RESUMO
INTRODUCTION: The severity of cardiotropic agents overuse is related to the risk of cardiac and hemodynamic life-threatening situations. Toxicity is attributed to their narrow therapeutic spectrum and pharmacodynamic properties. The clinical presentation, however, remains polymorphic and represents a challenge for the emergency physician to relate accountability to the exact agent. AIM: To evaluate epidemiological, clinical and prognostic profile of patients visiting emergency department in whom iatrogeny secondary to cardiotropic use was diagnosed. METHODS: This was a single-center prospective study over 12 months. We included successively all patients aged over 18 years in whom diagnosis of cardiotropic iatrogeny was made. Cardiotropic related drug-induced events were selected after collegial decision making processing. Prognosis was evaluated in terms of severity and mortality at day 30. Univariate analysis was conducted. P<0.05 was significant. RESULTS: We enrolled 51 patients. Median age was 72 years with IQR (25,75) of (62,78). Sex ratio was 0.64. Twenty cases of misuse were identified (39%) with 51% of cases being related to the physician. Accountability of the adverse drug event (ADE) was 51%. The ADE was considered severe in 45% of cases and the death rate on day 30 was 12%. Drug classes were dominated by beta-blockers in 20 patients (39%) and anti-arrhythmic agents (Amiodarone ®) in 18 patients (35%). Beta-blockers were significantly the most incriminated in the occurrence of severe ADE. A double iatrogeny was found in 13 patients (25%). Misuse and physician-related ADE were found to be predictive of the severity of ADE in univariate analysis with respectively: For misuse:(OR brut=22, CI95%=[5.2;93.5] ; p<0.001) and for related physician ADE (OR brut = 3,7 ; CI95%=[1.1;12] ; P= 0.015). Predictive factors of mortality at day 30 in the univariate analysis were: Past renal failure : OR brut 5,8; CI95%[1,3-26,5]; p=0,015 ; misuse with OR brut=16.7, 95% CI=[1.9-143.5], p=0.002 and severe ADE with OR brut=15, 95% CI=[1.75-129], p=0.032. CONCLUSION: This study showed that ADE related to Cardiotropic agents are frequent and remain a serious condition especially in elderly. Betablockers agents were the mostly incriminated therapeutic class in the severity of the clinical condition by its hemodynamic repercussions responsible of a high rate of hospitalizations and mortality. Misuse and physician-related ADE were found to be predictive of the severity. Whereas, occurrence of severe ADE, misuse and past renal failure were predictive of mortality. Moreover, in 51% patients, ADE was preventable and related to the prescription of physician showing the main role of the preventability and the role of the prescriber in the genesis of this severe condition.
Assuntos
Fármacos Cardiovasculares/efeitos adversos , Adulto , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosAssuntos
Isquemia Encefálica/diagnóstico , Imageamento por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Isquemia Encefálica/complicações , Protocolos Clínicos , Humanos , Imageamento por Ressonância Magnética/normas , Seleção de Pacientes , Sensibilidade e Especificidade , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X/normasRESUMO
We report an uncommon localization of mediterranean lymphoma of the terminal ileum in a 28 year-old male patient. Ultrasound and Computed Tomography showed moderate regular and symmetrical intestinal wall thickening simulating Crohn's disease. We highlight the role of computed tomography in the diagnosis, staging and detection of complications.
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Doença de Crohn/diagnóstico , Neoplasias do Íleo/diagnóstico , Doença Imunoproliferativa do Intestino Delgado/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/classificação , Neoplasias do Íleo/complicações , Neoplasias do Íleo/tratamento farmacológico , Doença Imunoproliferativa do Intestino Delgado/classificação , Doença Imunoproliferativa do Intestino Delgado/complicações , Doença Imunoproliferativa do Intestino Delgado/tratamento farmacológico , Masculino , Estadiamento de Neoplasias , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Ultrassonografia MamáriaRESUMO
OBJECTIVE: We report 4 patients with sickle cell anemia presenting with intra-splenic benign nodules corresponding to islands of preserved tissue within splenic ferro-calcinosis. MATERIAL AND METHODS: Ultrasound, CT and MRI findings were evaluated and compared to a follow-up study by ultrasound and CT done after 6 to 12 months. RESULTS: Ultrasound showed multiple well-defined rounded nodules appearing hypoechoic compared to the rest of the spleen that was hyperechoic. On CT, the nodules were homogenous, hypodense relative to the spleen, isodense to the liver in 3 cases and hypodense to the liver in 1 case. On MRI, the nodules appeared relatively hyperintense within low-signal-intensity spleens. The ultrasound and CT follow-up study demonstrated no remarkable change. CONCLUSION: In sickle cell patients, intra-splenic benign nodules corresponding to normal splenic tissue may be identified on imaging studies. The differential diagnosis is discussed.
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Anemia Falciforme/diagnóstico , Esplenopatias/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Adolescente , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Esplenopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Lissencephaly or agyria is a prototype of disorders of neuronal migration, a rare type of hereditary malformation of the brain, which manifests with smooth cerebral surface, poorly defined sylvian fissures with thickened cerebral cortical mantle. A case of an infant with isolated variety is presented highlighting some of the major associated clinical features, which include profound intellectual impairment, seizures and hypotonia that later evolves to spasticity in the 2nd year of life. Morbidity is usually high and mortality is dependent on associated deficits.
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PURPOSE: To evaluate the interest of color Doppler sonography in the watching of therapeutic ligature of hypogastric arteries. PATIENTS AND METHODS: Thirteen female patients presenting a serious haemorrhage in the post-partum and be in managed by bilateral hypogastric ligature, have undergone a systematic protocol of investigation involving a Doppler sonography in the fourth day after intervention and then monthly until repermeabilization of the internal iliac arteries. RESULTS: In all cases, the first exam showed down-side the ligature, a flow inversion with an important pelvic collateral circulation. The next Doppler exams showed repermeabilization of the hypogastric arteries after an average interval of 5 months (extremes: 1 to 6 months). CONCLUSION: Color Doppler showed the resolvent character of therapeutic ligature of the hypogastric arteries and may estimate with sufficient accuracy the interval of repermeabilization.
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Artéria Ilíaca/cirurgia , Hemorragia Pós-Parto/cirurgia , Ultrassonografia Doppler em Cores , Adulto , Circulação Colateral/fisiologia , Feminino , Seguimentos , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiologia , Ligadura , Gravidez , Fluxo Sanguíneo Regional/fisiologia , Sístole , Ultrassonografia de IntervençãoRESUMO
A 72-year-old patient was admitted for exploration of an opacity of the left base discovered fortuitously on a routine chest x-ray. Initial blood tests were normal. Fiberoptic bronchoscopy was normal. Computed tomography (CT) led to the diagnosis of a left kidney which had risen into a retro-cardiac position. Magnetic resonance imaging established the sub-diaphragmatic position of the kidney. Renal excretion was normal on intravenous urography. An ectopic kidney in an intrathoracic position is very uncommon and may raise a major challenge when visualized as a mediastinal or pulmonary opacity. Computed tomography or intravenous urography can provide the diagnosis and magnetic resonance imaging demonstrates its precise sub-diaphragmatic or supra-diaphragmatic position.
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Coristoma/diagnóstico por imagem , Rim , Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Idoso , Coristoma/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Pneumopatias/diagnóstico , Imageamento por Ressonância Magnética , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
We report a case in a patient aged 28 admitted with haemoptysis and dyspnoea. The chest x-ray showed multiple disseminated hydatid cysts throughout the lung fields. Computerized tomography and an abdominal echo found a hydatid cyst of the liver in contact with inferior vena cava which was probably responsible for the secondary pulmonary dissemination. Subsequently there was a multiplication of the lesions with rupture and infection of several cysts. After two years the disease progressed into chronic respiratory failure with the appearance of chronic cor pulmonale. The respiratory state rapidly worsened with several episodes of cardiorespiratory failure. Death occurred six months after the appearance of CPC.
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Equinococose Hepática/complicações , Equinococose Pulmonar/complicações , Doença Cardiopulmonar/parasitologia , Adulto , Doença Crônica , Equinococose Hepática/diagnóstico por imagem , Equinococose Pulmonar/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
A prospective study in 88 consecutive patients with solid hepatic mass was performed to determine the value of ultrasound in the diagnosis of pseudo-tumoral hydatid cyst. Ultrasonography systematically searched 5 evocative signs: hypoechoic spiral, peripheric hypoechoic rim surrounded by an echoic border, daughter cysts, hyperechoic areas with shadowing and/or enhancement of back-wall echos. Diagnosis of pseudo-tumoral hydatid cyst was based upon the association of, at least, 2 signs. The sensitivity of echography was 92.3% and the specificity was 98.3%. Furthermore this study allow us to propose a new, more accurate, definition of the hydatid spiral. However, serologic tests were found to be of little interest.
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Equinococose Hepática/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diagnóstico Diferencial , Equinococose Hepática/diagnóstico , Feminino , Humanos , Hepatopatias/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
We report an unusual case of subcutaneous pseudo-neoplastic focal fat necrosis in a woman with a Mersilen plate placed outside the abdominal wall muscles. To our knowledge, this association has not been previously reported in the radiologic literature. The differential diagnosis using ultrasound and computerized tomography is discussed.
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Músculos Abdominais , Necrose Gordurosa/etiologia , Polietilenotereftalatos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Neoplasias Abdominais/diagnóstico , Idoso , Diagnóstico Diferencial , Necrose Gordurosa/diagnóstico , Necrose Gordurosa/cirurgia , Feminino , Humanos , Próteses e Implantes , Tomografia Computadorizada por Raios XRESUMO
The authors present two cases of oesophageal duplication: tubular in one case and cystic in the other. This rare anomaly was identified in both cases by CT scan. A review of literature is proposed.
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Cistos/diagnóstico por imagem , Doenças do Esôfago/diagnóstico por imagem , Esôfago/anormalidades , Idoso , Cistos/cirurgia , Doenças do Esôfago/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Spontaneous CSF rhinorrhoea, secondary to trauma in the great majority of cases, is very rare (3-4%). The authors report a case of spontaneous CSF rhinorrhoea secondary to an ethmoidal osteodural defect, diagnosed by digital cisternography and confirmed by the surgical operation. The value of digital opaque cisternography and its place in the diagnostic arsenal are discussed.