Fractura de pene. Aportación de un caso

Fracture of the penis is a rare occurrence, and one which, in the majority of cases, is the result of a trauma during sexual intercourse. It affects one or two cavernous bodies, and is accompanied by a urethral lesion in between 10-38% of cases. Diagnosis is mainly clinical, although a rethrocystography is recommended if urethral lesion is suspected. Most authors currently prefer early surgery in order to prevent the appearance of sexual or urological sequelae, which occurs in 10-53% of patients treated conservatively.Here we present a case of fracture of the penis which was treated with early surgery, obtaining good aesthetic and functional results     

Tumor renal neuroendocrino. Un caso de rara presentación. Revisión de la literatura

The neuroendocrine renal tumors are of extremely strange presentation. We present a review of the literature published on this pathology     

Lesión de los cuerpos cavernosos por arma de fuego. Presentación de un caso y revisión de la literatura

Rupture of the corpora cavernosa is a very rare lesion. It occurs most commonly during intercourse. A far more exceptional cause is a gunshot wound; in this case, there are frequently concomitant lesions to other structures. We present the case of a man who suffered a lesion to the corpora cavernosa due to a gunshot and underwent emergency surgery. We reviewed existing literature and verified that the first step in managing a genital gunshot wound is to stabilise the patient, following which we should surgically explore the affected area.     

Rotura vesical extraperitoneal espontánea. presentación de un caso

The spontaneous extraperitoneal bladder rupture is an uncommon event and the diagnosis is very difficult. It is defined like the rupture of bladder wall in absence of traumatism or iatrogenic techniques. The extravasation usually is produced into the peritoneal cavity, because of the greater weakness of the vesical dome. The diagnosis is based on the retrograde cystography, being necessary the surgical treatment in the intraperitoneal rupture, while the extraperitoneal one, could be treated in a conservative way with a vesical catheter. Here we present a case of sponteneus extraperitoneal bladder rupture, with oliguria, abdominal pain and a righ hypochondrius mass as clinic presentation. Due to this, the diagnosis was made by the TAC, in which it was appreciated a continuity solution in the anterior bladder wall, with a contrast extravasation through the anterior abdominal wall. The retrograde cystography confirmed the definitive diagnosis. The treatment followed was based on the keeping of the vesical catheter and antibiotherapy     

La leucocitosis extrema puede inducir a un diagnóstico erróneo de hipoxemia severa. Descripción de un caso

The diagnosis and treatment of respiratory failure is a part of the anaesthesist's daily practice, as well as the hypoxaemia that is one of its physiological and analytical consequences. Patients with an extreme leucocytosis secondary to leukaemia can suffer an incorrect diagnosis of hypoxemia, called “pseudohypoxaemia”. This is basically due to the rapid in vitro oxygen consumption, and is characterized by a low partial pressure of oxygen in arterial blood (PaO₂) despite a normal oxygen saturation (SpO₂) measured by pulse oximetry. Pseudohypoxaemia appears in patients with thrombocytosis or hyper-leucocytosis occurring during blastic crisis of a leukaemia. It must be suspected in patients with a discrepancy between the SpO₂ measured by oximetry and the PaO₂. In this context, pulse oximetry is the most accurate way to establish the diagnosis and to avoid unnecessary actions. We report the case of a patient with chronic myeloid leukaemia and extreme leucocytosis requiring emergency surgery, and diagnosed with pseudohypoxaemia during the perioperative period that led to a delay in the extubation of the patient.     

Implicaciones anestésicas en la enfermedad de Pompe. Descripción de un caso

Pompe disease, or type ii glycogenosis, is a rare metabolic myopathy inherited in an autosomal recessive pattern, characterized by progressive muscle weakness and multisystem involvement. The disease often results in premature death. Patients with Pompe disease are at high risk for anaesthesia-related complications, particularly cardiac and respiratory problems, although difficult airway management is the greatest complication. It is essential to perform a comprehensive preoperative study in order to reduce the risk of perioperative morbidity and mortality, and to obtain as much information as possible for the surgical procedure. In this article, we report the case of a patient with a history of adult Pompe disease who underwent combined anaesthesia for osteosynthesis of the proximal end of the left humerus.     

Manejo anestésico de hipertensión intracraneal y embarazo. Informe de un caso

Hydrocephalus is an active distension of the ventricular system of the brain. The improved survival rates of patients with neurosurgical pathology is accompanied by a greater number of non-neurosurgical procedures in patients who have therapeutic neurosurgical devices.The real incidence of pregnancy in patients with obstructive hydrocephalus controlled with ventriculoperitoneal shunt (VPS) is unclear.We present a case of a pregnant 34-year-old female with a VPS for obstructive hydrocephalus. Due to VPS obstruction secondary to uterus volume, she presented several episodes of neurological impairment during pregnancy. An elective caesarean section (C-section) and VPS review were planned for the same operative time.This rare case reflects the challenge that the anaesthesiologist has to face in order to provide the best and simultaneous management of the wellbeing of the mother, the mother's brain and the foetus.     

Abdomen agudo e hiperparatiroidismo: descripción de un caso

Hypercalcaemia secondary to primary hyperparathyroidism may present with an insidious clinical picture and involve multiple organs, which may lead to a delay in its diagnosis and erroneous therapeutic actions, due to its similarity to other different conditions. We describe the case of a patient who was admitted to our hospital with the diagnosis of acute abdomen. A laparotomy was performed which was negative. The slow post-operative progress and the clinical neurology of the patient was resolved after checking for the presence of a significant hypercalcaemia secondary to a parathyroid lymph node.     

Insuficiencia mitral severa posresección de mixoma auricular gigante: presentación de un caso y revisión de la literatura

Evaluation of the competence of a mitral valve can often be impossible in the clinical setting of a giant atrial myxoma. A 50-year-old woman with severe mitral regurgitation in the post-bypass period following a myxoma resection was managed with a mitral valve replacement.The absence of mitral insufficiency in the preoperative examination should not be taken as a reliable predictor of normal valve function. So herein, we discuss the role of the intraoperative echocardiographic examination, the underlying mechanisms, and the proposed management of severe mitral regurgitation following the resection of an atrial myxoma.