RESUMO
BACKGROUND: Coronary microvascular impairment may cause myocardial ischemia and systolic dysfunction in patients with idiopathic dilated cardiomyopathy (IDC). PATIENTS AND METHODS: The study included 41 patients with IDC and 33 healthy control subjects. Serum total antioxidant status (TAS), serum interleukin (IL)-6 levels, and tumor necrosis factor (TNF)-α levels were assayed and coronary flow reserve (CFR) was measured in all subjects via echocardiography. RESULTS: High-sensitivity C-reactive protein (hsCRP) levels were significantly higher in patients with IDC than in the control group (3.42 ± 2.14 vs. 1.91± 1.40, p = 0.001). Serum TAS was statistically lower in patients with IDC than in controls (1.23 ± 0.16 vs. 1.77 ± 0.12, p < 0.001). CFR was statistically and significantly lower in the IDC group (2.10 ± 0.39 vs. 3.09 ± 0.49, p < 0.001). The IDC group was subsequently subdivided into two groups according to CFR values, as CFR ≥ 2 and CFR < 2. HsCRP (4.30 ± 2.42 vs. 2.58 ± 1.42, p = 0.01), TNF-α (16.67 ± 8.08 vs. 10.97 ± 1.63, p = 0.01), and IL-6 (7.54 ± 6.16 vs. 3.14 ± 1.10, p = 0.05) values were significantly higher in the CFR < 2 group compared with the higher CFR group. TAS (1.3 ± 0.16 vs. 1.14 ± 0.10, p < 0.001) was significantly lower in the CFR < 2 group. CFR correlated significantly with hsCRP, TAS, red cell distribution width (RDW), IL-6, and TNF-α. CONCLUSION: Plasma proinflammatory cytokine levels are increased in patients with IDC. CFR was impaired as a reflection of impaired coronary microvascular dysfunction in association with increasing plasma proinflammatory cytokine levels and hsCRP levels.
Assuntos
Antioxidantes/análise , Cardiomiopatia Dilatada/sangue , Cardiomiopatia Dilatada/complicações , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/complicações , Citocinas/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Cardiomiopatia Dilatada/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Masculino , Microvasos/diagnóstico por imagem , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia , Adulto JovemRESUMO
Extrapleural haematoma (EH) is a rare clinical condition of which four cases are presented. Different etiologies were encountered. Identical findings were found on the chest X-ray. Two cases were secondary to spontaneous rib fracture and the other two were iatrogenic. Surgical exploration was necessary in one patient following pleural biopsy. Medical treatment and clinical observation were the treatment of choice in the remaining three stable patients.
Assuntos
Hematoma/cirurgia , Toracotomia , Adulto , Diagnóstico Diferencial , Feminino , Fraturas Espontâneas/complicações , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Fraturas das Costelas/complicações , Traumatismos Torácicos/complicações , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/complicaçõesRESUMO
An 80-year-old male patient presented with the chief complaints of a sudden onset of pain in the right lower quadrant and constipation of 3 days' duration. In computerized tomographic examination an aneurysm of right internal iliac artery and an abnormally enlarged descending colon were seen. During an emergency operation a small rupture in the subserosa of the rectosigmoid junction was found.