RESUMO
A case of trigeminocardiac reflex following nasal packing for epistaxis led to respiratory and cardiac arrest and patient death.
RESUMO
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.
Assuntos
Falso Aneurisma/etiologia , Tronco Braquiocefálico/lesões , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Primitiva , Insuficiência Respiratória/cirurgia , Traqueostomia/efeitos adversos , Evolução Fatal , Humanos , Lacerações/etiologia , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/etiologia , Traqueostomia/métodosRESUMO
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.
Assuntos
Abscesso Pulmonar/complicações , Abscesso Pulmonar/microbiologia , Embolia Pulmonar/etiologia , Veillonella , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Hemoptise/induzido quimicamente , Hipertensão Pulmonar/tratamento farmacológico , Piperazinas/efeitos adversos , Insuficiência Respiratória/induzido quimicamente , Sulfonas/efeitos adversos , Vasodilatadores/efeitos adversos , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Quimioterapia Combinada , Humanos , Unidades de Terapia Intensiva , Masculino , Admissão do Paciente , Piperazinas/uso terapêutico , Purinas/efeitos adversos , Purinas/uso terapêutico , Citrato de Sildenafila , Sulfonas/uso terapêutico , Vasodilatadores/uso terapêuticoRESUMO
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].
Assuntos
Doenças da Aorta/patologia , Fístula Brônquica/patologia , Idoso , Aneurisma Aórtico/patologia , Aterosclerose/patologia , Hemoptise/etiologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Anti-Inflamatórios/uso terapêutico , Vesícula/diagnóstico , Vesícula/tratamento farmacológico , Broncodilatadores/uso terapêutico , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/tratamento farmacológico , Broncoscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Remissão EspontâneaRESUMO
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.
Assuntos
Síndrome Coronariana Aguda/induzido quimicamente , Antineoplásicos Fitogênicos/efeitos adversos , Espasmo Brônquico/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Vimblastina/análogos & derivados , Idoso , Humanos , Masculino , Vimblastina/efeitos adversos , VinorelbinaRESUMO
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.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria/epidemiologia , Angiopatias Diabéticas/prevenção & controle , Retinopatia Diabética/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Apneia Obstrutiva do Sono/prevenção & controle , Estados Unidos/epidemiologia , VeteranosRESUMO
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.
Assuntos
Esclerose Lateral Amiotrófica/complicações , Esclerose Lateral Amiotrófica/diagnóstico , Dispneia/etiologia , Paralisia Respiratória/etiologia , Idoso , Dispneia/terapia , Eletromiografia , Humanos , Masculino , Respiração com Pressão Positiva , Paralisia Respiratória/terapia , VeteranosAssuntos
Transtornos de Deglutição/etiologia , Estenose Esofágica/etiologia , Artéria Subclávia/anormalidades , Malformações Vasculares/complicações , Idoso de 80 Anos ou mais , Transtornos de Deglutição/tratamento farmacológico , Transtornos de Deglutição/patologia , Estenose Esofágica/diagnóstico , Estenose Esofágica/patologia , Humanos , MasculinoRESUMO
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.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Pneumopatias/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Apoptose/efeitos dos fármacos , Feminino , Hospitais de Veteranos , Humanos , Pulmão/citologia , Pulmão/efeitos dos fármacos , Pneumopatias/fisiopatologia , Pneumopatias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados UnidosRESUMO
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.
Assuntos
Peritonite Tuberculosa/diagnóstico , Dor Abdominal/etiologia , Ascite/etiologia , Líquido Ascítico/microbiologia , Biomarcadores/metabolismo , Evolução Fatal , Feminino , Humanos , Icterícia/etiologia , Pessoa de Meia-Idade , Peritonite Tuberculosa/complicaçõesRESUMO
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.
Assuntos
Dacriocistite/diagnóstico , Mucorales/isolamento & purificação , Mucormicose/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Dacriocistite/tratamento farmacológico , Dacriocistite/microbiologia , Dacriocistite/cirurgia , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Mucormicose/cirurgia , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Tazobactam , Tobramicina/uso terapêutico , Vancomicina/uso terapêuticoRESUMO
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.
Assuntos
Parada Cardíaca/etiologia , Hiperfosfatemia/complicações , Soluções Hipertônicas/efeitos adversos , Doença Iatrogênica , Fosfatos/efeitos adversos , Idoso , Constipação Intestinal/tratamento farmacológico , Evolução Fatal , Humanos , MasculinoRESUMO
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.
Assuntos
Anestésicos Locais/efeitos adversos , Benzocaína/efeitos adversos , Cianose/etiologia , Ecocardiografia Transesofagiana/efeitos adversos , Metemoglobina/análise , Metemoglobinemia/etiologia , Idoso , Benzocaína/administração & dosagem , Feminino , Humanos , Fatores de RiscoRESUMO
The occurrence of glomerular disease as a paraneoplastic manifestation of malignancy is well documented in the medical literature. The strongest association is between membranous glomerulonephritis and solid tumors. We report a patient with IgA nephropathy associated with small cell lung cancer. To our knowledge, this is the second documented occurrence of an IgA nephropathy with a casual association with small cell bronchogenic cancer. This observation leads to the hypothesis that IgA nephropathy might be a paraneoplastic manifestation of this histiologic type of lung cancer.
Assuntos
Carcinoma de Células Pequenas/complicações , Glomerulonefrite por IGA/etiologia , Neoplasias Pulmonares/complicações , Síndromes Paraneoplásicas , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
It is now possible to achieve complete remission in the majority of patients with acute promyelocytic leukemia (APL) if all-trans retinoic acid (ATRA) is administered as a single agent or in combination with cytotoxic chemotherapy. Despite its positive influence on recovery, ATRA is not without the potential for toxicity. It is important for clinicians participating in the care of patients undergoing treatment with this drug to be aware of ATRA syndrome and institute the appropriate therapy to reduce the likelihood of an adverse outcome.
Assuntos
Antineoplásicos/efeitos adversos , Insuficiência Respiratória/induzido quimicamente , Tretinoína/efeitos adversos , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/administração & dosagem , Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citarabina/administração & dosagem , Daunorrubicina/administração & dosagem , Dispneia/induzido quimicamente , Feminino , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Insuficiência Respiratória/prevenção & controle , Tretinoína/administração & dosagemRESUMO
Nocardiosis is an infection caused by a soil-borne aerobic micro-organism. The pathogen is most commonly introduced in humans by inhalation into the respiratory tract. This infection may be transient and subclinical or may result in an acute or chronic bronchopulmonary process. Although an unusual cause of pulmonary infection in immunocompentent individuals, human nocardiosis is now documented more often in patients whose cell-mediated immunity is compromised by immunosuppression from comorbid disease or as a result of modern medical intervention. The diagnosis is often elusive unless a high index of suspicion is maintained. We present a patient with localized pulmonary nocardiosis who was immunosuppressed by virtue of a myeloproliferative disorder.
Assuntos
Pneumopatias , Nocardiose , Nocardia asteroides , Nódulo Pulmonar Solitário/etiologia , Idoso , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Biópsia por Agulha , Broncoscopia , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias/diagnóstico , Pneumopatias/diagnóstico por imagem , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Pneumopatias/patologia , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/tratamento farmacológico , Nocardiose/diagnóstico , Nocardiose/diagnóstico por imagem , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Nocardiose/patologia , Nocardia asteroides/isolamento & purificação , Mielofibrose Primária/complicações , Mielofibrose Primária/tratamento farmacológico , Radiografia Torácica , Nódulo Pulmonar Solitário/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Despite the evolution of modern antibiotics, pleural space infection remains a common illness with significant morbidity and mortality. Every year up to 60 percent of the 1.2 million patients in the United States who present with community-acquired pneumonia develop parapneumonic pleural effusions. Few of these parapneumonic effusions progress to an empyema. Interestingly, in about 10 percent of the cases of empyema, no underlying pulmonary infection can be identified. These pleural space infections are called primary empyemas. We present a patient with a primary empyema caused by Streptococcus intermedius. Relatively few studies have investigated primary empyema caused Streptococcus intermedius. This case presentation serves as a reminder to the clinician about primary empyema caused by this micro-organism.