RESUMO
This is a three case study report of children with measles which later progressed to bronchopneumonia and subcutaneous emphysema. All three children were from farming families, and none had been previously vaccinate against measles. For a period of six months, 183 cases of measles were treated at our hospital of which only three worsened to subcutaneous emphysema, demonstrating an incidence rate of 1.6%; they also showed to have bronchopneumonia, with severe coughing episodes; which made us recall the possible physiopathology principle of the pressure gradient theory behind this complication proposed by Bloch in 1968. The factors related to our patients suggested a more severe and aggresive type of measles with a greater probability of having complications. The prognostic value of the severity of this type of measles in the presence of subcutaneous emphysema is limited and its management should be primarly focused on treating the added bronchial problem.
Assuntos
Sarampo/complicações , Enfisema Subcutâneo/etiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Enfisema Subcutâneo/fisiopatologiaRESUMO
A prospective study was conducted in 90 patients divided in two different groups: the first group included 45 labor patients operated of cesarean section and elective appendectomy, the second group included 45 labor patients operated of cesarean section without appendectomy (control group). The purpose was to evaluate if the elective removal of the appendix increase the postoperative morbidity. The most common indication of cesarean section was the mother-fetus disproportion (55.5%). The main type of uterine incision was the segmental transverse (over 90% of the cases). Appendectomy added 11.2 minutes to the operation time, as compared with the control group (p less than 0.01). There were 4 cases (8.8%) of decidual infection in the appendectomy group and 2 cases (4.4%) of decidual infection (one of these complicated with wound dehiscence) in the control group. Nevertheless there was not difference statistically significative in comparing the morbidity between the groups (p = 0.33). There were no complications directly attributable to elective appendectomy. It is concluded that the elective appendectomy does not increase the postoperative morbidity in labor patients undergoing cesarean section and it requires a good selection of patients to be appendectomized.