Aspiración de cuerpo extraño en paciente adulto durante un procedimiento dental. A propósito de un caso / Foreign-matter aspiration in an adult patient during a dental procedure. A case report

La aspiración de cuerpos extraños en las vías aéreas puede ser potencialmente mortal. Estos fenómenos ocurren sobre todo en niños, siendo la primera causa de muerte accidental en menores de un año. No obstante, que esto ocurra en pacientes adultos es menos frecuente. La clínica suele ser muy variable, pudiendo persistir la sensación de ahogo y disnea tras la aspiración del cuerpo extraño o bien una vez concluida la aspiración, encontrarse asintomático. Una buena anamnesis es primordial para orientar el diagnóstico y desobstruir la vía aérea lo más pronto posible. El tratamiento de elección en pacientes adultos es el broncoscopio flexible, también llamado fibrobroncoscopio. A continuación, describimos un caso de un paciente de 44 años que acude a Urgencias por presentar accidentalmente una aspiración de un destornillador dental. Aunque se encontraba asintomático al momento de la valoración, las características de dicho cuerpo extraño (tamaño, punzante, localización, etc.) hicieron necesaria una derivación a un centro de referencia y una broncoscopia de urgencia

The aspiration of foreign matter into the airways can be potentially fatal. This phenomenon occurs primarily in children, constituting the leading cause of death in children under one year old. However, its occurrence in adult patients is less frequent. Symptoms tend to vary greatly, from a persistent feeling of choking or dyspnea after the aspiration of the foreign matter to being asymptomatic after the aspiration. A thorough medical history is key to guide the diagnosis and clear the airway as soon as possible. The treatment of choice in adult patients is flexible bronchoscopy, also known as fibrobronchoscopy. Below, we will describe the case of a 44-year-old patient who went to the emergency room after accidentally aspirating a dental screwdriver. Although he was asymptomatic at the time of the examination, the characteristics of the foreign matter (size, sharpness, location, etc.) made referral to a reference center and an emergency bronchoscopy necessary

[Posterior reversible leukoencephalopathy syndrome in a patient with Parkinson's disease and initial psychiatric symptoms: a complex clinical presentation]. / Sindrome de leucoencefalopatia posterior reversible en un paciente con enfermedad de Parkinson y sintomatologia inicial psiquiatrica: una presentacion clinica compleja.

INTRODUCTION: The relevance of the immunosuppressive drug tacrolimus in the prevention of rejection and graft-versus-host disease in transplanted patients is beyond all doubt. However, tacrolimus often has neurotoxic effects, including severe conditions such as posterior reversible leukoencephalopathy syndrome. CASE REPORT: A 75-year-old male who had undergone a kidney transplantation five years earlier, for which he was receiving treatment with tacrolimus and mycophenolate. He also had advanced Parkinson's disease, treated with several dopamine agonists. The patient visited the emergency department after a week-long history of visual hallucinations, delirium, expansive mood, confusion and headache. The focal psychogeriatric examination revealed psychosis secondary to dopaminergic agonists as the first diagnostic option, without excluding other possible iatrogenic causes despite the tacrolimus being within the therapeutic range (8.3 ng/mL). Both cranial computed tomography, which did not show any significant findings, and a magnetic resonance scan, in which a bilateral parietooccipital oedema was observed, were performed, this latter finding being compatible with posterior reversible leukoencephalopathy syndrome. While the patient was in hospital, tacrolimus was replaced by everolimus, and the dopaminergic medication was adjusted, resulting in a swift and full remission of the clinical signs and symptoms. CONCLUSIONS: The diagnosis of posterior reversible leukoencephalopathy syndrome should be considered in patients with a history of organ transplantation treated with immunosuppressive drugs who have an acute onset condition with neurological or psychiatric symptoms.

TITLE: Sindrome de leucoencefalopatia posterior reversible en un paciente con enfermedad de Parkinson y sintomatologia inicial psiquiatrica: una presentacion clinica compleja.Introduccion. La relevancia del farmaco inmunosupresor tacrolimus en la prevencion del rechazo y la enfermedad de injerto contra huesped en pacientes trasplantados es indiscutible. Sin embargo, con frecuencia, el tacrolimus presenta efectos neurotoxicos, incluyendo cuadros graves, como el sindrome de leucoencefalopatia posterior reversible. Caso clinico. Varon de 75 años, con antecedentes de trasplante renal hace cinco años, en tratamiento con tacrolimus y micofenolato, y de enfermedad de Parkinson avanzada, en tratamiento con varios agonistas dopaminergicos. Acudio a urgencias por un cuadro de una semana de evolucion consistente en alucinaciones visuales, delirios, animo expansivo, confusion y cefalea. La exploracion psicogeriatrica por focos mostro como primera opcion diagnostica una psicosis secundaria a agonistas dopaminergicos, sin excluir otras causas yatrogenas a pesar de encontrarse el tacrolimus en el rango terapeutico (8,3 ng/mL). Se realizaron una tomografia computarizada craneal, que no mostro hallazgos significativos, y una resonancia magnetica, en la que se visualizo un edema parietooccipital bilateral, hallazgo compatible con un sindrome de leucoencefalopatia posterior reversible. Durante el ingreso se sustituyo el tacrolimus por everolimus y se ajusto la medicacion dopaminergica, con lo que se produjo de forma rapida una remision completa del cuadro. Conclusiones. El diagnostico de sindrome de leucoencefalopatia posterior reversible debe considerarse en los pacientes con antecedentes de trasplante de organo en tratamiento con farmacos inmunosupresores que presentan un cuadro de instauracion aguda con sintomas neurologicos o psiquiatricos.

Cultivation of Chlorella protothecoides with urban wastewater in continuous photobioreactor: biomass productivity and nutrient removal.

The capability to grow microalgae in nonsterilized wastewater is essential for an application of this technology in an actual industrial process. Batch experiments were carried out with the species in nonsterilized urban wastewater from local treatment plants to measure both the algal growth and the nutrient consumption. Chlorella protothecoides showed a high specific growth rate (about 1 day(-1)), and no effects of bacterial contamination were observed. Then, this microalgae was grown in a continuous photobioreactor with CO2-air aeration in order to verify the feasibility of an integrated process of the removal of nutrient from real wastewaters. Different residence times were tested, and biomass productivity and nutrients removal were measured. A maximum of microalgae productivity was found at around 0.8 day of residence time in agreement with theoretical expectation in the case of light-limited cultures. In addition, N-NH4 and P-PO4 removal rates were determined in order to model the kinetic of nutrients uptake. Results from batch and continuous experiments were used to propose an integrated process scheme of wastewater treatment at industrial scale including a section with C. protothecoides.

[Total bacterial count in raw milk from the dairy farms that characterize the zone northwest of Santa Fe and south of Santiago del Estero]. / Recuento de bacterias totales en leche cruda de tambos que caracterizan la zona noroeste de Santa Fe y sur de Santiago del Estero.

A total of 6,998 raw milk samples of bulk tank, belonging to 55 dairy farms associated to the Cooperativa Tambera Nueva Alpina Ltda., were collected between the years 1993 and 2002. The Total Mesophilic Aerobic Microorganisms Count was analyzed, obtaining a medium value of 1.2 x 10(5) +/- 2.4 x 10(5) CFU/ml that characterizes the zone. The final year of experience, observed a 97% of dairy farms evaluated with averages < or = 1.0 x 10(5) CFU/ml. Only a 3% it surpasses this limit, not being found establishments with levels over 1.5 x 10(5) CFU/ml. Relating this indicators with compositionals parameters, the most significant correlation resulted for: Total Bacterial Count vs Acidity (r = 0.292; P < 0.001) and Total Bacterial Count vs Freezing Point (r = 0.157; P < 0.001. The microbiological quality in raw milk of dairy farms belonging to the northwest zone of Santa Fe and south of Santiago del Estero showed a significant improvement during this time.

Recuento de bacterias totales en leche cruda de tambos que caracterizan la zona noroeste de Santa Fe y sur de Santiago del Estero / Total bacterial count in raw milk of dairy farms that characterize the northwest zone of Santa Fe and south of Santiago del Estero

Un total de 6.998 muestras de leche cruda de pool de tanque, correspondientes a 55 establecimientos lecheros asociados a la Cooperativa Tambera Nueva Alpina Ltda., fueron recolectadas entre los años 1993 y 2002. Se realizó el Recuento de Microorganismos Aerobios Mesófilos Totales, obteniéndose como resultado un valor medio de 1,2 x 105± 2,4 x 105UFC/ml que caracteriza la zona. El año de finalización de la experiencia, se observó un 97% de los tambos evaluados con promedios £ 1,0 x 105UFC/ml. Solamente un 3% sobrepasa este límite, no encontrándose establecimientos con niveles superiores a 1,5 x 105UFC/ml. Al relacionar este indicador con parámetros composicionales, las correlaciones más significativas resultaron para: Recuento de Bacterias Totales vs Acidez (r = 0,292; P < 0,001) y Recuento de Bacterias Totales vs Descenso Crioscópico (r = 0,157; P < 0,001). La calidad microbiológica en leche cruda de tambos que pertenecen a la zona noroeste de Santa Fe y sur de Santiago del Estero, presentó un mejoramiento significativo.

A total of 6.998 raw milk samples of bulk tank, belonging to 55 dairy farms associated to the Cooperativa Tambera Nueva Alpina Ltda., were collected between the years 1993 and 2002. The Total Mesophilic Aerobic Microorganisms Count was analyzed, obtaining a medium value of 1.2 x 105± 2.4 x 105CFU/ml that characterizes the zone. The final year of experience, observed a 97% of dairy farms evaluated with averages £ 1,0 x 105CFU/ml. Only a 3% it surpasses this limit, not being found establishments with levels over 1.5 x 105CFU/ml. Relating this indicators with compositionals parameters, the most significant correlation resulted for: Total Bacterial Count vs Acidity (r = 0.292; P < 0.001) and Total Bacterial Count vs Freezing Point (r = 0.157; P < 0.001. The microbiological quality in raw milk of dairy farms belonging to the northwest zone of Santa Fe and south of Santiago del Estero showed a significant improvement during this time.

Recuento de bacterias totales en leche cruda de tambos que caracterizan la zona noroeste de Santa Fe y sur de Santiago del Estero. / [Total bacterial count in raw milk from the dairy farms that characterize the zone northwest of Santa Fe and south of Santiago del Estero]

A total of 6,998 raw milk samples of bulk tank, belonging to 55 dairy farms associated to the Cooperativa Tambera Nueva Alpina Ltda., were collected between the years 1993 and 2002. The Total Mesophilic Aerobic Microorganisms Count was analyzed, obtaining a medium value of 1.2 x 10(5) +/- 2.4 x 10(5) CFU/ml that characterizes the zone. The final year of experience, observed a 97

of dairy farms evaluated with averages < or = 1.0 x 10(5) CFU/ml. Only a 3

it surpasses this limit, not being found establishments with levels over 1.5 x 10(5) CFU/ml. Relating this indicators with compositionals parameters, the most significant correlation resulted for: Total Bacterial Count vs Acidity (r = 0.292; P < 0.001) and Total Bacterial Count vs Freezing Point (r = 0.157; P < 0.001. The microbiological quality in raw milk of dairy farms belonging to the northwest zone of Santa Fe and south of Santiago del Estero showed a significant improvement during this time.

Low risk of invasive amebiasis in cyst carriers. A longitudinal molecular seroepidemiological study.

A seroepidemiological study of a household cohort, using both clinical observational and molecular criteria was conducted in a periurban area endemic for E. histolytica infection. This longitudinal study was undertaken to determine the risk of asymptomatic cyst carriers to develop invasive illness. Zymodeme patterns of strains isolated from these patients were correlated both with the clinical presentation of disease and with the serological response against the M-17 ameba antigen and further compared with that found in 16 proven cases of amebic liver abscess. From a total of 163 housewives screened, 39, (24%) were asymptomatic cyst carriers; 31 of them (index cases) and 114 members of their households remained in the study over an 8 month follow-up period to detect ameba infection and illness. Of the household members at risk, 46 (40%) became infected within 6 weeks. None of the index or secondary cases developed ameba-related symptoms and cyst excretion followed a chronic persistent, intermittent, or transient pattern over the period of the study. Amebas were recovered and zymodemes determined in 19 of 71 (27%) cyst carriers. Ameba shed from each of these 19 carriers exhibited nonpathogenic zymodeme 1, except for one index case where zymodeme 2 was recovered in one sampling, and returned to zymodeme 1 in subsequent samples. Of 48 of 71 cyst carriers studied, antibodies to crude E. histolytica antigen were detected by ELISA in 16 (31%); antibodies to the M-17 fusion protein were found in 8 (16%) by ELISA and in 2 (4%) by Western-Blot (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Traumatic subdural hygromas: a report of 70 surgically treated cases.

The Authors present 70 cases of traumatic subdural hygromas, classified into acute, subacute and chronic, according to the interval between injury and the appearance of symptoms. The acute cases were 22.9% of our series. Criteria for surgical treatment were established by means of CT scan serial investigations. Pathogenesis, clinical aspects and results are discussed. Mortality rate was 17.1%.

Bone dust and adhesive material for closing bony breaches of the skull. A new method.

Thirty one cases of patients affected by skull lesions are reported: 25 fractures of the frontal sinus, two fractures of ethmoidal bone, two fractures of the floor of the anterior cranial fossa, one fracture of the petrous bone, one opening of the mastoid cells. Five of these patients presented a cerebrospinal fluid fistula. All the patients were surgically treated with a mixture of autogenous sawdust and butyl-2-cyanoacrylate with favorable results in thirty cases. It was necessary to repeat the treatment only in one case and the patient recovered completely.

Spontaneous pneumo-cephalus caused by otogenous temporal abscess.

The Authors report a rare case of spontaneous intraparenchymal and intraventricular pneumocephalus, caused by the external rupture of an otogenous temporal abscess.