A Rare Case of a Middle Mediastinal Mass With Intense and Diffuse Contrast Enhancement.

Masses of the mediastinum have a wide differential diagnosis. Paragangliomas are rare neoplasms of neuroendocrine origin. These masses may be either parasympathetic or sympathetic in origin and have variable presentation.

A 28-Year-Old Pregnant Woman With a Lung Abscess and Complicated Pleural Effusion.

A 28-year-old woman G1P0 at 22 weeks of gestation and with no significant medical history presented to the ED complaining of worsening dyspnea and right-sided pleuritic chest pain. Symptoms started 2 weeks before presentation, with minimal productive cough and dyspnea on exertion. One week after the initial symptoms, the patient started noticing right-sided chest and shoulder pain along with subjective fevers and night sweats.

[Regionalization of perinatal health care in the province of Santa Fe, Argentina].

Objective: Improve the performance of the regionalization policy in the province of Santa Fe, Argentina, as a strategy to improve perinatal health care by analyzing implementation processes and building consensus among decision makers and stakeholders around an action plan.

Methods: Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy.

Incidence of Atrial Fibrillation After Atrial Flutter Ablation.

Objectives: This study was conceived to perform a comprehensive systematic review and meta-analysis of the available evidence to compute the incidence of atrial fibrillation (AF) after successful atrial flutter (AFL) catheter ablation, defined by targeting for bidirectional block, using different types of follow-up modalities and durations.

Background: Cavotricuspid-isthmus dependent AFL is usually initiated by short bursts of AF. The incidence of AF after AFL ablation is variable.

Pharyngeal collapsibility during sleep is elevated in insulin-resistant females with morbid obesity.

Insulin resistance is associated with sleep apnoea, leading us to hypothesise that it is also associated with elevations in pharyngeal collapsibility, even in the absence of sleep apnoea.90 bariatric patients were characterised for sleep apnoea, pharyngeal collapsibility and insulin resistance. Patients with a respiratory disturbance index (RDI) >10 events·h(-1), diabetes mellitus, tonsillar hypertrophy and pulmonary disease were excluded.

Caregiver perception of sleep-disordered breathing-associated symptoms in children of rural Andean communities above 4000 masl with chronic exposure to biomass fuel.

Background: Previous studies have uncovered a very high prevalence of sleep disorders in general, and of sleep-disordered breathing in particular among children exposed to indoor biomass fuel pollution. However, despite the significant symptomatology, parents are unlikely to report these issues during health-care visits.

Objective: The objective of this study was to determine whether reduced caregiver perception of sleep disorders may account for the infrequent diagnosis and treatment of such problems in children residing at high altitudes and exposed to high biomass pollution.

Central venous saturation in septic shock: co-oximetry vs gasometry.

Objectives: Central venous oxygen saturation calculated by gasometry (Gaso-Scvo2) is more available than central venous oxygen saturation measured by co-oximetry (Co-oxy-Scvo2) in environments with less resources and underdeveloped countries. Therefore, we aimed to determine the agreement between Co-oxy-Scvo2 and Gaso-Scvo2 and between central venous oxygen tension measured by gasometry (Gaso-Pcvo2) and Co-oxy-Scvo2, respectively.

Design And Settings: This is a prospective study in a university hospital's intensive care unit.

High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock.

We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock.

Adherence to reduced-polluting biomass fuel stoves improves respiratory and sleep symptoms in children.

Background: Symptoms of sleep apnea are markedly increased in children exposed to smoke from biomass fuels and are reduced by kitchen stoves that improve indoor biomass pollution. However, the impact of adherence to the use of improved stoves has not been critically examined.

Methods: Sleep-related symptom questionnaires were obtained from children <15 years of age in 56 families residing in the communities of Lliupapuquio, Andahuaylas province in Peru before and 2 years after installation of less-polluting Inkawasi cooking stoves.

Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome.

Rationale: Positive end-expiratory pressure (PEEP) and prone positioning may induce lung recruitment and affect alveolar dynamics in acute respiratory distress syndrome (ARDS). Whether there is interdependence between the effects of PEEP and prone positioning on these variables is unknown.

Objectives: To determine the effects of high PEEP and prone positioning on lung recruitment, cyclic recruitment/derecruitment, and tidal hyperinflation and how these effects are influenced by lung recruitability.

Prone Position Ventilation Used during a Transfer as a Bridge to Ecmo Therapy in Hantavirus-Induced Severe Cardiopulmonary Syndrome.

Background. Transport of critically ill patients is a complex issue. We present a case using prone positioning as a bridge to extracorporeal membrane oxygenation (ECMO), performed by a critical retrieval team from a university hospital.

[Celiac disease: descriptive study at the Anglo American clinic].

Background: Celiac disease (CD) is a condition in which gluten intake develops an autoimmune response generating intestinal villous atrophy, causing malabsorption. Prevalence worldwide is approximately 1%, in our country it is not known.

Material And Methods: Retrospective, descriptive, observational study in Anglo American Clinic between September 2004 and February 2012.

Higher than recommended amikacin loading doses achieve pharmacokinetic targets without associated toxicity.

Antibiotic therapy improves the outcome of severe sepsis and septic shock, however pharmacokinetic properties are altered in this scenario. Amikacin (AMK) is an option to treat community or nosocomial infections, although standard doses might be insufficient in critically ill patients. The aim of this study was to evaluate two AMK dosage regimens in comparison with standard therapy with regard to efficacy in achieving adequate plasma levels as well as safety.

Systematic approach for severe respiratory failure due to novel A (H1N1) influenza.

Aim: In April 2009, a novel influenza A (H1N1) virus appeared in Mexico. It rapidly acquired the characteristics of a pandemic disease. Our objective is to present a case series of mechanically ventilated patients with severe influenza, treated with a systematic approach.

Organizing pneumonia in patients with severe respiratory failure due to novel A (H1N1) influenza.

The authors describe two cases that developed organizing pneumonia (OP) associated with novel influenza A(H1N1) virus. These patients were admitted to intensive care unit (ICU) because of severe respiratory failure. After initial clinical improvement, both patients worsened their condition during their second week of ICU stay, presenting fever, increasing in inflammatory parameters and worsening in oxygen exchange and respiratory mechanics.

[Prolonged prone position ventilation for severe respiratory distress syndrome post-pneumonectomy. Report of one case].

Management of patients with severe respiratory failure is mainly supportive, and protective mechanical ventilation is the pivotal treatment. When conventional therapy is insufficient to improve oxygenation without deleterious effects, other strategies should be considered. We report a 53 year-old male who presented a severe respiratory failure refractory to conventional management after pneumonectomy.

[Long-term survival in carcinoid tumour of the appendix. An analysis of 8903 appendectomies].

Introduction: Appendiceal carcinoids are the most frequent tumors of the appendix and are usually detected as an incidental finding in the final pathology report. The aim of this study was to evaluate the clinical and pathological characteristics, surgical treatment and long-term survival in patients with an appendiceal carcinoid tumor.

Material And Methods: We performed a retrospective study of patients treated from 1980 to 2007 with a pathological diagnosis of appendiceal carcinoid tumor.

Fiberoptic bronchoscopy-assisted percutaneous tracheostomy is safe in obese critically ill patients: a prospective and comparative study.

Background: Obesity has reached epidemic proportions worldwide. In Latin America, 10% to 35% of the population is obese. Obese critically ill patients are at greater risk for requiring intubation and prolonged mechanical ventilation; and in some cases, it is necessary to perform a tracheostomy.

[Long term survival of patients operated for early gastric cancer].

Background: Early gastric cancer involves mucosa and submucosa, independent of lymph node involvement. Radical gastrectomy is the standard treatment.

Aim: To assess long term survival of patients operated for an early gastric cancer.

Extended prone position ventilation in severe acute respiratory distress syndrome: a pilot feasibility study.

Objectives: The aim of the study was to evaluate the safety of extended prone position ventilation (PPV) and its impact on respiratory function in patients with severe acute respiratory distress syndrome (ARDS).

Design: This was a prospective interventional study.

Setting: Patients were recruited from a mixed medical-surgical intensive care unit in a university hospital.

[Gastric adenocarcinoma appearing 32 years after the resection of a gastric lymphoma. Report of one case].

The association of gastric lymphoma and gastric adenocarcinoma in the same patient is uncommon. We report a 76 year-old male with a previous history of massive upper gastrointestinal bleeding who required a subtotal gastrectomy with Billroth II reconstruction in 1974. Pathology demonstrated a gastric lympho-histiocytic non-Hodgkin's lymphoma.

Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock.

Purpose: The objective of this article is to study the cumulative incidence of intra-abdominal hypertension (IAH) in septic shock (SS) patients during the first 72 hours of intensive care unit (ICU) admission and to determine if the presence and severity of IAH are associated with sepsis morbidity and mortality.

Materials And Methods: Eighty-one consecutive SS patients admitted to a surgical-medical ICU of an academic university hospital (January 2005 to January 2006) were included. Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were measured every 6 h (intermittently) for 72 h.