[Systemic loxoscelism presented in a pregnant patient]. / Loxoscelismo sistémico en una mujer embarazada.

BACKGROUND: Loxoscelism is a condition caused by the inoculation of a series of proteolytic enzymes through the loxosceles spider bite (violinist). Morbidity and mortality is unknown in our country. The loxoscelism toxi-syndrome of local expression may have a good prognosis; however, viscera-cutaneus or systemic form has a serious and often fatal evolution. We report a case of a systemic variant developed in a pregnant patient. CLINICAL CASE: We present the first reported case of systemic loxoscelism in a pregnant patient, highlighting the survival of the mother-son, in the presence of viscera-cutaneus behavior. We describe the natural history of clinical expression, highlighting the benefit of current therapeutic antivenom fourth generation and immunoregulation role in supporting the therapeutic approach and the guideline of the surgical approach. CONCLUSIONS: The appropriate multidisciplinary management coupled with an early use of antivenom limits the severity and the potential development of complications. Clinical suspicion is the cornerstone of therapeutic management of these patients.

INTRODUCCIÓN: el loxoscelismo se debe a la inoculación de un conjunto de enzimas proteolíticas por la mordedura de la araña Loxosceles. Puede tener una expresión local, sin embargo, la forma viscerocutánea o sistémica tiene una evolución grave. Se presenta el primer caso de la variante sistémica en una mujer embarazada. CASO CLÍNICO: mujer con embarazo normoevolutivo de 28 semanas. Después de estar expuesta a un ambiente semirrural, presentó placa plana eritematosa en el glúteo derecho, con aumento de la temperatura e hiperestesia local. Fue hospitalizada para administrarle antibióticos parenterales, por considerarse que se trataba de la picadura de un insecto. A las cuatro horas se incrementó el dolor y la paciente desarrolló deshidratación e hipotensión severas hasta llegar al choque, por lo que se inició tratamiento con cristaloides, aminas vasopresoras y protección de la vía aérea. Se realizó operación cesárea, de la que se obtuvo un niño, y se efectuó desbridación en el glúteo derecho. El diagnóstico fue loxoscelismo sistémico, por lo que se administró el antiveneno específico. La paciente fue egresada a los dos meses. CONCLUSIONES: el manejo multidisciplinario oportuno, aunado al empleo del antiveneno, limitó la severidad y el desarrollo potencial de complicaciones. La sospecha clínica es la piedra angular del tratamiento en estos pacientes.

[Diagnostic evaluation of fiberopticbronchoscopy in bronchogenic carcinoma in neoplasic-suspicious cases]. / Evaluación diagnóstica en el cáncer broncogénico por fibrobroncoscopia en casos sospechosos de neoplasia.

UNLABELLED: Fiberopticbronchoscopy (FOB) is a well established method for diagnosis in bronchogenic cancer (CABR). OBJECTIVE: To evaluate sensitivity and specificity of FOB in suspicious cases of lung neoplasia. MATERIAL AND METHODS: A total of 119 suspicious cases of CABR were subjected to FOB under local anesthesia with lidocaine and sedation and bronchial brushing and lavage were carried out. In all evident lesions, a biopsy was taken. Sputum was collected in carbowax for 5 days. When histopathogic and cytopathologic studies were negative, fine needle aspiration (FNA) of the lesion was performed; if pleural involvement was present, a biopsy and a sample of liquid were taken. RESULTS: Of 119 cases, diagnosis of CABR was confirmed by FOB in 45: brushing 25; lavage 25, and biopsy 29 with sensitivity 52.33%, specificity 100%, PPV 100%, and NPV, 42.31%. In 17, positivity was obtained in two-thirds samples; in carbowax, three were positive. In another 41 CABR-suspicious cases, all FOB samples were negative and neoplasia was confirmed by FNA in 15, biopsy of extrathoracic lymphatic node in 11, pleural biopsy in eight and liquid cytopathology in six. Non-malignant pathology was found in 33 cases: pneumonia 22, lung abscess three and tuberculosis, eight. FBO is indicated in CABR-suspicious cases. Negativity of FOB samples is due to different causes. All FOB instruments must be in optimal operative conditions and must be handled by a well-trained endoscopist.