ABSTRACT
Two cases of cardiogenic shock and pulmonary edema due to acute, severe, silent mitral regurgitation are discussed. The mechanism for the mitral regurgitation was papillary muscle rupture in the setting of acute myocardial infarction. Echocardiography established the presence, severity, and cause of the mitral regurgitation and the associated hyperdynamic left ventricular function in the setting of cardiogenic shock. Transesophageal echocardiography is excellent for assessing the mitral valve in critically ill patients in whom transthoracic echocardiography may be inadequate or misleading. This allowed for emergency mitral valve replacement without prolonged attempts at medical stabilization.
Subject(s)
Echocardiography, Doppler , Heart Rupture, Post-Infarction/etiology , Mitral Valve Insufficiency/complications , Papillary Muscles , Pulmonary Edema/etiology , Shock, Cardiogenic/etiology , Aged , Heart Rupture, Post-Infarction/diagnostic imaging , Heart Rupture, Post-Infarction/surgery , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Pulmonary Edema/diagnostic imaging , Pulmonary Edema/surgery , Shock, Cardiogenic/diagnostic imaging , Shock, Cardiogenic/surgerySubject(s)
Magnetic Resonance Imaging , Pacemaker, Artificial , Aged , Equipment Design , Humans , MaleABSTRACT
Twenty-two patients with inoperable adenocarcinoma of the pancreas were treated with 5-fluorouracil (5-FU), mitomycin C (Mito-C), and 1(-2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (MeCCNU). Fifteen were evaluable by completing 2 months of therapy. Two patients achieved a complete remission with the above combination. A partial remission seen in four other patients, which produced a response rate of 40% of evaluable, and 27% of entered, patients. Three had stable disease. The average time to progression in this study was 8 months. This combination was well tolerated and no deaths were secondary to drug therapy. Mucositis, leukopenia, thrombocytopenia, and hyperpigmentation were the significant toxicities seen in this study. These observations are worthy of further investigation.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Pancreatic Neoplasms/drug therapy , Adenocarcinoma/mortality , Adult , Aged , Aged, 80 and over , Alkylating Agents/administration & dosage , Alkylating Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Clinical Trials as Topic , Drug Administration Schedule , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Humans , Male , Middle Aged , Mitomycin , Mitomycins/administration & dosage , Mitomycins/adverse effects , Pancreatic Neoplasms/mortality , Pilot Projects , Semustine/administration & dosage , Semustine/adverse effectsABSTRACT
Giant cell arteritis is often referred to in the context of polymyalgia rheumatica with temporal artery involvement. There are, however, more malignant forms of presentation of this necrotizing arteritis involving either the great vessels of the aorta or, occasionally, the pulmonary arteries. Our case relates to giant cell arteritis presenting as pulmonary artery obstruction in a patient without polymyalgia rheumatica or extensive aortic or proximal great vessel involvement.