RESUMO
Cystic echinococcosis (CE) is an infection caused by the Echinococcus granulosus tapeworm. CE generally manifests in the liver, but it may present in any organ. These patients often first present to the emergency department. Mortality over 10 years is significant for those who go undiagnosed. We report the case of a 34-year-old patient who immigrated from Yemen six years earlier. She presented with acute onset dysuria, suprapubic pain, and fever. Imaging revealed a primary multicystic mass on the right renal pole with a secondary lesion in the right hepatic lobe. On further investigation, the patient's serum was positive for echinococcus antibodies.
RESUMO
OBJECTIVES: To determine the prevalence and clinical significance of early ST segment elevation resolution after primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). BACKGROUND: Despite angiographically successful restoration of coronary flow early during AMI, adequate myocardial reperfusion might not occur in a substantial portion of the jeopardized myocardium due to microvascular damage. This phenomenon comprises the potentially beneficial effect of early recanalization of the infarct related artery (IRA). METHODS: Included in the study were 117 consecutive patients who underwent angiographically successful [Thrombolysis in Myocardial Infarction (TIMI III)] primary PTCA. The patients were classified based on the presence or absence of reduction > or =50% in ST segment elevation in an ECG performed immediately upon return to the intensive cardiac care unit after the PTCA in comparison with ECG before the intervention. RESULTS: Eighty-nine patients (76%) had early ST segment elevation resolution (Group A) and 28 patients (24%) did not (Group B). Group A and B had similar clinical and hemodynamic features before referring to primary PTCA, as well as similar angiographic results. Despite this, ST segment elevation resolution was associated with better predischarge left ventricular ejection fraction (LVEF) (44.7 +/- 8.0 vs. 38.2 +/- 8.5, p < 0.01). Group B patients, as compared with those of Group A, had a higher incidence of in-hospital mortality (11% vs. 2%, p = 0.088), congestive heart failure (CHF) [28% vs. 19%, odds ratio (OR) = 4, 95% confidence interval (CI) 1 to 15, p = 0.04], higher long-term mortality (OR = 7.3, 95% CI 1.9 to 28, p = 0.004 with Cox proportional hazard regression analysis) and long-term CHF rate (OR = 6.5, 95% CI 1.3 to 33, p = 0.016 with logistic regression). CONCLUSIONS: Absence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are less likely to benefit from the early restoration of flow in the IRA, probably because of microvascular damage and subsequently less myocardial salvage.
Assuntos
Angioplastia Coronária com Balão , Eletrocardiografia , Infarto do Miocárdio/fisiopatologia , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Taxa de Sobrevida , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Visualization of the left ventricular cavity from coronary arterioventricular communications is rarely encountered in routine coronary angiography. We report 14 patients, of 5,500 consecutive cardiac catheterizations, in whom these communications were evident during coronary angiography. All 14 patients had angina pectoris; in each the arterioluminal communication originated from the left anterior descending coronary artery. Two patients had evidence of anterior wall ischemia despite a normal left anterior descending coronary artery, suggesting that a possible steal phenomenon is responsible for the myocardial ischemia.
Assuntos
Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Fístula/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Fístula Vascular/diagnóstico por imagem , Idoso , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Acquired left ventricular-right atrial communication due to infective endocarditis was diagnosed in a 64-year-old patient by transesophageal echocardiography and confirmed by cardiac catheterization. The patient was initially treated medically and then referred for corrective surgery.
Assuntos
Ecocardiografia Transesofagiana , Endocardite Bacteriana/complicações , Fístula/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Fístula/etiologia , Átrios do Coração , Cardiopatias/etiologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Cardiac injury caused by elevated levels of circulating catecholamines is a well-known phenomenon. We report a patient who, secondary to transient regional left ventricular dysfunction (despite normal coronary arteries), developed acute pulmonary edema. Echocardiography showed marked anteroapical hypokinesia and an apical thrombus. The diagnosis of pheochromocytoma was made by plasma catecholamine levels, abdominal ultrasound and finally at operation. The patient recovered completely long before surgical intervention was undertaken.
Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Cardiomiopatias/etiologia , Epinefrina/sangue , Norepinefrina/sangue , Feocromocitoma/complicações , Edema Pulmonar/etiologia , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico por imagem , Diagnóstico Diferencial , Ecocardiografia , Hemodinâmica/fisiologia , Humanos , Masculino , Feocromocitoma/sangue , Feocromocitoma/diagnóstico por imagem , Edema Pulmonar/sangue , Edema Pulmonar/diagnóstico por imagem , Função Ventricular Esquerda/fisiologiaAssuntos
Fígado/efeitos dos fármacos , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Humanos , Fígado/enzimologia , Testes de Função Hepática , Estreptoquinase/efeitos adversos , Estreptoquinase/uso terapêutico , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
Two patients are described in whom Streptococcus bovis bacteremia was the only clue to the presence of a colonic neoplasm. A third patient had the rare association of gastric carcinoma and Streptococcus bovis bacteremia that followed an operation for the carcinoma. The need for both complete gastrointestinal survey in patients with Streptococcus bovis bacteremia and administration of appropriate antibiotic prophylaxis during surgical manipulation is emphasized.
Assuntos
Neoplasias Gastrointestinais/complicações , Sepse/etiologia , Infecções Estreptocócicas/etiologia , Idoso , Neoplasias do Colo/complicações , Neoplasias Gastrointestinais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Sepse/prevenção & controle , Neoplasias Gástricas/cirurgia , Infecções Estreptocócicas/prevenção & controleRESUMO
We are reporting a case of epidural abscess complicating bacterial endocarditis. To the best of our knowledge, this association has not been reported before. Streptococcus sanguis was isolated from the blood. A full recovery followed surgery and antibiotic therapy. The relevant characteristics of both diseases are reviewed. No explanation for this rare association is available as yet.