Piomiositis primaria: un reto diagnóstico en la UCI / No disponible

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[Acute respiratory failure after treatment with cyclophosphamide in a patient with proliferative glomerulonephritis]. / Insuficiencia respiratoria aguda tras tratamiento con ciclofosfamida en paciente con glomerulonefritis proliferativa.

Cyclophosphamide is an alkylating immunosuppressant drug that is used mainly in neoplastic and immunologic diseases. Lung toxicity due to treatment with cyclophosphamide, though rare, often has a poor prognosis. Diagnosis of the lung lesion is difficult because these patients have associated immunosuppression and a consequent risk of opportunistic lung infections. We report the case of a man with acute respiratory distress syndrome after treatment with cyclophosphamide for proliferative crescentic glomerulonephritis. The diagnosis of lung lesion due to cyclophosphamide was based on ruling out other possible causes. The principal diagnostic tool used was bronchoalveolar lavage. The patient progressed satisfactorily, responding adequately to corticosteroids and then maintenance therapy, without the need for mechanical ventilation.

Insuficiencia respiratoria aguda tras tratamiento con ciclofosfamidaen paciente con glomerulonefritis proliferativa / Acute respiratory failure after treatment with cyclophosphamide in a patient with proliferative glomerulonephritis

La ciclofosfamida es un fármaco inmunosupresor alquilanteadministrado principalmente en enfermedades neoplásicase inmunológicas. La toxicidad pulmonar secundariaal tratamiento con ciclofosfamida, aunque rara,frecuentemente tiene un mal pronóstico. El enfoque diagnósticode la lesión pulmonar se ve entorpecido por serpacientes que asocian una inmunosupresión con el consiguienteriesgo de infecciones pulmonares oportunistas.Presentamos un paciente con un síndrome de distrésrespiratorio agudo tras tratamiento con ciclofosfamidapor una glomerulonefritis proliferativa con semilunas.El diagnóstico de lesión pulmonar secundaria a ciclofosfamidase basa en descartar otras posibles causas, ycomo principal herramienta el lavado bronquioalveolar.La evolución del paciente que se presenta fue favorablerespondiendo adecuadamente a la administración decorticoides y terapia de mantenimiento sin necesidad deventilación mecánica (AU)

Cyclophosphamide is an alkylating immunosuppressantdrug that is used mainly in neoplastic and immunologicdiseases. Lung toxicity due to treatment with cyclophosphamide,though rare, often has a poor prognosis.Diagnosis of the lung lesion is difficult because thesepatients have associated immunosuppression and aconsequent risk of opportunistic lung infections.We report the case of a man with acute respiratorydistress syndrome after treatment with cyclophosphamidefor proliferative crescentic glomerulonephritis. Thediagnosis of lung lesion due to cyclophosphamide wasbased on ruling out other possible causes. The principaldiagnostic tool used was bronchoalveolar lavage. Thepatient progressed satisfactorily, responding adequately tocorticosteroids and then maintenance therapy, without theneed for mechanical ventilation (AU)

[Meningococcal purpura fulminans: treatment with recombinant protein C activator in 3 cases]. / Púrpura fulminante meningocócica tratada con proteína C activada. A propósito de tres casos.

Purpura fulminans is a serious disease associated with high rates of morbidity and mortality. It usually leads to disseminated intravascular coagulation and septic shock related to reduced levels of protein C. Recombinant protein C (rPC) activator has been used successfully to inhibit this process. Intracranial hemorrhages are the most important, life-threatening adverse effects of treatment with rPC activator. We report 3 cases of patients with meningococcal purpura fulminans who developed septic shock and multiorgan dysfunction. They were treated with the protocol for septic shock, antibiotics and rPC activator from the time of admission, and improvement in hemodynamic dysfunction was observed within hours in all patients. All received platelet replacement transfusions. Subarachnoid bleeding complications occurred in 2 patients. One patient died 5 days after admission and 2 were discharged from the intensive recovery care unit 28 days after admission.

Púrpura fulminante meningocócica tratada con proteína C activada. A propósito de tres casos / Meningococcal purpura fulminans: treatment with recombinant protein C activator in 3 cases

La púrpura fulminante (PF) es una enferedad grave con una mortalidad y morbilidad elevadas. De forma característica se produce una coagulación intravasculardiseminada (CID) y shock séptico en relación con undescenso de los niveles de proteína C (PC). La proteínaC activada recombinante (PCAr) se ha utilizado con éxitopara detener este proceso. Las hemorragias intracranealesson el efecto adverso más importante y puedencondicionar el pronóstico.Presentamos tres casos de pacientes con púrpura fulminantemeningocócica que desarrollaron shock séptico y disfunción multiorgánica. Desde el ingreso fueron tratadoscon las medidas del protocolo de shock séptico,antibióticos y PCAr. En todos ellos se observó una mejoríade la disfunción hemodinámica durante las primerashoras. En todos ellos se trasfundieron plaquetas por plaquetopeniay en dos de los casos se hallaron hemorragiassubaracnoideas (HSA) como complicaciones. Uno de lospacientes falleció el quinto día, los otros dos fuerondados de alta de la Unidad de Reanimación y permanecían vivos a los 28 días (AU)

Purpura fulminans is a serious disease associated with high rates of morbidity and mortality. It usually leads to disseminated intravascular coagulation and septic shock related to reduced levels of protein C. Recombinant protein C (rPC) activator has been used successfully to inhibit this process. Intracranial hemorrhages are the most important, life-threatening adverse effects of treatment with rPC activator. We report 3 cases of patients with meningococcal purpura fulminans who developed septic shock and multiorgan dysfunction. They were treated with the protocol for septic shock, antibiotics and rPC activator from the time of admission, and improvement in hemodynamic dysfunction was observed within hours in all patients. All received platelet replacement transfusions. Subarachnoid bleeding complications occurred in 2 patients. One patient died 5 days after admission and 2 were discharged from the intensive recovery care unit 28 days after admission (AU)

La ventilación mecánica no invasiva domiciliaria en el paciente EPOC / Non-invasive home mechanical ventilation in the COPD patient

Fundamento. El potencial beneficio de la ventilación mecánica no invasiva en los pacientes EPOC clínicamente estables no es aún bien conocido ni ha sido suficientemente estudiado. Se pretende valorar si la ventilación mecánica no invasiva beneficia a estos pacientes.Material y métodos. Se realiza un estudio transversal valorando la aplicación de la ventilación mecánica no invasiva (BIPAP) domiciliaria durante el descanso nocturno en 23 pacientes EPOC, los cuales se caracterizaban por presentar hipercapnia en la gasometría arterial basal realizada durante la estabilidad clínica. Se realizan revisiones clínicas, gasométricas y espirométricas a los 3, 6 y 12 meses de instaurar dicha terapia. Así mismo se evalúa el número de ingresos por agudización de la patología respiratoria subyacente durante un año.Resultados. Los pacientes incluidos en el estudio tenían una media de edad de 68,83 años. El 60,9% presentaban grado severo de EPOC. El 69,6% del total de la muestra recibían previamente oxigenoterapia continua domiciliaria; de ellos el 75% presentaban EPOC severa o muy severa. Durante el período de tiempo del estudio se objetivó un descenso en el número de ingresos hospitalarios por agudización (0,61±0,15 ingresos anuales de media) respecto al mismo período de tiempo previo a la ventilación mecánica no invasiva (1,07±0,16 ingresos de media) resultando más beneficiados los que presentaban previamente un mayor número de ingresos y los que asociaban comorbilidad. También se aprecia disminución de la presión arterial de dióxido de carbono (PaCO2) en la mayoría de los casos, principalmente aquellos que presentaban al inicio del estudio una PaCO2>63,32 mm de Hg; dicha mejoría se aprecia desde los primeros tres meses de tratamiento

Background. The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients.Methods. A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year.Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61±0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07±0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment

[Non-invasive home mechanical ventilation in the COPD patient]. / La ventilación mecánica no invasiva domiciliaria en el paciente EPOC.

BACKGROUND: The potential benefits of non-invasive mechanical breathing in clinically stable COPD patients are still not well known, nor have they been sufficiently studied. We evaluate whether non-invasive mechanical ventilation is beneficial to these patients. METHODS: A cross sectional study was carried out evaluating the application of non-invasive home mechanical ventilation (BIPAP), during the nocturnal rest in 23 COPD patients, who presented hypercapnia in basal arterial gasometry during clinical stability. Clinical, gasometric and spirometric evaluations were carried out 3, 6 and 12 months after initiating this therapy. Similarly, an evaluation was made of the number of admissions due to worsening of the underlying respiratory pathology during one year. Results. The patients included in the study had an average age of 68.83 years. Sixty point nine percent (60.9%) presented a severe degree of COPD. Sixty-nine point six percent (69.6%) of the total sample had previously received continuous oxygenotherapy at home; 75% of them presented severe or very severe COPD. During the period of time of the study a fall was recorded in the number of hospital admissions due to worsening (0.61+/-0.15 annual admissions on average) with respect to the period of time prior to the non-invasive mechanical ventilation (1.07+/-0.16 admissions on average), with greater benefits obtained by those who had previously shown a higher number of admissions and those with associated comorbidity. A reduction was also appreciated in the arterial pressure of carbon dioxide (PaCO2) in the majority of cases, principally those who at the start of the study presented a PaCO2>63.32 mm of Hg; this improvement was appreciated from the first three months of treatment.

[Mortality in Taranto from the early seventeenth century to 1860]. / I decessi a Taranto dall'inizio del seicento al 1860.

PIP: Mortality trends in Taranto, Italy, from around 1600 to 1860 are analyzed using data from parish records. Attention is given to mortality changes over time and to infant mortality.^ieng