RESUMO
The complexity of the diagnosis and therapy as well as the deficits in care are presented on the basis of the casuistry of a 75-year-old female patient with giant cell arteritis and a complicative course.
Assuntos
Proteína C-Reativa/análise , Fluordesoxiglucose F18 , Arterite de Células Gigantes , Isquemia/diagnóstico , Idoso , Feminino , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos RadiofarmacêuticosRESUMO
INTRODUCTION: Inhaled drugs can only be effective if they reach the middle and small airways. This study introduces a system that combines a trans-nasal application of aerosols with noninvasive pressure support ventilation. METHODS: In a pilot study, 7 COPD patients with GOLD stages II and III inhaled a radiolabeled marker dissolved in water via a trans-nasal route. The mean aerosol particle size was 5.5âµm. Each patient took part in two inhalation sessions that included two application methods and were at least 70 hours apart. During the first session ("passive method"), the patient inhaled the aerosol through an open tube system. The second session ("active method") included pressure support ventilation during the inhalation process. A gamma camera and planar scintigraphy was used to determine the distribution of aerosol particles in the patient's body and lung. RESULTS: The pressure supported inhalation ("active method") results in an increased aerosol lung deposition compared to the passive method. Above all, we could demonstrate deposition in the lung periphery with relatively large aerosol particles (5.5âµm). DISCUSSION: The results prove that the combination of trans-nasal inhalation with noninvasive pressure support ventilation leads to significantly increased particle deposition in the lung.
Assuntos
Administração por Inalação , Pulmão/metabolismo , Respiração com Pressão Positiva/instrumentação , Doença Pulmonar Obstrutiva Crônica/metabolismo , Radioisótopos/administração & dosagem , Radioisótopos/farmacocinética , Aerossóis , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Tamanho da Partícula , Projetos Piloto , Respiração com Pressão Positiva/métodos , Distribuição TecidualRESUMO
A 59-year-old patient was admitted to hospital with recurrent flush symptoms and pathologically elevated 5-hydroxyindoleacetic acid (5-HIAA) levels in urine. A known cystic lesion of the liver which had been followed for years by ultrasound examinations and was regarded as a bland hepatic cyst was identified as a metastasis of a neuroendocrine neoplasm of the ileum. In two sequential surgical interventions the primary tumor with mesenteric lymph node metastases as well as the cystic liver metastasis could be resected. After surgical treatment an R1 situation at the mesenteric site and suspicious para-aortic lymph nodes remained. The long established treatment of factor-V Leiden mutation by anticoagulation with phenprocoumon was supplemented by deep subcutaneous injection of lanreotide autogel every 4 weeks. Currently, there is no evidence for progressive disease and the patient is without clinical signs of a carcinoid syndrome.
Assuntos
Cistos/diagnóstico , Cistos/prevenção & controle , Rubor/diagnóstico , Rubor/prevenção & controle , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Síndrome do Carcinoide Maligno/diagnóstico , Síndrome do Carcinoide Maligno/terapia , Cistos/complicações , Diagnóstico Diferencial , Rubor/etiologia , Humanos , Neoplasias Hepáticas/complicações , Masculino , Síndrome do Carcinoide Maligno/complicações , Pessoa de Meia-IdadeRESUMO
A 79-year-old patient presented with weight loss, subfebrile body temperature and unclear jaw pain. After ruling out malignant and infectious causes, positron emission tomography-computed tomography (PET-CT) revealed markedly elevated glucose utilization of the large thoracic and upper limb arteries, suggesting systemic vasculitis. Color-coded duplex sonography confirmed thickening of the wall of the external carotid artery consistent with vasculitis. The patient was diagnosed with giant cell arteritis involving the large thoracic arteries and the upper limb arteries but without involvement of the superficial temporal artery. Based on the involvement of the external carotid artery, the jaw pain could be classified as jaw claudication. Clinical and laboratory remission was achieved with systemic glucocorticoids which could subsequently be tapered. The patient is well and asymptomatic 12 months after diagnosis and 2 months without steroids.
Assuntos
Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/prevenção & controle , Doenças Maxilomandibulares/diagnóstico , Doenças Maxilomandibulares/tratamento farmacológico , Idoso , Diagnóstico Diferencial , Arterite de Células Gigantes/complicações , Humanos , Claudicação Intermitente/etiologia , Doenças Maxilomandibulares/etiologia , Masculino , Resultado do TratamentoRESUMO
Solid pseudopapillary neoplasms of the pancreas (SPNs, Gruber-Frantz-Tumor) are a rare entity representing 1-5% of all exocrine pancreatic tumors. The pseudocystic lesions preferentially affect young females <30 years, are mostly benign (â¼90%) and normally present with unspecific symptoms. We describe the case of a 16-years-old Asian woman that was initially diagnosed with an SPN in the pancreatic head with mesenterial and hepatic metastases. After diagnosis, an extensive tumor resection was performed including pyloric-preserving pancreatic head resection followed by sequential resection of all hepatic metastases. After the patient was diagnosed with a hepatic recurrence and high intrahepatic tumor load, we chose a multimodal procedure and performed a selective internal radiotherapy (SIRT). Four years after SIRT and 10 years after initial diagnosis of metastatic SPN, the patient is in a good condition without any evidence for hepatic recurrence. This case represents a rare clinical course of a malignant and invasive SPN with an exceptionally long survival despite of high initial tumor burden. The selective internal radiotherapy is a suitable approach for inducing long-term remissions of the strongly vascularized liver metastases.
Assuntos
Carcinoma Papilar/radioterapia , Neoplasias Hepáticas/radioterapia , Neoplasias Pancreáticas/radioterapia , Adolescente , Carcinoma Papilar/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Adulto JovemRESUMO
Descending necrotizing mediastinitis (DNM) is a primary complication of cervical or odontoiatric infections that can spread to the mediastinum through the anatomic cervical spaces. The delay of the diagnosis or under assessment of the disease, with no adequate draining techniques, results in high mortality up to 20%. We report our experience about 9 clinical cases of DNM observed and surgically treated in our unit from 2000 to 2006; five of these patients were admitted in the last two years. We stress the differences of management of this affection that needs a close cooperation between surgeon, intensive care unit and infectious disease specialist.
Assuntos
Mediastinite , Adulto , Feminino , Humanos , Masculino , Mediastinite/diagnóstico , Mediastinite/patologia , Mediastinite/cirurgia , Mediastino/patologia , Pessoa de Meia-Idade , NecroseAssuntos
Brônquios/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Adulto , Idoso , Bronquiolite Obliterante/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoidose/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
An anomalous systemic pulmonary supply may be acquired and present only one symptom: hemoptysis. The incidence of this pathology is unknown. A case of acquired systemic pulmonary arterialization was observed after surgical intervention of myocardium vascularization with the left mammary artery. The diagnosis was obtained through an arteriography of the left mammary artery. In this case, the therapy consists in ablating the affected parenchyma followed by the interposition of a bovine pericardium patch between the mammary artery and the remaining pulmonary tissue.
Assuntos
Hemoptise/etiologia , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Pulmão/irrigação sanguínea , Angiografia , Animais , Bovinos , Seguimentos , Humanos , Pulmão/cirurgia , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Pericárdio/cirurgia , Pericárdio/transplante , Artéria Pulmonar/diagnóstico por imagem , Fatores de TempoRESUMO
A case of serious haemorragic shock caused by the rupture into the duodenum of a septic aneurysm of the pancreatic-duodenal artery is reported. The diagnostic difficulties and the need to carry on "blind" laparotomies, in these cases, are underlined.