Assuntos
Reanimação Cardiopulmonar/métodos , Eletrocardiografia , Parada Cardíaca/etiologia , Frequência Cardíaca/fisiologia , Fibrilação Ventricular/complicações , Idoso , Evolução Fatal , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Humanos , Masculino , Fibrilação Ventricular/fisiopatologiaAssuntos
Avalanche , Temperatura Corporal , Parada Cardíaca/terapia , Hipotermia , Reanimação Cardiopulmonar/métodos , Evolução Fatal , Parada Cardíaca/etiologia , Humanos , Hipotermia/complicações , Hipotermia/diagnóstico , Hipotermia/terapia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Reaquecimento/métodos , Termografia/métodosRESUMO
Hiatus hernia (HH) is a frequent condition and is asymptomatic most of the time. Common symptoms can include epigastric pain, postprandial fullness, and nausea. We report a case of postprandial acute right and left heart failure caused by an intrathoracic stomach in a previously asymptomatic woman. Clinical manifestations included acute pulmonary edema and severe hypotension after administration of vasodilators for treatment of acute left heart failure. Chest computed tomography images showed a pre- and afterload compromise caused by a large compressive HH with massive gastric distension. To the best of our knowledge, ours is the first report of both acute right and left heart failure due to an HH. The prompt placement of a nasogastric tube was lifesaving. We believe that the diagnosis of HH ought to be taken into consideration by emergency physicians and included in the differential diagnosis for acute postprandial heart failure.
Assuntos
Insuficiência Cardíaca/etiologia , Hérnia Diafragmática/complicações , Gastropatias/complicações , Idoso de 80 Anos ou mais , Feminino , Hérnia Diafragmática/radioterapia , Humanos , Estômago/diagnóstico por imagem , Estômago/patologia , Gastropatias/diagnóstico por imagem , Gastropatias/patologia , Tomografia Computadorizada por Raios XRESUMO
The definitive diagnosis of several hematological diseases, as for instance leukaemias, unexplained pancytopenias and other bone marrow disorders, requires a bone marrow aspiration and biopsy. Not only haematologists, but also internists, need to master this rather invasive procedure. The knowledge of indications, contra-indications, potential complications and their prevention of its complications is of utmost importance. This article reviews these topics about bone marrow biopsy, giving some practical advices on this procedure.
Assuntos
Biópsia por Agulha Fina/métodos , Medula Óssea/patologia , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/instrumentação , HumanosRESUMO
Acute aortic dissection (AAD) is uncommon, and associated with high morbidity and mortality rates. Positive or negative likelihood ratios of clinical parameters, ECG and chest x-ray do not allow to rule in or rule out AAD. Angio-CT, transoesophageal echocardiography, and MRI are validated tools for AAD diagnosis, although they are invasive and associated with significant complications. In several studies, D-dimer level within the normal range appears to have a negative predictive value that is low enough to rule out AAD. However, flaws of study design, heterogeneity of D-dimer tests and of their cut-offs (from 100 to 900 microg/l), and the absence of a validated workup strategy are strong arguments against the current use of D-dimer as a unique test to rule out AAD in clinical practice.
