RESUMEN
BACKGROUND: Catecholamine-induced cardiogenic shock is a rare manifestation of paragangliomas. The high mortality rate of this condition makes the immediate, multidisciplinary approach mandatory. CASE REPORT: We report a case of an 18-year-old woman with a retroperitoneal secreting paraganglioma, complicated with a cardiogenic shock and an acute adrenergic myocarditis, requiring hemodynamic support and emergency arterial embolization prior to surgical excision, with a favorable outcome. CONCLUSION: Paraganglioma-induced myocarditis is rare but can be dramatic. Management requires appropriate and immediate hemodynamic support. Embolization may be an alternative to stabilize the patient prior to surgery.
RESUMEN
Venous thromboembolism (VTE) is a common clinical problem that is associated with substantial morbidity and mortality. The aim of this study was to describe the clinical practices in VTE prophylaxis in university and peripheral hospitals in Morocco. This is a national, cross-sectional, multicenter, observational study assessing the management of the VTE risk in selected Moroccan hospitals (four university and three peripheral). The thromboembolic risk of the selected patients was assessed according to the American College of Chest Physicians (ACCP) guidelines (2008). We hypothesized that interventions for VTE guideline implementation in those hospitals may improve prophylaxis use for hospitalized patients. A total of 1318 patients were analyzed: 467 (35.5%) medical and 851 (64.5%) surgical. The mean age of patients was 52.6 ± 16.5 years, and 52.7% were female. A total of 51.1% patients were considered to be at risk of VTE according to ACCP guidelines and were eligible for thromboprophylaxis (TP). Medical patients were more likely to present risk factors than surgical patients (53.6 vs. 50.7%, respectively). TP was prescribed for 53.1% of these patients, 57.4% in at-risk surgical patients and 50.3% in at-risk medical patients. TP was also prescribed for 42.9% of non-at-risk patients. The concordance between the recommended and the prescribed prophylaxis was poor for the total population (kappa = 0.110). TP did not improve sufficiently in our hospitals, even after implementation of the guidelines. New strategies are required to appropriately address TP in hospitalized patients.
Asunto(s)
Premedicación/métodos , Tromboembolia Venosa/prevención & control , Adulto , Anciano , Estudios Transversales , Femenino , Adhesión a Directriz , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Medición de Riesgo , Resultado del TratamientoRESUMEN
We report the case for a 44-year-old patient without medical history, admitted in our department for bilateral acute limb ischemia (H6). The patient was hemodynamically stable and the physical examination shows limb sever ischemia (no femoral arterial pulses, coldness, cyanosis and paralysis). Abdominal CT angiography showed a complete occlusion of the infra renal abdominal aorta compatible with embolus. An embolectomy with Fogarty catheters was performed. Echocardiography showed a mass in the left atrium. Pathological examination of the material embolic confirmed the diagnosis of the cardiac myxoma. The clinical course was marked by the development of a sever syndrome of revascularization, death occurred the third day of hospitalization. Cardiac myxomas are the most common primary cardiac tumor. The mobility of the tumor and its gelatinous and crumbly consistency generates peripheral emboli.
Asunto(s)
Aorta Abdominal , Arteriopatías Oclusivas/etiología , Embolectomía/instrumentación , Atrios Cardíacos , Neoplasias Cardíacas/complicaciones , Pierna/irrigación sanguínea , Mixoma/complicaciones , Enfermedad Aguda , Adulto , Angiografía , Aorta Abdominal/diagnóstico por imagen , Ecocardiografía , Resultado Fatal , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Masculino , Mixoma/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: The authors report a rare case of facial palsy associated with leptospirosis. CASE REPORT: A 60-year-old man was admitted to ICU with severe leptospirosis. On the eighth day of hospitalisation, he developed left peripheral facial palsy with a favourable course in response to corticosteroids. DISCUSSION: Several types of neurological complications of leptospirosis have been reported: encephalitis, myelitis, stroke, cerebral arteritis, mononeuritis, polyradiculoneuropathy, and cranial nerve palsy. Peripheral facial palsy is a rare complication of leptospirosis. CONCLUSION: This case illustrates the possible association between leptospirosis and facial palsy.
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Parálisis Facial/etiología , Leptospirosis/complicaciones , Antibacterianos/uso terapéutico , Parálisis Facial/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Ictericia/tratamiento farmacológico , Ictericia/etiología , Leptospirosis/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Penicilina G/uso terapéutico , Prednisolona/uso terapéuticoRESUMEN
INTRODUCTION: Cataract caused by high tension electric trauma remains a rare entity. It is often bilateral and late-onset especially if the electric current passes through the head. PATIENTS AND METHODS: We report a case of a bilateral cataract secondary to high tension electric trauma. RESULTS: A 13-year-old child presented with bilateral cataract secondary to high tension electric trauma (22 000sVolts) two years earlier accidentally on the railroad. The electric current has crossed the head and both upper limbs. This had resulted in immediate burns on the right scalp and hand. Ophthalmological examination found a total white cataract in the RE and anterior subcapsular lens opacities in the LE. CONCLUSION: Cataract is a rare but serious complication of severe electric trauma requiring regular and prolonged eye monitoring owing to its possible late occurrence.
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Quemaduras por Electricidad/complicaciones , Catarata/etiología , Quemaduras Oculares/complicaciones , Adolescente , Catarata/diagnóstico , Humanos , MasculinoRESUMEN
Fahr's disease refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcifications. The basal ganglia and dentate nucleus are the most common site of involvement and most cases present extrapyramidal symptoms. This disease is mostly associated with a phosphocalcic metabolism disorder, especially to hypoparathyroidism. The authors report a case of Fahr syndrome (FS) discovered when a young patient with hypocalcemia and bacterial meningitis had a cerebral CT scan disclosing intracerebral calcifications. She fully recovered after both meningitis and hypocalcemia were treated.
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Encefalopatías/etiología , Calcinosis/etiología , Meningitis Bacterianas/complicaciones , Adulto , Confusión/etiología , Femenino , Lateralidad Funcional , Humanos , Agitación Psicomotora/etiología , SíndromeRESUMEN
OBJECTIVE: To describe the neuroimaging findings in eclamptic patients still symptomatic after 24 hours. PATIENTS AND METHODS: All parturients consecutively admitted over a 12-month period for eclampsia and presenting with neurological disorders (coma, focal neurological abnormalities, and eye sight disturbance) underwent cerebral CT-scan and/or MRI. RESULTS: Nineteen women were studied, and all had abnormal neuroradiological findings. The CT-scan was normal in three cases. Cerebral oedema was the predominant lesion (14 cases). It was localized in the parietal or occipital area (12 cases), paraventricular area (1 case), or was diffuse (1 case). Diffusion weighted MRI was performed in four cases and showed cytotoxic cerebral oedema in one case. There were three cases of cerebral venous thrombosis and two cases of intracerebral haemorrhage. CONCLUSION: Various neuroradiological lesions can be observed in eclamptic patients. A localized cerebral oedema is the most frequent. Diffusion weighted MRI should be systematically done when neurological disorders persist.
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Encefalopatías/diagnóstico , Imagen de Difusión por Resonancia Magnética , Eclampsia/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Antihipertensivos/uso terapéutico , Encefalopatías/diagnóstico por imagen , Encefalopatías/etiología , Edema Encefálico/diagnóstico , Edema Encefálico/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico por imagen , Venas Cerebrales/diagnóstico por imagen , Venas Cerebrales/patología , Ventrículos Cerebrales/patología , Cesárea , Femenino , Muerte Fetal/etiología , Humanos , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/diagnóstico por imagen , Lóbulo Occipital/diagnóstico por imagen , Lóbulo Occipital/patología , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/patología , Embarazo , Resultado del EmbarazoRESUMEN
Legionella pneumonia is frequently reported in immunocompromised patients. The most important predisposing factor is a quantitative and qualitative defect of the monocytic-macrophagic system. We report a case of Legionella pneumophila in a 43-year-old man revealing hairy cell leukemia. The patient presented with community-acquired pneumonia resistant to common antibiotics. Serology provided the diagnosis and the patient improved with adequate treatment. Early diagnosis and appropriate treatment may reduce the mortality of this serious complication.
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Enfermedad de los Legionarios/diagnóstico , Leucemia de Células Pilosas/diagnóstico , Adulto , Antibióticos Antituberculosos , Humanos , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/tratamiento farmacológico , Masculino , Rifampin/uso terapéuticoRESUMEN
Volvulus of the caecum is a rare entity in childhood. We report on a case of caecal volvulus in a 6-year-old child, admitted with clinical symptoms of gut occlusion and shock. Outcome was favourable after surgical treatment. The epidemiological, clinical, radiological aspects and therapy are discussed in light of data of the literature.
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Enfermedades del Ciego , Vólvulo Intestinal , Enfermedades del Ciego/diagnóstico , Enfermedades del Ciego/cirugía , Niño , Humanos , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/cirugía , Masculino , Resultado del TratamientoRESUMEN
Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis is responsible for a high mortality rate. We report the case of a woman, unknown diabetic, who presented with emphysematous pyelonephritis. Early diagnosis performed by CT-scan allowed effective and conservative surgical treatment and final positive outcome.
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Enfisema/tratamiento farmacológico , Infecciones por Escherichia coli/tratamiento farmacológico , Necrosis Papilar Renal/tratamiento farmacológico , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Terapia Combinada , Desbridamiento , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Susceptibilidad a Enfermedades , Drenaje , Quimioterapia Combinada/uso terapéutico , Enfisema/diagnóstico por imagen , Enfisema/cirugía , Infecciones por Escherichia coli/diagnóstico por imagen , Infecciones por Escherichia coli/cirugía , Femenino , Humanos , Insulina/uso terapéutico , Necrosis Papilar Renal/diagnóstico por imagen , Necrosis Papilar Renal/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Pneumorachis, defined as the presence of air within the spinal canal, has rarely been described, and is exceptionally due to thoracic trauma. We report the case of a 37-year-old patient who sustained a motor vehicle accident. The chest CT-scan showed a bilateral-hemothorax, a small right pneumothorax, rib fractures, and a fracture of the fourth thoracic vertebra associated with air in the spinal canal extending from T6 to L2. The fracture of T4 associated with the pleural lesion is probably responsible for the pneumorachis. Possible pathogenic mechanisms of this rare blunt chest complication are discussed.
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Aire , Traumatismos Vertebrales/complicaciones , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Accidentes de Tránsito , Adulto , Resultado Fatal , Hemotórax/complicaciones , Hemotórax/diagnóstico por imagen , Humanos , Masculino , Neumotórax/complicaciones , Neumotórax/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/etiología , Fracturas de las Costillas/complicaciones , Fracturas de las Costillas/diagnóstico por imagen , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/diagnóstico por imagen , Vértebras Torácicas/lesiones , Tomografía Computarizada por Rayos XRESUMEN
Prolonged inhalation of gas butane induced mostly neurological and cardiovascular symptoms. We reported two very rare cases of acute rhabdomyolysis caused by accidental prolonged inhalation of butane. The early diagnosis and the symptomatic treatment were associated with favourable evolution in the two cases. The mechanism of this complication is discussed and compared with the literature.
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Butanos/envenenamiento , Rabdomiólisis/inducido químicamente , Enfermedad Aguda , Adulto , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/fisiopatología , Creatina Quinasa/sangre , Electromiografía , Humanos , Exposición por Inhalación , Masculino , Persona de Mediana Edad , Examen Neurológico , Síndromes de Neurotoxicidad/fisiopatología , Terapia por Inhalación de Oxígeno , Rabdomiólisis/diagnósticoRESUMEN
Few cases of postoperative hypoglycaemia complicating the removal of a phaeochromocytoma have been reported in the literature. We reported one case of hypoglycaemia secondary to the removal of right phaeochromocytoma in a 30-year-old patient. Seven hours after the excision of the tumour, the patient developed a severe hypoglycaemia at 1.67 mmol x l(-1) revealed by seizures completely resolving in 24 h. The hypoglycaemia in this context resulted probably from the massive secretion of insulin by the beta cells of Langerhans islands due to the suppression of alpha-adrenergic inhibition. The prevention of this complication requires the repeated measurement of the capillary glycaemia in the postoperative period. An important supply of carbohydrate may be necessary to maintain a normoglycaemia.
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Neoplasias de las Glándulas Suprarrenales/cirugía , Hipoglucemia/etiología , Feocromocitoma/cirugía , Complicaciones Posoperatorias/etiología , Antagonistas Adrenérgicos alfa/efectos adversos , Adulto , Femenino , Humanos , Insulina/metabolismo , Secreción de Insulina , Convulsiones/etiologíaRESUMEN
Muscle paralysis due to potassium depletion are unusual. We report the case of a patient who developed quadriplegia and language disorders due to potassium depletion, following large intestinal resection. Potassium supplementation was given intravenously at a rate of 0.25 mmol.kg-1.h-1 during the first 48 h. This allowed complete total and rapid recovery from the paralysis.
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Hipopotasemia/fisiopatología , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/cirugía , Complicaciones Posoperatorias , Potasio/uso terapéutico , Cuadriplejía/etiología , Electroencefalografía , Femenino , Humanos , Hipopotasemia/diagnóstico , Hipopotasemia/terapia , Infusiones Intravenosas , Persona de Mediana Edad , Potasio/administración & dosificaciónRESUMEN
In this study, a case of emphysematous pyelonephritis has been reported in a 70-year old diabetic male with a non-functional contralateral kidney. In spite of appropriate medical treatment and surgical drainage, the outcome was negative. The case in question concerned a rare form of the disease, i.e., emphysematous pyelonephritis, a severe and necrotizing infection which is characterized by the presence of intraparenchymal gas produced by anaerobic bacteria, and the rapid development of acute sepsis or septic shock. Medical treatment alone is seldom sufficient, and surgical intervention, in most instances consisting of radical nephrectomy rather than surgical drainage, is advocated due to the extent of the necrotic lesions.
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Enfisema/terapia , Pielonefritis/terapia , Anciano , Resultado Fatal , Humanos , MasculinoRESUMEN
We report five cases of phaeochromocytoma in patients admitted for myocardial infarction, severe cardiac failure, with shock, stroke and ischaemic gangrene of a lower limb respectively. The pathophysiology of these events is discussed. Early surgery prevents visceral damage from massive release of catecholamines.
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Neoplasias de las Glándulas Suprarrenales/diagnóstico , Feocromocitoma/diagnóstico , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/fisiopatología , Neoplasias de las Glándulas Suprarrenales/cirugía , Adulto , Trastornos Cerebrovasculares/complicaciones , Femenino , Gangrena/complicaciones , Insuficiencia Cardíaca/complicaciones , Humanos , Pierna , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Feocromocitoma/complicaciones , Feocromocitoma/fisiopatología , Feocromocitoma/cirugía , Choque/complicacionesRESUMEN
We performed a retrospective analysis of morbidity and mortality in 100 cases of ulcerative colitis treated at the surgical care unit of the Ibn Sina hospital over a 10 year period from 1984 to 1994. One major complication, usually infection, was observed in 40% of the cases. Overall mortality was 22%, a rate higher than the larger published series. The main factor incriminated in our study ; besides surgical circumstances, was the delay in care, including in the intensive care unit. It must be concluded that medical and surgical management must be initiated as soon as a flare up is diagnosed.