[Review of the post-intubation tracheal stenosis: a case report]. / Revisión de las estenosis traqueales tras intubación: a propósito de un caso.

Postintubation tracheal stenosis is a very important clinical situation. It is estimated to occur in approximately 5% to 20% of intubated or tracheostomized patients. However, 1% also suffers severe respiratory dysfunction. We report the case of a 45-year old patient who required surgery under general anesthesia (first intubation experience) after suffering severe coronary disease. The patient was admitted to the intensive care unit, connected to maintained mechanical ventilation for 9 days when he was weaned and extubated. He then suffered a picture of respiratory failure requiring reintubation (for a second time) and reconnection to the mechanical ventilator. He evolved favorably, and it was possible to wean him again with final extubation on the 12th day. At 28 days, he presented a picture of dyspnea, stridor, tachypnea and a bronchoscope examination show tracheal stenosis in the subglotic region. He was treated with laser and silicone tracheal stent, with good evolution.

[Diffuse lung hemorrhage and necrotizing glomerulonephritis in a case of Wegener's granulomatosis. Diagnostic and therapeutic approach]. / Hemorragia pulmonar difusa y glomerulonefritis necrotizante en un caso de granulomatosis de Wegener. Actitud diagnóstica y terapéutica.

We present the case of a 59 years old male with Wegener's Granulomatosis with uncommon manifestations such as diffuse pulmonary hemorrhage and acute renal failure due to necrotizing glomerulonephritis. Neutrophil anticytoplasmic antibodies determination was negative. Conventional and high resolution thoracic computed tomography showed cavitated lung nodules with small peripheral vessels. These lesions, that are characteristic of this type of vasculitis, were not appreciated on the routine chest roetgenogram. Definitive diagnosis was made by the histological study of open lung and renal biopsies. Favourable response to corticosteroids, immunosuppressive drugs and hemodialysis was obtained. Diffuse pulmonary hemorrhage is an uncommon manifestation of Wegener's Granulomatosis, and must be considered as a vital emergency that justify the use of aggressive diagnostic and therapeutic methods.

[Pulmonary lymphangiomatosis associated with renal angiomyolipoma. Presentation of a case and review of the literature]. / Linfangiomiomatosis pulmonar asociada con angiomiolipoma renal. Presentación de un caso y revisión de la literatura.

The case concerned is one of lymphangiomyomatosis (LAM) in a woman aged 39, that after a episode of spontaneous pneumothorax was subject to medical research for progressive dyspnea of medium efforts and bloodstained sputum. High resolution CT showed numerous thin-walled cystic airspaces of varying sizes distributed diffusely throughout the lungs. The abdominal CT and ultrasound developed multiple right renal angiomyolipomas. The histopathological study of the sample obtained by open lung biopsy was conclusive of LAM. The main feature of this rare disease, which occurs almost exclusively in women of reproductive age, is the abnormal proliferation of immature smooth muscle at the level of the distal airway, small blood vessels and lung lymphatic system, including sometimes the mediastinal and retroperitoneal lymphatic system. The clinical, functional, radiological and differential diagnostic aspects with entities histopathologically similarities are discussed and the therapeutic possibilities are reviewed.

[Trimethoprim-sulfamethoxazole++ in the treatment of a case of localized Wegener's granulomatosis]. / Trimetoprim-sulfametoxazol en el tratamiento de un caso de granulomatosis de Wegener localizada.

A 50 year old man, affected by a Wegener's granulomatosis limited to lung, is presented. The indirect immunofluorescence test for "Anticytoplasmic Antibodies" (ACPA) was negative and we got the definitive diagnostic by the histological study from thoracotomy and biopsy samples. We started treatment with trimethoprim-sulfamethoxazole and a good evolution with an adequate clinical control, x-ray study and blood test was obtained. Some aspects of the value of the ACPA as diagnostic and activity markers of the disease and also the use of an antimicrobial agent on the treatment of this nosological entity are discussed.