Quilotórax secundarios a trombosis del sistema venoso superior / Chylothorax due to upper-extremity deep vein thrombosis

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[Massive Upper Airway Bleeding: A Rare Case of Aortobronchial Fistula]. / Hemorragia Maciça na Via Aérea Superior: Um Caso Raro de Fístula Aorto-Brônquica.

Clinical presentation of haemoptysis and haematemesis often generates confusion, becoming a difficult task to determine the source of upper airway bleeding. Aortobronchial fistula is a rare entity, but has been a reported complication in patients that have undergone aortic vascular surgery. A high clinical suspicion is fundamental to making this diagnosis. A 69 year old male, with a previous diagnosis of chronic gastritis, is admitted to the emergency room for vomiting blood. In the first 24 hours after admission, the patient develops respiratory insufficiency after an episode of massive bleeding from his mouth. A computed tomography is performed, which shows a descending thoracic aortic aneurism and signs of aortobronchial fistula. Urgent thoracic endovascular repair was performed. Early symptoms of aortobronchial fistulae are nonspecific which complicates the diagnosis and can lead to treatment delay. The use of bronchoscopy in these cases is controversial.

A apresentação clínica de hemoptise e hematemese gera muitas vezes confusão. Nessas situações, a determinação da proveniência do sangue presente na via aérea superior pode tornar-se uma tarefa difícil. A fístula aorto-brônquica é uma entidade rara, mas tem sido descrita em doentes submetidos a cirurgia vascular da aorta torácica. A suspeita clínica é fundamental. Os autores apresentam o caso de um doente de 69 anos, sexo masculino, com o diagnóstico prévio de gastrite crónica que foi admitido por vómitos hemáticos. Após 24 horas na enfermaria, o doente apresentou um novo episódio de hemorragia maciça complicado com insuficiência respiratória. A tomografia computorizada do tórax mostrou um aneurisma da aorta torácica descendente e sinais de fístula aorto-brônquica que motivaram a realização de cirurgia endovascular urgente. Os sintomas iniciais da fístula aorto-brônquica são inespecíficos dificultando o diagnóstico, o que pode conduzir a um atraso na instituição do tratamento adequado. A realização de broncoscopia nestes casos é controversa.

Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation.

The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation / Malformação de Chiari e síndrome de apneia central do sono: eficácia do tratamento com servoventilação adaptativa

The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

A malformação de Chiari tipo I (MC-I) tem sido associada a distúrbios respiratórios do sono, sobretudo à síndrome de apneia central do sono. Apresentamos o caso de uma paciente do sexo feminino de 44 anos de idade com MC-I que foi encaminhada à nossa unidade de sono por suspeita de apneia do sono. A paciente havia sido submetida a cirurgia descompressiva 3 anos antes. A gasometria arterial mostrou hipercapnia. A polissonografia revelou um índice de distúrbio respiratório de 108 eventos/h, sendo todos os eventos apneias centrais. Foi iniciado tratamento com servoventilação adaptativa e houve resolução da apneia central. Este relato demonstra a eficácia da servoventilação no tratamento da síndrome de apneia central do sono associada à hipoventilação alveolar em uma paciente com MC-I previamente submetida a cirurgia descompressiva.

Las paradojas de las políticas de empleo europeas: de la justicia a la terapia / Paradoxes of European Employment Policies: From Fairness towards Therapy

Las sociedades europeas están experimentando importantes cambios en los pilares axiológicos y políticos de su modelo social. Las políticas sociales y de empleo contemporáneas tienen como principal característica un desplazamiento radical hacia la psicologización y moralización del trabajo. Un análisis de las nociones centrales del discurso de las instituciones europeas sobre el trabajo (empleabilidad, activación, flexiguridad) permite desvelar las doxas o presupuestos que lo fundamentan. La paradoja es una estructura retórica fundamental de este discurso. Esta paradoja es reveladora del carácter perverso del discurso neoliberal que, por un lado, apela a la responsabilidad personal, pero, por otro, desprovee al sujeto de las condiciones sociales y políticas necesarias para el ejercicio de la autonomía.

European societies are undergoing important changes in the axiological and political pillars of its social model. One of the main current features of social and employment policies is a radical shift towards the psychologization and moralization of work. An analysis of the key concepts of the EU discourse on employment (employability, activation, flexicurity) allows unveiling the underlying doxas and assumptions. The paradox is a principally rhetorical structure of this discourse. This paradox reveals the perverse nature of the neoliberal discourse which, on the one hand, appeals to personal responsibility, but on the other hand, it deprives to subject of the social and political conditions necessary to be autonomous.

Effects of DA D1 and D2 antagonists on the sensitisation to the motor effects of morphine in mice.

Acute morphine administration produces hyperactivity in mice and repeated treatment induces an enhancement of this effect. In this experiment, we study the sensitisation to the hyperactivity induced by intermittent morphine administration (40 mg/kg) and the effects of dopamine (DA) antagonists on this phenomenon. Animals received three injections, separated by 48 h, and after each injection, their activity was registered between 30 and 60 min. In Experiment 1, animals were divided into two groups, which received saline and morphine (S-S-M) or only morphine (M-M-M). In Experiment 2, animals were divided into 12 groups. Half, which was designed to study the effects of DA antagonists on the acquisition of morphine sensitisation, received morphine plus 0.125, 0.25, or 0.5 mg/kg SCH 23390 or raclopride in the two first administrations and only morphine in the third (M+SCH-M+SCH-M; M+R-M+R-M). The other groups, designed to study the effects of DA antagonists on the expression of morphine sensitisation, received morphine in the two first administrations and morphine plus DA antagonists in the last injection (M-M-M+SCH; M-M-M+R). Intermittent morphine administration produces greater hyperactivity than acute morphine. DA D1 antagonists reduce acquisition and block expression of sensitisation, while DA D2 antagonists only affect expression with the intermediate and high dose. These results support the implication of DA in the behavioural sensitisation of morphine in mice.