RESUMEN
A case is reported in which multiple needles were inserted into the heart by a patient, resulting in the unusual combination of a coronary artery-cameral fistula to the left ventricle, an intramural defect of the left ventricular free wall and a ventricular septal defect. This unique lesion was suspected on the basis of two-dimensional and Doppler echocardiography and contrast computed tomographic imaging. Its presence was confirmed during cardiac catheterization and cineangiography.
Asunto(s)
Cuerpos Extraños/complicaciones , Lesiones Cardíacas/etiología , Corazón , Heridas Penetrantes/etiología , Adulto , Cardiomiopatías/etiología , Fístula/etiología , Cuerpos Extraños/diagnóstico , Lesiones Cardíacas/diagnóstico , Humanos , Masculino , Heridas Penetrantes/diagnósticoAsunto(s)
Presión Sanguínea/efectos de los fármacos , Cadmio/farmacología , Corteza Renal/fisiología , Renina/antagonistas & inhibidores , Zinc/farmacología , Animales , Bioensayo , Bovinos , Diálisis , Técnicas In Vitro , Corteza Renal/efectos de los fármacos , Masculino , Renina/análisis , Estimulación QuímicaRESUMEN
We report 6 cases of bile duct strictures in patients receiving intraarterial floxuridine chemotherapy for metastatic colon carcinoma. The computed tomographic and cholangiographic features of these cases mimic those seen with primary sclerosing cholangitis. The postulated mechanism for development of biliary strictures is direct toxicity and/or occlusion of the peribiliary vascular plexus with resultant biliary fibrosis.
Asunto(s)
Enfermedades de los Conductos Biliares/inducido químicamente , Floxuridina/efectos adversos , Neoplasias del Colon/patología , Constricción Patológica , Floxuridina/administración & dosificación , Arteria Hepática , Humanos , Infusiones Intraarteriales , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Estudios RetrospectivosRESUMEN
Fifty-six patients, selected by clinical criteria, underwent angiography for suspected acute mesenteric ischemia. Twenty-nine patients subsequently did not have mesenteric ischemia and had negative arteriograms. Twenty-seven patients had mesenteric ischemia: arterial thrombosis (three), arterial embolus (seven), venous thrombosis (five), vasculitis with thrombosis (one), and nonocclusive ischemia (11). Of these 27 patients, 12 (44%) received intraarterial vasodilator infusions. Overall, 13 (48%) of the 27 patients survived their hospitalization, including five (45%) of 11 with nonocclusive ischemia. This experience confirms that nonocclusive ischemia is the most common form of the disorder diagnosed by angiography. Most patients with mesenteric ischemia are candidates for intraarterial vasodilator therapy. Early angiography in patients with suspected acute mesenteric ischemia permits early diagnosis and differentiation between occlusive and nonocclusive types. Interventional infusion therapy may improve survival.
Asunto(s)
Arterias Mesentéricas/diagnóstico por imagen , Oclusión Vascular Mesentérica/diagnóstico por imagen , Venas Mesentéricas/diagnóstico por imagen , Enfermedad Aguda , Embolia/diagnóstico por imagen , Humanos , Oclusión Vascular Mesentérica/etiología , Persona de Mediana Edad , Poliarteritis Nudosa/diagnóstico por imagen , Radiografía , Trombosis/diagnóstico por imagenRESUMEN
Six elderly patients had percutaneous balloon aortic valvuloplasty for severe, symptomatic calcific aortic stenosis because valve replacement surgery was considered too risky in five patients with severe coexisting cardiac or other medical problems and because one patient refused to have surgery. The procedure resulted in a significant reduction in the mean (+/-SD) aortic valve gradient, from 47 +/- 13 to 32 +/- 12 mm Hg (change, -32%, p less than 0.01), and a significant increase in the mean area of the aortic valve, from 0.64 +/- 0.12 to 0.90 +/- 0.17 cm2 (change, +40%, p less than 0.001). Blood loss from the femoral puncture site was the only major procedural complication. At a mean follow-up of 2 months after the procedure, all patients were alive and dyspnea had improved by two New York Heart Association functional classes in four patients and by one functional class in two patients. A significant short-term increase in aortic valve area and alleviation in symptoms can be achieved safely by percutaneous balloon aortic valvuloplasty in elderly patients with severe calcific aortic stenosis who are at high risk for surgical complications.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/fisiopatología , Calcinosis/terapia , Dilatación/efectos adversos , Dilatación/métodos , Disnea/etiología , Disnea/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , RiesgoRESUMEN
Primary chylopericardium is often a benign asymoptomatic disease, but patients with associated mediastinal lymphatic tumors may develop cardiac tamponade. Lymphangiography demonstrates mediastinal lymphatic abnormalities in these high risk patients on whom subtotal pericardiectomy and thoracic duct ligation should be performed. Since such tumors have been found in half of reported cases and because extrathoracic lymphangiomas may coexist, lymphangiography with skeletal survey is recommended in all cases. These conclusions are based on a review of 31 published cases and an additional case of our own. Lymphangiographic findings were available in 17 of these patients.