In Catanzaro, Italy, an adult male with severe burns all over his body and in a state of coma was promptly rescued by the medical team at the air ambulance service (HEMS), who provided airway safety through laryngeal mask placement (LMA). The patient was subsequently transferred to the nearest Hub center, where an emergency tracheostomy was performed to ensure better airway management during the flight to the nearest available major burn center. This is the first documented case at regional level of a patient undergoing rapid tracheostomy through an imminent transfer with air ambulance.

Drowning is an acute respiratory failure as a result from immersion or submersion of the airways in a liquid medium (predominantly water). Inhalation of water causes severe lung damage due to the destruction of pulmonary surfactant, resulting in decreased lung elasticity, alveolar collapse, alteration of ventilation-perfusion ratio, intrapulmonary blood shunting, hypoxia, acute lung injury, and Acute Respiratory Distress Syndrome (ARDS). Poractant alfa (Curosurf®), a natural surfactant effective in the treatment of newborn respiratory distress, has been used in various forms of ARDS, but in drowning syndromes, experience is still poor. We describe a series of nine clinical cases of drowning, six adults and three children, treated in our Intensive Care Unit (ICU) with endobronchial administration of poractant alfa. After 24 and 48 hours of administration in all cases, there was an improvement in arterial blood gas analysis (ABG) parameters and imaging. All patients were discharged without clinical consequences.

Multiresistant bacteria infections cause widespread morbidity and mortality and lead to an increase in expenses for hospital stays and complications. We describe the case of a 27-year-old patient with puerperal sepsis after cesarean section due to Escherichia coli complicated by multiresistant Klebsiella ESBL-producing superinfection with septic shock and multiple organ dysfunction syndrome, successfully treated with ceftolozane/tazobactam.

Traumatic rhabdomyolysis is a clinical and biological syndrome secondary to lysis of striated muscle fibers resulting in extended musculoskeletal damage. An acute muscle damage causes the release of constituent elements of the sarcoplasmic reticulum, such as muscle enzymes, potassium, and myoglobin in plasma circulation; these conditions are at great risk of dangerous systemic complications for life such as hypovolemic shock, hyperkalemia, and acute kidney injury. We describe the case of a patient who suffered a severe musculoskeletal and vascular trauma with elevated creatine kinase values and myoglobinemia treated early with coupled plasma filtration adsorption in order to prevent kidney damage, associated with volume replacement, loop diuretics, and correction of metabolic acidosis.

Background: Malignant tumors arising in the paranasal sinuses, upper maxilla or orbital region sometimes spread to the skull base and the anterior cranial fossa and therefore large craniofacial resections are needed. Many approaches have been described and often include transfacial incisions with deleterious consequences such as non-aesthetic scars, postoperative facial nerve palsy and functional impairment of facial muscles. When the craniofacial resection of a tumor includes an orbital exenteration, a transconjuntival, perilimbic incision can be added to the coronal approach in order to preserve the eyelids and the conjunctiva, avoiding other cutaneous midfacial incisions.

Background: Orthognathic surgery is traditionally linked to orthodontics with brackets. These fixed appliances are almost always an essential complement, but they have many disadvantages and can be regarded as an inconvenience by patients. In the last years, new technologies have enabled the development of more appealing and convenient orthodontic devices, but they are still scarcely used in the orthognathic surgery field.

Severe musculoskeletal injuries induce the release of sarcoplasmic elements such as muscle enzymes, potassium, and myoglobin in the systemic circulation. The circulating myoglobin damages the glomerulus and renal tubules. Conventional haemodialysis is not able to remove myoglobin, due to its high molecular weight (17,8 kilodaltons [kDa]). We treated four traumatic rhabdomyolysis patients with Coupled Plasma Filtration Adsorption (CPFA) in order to remove myoglobin followed by 14 hours of Continuous Veno-Venous Hemofiltration (CVVH). During the treatment, all patients showed clinical improvement with a decrease in muscular (creatine kinase [CK] and myoglobin) and renal (creatinine and potassium) damage indices. One patient, in spite of full renal recovery, died of cerebral haemorrhage on the 26th day of hospital stay.

The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe.

Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological complication associated with several medical conditions and it has been described in clinical findings of seizures, headache, vomiting, altered mental status, and visual changes and focal neurologic deficit, in conjunction with radiological findings of primarily posterior cerebral white matter edema of both cerebral hemispheres. PRES can develop in a wide array situations including pregnancy and postpartum in patients with or without symptoms and signs of eclampsia. A prompt diagnosis of PRES by magnetic resonance imaging and an immediate antihypertensive and anticonvulsant therapy can help to prevent serious complications. The clinical case presented deals with a 35 year-old pregnant woman whose history of eclampsia was observed after a cesarean section.

The scombroid poisoning is due to the ingestion of poorly preserved fish (especially tuna, sardines, and mackerel) out of the cold chain. Under the influence of the proliferation of gram negative bacteria that occurs for heating, the histidine content in the muscle of the fish is converted into histamine, by the action of the enzyme histidine decarboxylase. If the histamine is ingested in large quantities, it causes an anaphylactoid reaction with a variety of symptoms from moderate to severe to life-threating. We will describe two cases that came under our observation after consuming a meal of bluefin tuna. The diagnosis of scombroid syndrome was made on the basis of the anamnestic data and the clinical one. The rapid resolution of the signs and symptoms after treatment with histamines H1-H2 receptor blockers confirmed the suspected diagnosis.

OBJECTIVES We examined the relationships among Body Mass Index (BMI) with or without Metabolic Syndrome (MetS), ICU length of stay (ICU-LOS), duration of mechanical ventilation and mortality among ICU patients. MATERIALS AND METHODS This prospective observational study included all patients hospitalized in a 10-bed polyvalent ICU over a period of one year and seven months. We divided the studied population into 4 groups by BMI values: group A: between 18.5 and 24.9 (n=369); group B1: 25-39.9 without MetS (n=86); B2 group: 25-39.9 with MetS (n=72); group C: >40 (n=42). Major exclusion criteria were: age <18 years, death or cerebral death within 24 hours from ICU admission. The chi square test and the variance analysis were used to compare groups. Variables significantly associated with ICU mortality were entered in a multiple regression model, allowing the determination of independent predictors. RESULTS 620 patients were included in the study. Their SOFA score was between 8 and 15. Significant differences between B1 and B2 subgroups were observed in ICU-LOS (p <0.01), duration of mechanical ventilation (p <0.01) and ICU mortality (p <0.01). We found no statistically significant differences in mortality between B2 and C groups, as well as between A and B1 groups (42.34%/45.15% vs 16.27%/19.07%, respectively). We found that a BMI >25 with MetS was an independent predictive factor of: lower ICU-LOS, lower duration of mechanical ventilation, higher mortality rate. CONCLUSIONS In our study, a BMI >25 with MetS was significantly associated with increased morbidity and mortality in ICU patients.

Resumen: La fascitis nodular es una entidad clínica relativamente poco frecuente caracterizada por una tumoración de crecimiento rápido, aunque de comportamiento clínico benigno y de características histológicas pseudosarcomatosas.Su aparición en el territorio maxilofacial es poco común, por lo que presentamos dos casos que acudieron por nódulos de consistencia dura, indoloros, en las regiones cigomática y paramandibular, que fueron diagnosticados de fascitis nodular.Destacamos estos casos por tratarse de fascitis nodular de localización atípica y revisamos su histopatología.

espanolLa orbitopatia tiroidea es una enfermedad debilitante del sistema visual caracterizada por presentar cambios en los tejidos blandos orbitarios y periorbitarios debidos a un proceso inflamatorio, o a la consecuencia del mismo, y que se relaciona con alteraciones sistemicas de la glandula tiroides. Aparte de las alteraciones esteticas que ocasiona, los pacientes pueden presentar queratitis de repeticion por exposicion, diplopia, dolor retrobulbar, compresion del nervio optico e incluso ceguera. La cirugia constituye el tratamiento definitivo del exoftalmos en la orbitopatia de Graves, mejorando la proptosis y la vision, asi como diminuyendo la sintomatologia ocular, con una morbilidad minima. Presentamos un caso de exoftalmos severo que fue intervenido mediante osteotomia y avance del marco orbitario superior, lateral e inferior, remocion parcial de dos paredes orbitarias y lipectomia. Los resultados esteticos y el alivio de la sintomatologia ocular resultaron satisfactorios. EnglishThyroid-associated orbitopathy is a debilitating disease of the visual system that is characterized by changes in the softtissues of the orbit and periorbita as a result of an inflammatory process, or as a consequence of this, and related to systemic disorders of the thyroid gland. Apart from the aesthetic changes that arise, patients may also present persistent keratitis due to exposure, diplopia, retrobulbar pain, compression of the optic nerve and even blindness. Surgery represents the definitive treatment for exophthalmos in Graves? orbitopathy as improvements are shown in proptosis and vision. A decrease is also experienced in ocular symptomatology and there is minimal morbidity. We present the case of severe exophthalmos that was surgically operated on with an advancement osteotomy of the supero-, lateral- and infraorbital rim, with partial removal of two of the orbital walls with lipectomy. The aesthetic results and the relief of the ocular symptoms were satisfactory.

Material-Method: After ethical comittee approval and informed consent, 25 patients were randomly divided into two groups: EA(n 13), LPSB(n 12). Lumbar plexus block was performed with modified Winnie’s technique and sciatic nerve block was based on Labat’s technique using ropivacaine % 0,375; total dose of 60 mL. EA was performed with loss of resistance technique at L4-5 or L5-S1 interspaces, using ropivacaine % 0,75 20 mL. Spent time to perform block(STB), onset time of sensory block(SOT), onset time of motor block(MOT), degree of motor block(MBD), hemodynamic changes, time to first analgesic requirement(FAT), comfort of surgery, patient and surgeon satisfaction were determined.

Levobupivacaine is a long acting local anesthetic with a clinical profile closely resembling that of bupivacaine; clonidine is an alpha2 agonist broadly used as adiuvant in the peripheral nervous blocks prolonging the postoperative analgesia. The aim of this study was the comparison of clinical profile of brachial plexus block performed with either 0.5% levobupivacaine plus clonidine or 0.5% ropivacaine-clonidine mixture.