Neumomediastino y neumotórax bilateral en paciente con fibrosis pulmonar idiopática / Pneumomediastinum and Bilateral Pneumothorax in Patients with Idiopathic Pulmonary Fibrosis

Los pacientes con fibrosis pulmonar idiopática (FPI) presentan un mayor riesgo de desarrollar complicaciones pulmonares agudas, incluyendo entre ellas el neumotórax y el neumomediastino. Describimos los hallazgos en la radiografía y el TAC de tórax en un paciente con diagnóstico de FPI. El examen radiológico realizado por dos radiólogos especialistas de tórax reveló hallazgos de aire extra alveolar. La disnea, disfagia, afonía y dolor torácico fueron los síntomas más llamativos que presentó el paciente. En la Rx de tórax se apreció neumotórax bilateral y neumomediastino. El paciente falleció a los 22 días de iniciado el deterioro clínico por insuficiencia respiratoria

Patients with idiopathic pulmonary fibrosis (IPF) have a higher risk of developing acute pulmonary complications, including pneumothorax and spontaneus pneumomediastinum. We describe the findings in the xray and CT scan of the thorax in a patient diagnosed with IPF. The radiography examination by two thoracic specialist radiologists revealed evidenced extravascular air in the thorax. Disnea, disphagia, aphonia, thoracic pain were the most concerning symptom presented in the patient. The thoracic radiology display air in the pleural cavity along bilateral pneumothorax and pneumomediastinum. The patient died 22 days after the start of clinical deterioration due to respiratory failure

Gas en el corazón / Gas in the heart

No disponible

Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año / Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality

Revisar el tratamiento perioperatorio de los pacientes con fracturas de cadera y tratamiento concomitante con antiagregantes plaquetarios, así como analizar las diferencias de mortalidad al año, y el sangrado perioperatorio según la pauta de cirugía precoz (< 48 h) vs. demorada (> 5 días). Paralelamente, determinar al ingreso y en el preoperatorio inmediato la agregabilidad plaquetaria en todos los pacientes incluidos en el estudio. Pacientes y método. Sobre 175 pacientes mayores de 65 años con fractura de cadera de baja energía se aleatorizaron 3 grupos: antiagregados con cirugía precoz, antiagregados con cirugía demorada, y no antiagregados con cirugía precoz; se recogieron prospectivamente los mismos datos clínicos y analíticos para todos ellos. La agregabilidad plaquetaria se determinó mediante un sistema informatizado semicuantitativo basado en la agregometría por impedancia en sangre completa. Resultados. El sangrado, los requerimientos transfusionales y los resultados analíticos no mostraron diferencias estadísticamente significativas entre los grupos. Un 59,8% de los pacientes que no referían tomar antiagregantes se encontraban analíticamente antiagregados al ingreso, mientras que un 13,5% de los que tomaban antiagregantes no se encontraban correctamente antiagregados. El análisis multivariante mostró mayor mortalidad a 12 meses para las variables del índice de Barthel bajo previo a la fractura (OR: 0,9-0,9) y número de transfusiones (OR: 1,1-1,5). La estancia media fue de 4,1 días mayor en el grupo demorado. Conclusión. La pauta de cirugía precoz para los pacientes en tratamiento antiagregante tiene resultados clínicos parecidos a la demorada, pero mejora la eficiencia hospitalaria al reducir la estancia media. La antiagregación farmacológica referida por el paciente resultó poco concordante con la determinación de la agregabilidad(AU)

Objective. A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study. Patients and methods. A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. Results. Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. Conclusion. Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation(AU)

[Randomised comparative study of early versus delayed surgery in hip-fracture patients on concomitant treatment with antiplatelet drugs. Determination of platelet aggregation, perioperative bleeding and a review of annual mortality]. / Estudio comparativo aleatorizado de la intervención quirúrgica temprana frente a la demorada en los pacientes con fractura de cadera tratados con antiagregantes plaquetarios. Determinación de la agregabilidad plaquetaria y el sangrado perioperatorio, y la revisión de la mortalidad al año.

OBJECTIVE: A review of the perioperative management of patients with hip fractures and concomitant therapy with antiplatelet agents, and to analyse the differences in mortality and perioperative bleeding in early surgery (<48 h) versus delayed surgery (>5 days). Platelet aggregation was measured on admission and immediately before surgery in all patients included in the study PATIENTS AND METHODS: A total of 175 patients over 65 years old, with low energy hip fracture were randomised into 3 groups: Patients on antiplatelet therapy undergoing early surgery, patients on antiplatelet therapy undergoing delayed surgery, and patients not on antiplatelet therapy undergoing early surgery. The same clinical and laboratory data were collected prospectively up to 12 months for all the patients. The platelet aggregation was determined by a semi-quantitative computerised system based on impedance aggregometry in whole blood. RESULTS: Bleeding, transfusion requirements and analytical results showed no significant differences between groups. More than half (59.8%) of the patients not taking antiplatelet therapy had normal platelet aggregation on admission, while 13.5% of those taking antiplatelet agents did not. Multivariate analysis showed increased mortality at 12 months for the variables, low Barthel index before hip fracture (OR: 0.9-0.9) and number of transfusions (OR: 1.1-1.5). The average lenth of stay was 4.1 days greater in the delayed surgery group. CONCLUSION: Early surgery for patients receiving antiplatelet therapy has similar clinical outcomes to the delayed, but improves hospital efficiency by reducing the average length of stay. The antiplatelet drug reported by the patient showed low concordance with the determination of the platelet aggregation.

[Distal coronary thrombosis during L-asparaginase treatment for an acute lymphoblastic leukaemia]. / Thrombose coronaire distale compliquant une leucémie aiguë lymphoblastique traitée par asparaginase.

A 53-year-old man is treated by L-asparaginase for an acute lymphoblastic leukaemia. He received anti thrombin infusions. A systematic electrocardiogram showed an asymptomatic subepicardium ischemia without troponin elevation. Echocardiography and heart magnetic resonance imaging showed an apical thrombus facing a zone of myocardial necrosis. A thrombus regression was observed under anticoagulation. Atypical and asymptomatic coronary thrombosis may occur following L-asparaginase treatment. Regular electrocardiogram monitoring is proposed along this treatment. Arterial thrombosis associated with anti tumor chemotherapies are reviewed.

Trombosis venosa profunda asociada a bacteriemia por campylobacter fetus / Deep vein thrombosis related to Campylobacter fetus bacteriemia

Presentamos el caso de una paciente que ingresa por un cuadro de desorientación, fiebre y deposiciones diarreicas. La exploración y pruebascomplementarias mostraron una trombosis venosa profunda en la pierna izquierda, junto con hemocultivos positivos a C. fetus. E stá descrita la asociación de C. fetus a fenómenos tromboembólicos, pero no hemos encontrado en nuestra revisión biliográfica casos en la literatura donde se confirme dicha asociación con el aislamiento del microorganismo en hemocultivos, salvo una trombosis séptica de vena ovárica (AU)

We present a patient who was admitted with symptoms of disorientation, fever, and diarrheal stools. E xamination and laboratory tests showed a deep vein thrombosis in the left leg, and isolation of C. fetus in blood cultures taken during a fever peak. T he association of C. fetus with thromboembolic events has been reported, but we haven’t found any cases in our biliograpich search describing this association confirmed by the isolation of the organism in blood cultures, except for a ovaric vein thrombosis (AU)

[Lacrimal adenocarcinoma and anophtalmos]. / Adénocarcinome lacrymal et orbite anophtalme.

INTRODUCTION: The classical symptoms of orbital tumors are modified in the event of an anophthalmic socket. CASE REPORT: We report a case of primary malignant neoplasm of the lacrimal gland in an enucleated 70-year-old women. DISCUSSION: Patients with an anophthalmic orbit often present postenucleation socket syndrome: problems of tolerance and rocking of the ocular prothesis, enophthalmos, ptosis, lower eyelid ectropion. Development of a malignant tumor of the lacrimal gland is however exceptional. An oversized lacrimal gland is suggestive of tumor development. Rigorous clinical and radiological follow-up (CT, MRI) is essential. We discuss diagnostic and therapeutic aspects including the type of exenteration, radiotherapy, and reconstruction technique.

[Pulmonary arterial hypertension revealing pseudolymphoma associated with Sjogren's syndrome]. / Hypertension arterielle pulmonaire revelant un syndrome de Gougerot-Sjorgen primitif dans sa forme pseudolymphomateuse.

INTRODUCTION: The authors related a right heart failure related to a primitive pulmonary arterial hypertension without past medical. METHODS AND RESULTS: This diagnosis has been noticed on the cardiac catheterism as well as the cardiac echography (no shunt). Two years later systemic anomalies such as polyarthritis and salivary glands disease were noticed. The Biopsy revelated a primitive Gougerot-Sjorgen pseudolymphomas syndrom. CONCLUSION: Three years under conventional treatment were a failure as the evolution of the disease resulted to death.

Innervation of biceps brachii and brachialis: Anatomical and surgical approach.

This study describes the anatomy of the musculocutaneous nerve (MCN) in the middle and lower thirds of the arm, with special reference to the motor branches to the biceps and brachialis muscles, given their importance in certain clinical, particularly surgical, procedures. In each dissection (46 upper limbs) we recorded the course of the MCN and its variations, and the number, type of distribution pattern and length of the motor branches to the biceps brachii and brachialis muscles. We also recorded the position at which those branches arose from the MCN trunk. We found three branching patterns for biceps brachii: 1) one branch (60.5%); 2) two branches, one for each biceps head (27.9%); and 3) two branches, one for the two biceps heads and one for the common belly (11.6%). The mean distance between the acromion and the motor branches to biceps brachii was 133.8 mm, 45.3% of the acromion-lateral epicondyle distance. The mean length of those branches was 31.2 mm. We found two branching patterns for brachialis: 1) one branch (72.1%); and 2) two branches (27.9%). These motor nerves to brachialis arose from the MCN at a mean distance of 185.3 mm, 61.5% of the acromion-lateral epicondyle distance, and their average length was 33.0 mm. The data were expressed as the percentage of the distance between the acromion and the lateral epicondyle of the humerus, to make their clinical use easy and to avoid errors caused by anthropometric differences.

[Infectious crystalline keratopathy: a case report]. / Kératopathie cristalline infectieuse: à propos d'une observation.

We report a case of perforated infectious crystalline keratopathy in a 88-year-old woman. Corneal surgery like keratoplasty and topical corticosteroids are the main causative factors present in the rare reported cases. Clinically, the anterior layers of cornea exhibit slowly progressive stellate infiltrates. "Viridans streptococci" are the most common micro-organisms involved but their culture for identification is difficult. As compared to cultures, histologic examination is more sensitive for diagnosis, by showing clusters of bacteria in the corneal stroma with no inflammatory response.

[Plasmacytoma and AIDS: unusual duodenal localization]. / Plasmocytome et SIDA: une localisation duodénale inhabituelle.

We report an uncommon presentation of plasmocytoma in an AIDS patient. AIDS is associated with an increased risk of neoplasms. The incidence of Plasma Cell tumors in HIV-positive patients is greater than in non-infected patients. Multiple factors contribute to B cell neoplasms development.

[Endoluminal treatment of peripheral aneurysm with covered endoprosthesis]. / Traitement par voie endoluminale des anévrismes périphériques par endoprothèse couverte.

PURPOSE: To evaluate the feasibility and middle term patency results, for endovascular treatment of peripheral aneurysms, using covered stents. MATERIALS AND METHODS: Between December 1993 and may 2000 25 peripheral aneurysms on 24 patients, mean age 67.8 years (42-81), were treated with covered stents (Cragg EndoPro system or passenger, hemobahn, Word Medical). Aneurysm locations were: 17 iliac, 4 popliteal, 1 femoral, 1 subclavian, 1 carotid. The follow-up range from 1 to 75 months (mean 30.1 months). RESULTS: Successful aneurysm exclusion was achieved in all patients, while maintaining good lower extremity perfusion. All but one stent remained patent during the early follow-up period. At one year 94.4% stents were patent, at two years 90.2. CONCLUSION: Treatment of peripheral aneurysms with covered stents has a high rate of immediate procedural and clinical success. At middle term follow-up patency is encouraging except with popliteal procedure, however long term follow-up and larger series is warranted to assess the place of this procedure as an alternative to the surgery.

Contribution of femoral and proximal sciatic nerve branches to the sensory innervation of hindlimb digits in the rat.

The present study was performed to investigate the possibility of "aberrant" innervation of the tips of the hindlimb digits in the rat, i.e., from other sources than the femoral and the main sciatic branches (tibial, peroneal, sural). Cutaneous injections of fluorescent tracers in the digits were combined with either selective nerve transections to restrict afferent routes followed by detection of labeled neurons in dorsal root ganglia (DRGs), or by a delayed application of a second tracer to afferent nerves under study to detect double labeled neurons in DRGs. The results show that the tips of the digits were represented in DRGs L3-6. The femoral nerve afferents from digits 1 and 2 projected primarily to DRG L3 and to a smaller extent to DRG L4. A small number of neurons from primarily medial digits 1 and 2, but also from lateral digits 3-5, were found to project to DRGs L4 and L5 via a proximal branch that leaves the sciatic nerve near the sciatic notch and runs distally in the posterior part of the thigh, here called the musculocutaneous nerve of the hindlimb. We also have some evidence indicating innervation of the tips of the digits from the posterior cutaneous nerve of the thigh. Aberrant innervation such as that described here might contribute to remaining and perhaps abnormal sensibility after nerve injury and is of interest for the interpretation of results in experimental studies of collateral and regenerative sprouting after such injury.

[Hamartomatous adiposity of the thyroid]. / Adipose hamartomateuse de la thyroïde.

Report of one case of hamartomatous adiposity of the thyroid gland. Only eight cases have been reported. The lesion is composed of thyroid tissue and mature adipose elements. Previously reported cases are reviewed and the pathogenesis is discussed.