Systemic Air Embolism after Percutaneous Lung Biopsy: A Manageable Complication.

CT-guided percutaneous biopsy is a resourceful and widely used tool to evaluate pulmonary nodules that frequently avoids costly and unnecessary surgeries. Severe complications occur in less than 1% of cases and include gas embolism, which is rarely documented. We report a case of gas embolism after transthoracic biopsies and discuss the pathophysiology and the benefits of early diagnosis and proper management.

Previable preterm rupture of membranes: gestational and neonatal outcomes.

INTRODUCTION: Previable (less than 24 weeks) premature rupture of membranes complicates about 1 in every thousand births and is responsible for substantial perinatal mortality. SUBJECTS AND METHODS: In this paper, we retrospectively analyzed one twin and 35 singleton pregnancies. RESULTS: Twenty cases occurred before and 16 after 20 weeks. Latency period ranged from 0 to 137 days, with an average of 35 days. Amniotic fluid index was reduced in 27 cases and normal in 6 cases. Expectant management was adopted in 31 cases (86%), five patients declined and opted for termination (14%) at admission or during the course of pregnancy. Steroids were prescribed for 12 patients at or after 24 weeks (39%), leukocyte count at admission varied from 6,000 to 16,200/mm(3), with an average of 11,310, in only 9% it was greater than 15,000, immature forms were present in 10 cases (28%). Clinical chorioamnionitis occurred in 71%, being three times more frequent in parous women. Bacteriuria was present in 2 of 30 cases (6.6%). Two women developed laboratorial and clinical signs of sepsis, none of them needed hysterectomy. There were no maternal deaths. Mean gestational age at delivery was 24 weeks, ranging from 16 to 39 weeks. In the expectant group, preterm delivery rate was 68%. There was one case of abruption. Cesarean rate was 31%. Neonatal mortality was 42% (8 cases). Overall neonatal survival was 35% (11 in 32 newborns). CONCLUSION: Perinatal mortality is high in pregnancies complicated by previable rupture of membranes, however gestational age at occurrence is a strong predictor of outcome. An individualized approach is the best management option regarding maternal risks and fetal outcomes.

Degeneração olivar hipertrófica após ressecção de metástase cerebelar: relato de caso e revisão da literatura / Hypertrophic olivary degeneration secondary to resection of cerebellar metastasis: case report and literature review

Degeneração olivar hipertrófica resulta de lesão no circuito formado pelos núcleos denteado, rubro e olivar inferior (triângulo de Guillain e Mollaret). Pode ser secundária a hemorragias, trauma, neoplasias, entre outras causas que lesem estruturas desse circuito. Destaca-se a relevância deste relato de caso por apresentar um caso de degeneração olivar hipertrófica bilateral, secundária a insulto em ambos os núcleos denteados após ressecção de metástase.

Hypertrophic olivary degeneration represents the results of a lesionthat damages the neuronal connections between the dentate nucleus of the cerebellum, the red nucleus, and the inferior olivary nucleus (Guillain Mollaret triangle). This entity can occur secondary to hemorrhage, trauma, neoplasm and other causes that candamage structures of this pathway. This is an important case report because of its description of a bilateral hypertrophic olivary degeneration, secondary to injuries in both dentate nucleous after metastatic resection.