RESUMEN
Pheochromocytoma is a rare tumor that secretes excess catecholamines. Pheochromocytoma crises may be precipitated by the use of several drugs. This article describes the case of a patient affected by pheochromocytoma in whom multiple organ failure developed after contemporary administration of ergotamine, caffeine, and nimesulide. The patient recovered completely long after surgical intervention.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Antiinflamatorios no Esteroideos/efectos adversos , Cafeína/efectos adversos , Ergotamina/efectos adversos , Insuficiencia Multiorgánica/inducido químicamente , Feocromocitoma/complicaciones , Sulfonamidas/efectos adversos , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/cirugía , Adulto , Analgésicos no Narcóticos/efectos adversos , Antihipertensivos/uso terapéutico , Combinación de Medicamentos , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Metoprolol/uso terapéutico , Feocromocitoma/diagnóstico , Feocromocitoma/cirugía , Verapamilo/uso terapéuticoRESUMEN
We report the case of a young woman suffering from colonic mucinous adenocarcinoma with the unusual clinical presentation as a right atrial metastasis. The tumor was successfully resected, and after histopathological characterization, the primary lesion was searched for and discovered. The tumor had the clinical appearance and echocardiographic pattern of a pedunculated atrial myxoma. The aspects of echo-patterns useful for differential diagnosis are discussed.
Asunto(s)
Adenocarcinoma Mucinoso/secundario , Neoplasias del Colon/diagnóstico , Neoplasias Cardíacas/secundario , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patología , Adulto , Biopsia , Neoplasias del Colon/patología , Diagnóstico Diferencial , Ecocardiografía , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , HumanosRESUMEN
Propafenone efficacy in conversion of atrial fibrillation to sinus rhythm has been well documented. In this study we considered propafenone efficacy according to a graduated protocol of administration. Forty-two patients with recent-onset atrial fibrillation, without left ventricular failure, ischemic symptoms and in absence of antiarrhythmical treatment, were treated according to the following protocol: propafenone 1 mg/kg i.v. (5 min) followed, in the non-responder patient group, by a second dose, 0.5 mg/kg i.v. (15 min). Patients with persistent atrial fibrillation received 900 mg/daily of propafenone per os, at home for two days. Thereafter, patients still not restored to sinus rhythm were considered non-responders. Patients who were converted to sinus rhythm received 450 mg daily of the drug (oral administration), at home, as antiarrhythmical prophylaxis, for three months. Thirty-nine patients were converted to sinus rhythm (92.8%), 24 of them after intravenous propafenone (57.2%), and the other 15 (35.6%) after oral administration of the drug. The average heart rate in patients not converted to sinus rhythm with intravenous propafenone was significantly reduced after drug administration, compared to basal values (from 136.4 +/- 18.1 to 107.1 +/- 17.6, p < 0.01), allowing home treatment. No major cardiac effects were observed after infusion, nor after oral administration of propafenone. During a three-month follow-up we observed 3 cases of relapsed atrial fibrillation and 2 discontinued treatments due to minor gastroenteric side effects. In conclusion, propafenone therapy in ambulatory regimen is safe and effective in patients with recent-onset atrial fibrillation. In many patients refractory to IV treatment, further therapeutic success may be achieved following oral propafenone administration.