Diagnóstico y Tratamiento de Tromboembolismo Pulmonar Masivo Mediante Trombectomía Mecánica. Reporte de un caso / Diagnosis and Treatment of Massive Pulmonary Embolism by Means of Mechanical Thrombectomy. Case Report

El Tromboembolismo pulmonar puede considerarse una de las complicaciones más graves en Medic ina. Consiste en la obstrucción de una arteria pulmonar, usualmente secundaria a un trombo. Esta obstrucción condiciona una disminución de la perfusión sanguínea a los alveolos, lo que lleva a la disminución de la oxigenación sanguínea corporal. Entre los síntomas más comunes, podemos obs erv ar disnea, dolor torácico y los signos más comunes son la disminución de la saturación de ox igeno, la taquipnea y la taquicardia. Con las mejoras tecnológicas y las mejoras en la precisión diagnóstica, la tomografía computada se ha convertido en el estudio de elección es pecíficamente, la Angiotomografía de Tórax.

Pulmonary Thromboembolism can be considered one of Medicine's most severe complications. It cons ists in the obstruction of a pulmonary artery, usually caused by a thrombus. This obstruction caus es a reduction of blood flow to the alveoli which consequently diminishes blood oxygenation for the rest of the body. The most common symptoms seen are dyspnea, thoracic pain and the most common clinical signs are tachycardia, tachypnea and a reduction in blood saturation. With the adv ances in technology and the improvements in diagnostic precision, Computed Tomography has become today's gold standard, specifically Computed Angiotomography.

Analysis of coronary angiography related psychophysiological responses.

BACKGROUND: Coronary angiography is an important tool in diagnosis of cardiovascular diseases. However, it is the administration is relatively stressful and emotionally traumatic for the subjects. The aim of this study is to evaluate psychophysiological responses induced by the coronary angiography instead of subjective methods such as a questionnaire. We have also evaluated the influence of the tranquilizer on the psychophysiological responses. METHODS: Electrocardiography (ECG), Blood Volume Pulse (BVP), and Galvanic Skin Response (GSR) of 34 patients who underwent coronary angiography operation were recorded. Recordings were done at three phases: "1 hour before," "during," and "1 hour after" the coronary angiography test. Total of 5 features obtained from the physiological signals were compared across these three phases. Sixteen of the patients were administered 5 mg of a tranquilizer (Diazepam) before the operation and remaining 18 were not. RESULTS: Our results indicate that there is a strong correlation between features (LF/HF, Bk, DN1/DN2, skin conductance level and seg_mean) in terms of reflecting psychophysiological responses. However only DN1/DN2 feature has statistically significant differences between angiography phases (for diazepam: p = 0.0201, for non_diazepam p = 0.0224). We also note that there are statistically significant differences between the diazepam and non-diazepam groups for seg_mean features in "before", "during" and "after" phases (p = 0.0156, 0.0282, and 0.0443, respectively). CONCLUSIONS: The most intense sympathetic activity is observed in the "during" angiography phase for both of the groups. The obtained features can be used in some clinical studies where generation of the customized/individual diagnoses styles and quantitative evaluation of psychophysiological responses is necessary.

Optimisation of contrast medium volume and injection-related factors in CT pulmonary angiography: 64-slice CT study.

OBJECTIVE: To compare the image quality of computed tomography pulmonary angiography (CTPA) obtained with the injection of various low doses of contrast medium (CM) with different injection-related factors. METHODS: A total of 90 patients (42 females, 48 males; 54.3 +/- 18.6 years) undergoing CTPA were included. Three CM protocols, each containing 30 patients, were created. Protocols 1, 2 and 3 consisted of a CM of 60 ml, 55 ml and 50 ml, and a bolus trigger level of 120 HU, 90 HU and 75 HU, respectively. Injection was uniphasic for protocols 1 and 2 (flow rate 5 ml/s), and biphasic for protocol 3 (flow rates 5 and 4 ml/s); with saline flushing afterwards. Enhancement was measured in three central and six peripheral pulmonary arteries. RESULTS: The mean attenuation value for pulmonary arteries was over 250 HU for all protocols. There was no difference between the attenuation levels with the protocols (p > 0.05). The percentage of pulmonary arteries exceeding optimal attenuation (> or =250 HU) showed that protocols 2 and 3 were 90-100% successful (p < 0.05). CONCLUSION: The use of proper injection-related factors during CTPA, such as a low trigger level and a high flow rate with saline injection following a decreased CM volume (55 ml or 50 ml), will enable adequate pulmonary artery contrast enhancement.

Intra-arterial injection of dissolved flunitrazepam tablets.

Intra-arterial application of dissolved tablets is associated with a high risk of tissue necrosis. An early active vasodilatating and recanalising treatment is necessary. We present the case of 21-year-old female who applied three dissolved Flunitrazepam tablets into the ulnar artery and was successfully treated with prostaglandin E1 and recombinant tissue plasminogen activator.

Improvement of cardiac function in thalassemia major treated with L-carnitine.

INTRODUCTION: Heart disease secondary to chronic anemia and hemosiderosis remains the major cause of morbidity and mortality in thalassemic patients. Chronic anemia and the tissue hypoxia it induces impair free fatty acid oxidation and ATP production in myocardial cells. The use of L-carnitine, a butyric acid derivative, may help overcome some of these defects. OBJECTIVE: To investigate the effect of L-carnitine therapy on cardiac function in thalassemia major patients. MATERIALS AND METHODS: Cardiac function was evaluated in 30 patients attending our clinic. The mean (+/-SD) age was 15.87 +/- 3.19 years. The studies we performed included echocardiography, Doppler and multigated equilibrium radionuclide angiography (MUGA). Systolic and diastolic function was evaluated before starting L-carnitine treatment and after 6 months of oral L-carnitine (50 mg/kg/day). RESULTS: Echocardiography studies revealed no significant changes in systolic and diastolic function after L-carnitine therapy (p > 0.05). Analysis of the data taken by MUGA performed in 20 of the patients, however, showed a significant improvement of diastolic function after 6 months of L-carnitine therapy. The mean peak filling rate (end-diastolic volume/s) increased from 3.15 +/- 1.06 to 3.61 +/- 1.68 (p < 0.03). The time to peak (during filling) decreased significantly from 143.45 +/- 42.04 to 117.70 +/- 24.40 s (p < 0.02). Systolic function showed a significant increase in the left ventricular ejection fraction from 58.25 +/- 9.92 to 63.95 +/- 10.11% (p = 0.0001). CONCLUSION: L-carnitine may be an effective drug for improving the cardiac status of thalassemic patients. MUGA is the most accurate technique of those used here for assessing left ventricular function in these patients.

[Thrombolysis-block technique--a new local form of treatment of distal venous and arterial occlusions of the leg]. / Lyseblock-Technik--eine neue lokale Behandlungsform von Unterschenkelvenen- und-arterienverschlüssen.

Lysis-block technique is a new treatment form for deep vein and arterial thrombosis. A strictly local lysis is achieved by using "BIERS blockade" combined with a peripheral intravenous injection of the lytic substance. The new technique is demonstrated on four patients. Two patients had popliteal vein thrombosis. One patient was treated with urokinase. The other patient (unsuccessfully) with urokinase and (subsequently) successfully with rt-PA. In both cases full recanalization of the vessels was achieved. Two patients had occlusions of lower leg arteries. Clinically and angiographically perfusion could be distinctively improved by fibrinolytic treatment with urokinase. Analysis of fibrinogen and plasminogen levels showed no systemic fibrinolytic effect. This was of importance in one patient with a meningioma and in another patient with peptic ulcers of the stomach where otherwise no fibrinolysis would have been possible. Thus, lysis-block-therapy is an important new alternative to systemic fibrinolytic treatment especially in those patients with contraindications for systemic lysis.