Embolia de líquido amniótico: Criterio diagnóstico en dos casos fatales / Amniotic fluid embolism: Diagnostic criteria in two fatal cases

La embolia de líquido amniótico continúa siendo una causa importante de mortalidad materna. Presentamos la información obtenida por medio de la cateterización cardíaca derecha y la ecocardiografía, en dos pacientes que desarrollaron embolia de líquido amniótico y fallecieron por shock y coagulación intravascular diseminada a pesar del tratamiento intensivo. Aunque la fisiopatología continúa siendo discutida, la embolia por líquido amniótico se puede diagnosticar y manejar a partir de los valores hemodinámicos y el ecocardiograma.

Amniotic fluid embolism still remains an important cause of maternal mortality. We present information obtained by echocardiography and right cardiac catheterization of two patients who developed amniotic fluid embolism and died from shock and disseminated intravascular coagulation despite intensive medical treatment. Although the pathophysiology remains controversial, amniotic fluid embolism can be presumptively diagnosed and managed with hemodynamic values and echocardiography.

Pseudoaneurisma micótico de la arteria carótida extracraneana por infección parafaríngea / Extracranial carotid pseudoaneurysm within a parapharyngeal infection

El 5 por ciento de los aneurismas micóticos (AM) se ubica en el territorio carotídeo y la localización en su sector extracraneal es extremadamente rara...Se presenta un paciente con pseudoaneurisma micótico de la arteria carótida extracraneal secundario a infección parafaríngea, complicado con infarto cerebral y tratado con ligadura de vaso

Neumonía y distres respiratorio por varicela en un adulto inmunocompetente / Varicella pneumonitis eith acute respiratory distress syndrome in immunocompetent adult

La varicela es una enfermedad prevalente en países desarrollados no obstante contarse con una vacuna efectiva. De evolución benigna en niños, la incidencia en adultos se duplicó en los últimos 20 años y está asociada con mayor número de complicaciones. La neumopatía es la más importante y se refirió una mortalidad de 10-30 por ciento que se eleva a 50 por ciento si es necesaria la asistencia resporatoria mecánica...Se presenta un varón adulto inmunocompetente con neumonía grave y distres respiratorio por varicela, que requirió asistencia respiratoria mecánica.

Beriberi cardiovascular agudo (shoshin-beriberi) / Acute cardiovascular beriberi (shoshin-beriberi)

Beriberi (BB), thiamine deficiency, has been described in the Asian literature in the 17th century and is characterized by peripheral neuropathy and muscle weakness, also called "dry" beriberi (BB) to differentiate it from "wet" BB, with essentially cardiovascular manifestations. Wet can be either "classic" wet BB in which signs and symptoms of right-sided heart failure with normal or high cardiac output are the presenting features or the "shoshin" BB variant with severe biventricular failure and metabolic acidosis, which must be treated early to prevent the rapid development of low cardiac output failure and sudden death. In this case, we report a 58 year old alcoholic woman who developed dyspnea, oliguria, edema, cardiac failure with high output, metabolic acidosis, renal tubular dysfunction and serum lactate level of 5.6 mEq/L. Neurological examination revealed peripheral neuropathy in the lower legs and cognitive alteration. She was treated with a loading dose of 100 mg of intravenous thyamine and responded with a marked increase in urine output, correction of acidosis, reduction in pulmonary-capillary wedge pressure and a change of the hemodynamic pattern. We conclude that shoshin-BB is uncommonly encountered but not widely recognized. In lactic acidosis and/or hyperdynamic circulation without any other apparent etiology in patients with possible vitamin B1 deficiency, the diagnosis of BB must be considered and thiamine should be administered