RESUMEN
A case of trigeminocardiac reflex following nasal packing for epistaxis led to respiratory and cardiac arrest and patient death.
Asunto(s)
Anticoagulantes/efectos adversos , Enfermedades Bronquiales/inducido químicamente , Calcinosis/inducido químicamente , Enfermedades de la Tráquea/inducido químicamente , Warfarina/efectos adversos , Enfermedades Bronquiales/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/diagnóstico por imagenRESUMEN
Percutaneous dilatational tracheostomy (PDT) has become an appropriate alternative to conventional surgical tracheostomy. It is now performed worldwide by a diverse array of physician specialists. Although adverse events are relatively uncommon, serious complications can arise from this bedside procedure. We report a patient who suffered life-threatening hemorrhage from a common carotid artery laceration and pseudo-aneurysm formation in the innominate artery following an elective PDT procedure.
Asunto(s)
Aneurisma Falso/etiología , Tronco Braquiocefálico/lesiones , Traumatismos de las Arterias Carótidas/etiología , Arteria Carótida Común , Insuficiencia Respiratoria/cirugía , Traqueostomía/efectos adversos , Resultado Fatal , Humanos , Laceraciones/etiología , Masculino , Persona de Mediana Edad , Insuficiencia Respiratoria/etiología , Traqueostomía/métodosRESUMEN
We are reporting a case of a 63-year-old-male patient with an unusual presentation of multiple lung abscesses. The patient likely had septic pulmonary emboli secondary to periodontal disease. The implicated organism was Veillonella species. Veillonella are anaerobe bacteria that traditionally been considered nonpathogenic flora.
Asunto(s)
Absceso Pulmonar/complicaciones , Absceso Pulmonar/microbiología , Embolia Pulmonar/etiología , Veillonella , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We present a fatal case of aortobronchial fistula due to ruptured atherosclerotic aneurysm of the aorta into the left lower lobe, bronchus. Also, review of the pertinent literature is presented. Fistulas between the aorta and tracheobronchial tree are rare but usually lethal if not treated promptly and timely, as they can cause fatal hemoptysis. Aortobronchial fistulas occur most often in patients who have a history of thoracic vascular surgery. Nevertheless, few cases without previous thoracic surgery, trauma or infectious process of the aorta have been described in the literature. [corrected].
Asunto(s)
Enfermedades de la Aorta/patología , Fístula Bronquial/patología , Anciano , Aneurisma de la Aorta/patología , Aterosclerosis/patología , Hemoptisis/etiología , Humanos , Angiografía por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Sildenafil, usually a well-tolerated drug traditionally used for erectile dysfunction (ED), was recently approved for pulmonary arterial hypertension. In the literature, there are few cases of hemoptysis following sildenafil use for ED; however, to our knowledge, we are reporting the first case of hemoptysis following sildenafil use for pulmonary hypertension. We are documenting a case of a 90-year-old male patient who was admitted to the intensive care unit with hemoptysis and respiratory failure two weeks after he was started on sildenafil.
Asunto(s)
Hemoptisis/inducido químicamente , Hipertensión Pulmonar/tratamiento farmacológico , Piperazinas/efectos adversos , Insuficiencia Respiratoria/inducido químicamente , Sulfonas/efectos adversos , Vasodilatadores/efectos adversos , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/efectos adversos , Aspirina/uso terapéutico , Quimioterapia Combinada , Humanos , Unidades de Cuidados Intensivos , Masculino , Admisión del Paciente , Piperazinas/uso terapéutico , Purinas/efectos adversos , Purinas/uso terapéutico , Citrato de Sildenafil , Sulfonas/uso terapéutico , Vasodilatadores/uso terapéuticoRESUMEN
Spontaneous resolution of giant pulmonary bullae occurs infrequently. The mechanisms responsible for the natural elimination of giant bullae are variable. We report a patient who experienced spontaneous total regression of his giant bulla following intensification of his inhaled bronchodilator and airway anti-inflammatory therapies. This occurrence suggests that smoking cessation and optimization of inhaled bronchodilator and anti-inflammatory therapies should be undertaken before referral for surgical bullectomy. These relatively simple measures may obviate the need for an invasive procedure.
Asunto(s)
Antiinflamatorios/uso terapéutico , Vesícula/diagnóstico , Vesícula/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/tratamiento farmacológico , Broncoscopía , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Remisión EspontáneaRESUMEN
Vinorelbine is a semi-synthetic vinca-alkaloid with a broad spectrum anti-tumor activity. The dose-limiting toxicity of vinorelbine is neutropenia and leucopenia which is seen in majority of the patients. The previous case reports on the cardiac toxicity occurred mainly in combination therapy of vinorelbine with cisplatin or carboplatin. We offer evidence that acute coronary syndrome and resultant diastolic heart failure developed as a result of acute bronchospasm due to intravenous vinorelbine monotherapy.
Asunto(s)
Síndrome Coronario Agudo/inducido químicamente , Antineoplásicos Fitogénicos/efectos adversos , Espasmo Bronquial/inducido químicamente , Neoplasias Pulmonares/tratamiento farmacológico , Vinblastina/análogos & derivados , Anciano , Humanos , Masculino , Vinblastina/efectos adversos , VinorelbinaRESUMEN
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. OBJECTIVE: We studied the link between sleep apnea and microvascular diabetic complications in veterans with type 2 diabetes mellitus (DM-2). DESIGN: A retrospective electronic chart of all veterans referred for sleep studies over a 1-year period was reviewed. Ninety-eight patients with a glycosylated hemoglobin < 6.5% were included in the study. The degree of glycemia (HbA1c) and presence of macro- and microvascular complications were compared with OSAS variables. METHOD: Statistical analysis examined bivariate associations between OSAS variables and metabolic syndrome parameters. RESULTS: The apnea hypopnea index was significantly related to diabetic microvascular complications, particularly retinopathy. Oxygen desaturation was significantly and inversely related to microalbuminuria, microvascular complications, retinopathy, and HbA1c. CONCLUSIONS: Sleep apnea is associated with microvascular complications even in well-controlled DM-2 veterans. CLINICAL IMPLICATIONS: Screening for OSAS should be considered in patients with DM-2.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Angiopatías Diabéticas/epidemiología , Apnea Obstructiva del Sueño/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Albuminuria/epidemiología , Angiopatías Diabéticas/prevención & control , Retinopatía Diabética/epidemiología , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Apnea Obstructiva del Sueño/prevención & control , Estados Unidos/epidemiología , VeteranosRESUMEN
Stiff-person syndrome (SPS) is a rare disorder that affects the central nervous system, being characterized by intermittent episodes of muscle spasms, rigidity, and a significant increase in morbidity and mortality. We report a 29-year-old patient, with left-sided chylothorax and thymoma, who presented with truncal, lower extremities stiffness and painful cramps alleviated by diazepam and opiates. His clinical picture was suggestive of SPS secondary to invasive thymoma. This syndrome is best approached by its early recognition and prompt treatment since a missed diagnosis can have deleterious outcome. An intensive search for the underlying etiology is of utmost importance in the management of SPS. A review of the current literature is also included in this manuscript.
Asunto(s)
Síndrome de la Persona Rígida/epidemiología , Timoma/epidemiología , Adulto , Comorbilidad , Humanos , Masculino , Derrame Pleural/epidemiología , Síndrome de la Persona Rígida/diagnósticoRESUMEN
In Western countries the incidence of amyotrophic lateral sclerosis (ALS) is 1.89 per 100,000 per year and the prevalence is 5.2 per 100,000. The incidence of ALS is lower among African, Asian, and Hispanic ethnicities when compared to Caucasians. The mean age of onset for sporadic ALS is about 60 years and there is a slight male predominance (male to female ratio of 1.5 to 1). Approximately two thirds of patients with ALS have the spinal form of the disease with symptoms presenting in the extremities. Patients typically have evidence of both lower motor neuron degeneration (atrophy, weakness, and fasciculations) and upper motor neuron degeneration (spasticity, weakness, and hyperreflexia). Patients with limb onset ALS typically complain of focal muscle weakness and wasting. The symptoms may start either distally or proximally in the upper and/or lower limbs. Gradually spasticity develops in the weakened atrophic limbs, affecting manual dexterity and gait. Patients with bulbar onset ALS typically present with dysarthria and dysphagia for solid or liquids. Limb symptoms can develop simultaneously with bulbar onset. In the vast majority of patients, limb weakness will occur within 1-2 years of bulbar onset ALS symptoms. A case of bulbar and sporadic limb ALS in a 70-year-old veteran, presenting with right diaphragmatic paralysis and respiratory failure, is presented.
Asunto(s)
Esclerosis Amiotrófica Lateral/complicaciones , Esclerosis Amiotrófica Lateral/diagnóstico , Disnea/etiología , Parálisis Respiratoria/etiología , Anciano , Disnea/terapia , Electromiografía , Humanos , Masculino , Respiración con Presión Positiva , Parálisis Respiratoria/terapia , VeteranosAsunto(s)
Trastornos de Deglución/etiología , Estenosis Esofágica/etiología , Arteria Subclavia/anomalías , Malformaciones Vasculares/complicaciones , Anciano de 80 o más Años , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/patología , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/patología , Humanos , MasculinoRESUMEN
BACKGROUND: Amiodarone (AM) is a widely used anti-arrhythmic medication. Its utility is, however, limited by adverse side effects. The mechanism of amiodarone-induced toxicity (APT) in the lungs is attributed primarily to stimulation of the angiotensin enzyme system leading to lung cell apoptosis and cell death. This mechanism has been demonstrated by in vitro and in vivo experimental animal studies. To date, however, no in vivo human studies have confirmed this mechanism for APT. PURPOSE: This study was undertaken to determine whether angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) offer a protective effect against APT in humans. Demonstration of a protective effect of an ACE-I or ARB would suggest that stimulation of the angiotensin enzyme system may be a key process in APT. DESIGN: An 8-year retrospective analysis of all patients on AM therapy at the James H. Quillen Veterans Affairs Medical Center was undertaken. RESULTS: A total of 1000 patients on AM were identified. One-hundred-and-seventeen were excluded from the study. Five-hundred-and-twenty-four patients were simultaneously on an ACE-I or ARB. The remaining 359 patients were not. Pulmonary toxicity attributed to AM was identified in five and 14 patients with and without concomitant ACE-I or ARB therapy, respectively. The APT rate for the entire patient sample was 2.2%. APT occurred in 1% of patients on an ACE-I or ARB and in 3.9% of patients not taking an ACE-I or ARB. This observed difference in percentage of APT was statistically significant. CONCLUSION: The concomitant use of ACE-I or ARB in patients taking AM appears to offer a protective effect against APT. This observation suggests that the stimulation of the angiotensin enzyme system may play an important role in APT in humans.
Asunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Enfermedades Pulmonares/inducido químicamente , Adulto , Anciano , Anciano de 80 o más Años , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Apoptosis/efectos de los fármacos , Femenino , Hospitales de Veteranos , Humanos , Pulmón/citología , Pulmón/efectos de los fármacos , Enfermedades Pulmonares/fisiopatología , Enfermedades Pulmonares/prevención & control , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados UnidosRESUMEN
Extrapulmonary manifestations of Mycobacterium tuberculosis (MTB) in general, and tuberculous peritonitis (TBP) in particular, have posed complex diagnostic challenges for centuries. Peritoneal tuberculosis is a very rare manifestation of MTB with subtle clinical findings that may result in a significant diagnostic delay, often of more than four months. As the incidence of tuberculosis is declining in developed nations, clinicians may overlook the need to establish an early diagnosis and prompt therapy for this disorder. We present a case of peritoneal tuberculosis and a review of the literature.
Asunto(s)
Peritonitis Tuberculosa/diagnóstico , Dolor Abdominal/etiología , Ascitis/etiología , Líquido Ascítico/microbiología , Biomarcadores/metabolismo , Resultado Fatal , Femenino , Humanos , Ictericia/etiología , Persona de Mediana Edad , Peritonitis Tuberculosa/complicacionesRESUMEN
Mucormycosis is an acute fungal infection in humans that is often fulminant and potentially fatal. It occurs most frequently in immunocompromised individuals. We report a diabetic patient who presented in ketoacidosis with lacrimal sac infection from this organism. To the best of our knowledge, this is only the second patient with dacryocystitis caused by this fungus described in the medical literature. Our patient is unique in that she had no evidence of concurrent sinus involvement. Surgical debridement and antifungal therapy were combined to ensure a successful outcome.
Asunto(s)
Dacriocistitis/diagnóstico , Mucorales/aislamiento & purificación , Mucormicosis/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Dacriocistitis/tratamiento farmacológico , Dacriocistitis/microbiología , Dacriocistitis/cirugía , Inhibidores Enzimáticos/uso terapéutico , Femenino , Humanos , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Mucormicosis/cirugía , Ácido Penicilánico/análogos & derivados , Ácido Penicilánico/uso terapéutico , Piperacilina/uso terapéutico , Tazobactam , Tobramicina/uso terapéutico , Vancomicina/uso terapéuticoRESUMEN
Hypertonic sodium phosphate enemas are available for relief of constipation. They are widely used as colorectal laxatives because of their efficacy and because most patients tolerate the preparation well. Nevertheless, their use has been associated with decreases in intravascular volume as well as measurable changes in serum phosphorus and calcium levels. Usually these effects are transient and cause no ill effects. Severe toxicity may occur when the osmotically active hypertonic phosphate enema is retained or when it is administered to a patient with a decreased glomerular filtration rate. We report an elderly patient with previously normal renal function who developed severe hyperphosphatemia, hypocalcemia, and cardiac arrest after the administration of hypertonic sodium phosphate enemas for the treatment of an ileus. We review the patient characteristics that increase the risk of adverse effects from hypertonic sodium phosphate enemas and emphasize the danger that moderate dehydration poses when considering the use of these cathartics.
Asunto(s)
Paro Cardíaco/etiología , Hiperfosfatemia/complicaciones , Soluciones Hipertónicas/efectos adversos , Enfermedad Iatrogénica , Fosfatos/efectos adversos , Anciano , Estreñimiento/tratamiento farmacológico , Resultado Fatal , Humanos , MasculinoRESUMEN
The transthoracic application of synchronized direct current cardioversion (DCC) is widely used to terminate atrial fibrillation, atrial flutter, and other supraventricular tachyarrhythmia. DCC is a highly effective method for acute restoration of sinus rhythm. Although DCC is a relatively safe and frequently performed procedure, data on potential side effects are very rarely reported in the literature. The most serious complications associated with DCC are thromboembolism and intracranial hemorrhage. The true incidence of postcardioversion pulmonary edema is not known, but it is estimated to occur in 1% to 3% of patients, particularly those with coexistent heart disease. We report on a patient with a structurally normal heart who developed acute pulmonary edema after undergoing DCC. The patient had no evidence of myocardial injury according to an electrocardiogram and cardiac biomarkers. The patient was treated with intravenous diuretics. After 4 days, the pulmonary edema resolved.
Asunto(s)
Fibrilación Atrial/terapia , Cardioversión Eléctrica/efectos adversos , Edema Pulmonar/etiología , Enfermedad Aguda , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Diuréticos/administración & dosificación , Humanos , Hipertensión , Masculino , Persona de Mediana Edad , Miocardio/metabolismo , Miocardio/patología , Edema Pulmonar/tratamiento farmacológicoRESUMEN
Topical anesthesia is routinely employed to facilitate diagnostic and therapeutic procedures that involve the oropharynx. Although this practice is usually safe, there is always the potential that methemoglobinemia might be induced by the topical anesthetic agent. The clinician should consider this possible complication when the patient experiences signs or symptoms of oxygen desaturation in the absence of another explanation. Because methemoglobinemia can be life-threatening, early recognition and treatment are extremely important.
Asunto(s)
Anestésicos Locales/efectos adversos , Benzocaína/efectos adversos , Cianosis/etiología , Ecocardiografía Transesofágica/efectos adversos , Metahemoglobina/análisis , Metahemoglobinemia/etiología , Anciano , Benzocaína/administración & dosificación , Femenino , Humanos , Factores de RiesgoRESUMEN
Strongyloidiasis can present with a wide variety of symptoms and can lead to a potentially fatal hyperinfection. Although any factors that suppress the host defense mechanisms can potentially trigger hyperinfection, prolonged steroid use has been quite well described. A patient with disseminated small cell lung cancer suffered a Strongyloides stercoralis hyperinfection syndrome complicating ectopic adrenocorticotropic hormone (Cushing syndrome). Evaluation revealed lymphopenia, elevated levels of adrenocorticotropic hormone in the setting of elevated cortisol levels, a normal pituitary, and metastatic malignancy. S. stercoralis larval forms were seen in the stool and sputum. At autopsy, S. stercoralis larval forms were seen in the lung along with evidence of metastatic small cell lung carcinoma.