Archivos de bronconeumología
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Arch. Bronconeumol. · Oct 1996
Case Reports[Necrotizing descendent mediastinitis of oropharyngeal origin].
The spread of oropharyngeal infections to the mediastinum can give rise to descending necrotizing mediastinitis (DNM), which causes a high rate of mortality (around 40%), particularly when diagnosis is late and drainage inadequate. In the first case we report, successful drainage of the mediastinum was achieved at the cervical and sub-xiphisternum levels and by thoracotomy. ⋯ Cervical drains, which may be adequate when there is perforation of the cervical esophagus, is insufficient in DNM, which calls for more aggressive, early drainage, such as can be achieved by thoracotomy. Computerized axial tomography of the chest is essential for rapid diagnosis, to plan the most appropriate surgical approach and for follow-up and evaluation of drainage.
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Arch. Bronconeumol. · Oct 1996
[Tracheal intubation using bronchofiberoscopy (experience of a hospital service)].
Fiberoptic endoscopy has brought about significant progress in the management of so-called difficult intubations. We describe the techniques applied and results in one hospital service performing intubation guided by fiberoptic bronchoscope (FB). A total of 512 consecutive intubations (64.18% men and 35.15% women) performed over the past 18 years were analyzed. ⋯ Thirty-five (6.84%) complications of various types were recorded, and intubation was impossible in 3 (0.59%) cases. Intubation in patients under general anesthesia presented special technical difficulties due to loss of muscle tone and the need to maintain ventilation. We recommend intubation only in patients who are breathing spontaneously through the nose, using lidocaine as a local anesthetic and a large caliber endotracheal tube with as small a tip as possible.
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Arch. Bronconeumol. · Oct 1996
Case Reports[Strongyloides stercoralis infection in a cortico-dependent patient with chronic airflow obstruction].
We report a case of Strongyloides stercoralis infection in a male agricultural worker with corticoid dependent chronic obstructive air flow disease and bronchial hyperreactivity. The clinical picture initially involved digestive symptoms and bronchospasm resistant to steroid treatment. Diagnosis was established by demonstrating the larvae of S. stercoralis in stool. We emphasize that this infection should be suspected in patients living in endemic areas such as Spain, and describe S. stercoralis-caused respiratory manifestations that can be masked by bronchial disease.