamente el ataque. Dos horas después de este acontecimiento, al ser ingresada en un Centro de Traumas, se le observó hinchazón en el lado izquierdo de la cara, con una baja saturación percutánea de oxígeno. La radiografía del pecho y la tomografía computarizada mostraron un edema pulmonar. Este cuadro clínico mejoró dramáticamente en corto tiempo, y fue dada de alta al quinto día de su hospitalización. El edema pulmonar inducido por sofocación ha sido raramente reportado. Se discuten los posibles mecanismos por los cuales el edema pulmonar podría formarse después de desbloquearse la obstrucción de la vía respiratoria.

Moyamoya disease associated with positive findings for rheumatoid factor and myeloperoxidase-anti-neutrophil cytoplasmic antibody / La enfermedad de moyamoya asociada con hallazgos positivos en relación con el factor reumatoideo y los anticuerpos citoplasmáticos antineutrófilos mieloperoxidasa

A 39-year old female suddenly fell into a state of unconsciousness. She had no significantpast medical history. A computed tomography scan of the head demonstrated a massive left putaminal haemorrhage with a ventricular perforation, low density areas in the right frontal lobe, corona radiata and occipital lobe. A single emergency burr hole drainage of the haematoma was performed. Bilateral common carotid arteriograms showed stenosis of the right internal carotid artery and a complete obstruction of left internal carotid artery which were both accompanied by moyamoya vessels. The biochemical studies indicated serological positive findings for RF and MPO-ANCA. She was transferred to another hospital for nursing care in a vegetative state on the 163nd hospital day. This case indicates that immunological factors, inflammation or vasculitis might have possibly been associated with the development of either an obstruction or stenosis of the intracranial internal carotid arteries.