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Background: Chemotherapy of acute myeloid leukaemia (AML) can cause a broad spectrum of cardiotoxic effects. Cardiac magnetic resonance (CMR) is key for the diagnosis of eosinophilic myocarditis (EM) defined by the presence of sub-endocardial necrosis and fibrosis. This case report describes the picture of severe triple-vessel ischaemia due to infiltration of eosinophilia without atherosclerotic coronary artery disease (CAD). Case summary: A 57-year-old woman was diagnosed with AML requiring chemotherapy. Three days after initiation of chemotherapy, the patient presented with chest pain and new left ventricular (LV) dysfunction and hyper-eosinophilia. A CMR examination initially was compatible with severe triple-vessel ischaemia. Tissue characterization by CMR was not done due to severe dyspnoea promoting the differential diagnosis of triple-vessel CAD or chemotherapy-induced triple-vessel coronary spasm. However, invasive coronary angiography excluded obstructive CAD. Severe LV dysfunction and troponin elevation persisted arguing against coronary vasospasm. Chemotherapy induced a massive increase in blood eosinophils, and EM was considered as most likely diagnosis. Immunosuppressive treatment improved the patient's status and a CMR later on confirmed the diagnosis of EM. Discussion: Chemotherapy-induced massive eosinophilia can cause widespread coronary micro-vascular infiltration mimicking severe triple-vessel CAD. Early CMR did not evaluate tissue composition, and EM was not considered which delayed adequate treatment. A complete CMR assessment is key to establish the correct diagnosis.
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Dialysis, hemodialysis or peritoneal dialysis, allows the purification of body waste, the elimination of excess water (ultrafiltration) and the restoration of homeostasis. The treatment is nevertheless cumbersome and burdened with multiple constraints that have changed little over the last 70 years. The ecological balance of hemodialysis is also very heavy. Advances, both ecological and technological, have been announced for the next few years, so we will take a look at them.
La dialyse, l'hémodialyse ou la dialyse péritonéale, permettent l'épuration des déchets de l'organisme, l'élimination de l'eau en excès (ultrafiltration) et le rétablissement de l'homéostasie. Le traitement est néanmoins lourd et grevé de multiples contraintes qui n'ont que peu évolué ces 70 dernières années. Le bilan écologique de l'hémodialyse est également très lourd. Des avancées écologiques et technologiques, dont nous faisons un tour d'horizon dans cet article, sont annoncées pour les prochaines années.
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Diálise Peritoneal , Diálise Renal , Humanos , Tecnologia , ÁguaRESUMO
2019 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From new indications for SGLT2 inhibitors and rivaroxaban, to antibiotic duration for Gram negative bacteriemia, passing by the delay for cardioversion of recent-onset atrial fibrillation or for beginning sacubitril/valsartan after stabilization of a cardiac failure, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings: here is their selection of eleven articles, chosen, summarized and commented for you.
L'année 2019 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne hospitalière. Des nouvelles indications pour les inhibiteurs du SLGT2 et le rivaroxaban, à la durée du traitement des bactériémies à Gram négatif en passant par le délai pour la cardioversion d'une fibrillation auriculaire inaugurale ou celui pour introduire du sacubitril/valsartan après stabilisation d'une insuffisance cardiaque, les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre Hospitalier Universitaire Vaudois (CHUV) se réunissent pour partager leurs lectures: voici une sélection de onze articles choisis, revus et commentés pour vous.
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Fibrilação Atrial , Insuficiência Cardíaca , Medicina Interna , Aminobutiratos , Cardioversão Elétrica , Humanos , Medicina Interna/tendências , Publicações Periódicas como Assunto , Rivaroxabana , Tetrazóis , Resultado do TratamentoRESUMO
2018 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From bezafibrate in primary biliary cholangitis to the new Clostridioides difficile guidelines, passing by use of procalcitonine, cristalloids, copeptin and how to administer furosemide, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings : here is their selection of 12 articles, chosen, summarized and commented for you.
L'année 2018 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne. Du bézafibrate dans la cholangite biliaire primitive aux nouvelles recommandations pour le traitement du Clostridioides difficile en passant par l'utilisation de la procalcitonine, des cristalloïdes, de la copeptine et du mode d'administration du furosémide, les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV) se réunissent pour partager leurs lectures : voici une sélection de 12 articles choisis, revus et commentés pour vous.