RESUMEN
Resumen Introducción: El síndrome de hipertermia maligna es un trastorno farmacogenético del músculo esquelético de carácter hereditario, que se caracteriza por un estado hipermetabólico relacionado con la exposición a anestésicos inhalatorios o relajantes musculares despolarizantes. Se trata de una afección infrecuente en individuos genéticamente predispuestos, con una incidencia muy baja en pediatría (1 de cada 10,000-15,000 procedimientos anestésicos). Caso clínico: Se presenta un caso de hipertermia maligna relacionado con la exposición a sevoflurano durante una cirugía de adenoidectomía en un paciente de sexo femenino de 6 años de edad. La paciente presentó taquicardia, hipercapnia e hipertermia, que precisaron la administración de dos dosis sucesivas de dantroleno sódico. La evolución posterior fue buena. Conclusiones: El síndrome de hipertermia maligna es un cuadro poco frecuente en la edad pediátrica. Se debe sospechar de forma precoz, ya que es fundamental su detección temprana para iniciar el tratamiento.
Abstract Background: Malignant hyperthermia syndrome is a hereditary pharmacogenetic disorder of skeletal muscle characterized by hypermetabolic state related to the exposure of volatile anesthetic gases or depolarizing muscle relaxants. It is an infrequent entity that occurs in genetically predisposed individuals, with a very low incidence in pediatrics (1 in 10,000-15,000 anesthetic procedures). Case report: We report a case of malignant hyperthermia related to exposure to sevoflurane during adenoidectomy surgery in a 6-year-old female. The patient presented with tachycardia, hypercapnia, and hyperthermia, requiring two successive doses of dantrolene sodium administration, with an adequate response to the treatment. Conclusions: Malignant hyperthermia syndrome is a rare condition in pediatric patients that should be detected in early stages since it is essential to initiate the treatment as soon as possible.
Asunto(s)
Niño , Femenino , Humanos , Anestésicos por Inhalación , Sevoflurano , Hipertermia Maligna , Adenoidectomía , Anestésicos por Inhalación/efectos adversos , Dantroleno/uso terapéutico , Sevoflurano/efectos adversos , Hipertermia Maligna/etiología , Hipertermia Maligna/tratamiento farmacológicoRESUMEN
Background: Malignant hyperthermia syndrome is a hereditary pharmacogenetic disorder of skeletal muscle characterized by hypermetabolic state related to the exposure of volatile anesthetic gases or depolarizing muscle relaxants. It is an infrequent entity that occurs in genetically predisposed individuals, with a very low incidence in pediatrics (1 in 10,000-15,000 anesthetic procedures). Case report: We report a case of malignant hyperthermia related to exposure to sevoflurane during adenoidectomy surgery in a 6-year-old female. The patient presented with tachycardia, hypercapnia, and hyperthermia, requiring two successive doses of dantrolene sodium administration, with an adequate response to the treatment. Conclusions: Malignant hyperthermia syndrome is a rare condition in pediatric patients that should be detected in early stages since it is essential to initiate the treatment as soon as possible.
Background: Introducción">El síndrome de hipertermia maligna es un trastorno farmacogenético del músculo esquelético de carácter hereditario, que se caracteriza por un estado hipermetabólico relacionado con la exposición a anestésicos inhalatorios o relajantes musculares despolarizantes. Se trata de una afección infrecuente en individuos genéticamente predispuestos, con una incidencia muy baja en pediatría (1 de cada 10,000-15,000 procedimientos anestésicos). Caso clínico: Se presenta un caso de hipertermia maligna relacionado con la exposición a sevoflurano durante una cirugía de adenoidectomía en un paciente de sexo femenino de 6 años de edad. La paciente presentó taquicardia, hipercapnia e hipertermia, que precisaron la administración de dos dosis sucesivas de dantroleno sódico. La evolución posterior fue buena. Conclusiones: El síndrome de hipertermia maligna es un cuadro poco frecuente en la edad pediátrica. Se debe sospechar de forma precoz, ya que es fundamental su detección temprana para iniciar el tratamiento.
Asunto(s)
Anestésicos por Inhalación , Hipertermia Maligna , Sevoflurano , Adenoidectomía , Anestésicos por Inhalación/efectos adversos , Niño , Dantroleno/uso terapéutico , Femenino , Humanos , Hipertermia Maligna/tratamiento farmacológico , Hipertermia Maligna/etiología , Sevoflurano/efectos adversosRESUMEN
INTRODUCTION: Panniculits presents as an inflammation of the subcutaneous adipose tissue of the skin. In breast, panniculitis is very rare and is usually a manifestation of underlying inflammatory conditions. The typical presentation is palpable tender nodules, which in cases of breast panniculitis, triggers an extensive work up to exclude a malignancy. Herein we present a case of septal and lobar panniculitis in a female with clinical history of invasive ductal carcinoma. PRESENTATION OF THE CASE: A 52-year old female with past medical history of invasive breast carcinoma 5 years prior to the presentation. The patient's chief complaint was a 1-year history of a subcutaneous nodular lesion on her left breast. A core biopsy of the firm nodule showed marked inflammation of the breast. A second skin biopsy showed an abundant chronic inflammatory infiltrate, with lymphocytic vasculitis and neuritis, suggestive of an underlying autoimmune process. DISCUSSION: Subcutaneous panniculitis with or without vasculitis is a rare condition when presenting in the breast. Panniculitis can mimic malignancy and thus, it is important to differentially diagnose it from breast carcinoma. Histologically, it is classified in lobular and septal lymphocytic panniculitis depending on specific diagnostic characteristics. CONCLUSION: Panniculitis of the breast is a rare condition that needs to be included in the differential diagnosis of subcutaneous breast masses. In all cases, but specifically in females with history of breast cancer, panniculitis still should be thought of as a possibility, and imaging as well as other diagnostic techniques can aid in making the correct diagnosis.
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OBJECTIVE: To determine the validity of plasma lactate in the emergency department for the early detection of tissue hypoperfusion in septic patients. MATERIALS AND METHODS: Longitudinal descriptive study. Non probabilistic sampling for convenience. Plasma lactate levels were determined in patients admitted to the emergency department with systemic inflammatory response data and clinical suspicion or documented infection. Follow-up was seven days. Complications were considered if the patients presented septic shock, severe sepsis, entry to intensive care or death. RESULTS: Ninety patients were included. The mean age was 57.4±20.31. Fifty five percent (n=49) were women. 25% (n=22) of the patients showed complications. Plasma lactate levels were 1.55mmol/L in uncomplicated patients and 3.72mmol/L for complicated patients (p<0.001). The area under the ROC curve was 0.72 (95% CI, 0.575-0.829). The cutoff point that best described the relationship with the probability of complications was that set at 4.2mmol/L. The variables studied that showed a significant association with the probability of complications were edema (p=0.004), and infections of the respiratory tract (p=0.037). A model that included lactate levels, using as adjustment variables edema and the presence of low respiratory tract infection explained between 0.234 and 0.349 of the dependent variant, correctly classifying 80% of the cases. CONCLUSION: Plasma lactate is useful in emergency departments as a predictive test for the early detection of patients with tissue hypoperfusion that evolve to severe sepsis, septic shock or death.
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Ácido Láctico/sangre , Sepsis/sangre , Choque Séptico/sangre , Adulto , Anciano , Biomarcadores/sangre , Diagnóstico Precoz , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Masculino , México , Persona de Mediana Edad , Insuficiencia Multiorgánica/sangre , Insuficiencia Multiorgánica/etiología , Curva ROC , Sepsis/complicaciones , Sepsis/mortalidad , Choque Séptico/complicaciones , Choque Séptico/mortalidad , Factores de TiempoRESUMEN
Acute heart failure (HF) is a prevalent disease with important socio-economic repercussions. Due to the aging of population, these values will increase in the coming years, so it may be useful to the implementation of intervention programs in these patients to decrease morbidity and mortality. A quasi-experimental prospective study (n = 262) of patients admitted at the Internal Medicine Department of the Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain, diagnosed of HF between November 2013 and October 2014 (both dates inclusive) (n = 108) followed up for 1 year was performed. Within this group, a subgroup with an intensive intervention (n = 30) was performed. The data were compared with a historical cohort of patients admitted to the same department during the same time in the previous year (from November 2012 to October 2013) (n = 154). Statistically significant differences between groups attending to the therapeutical adherence to clinical guidelines (p < 0.011) were observed. Considering the intensive intervention subgroup, statistically significant differences were observed in the rate of exitus (p < 0.032) and survival (log rank <0.030) compared to the control group. The close monitoring of patients with HF improves adherence, reduces mortality and improves survival. This May result in a decline in the use of health resources, which entails significant socio-economic benefits.
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Adhesión a Directriz , Insuficiencia Cardíaca/terapia , Hospitalización , Guías de Práctica Clínica como Asunto , Anciano , Anciano de 80 o más Años , Femenino , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Estudios Prospectivos , Factores Socioeconómicos , España , Tasa de SupervivenciaRESUMEN
RESUMEN La disección aislada y espontánea de la arteria celíaca es una entidad clínica rara. Es la cuarta causa de aneurismas abdominales por detrás de los que ocurren en las arterias esplénica, hepática y mesentérica superior. Es importante sospechar el diagnóstico de esta enfermedad cuyos síntomas son inespecíficos. Presentamos el caso de un varón de 60 años de edad atendido en nuestro hospital por esta enfermedad, y hacemos una revisión del tema con énfasis en el diagnóstico y en los diferentes tratamientos disponibles.
SUMMARY Spontaneous and isolated celiac artery dissection is a rare clinical disease. It is the fourth cause of abdominal aneurysms behind those that occur in the splenic, hepatic, and superior mesenteric arteries. It is important to suspect the diagnosis of this entity whose clinical symptoms are unspecific. We report the case of a 60 year-old male treated in our hospital because of this illness, and present a review of this pathology, specially focused on the diagnosis and the different treatments available.
RESUMO A dissecção isolada e espontânea da artéria celíaca é uma entidade clínica rara. É a quarta causa de aneurismas abdominais por detrás dos que ocorrem nas artérias esplénica, hepática e mesentérica superior. É importante suspeitar o diagnóstico desta doença cujos sintomas são inespecíficos. Apresentamos o caso de um homem de 60 anos de idade atendido no nosso hospital por esta doença, e fazemos uma revisão do assunto com ênfase no diagnóstico e nos diferentes tratamentos disponíveis.