ABSTRACT
La flebectasia de la vena yugular es una dilatación fusiforme congénita de la vena yugular, blanda y compresible, que aparece durante el esfuerzo o con las maniobras de Valsalva. Presentamos el caso clínico de un paciente de seis años de edad que acude a Urgencias por una tumoración cervical que aumenta con las maniobras de Valsalva (AU)
Jugular vein phlebectasia is a congenital fusiform dilatation of the jugular vein that appears as a soft, compressible mass in the neck during straining or triggered by the Valsalva maneuver. We report the case of a patient of 6-years-old patient who came to the emergency room for a cervical tumor that increases in size with Valsalva maneuvers (AU)
Subject(s)
Humans , Male , Child , Varicose Veins/diagnosis , Jugular Veins/physiopathology , Jugular Veins , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/physiopathology , Valsalva Maneuver/physiology , Cervical Vertebrae/pathology , Cervical Vertebrae , Diagnosis, DifferentialABSTRACT
Presentamos el caso clínico de dos hermanas que acuden a la consulta por lesiones cutáneas papulopustulosas, sin otra sintomatología, con antecedente de haber acudido días previos a balnearios y piscinas. La foliculitis por Pseudomonas es una infección cutánea de los folículos pilosos causada por P. aeruginosa, frecuente en personas que usan baños calientes, saunas, piscinas, juegos de agua y piscinas de fisioterapia. Es una infección autolimitada que se resuelve sin dejar lesiones residuales (AU)
We present the case of two sisters who came to the pediatric consultation for papulopustular skin lesions without other symptoms, but a history of being bathed in a public swimming pool and a spa the previous days. Pseudomonas folliculitis is a skin infection of the hair follicles caused by Pseudomonas aeruginosa that is commonly suffered by people who baths in hot tubs, saunas, swimming pools, fountains and physiotherapeutic pools. It is a self-limited infection that resolves without any residual lesion (AU)
Subject(s)
Humans , Female , Child , Folliculitis/diagnosis , Folliculitis/physiopathology , Swimming Pools/standards , Swimming Pool Sanitation , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/diagnosis , Water Pollution/adverse effects , Water Chlorination/prevention & control , Water Pollution/analysis , Infection Control/standardsABSTRACT
La cerebelitis aguda (CA) acompañada de inflamación fatal del cerebelo es un cuadro muy poco frecuente con diferentes formas de tratamiento. Presentamos el caso de un niño que desarrolló una CA de evolución mortal. Realizamos una revisión de la bibliografía incluyendo diferentes opciones de tratamiento. Se trata de un varón de 5 años de edad que, tras un cuadro de cefalea y vómitos, evoluciona rápidamente a coma. La resonancia magnética cerebral muestra una hidrocefalia obstructiva por compresión del tronco cerebral debido a un aumento de volumen de los hemisferios cerebelosos. Se decidió realizar tratamiento médico con esteroides, y tratamiento quirúrgico mediante la colocación de una válvula de derivación externa, a pesar de lo cual el paciente falleció. La necropsia fue compatible con una CA. Existen pocos casos descritos en la bibliografía de evolución mortal de una CA. El tratamiento esteroideo puede ser insuficiente, por lo que es necesario realizar una intervención neuroquirúrgica rápida mediante un drenaje ventricular externo. Algunos pacientes pueden precisar una descompresión de la fosa posterior mediante una craniectomía suboccipital descompresiva. En este caso clínico, la evolución fue tan rápida que impidió dicho procedimiento (AU)
Acute cerebellitis (AC) accompanied of fatal inflammation of the cerebellum is a rare disease with different forms of medical and surgical treatment. We report the case of a child who developed a CA of fatal evolution. We review the literature and discuss about it including different treatment options. This is a 5-year-old male patient who presents symptoms such as a headache and vomits evolving rapidly into a comma. The cerebral MRI shows an obstructive hydrocephalus and compression of the cerebral trunk due to an increase of volume of the cerebellar hemispheres. The decision is of medical treatment and steroids and a surgical intervention by means of placing an eternal ventricular drain all was ineffective and the patient dies. The autopsy was compatible with AC. The steroid treatment may be insufficient therefore it is necessary to establish a rapid neuro-surgery by means of an external ventricular drainage. Some patients might need a decompression of the posterior cavity by means of a decompressive suboccipital craniectomy. In this clinical case, the evolution was so fast that the above-mentioned procedure was prevented (AU)
Subject(s)
Humans , Male , Child, Preschool , Hydrocephalus/complications , Encephalitis/complications , Nerve Compression Syndromes/complications , Cerebellar Ataxia/complications , Craniotomy , AmygdalaABSTRACT
OBJECTIVE: Extracorporal membrane oxygenation (ECMO) is an alternative to cases of respiratory or cardiopulmonary insufficiency when conventional therapy has failed. We present the first 22 patients treated with ECMO at the neonatology unit of the "Gregorio Marañon" Hospital. PATIENTS AND METHODS: From October 1997 until September 1999, 22 patients were treated with ECMO. In 8 of them ECMO was necessary because of respiratory insufficiency without response to conventional treatment (r-ECMO) and a veno-venous tidal flow system was used. In 14 patients, cardiac ECMO was necessary in the veno-arterial modality because of ventricular failure after extracorporal circulatory assistance during cardiovascular surgery. RESULTS: The 8 patients of the respiratory ECMO group had a mean previous oxygenation index of 89 +/- 36.6 (50-150). The mean duration of ECMO was 7.8 +/- 6.5 (1-16) days and the age at the beginning of ECMO ranged between 1 and 151 days. The most frequent indications in this group were congenital diaphragmatic hernia in three cases, meconium aspiration syndrome in 2 cases and 1 case each of septic shock, idiopathic pulmonary hypertension and air leak. The cannula was removed in 5/8 patients due to recovery and 5/8 survived. The 14 patients of the cardiac ECMO group needed veno-arterial ECMO because of severe ventricular failure. Eight out of fourteen were decannulated after improvement. In 5/14 there was multiorgan failure or bad neurological prognosis resulting in death while on ECMO. In 1 out of 14 patients removal of the cannula was impossible because of cardiac insufficiency. The mean age at the beginning of ECMO was 54 (3-178) days. The mean weight at ECMO was 3209 +/- 739 (2700-5000) gr and the mean duration of ECMO was 6 (1-15) days. CONCLUSIONS: ECMO is an effective treatment in rescuing critical patients when conventional treatment fails. Meconium aspiration syndrome is the pathology with the best prognosis on ECMO. Cardiac ECMO represents a complex group of patients in which ECMO is the only treatment and which may result in recovery in 40% of the patients.
