Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
1.
BMC Anesthesiol ; 23(1): 310, 2023 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-37700240

RESUMO

BACKGROUND: Checkpoint inhibitor-induced overlap syndrome ([OS] myocarditis, and myositis with or without myasthenia gravis) is rare but life-threatening. CASES PRESENTATION: Here we present a case series of four cancer patients that developed OS. High troponinemia raised the concern for myocarditis in all the cases. However, the predominant clinical feature differed among the cases. Two patients showed marked myocarditis with a shorter hospital stay. The other two patients had a prolonged ICU stay due to severe neuromuscular involvement secondary to myositis and myasthenia gravis. Treatment was based on steroids, plasmapheresis, intravenous immunoglobulin, and immunosuppressive biological agents. CONCLUSION: The management of respiratory failure is challenging, particularly in those patients with predominant MG. Along with intensive clinical monitoring, bedside respiratory mechanics can guide the decision-making process of selecting a respiratory support method, the timing of elective intubation and extubation.


Assuntos
Miastenia Gravis , Miocardite , Miosite , Insuficiência Respiratória , Humanos , Inibidores de Checkpoint Imunológico , Imunossupressores , Síndrome , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/terapia
2.
Mayo Clin Proc ; 98(3): 451-457, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36868753

RESUMO

There is scant information on the clinical progression, end-of-life decisions, and cause of death of patients with cancer diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death, 3 board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion among the 3 reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit; among them, 61 (11.6%) were nonsurvivors. Among nonsurvivors, 31 (51%) patients had hematologic cancers, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% confidence interval [CI], 11.8 to 18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission; however, 53 (87%) had do-not-resuscitate orders at the time of death. Most deaths were deemed to be COVID-19 related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents die because of their comorbidities, in our study only 1 of every 10 patients died of cancer-related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with nonresuscitative measures rather than full support at the end of life.


Assuntos
COVID-19 , Neoplasias Hematológicas , Neoplasias , Humanos , Causas de Morte , Oncologia
3.
Mo Med ; 108(1): 37-41, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21462609

RESUMO

Reno vascular hypertension (RVH) is an important challenge for clinicians managing patients with hypertension. With recent advances in imaging techniques, the diagnosis and recognition of Renal artery stenosis (RAS) has increased resulting in a 3-4 fold increase in endovascular procedures. Recent prospective, randomized trials have demonstrated equivocal results for interventions and a third trial is under way. In managing such patients, clinicians need to consider the risk-benefit of expensive and invasive workup and interventions.


Assuntos
Hipertensão Renal/diagnóstico , Hipertensão Renal/terapia , Nefrologia/métodos , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/terapia , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Aterosclerose/terapia , Humanos , Hipertensão Renal/epidemiologia , Obstrução da Artéria Renal/epidemiologia , Fatores de Risco
4.
Mediterr J Hematol Infect Dis ; 12(1): e2020044, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670522

RESUMO

The emergence and spread of 2019 novel coronavirus have led to an unprecedented public health crisis around the globe, threatening the lives of millions of people. We report a severe case of COVID-19 in a patient with chronic lymphocytic leukemia and describe primarily the clinical presentation and the challenges encountered in the COVID-19 diagnosis, treatment, and specimens sampling pitfalls. This case highlights the importance of a comprehensive diagnostic approach of pneumonia in immunocompromised hosts, including timely and safe bronchoscopy, because of the broad differential diagnosis, more challenging with the current outbreak of COVID-19.

5.
Hemodial Int ; 16 Suppl 1: S58-61, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23036039

RESUMO

A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high-output congestive heart failure. A right heart catheterization was done, which confirmed elevated right-sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan-Ganz catheter, improved from 37 to 30 mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow-up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post-kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post-transplant patients.


Assuntos
Cateterismo Cardíaco , Débito Cardíaco Elevado , Insuficiência Cardíaca , Transplante de Rim , Diálise Renal , Idoso , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/terapia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Masculino
6.
Cardiorenal Med ; 1(3): 183-192, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22096454

RESUMO

The relationship between hypertension and chronic kidney disease (CKD) is bidirectional in nature and, generally, management strategies for cardiovascular risk reduction also attenuate progression of CKD. Prevalent hypertension increases with diminishing kidney function, and the management strategy changes with level of kidney function. In this review, we will examine the evidence for management of hypertension, as a modifiable risk factor for cardiovascular disease in CKD, and the impact of this management on progression of CKD.

7.
Hemodial Int ; 14 Suppl 1: S38-41, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21040418

RESUMO

It is well known that the uremic milieu predisposes patients to an increased risk of bleeding. We report a case of a patient on hemodialysis who developed recurrent unexplained bleeding episodes. His renal failure was secondary to systemic lupus erythematosus. Further investigations revealed that his bleeding was secondary to the development of acquired inhibitors to factor VIII: C following a flare up of his systemic lupus erythematosus. Management issues related to recurrent bleeding in this situation are discussed and reviewed.


Assuntos
Fator VIII/antagonistas & inibidores , Falência Renal Crônica/metabolismo , Lúpus Eritematoso Sistêmico/metabolismo , Adulto , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Lúpus Eritematoso Sistêmico/complicações , Masculino , Diálise Renal/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA