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1.
An. sist. sanit. Navar ; 45(1): e0974, enero-abril 2022. ilus, tab
Article in Spanish | IBECS | ID: ibc-202916

ABSTRACT

La aparición de complicaciones graves, como el neumotórax o las cavitaciones pulmonares, en pacientes con infecciones recientes por el SARS-CoV-2 aumenta la morbi-mortalidad, y supone un reto diseñar la estrategia terapéutica más adecuada que permita mejorar su pronóstico. Las cavitaciones pulmonares se suelen asociar a complicaciones secundarias como la hemoptisis y el neumotórax, y confieren mal pronóstico. Se presenta el caso de dos pacientes con enfermedad COVID-19 confirmada por PCR nasofaríngea y que, tras evolución inicialmente satisfactoria, reingresaron con afectación pulmonar compatible con cavitaciones pulmonares y con insuficiencia respiratoria. Las lesiones cavitadas pulmonares en pacientes que hayan sufrido COVID-19 deben identificarse de forma precoz y realizar las determinaciones y cultivos necesarios para descartar sobreinfecciones añadidas que puedan empeorar el pronóstico.(AU)


Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.(AU)


Subject(s)
Humans , Health Sciences , Coronavirus , Cavitation , Severe acute respiratory syndrome-related coronavirus , Superinfection , Pneumothorax
2.
An Sist Sanit Navar ; 45(1)2022 Apr 27.
Article in Spanish | MEDLINE | ID: mdl-34703033

ABSTRACT

Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.


Subject(s)
COVID-19 , Pneumothorax , COVID-19/complications , Humans , Lung , Pneumothorax/etiology , SARS-CoV-2
4.
Med. intensiva (Madr., Ed. impr.) ; 26(3): 132-135, mar. 2002. ilus
Article in Es | IBECS | ID: ibc-10895

ABSTRACT

El síndrome de Kearns Sayre es un tipo de enfermedad mitocondrial que se caracteriza por la presencia de la oftalmoplejía externa progresiva, retinitis pigmentaria y comienzo de los síntomas antes de los 20 años. Además debe presentar uno de estos criterios menores: bloqueo de la conducción cardíaca, síndrome cerebeloso o proteinorraquia mayor de 100 mg/dl. Existen formas incompletas de la enfermedad. El pronóstico y la supervivencia de esta enfermedad están ligados en muchas ocasiones a la evolución de las alteraciones cardíacas.Presentamos el caso de un síndrome de Kearns Sayre incompleto con alteraciones de la conducción cardíaca y evolución hacia el bloqueo auriculoventricular completo. Revisamos las indicaciones de implantación de marcapasos definitivos en estos pacientes (AU)


Subject(s)
Adult , Female , Humans , Kearns-Sayre Syndrome/diagnosis , Electrocardiography , Pacemaker, Artificial , Kearns-Sayre Syndrome/surgery
5.
Rev Neurol ; 33(6): 522-5, 2001.
Article in Spanish | MEDLINE | ID: mdl-11727231

ABSTRACT

INTRODUCTION: In the clinical daily practice, exist multiple situations in which could produce phenomenons of serious hypoxia to encephalic level, normally with important repercussions for the patient. OBJECTIVES: Study if after the existence of a situation of serious encephalic hypoxia, any typical pattern in the exploration transcranial Doppler (TCD) exists, and the possible diagnostic and/or prognostic implications could bear. PATIENTS AND METHODS: We presented 10 patients admitted in our Unit of Intensive Care, for clinical situations in which a situation of encephalic hypoxia took place and to which was practiced a TCD like exploration of encephalic flow. We related the discoveries of the DTC, with the clinical situation, the images of the cerebral computed tomography in three of the patients, and the data of the electroencephalogram in the other seven. Like statistical tool, is used the test of square ji, demanding a confidence interval of the 95%. RESULTS: In all the patients, we found a patron TCD, of high speed mean with low Pulsatility Index. Nine patients died, surviving with serious sequels the last patient. CONCLUSIONS: In our series, we could conclude, that the existence of a patron TCD with high speed mean and with low Pulsatility Index, after an episode of brain hypoxia, its associated to a wrong presage, existing a high risk of death of the patient.


Subject(s)
Hypoxia, Brain/diagnostic imaging , Ultrasonography, Doppler, Transcranial/methods , Adult , Aged , Electroencephalography , Female , Glasgow Coma Scale , Humans , Hypoxia, Brain/physiopathology , Male , Middle Aged , Predictive Value of Tests , Severity of Illness Index
6.
Rev Esp Cardiol ; 51(9): 740-9, 1998 Sep.
Article in Spanish | MEDLINE | ID: mdl-9803800

ABSTRACT

INTRODUCTION: Several studies point out the importance of what is called rescue angioplasty or fibrinolysis when thrombolysis has been ineffective in acute myocardial infarction. Therefore, it is necessary to make use of new non-invasive methods to asses reperfusion and to safely establish that such a treatment has not been effective. PATIENTS AND METHOD: We present a work which is based on the assessment of patients with acute myocardial infarction treated with or without fibrinolysis. After determining cardiac enzymatic profiles of creatine kinase and MB isoform (time course, peak, appearance rate constant time-activity: K1). With cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography pre and post treatment after to calculating myocardium at risk, salvage and relationship. RESULTS: In patients treated with fibrinolysis, the salvage myocardium was higher (8.3% vs 3.0%; p < 0.05). Considering that an improvement in perfusion defect (salvaged myocardium/myocardium at risk) higher than 30% can be viewed as an effective reperfusion, we can see that the percentage in the group treated with fibrinolysis being 45.8%, and the percentage in the group under conventional treatment being just 6.7%. Patients with acute myocardial infarction treated with fibrinolysis show much shorter start of rise-peak time and pain-peak time, all this with very significant differences for the creatine kinase (p < 0.0001) as well as for the MB (p < 0.001). Patients with reperfusion show a rapid increase in activity enzymatic, as demonstrated by the pain-peak time variable and the appearance rate constant time-activity (K1), with very significant differences in the latter (p < 0.0001). In relation with gammagraphy, values of K1 higher or equal to 0.19 for the creatine kinase and 0.14 for the MB isoform, achieved a sensibility of 83% and 91%, and a specificity of 85% and 80% respectively, to asses reperfusion. CONCLUSION: We think that cardiac imaging gammagraphy with isonitriles as well as as determination of the appearance rate enzymatic constant time-activity, can be useful in monitoring treatment with fibrinolysis in infarction patients. New studies are needed to assess these same aspects, with a lesser number of enzymatic determinations.


Subject(s)
Creatine Kinase/blood , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/drug therapy , Myocardial Reperfusion , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Thrombolytic Therapy , Aged , Contraindications , Female , Humans , Isoenzymes , Male , Middle Aged , Myocardial Infarction/enzymology , Radionuclide Imaging , Sensitivity and Specificity
7.
Rev Esp Med Nucl ; 17(4): 283-93, 1998.
Article in Spanish | MEDLINE | ID: mdl-9721345

ABSTRACT

Several studies point out the importance of what is called rescue angioplasty or fibrinolysis (FB) when thrombolysis has been ineffective in acute myocardial infaction (AMI). Therefore, it is necessary to make use of new methods to asses reperfusion and to safely establish that such a treatment has not been effective. We present a work which is based on the assessment of patients with acute coronary heart disease: AMI patients treated with FB (N = 48), without FB (N = 15), unstable angina (N = 9); after determining cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography (MIBI-SPECT) pre and post treatment, to assess myocardium at risk (MR), salvage (MS) and the existence or not of gammagraphic reperfusion. Unstable angina patients show a myocardial perfusion that is similar to AMI patients. However, in the case of unstable angina, perfusion is practically of a 100% 48 hours later, having almost completely saved the myocardium at risk (MS/MR = 81.5% +/- 27.7%), and with a non-existent residual myocardium (3.2% +/- 5.8%). In AMI patients treated with FB the salvage myocardium was higher [8.3 vs 3.0; p < 0.05). Considering that an improvement in perfusion defect (MS/MR)] higher than 30% can be viewed as an effective reperfusion, we can see that all the patients with unstable angina show reperfusion, the percentage in the AMI group treated with FB being 45.8%, and the percentage in the AMI group under conventional treatment being just 6.7%. Gammagraphy with 99mTc-MIBI-SPECT at admission allowed assessing regional perfusion in AMI patients during the early stage of their evolution. With a second exploration we could determine the amount of salvage myocardium and the existence of secondary reperfusion to FB treatment.


Subject(s)
Myocardial Infarction/diagnostic imaging , Myocardial Reperfusion/methods , Technetium Tc 99m Sestamibi , Thrombolytic Therapy , Tomography, Emission-Computed, Single-Photon , Aged , Angina, Unstable/diagnostic imaging , Chest Pain/diagnostic imaging , Coronary Circulation , Evaluation Studies as Topic , Female , Fibrinolytic Agents/therapeutic use , Heart/diagnostic imaging , Humans , Male , Middle Aged , Myocardial Infarction/drug therapy , Myocardial Infarction/pathology , Myocardium/pathology , Prospective Studies , Sensitivity and Specificity , Time Factors
8.
An Med Interna ; 11(4): 189-91, 1994 Apr.
Article in Spanish | MEDLINE | ID: mdl-8043741

ABSTRACT

We present a case of varicellous pneumonia in a 40-year-old patient without immunitary compromise, who quickly evolved to respiratory distress in the adult and required sustained ventilatory support. We review the literature, with special mention to the indications of the antivirical treatment with Aciclovir.


Subject(s)
Chickenpox/complications , Pneumonia, Viral/complications , Respiratory Distress Syndrome/microbiology , Adult , Humans , Male
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