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4.
Proc (Bayl Univ Med Cent) ; 31(1): 67-69, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29686558

RESUMO

Patent foramen ovale (PFO) occurs in 25% of people. The decision on whether to close the PFO found after myocardial infarction and specifically right ventricular infarction is debated, with no solid guidelines addressing this subject. Here we present the case of a 59-year-old man who presented with a myocardial infarction and was found to have PFO. He was treated with revascularization of the culprit artery, followed by supportive care.

7.
Case Rep Pulmonol ; 2016: 2359437, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27190667

RESUMO

Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. We report the case of a twenty-nine-year-old female with Hodgkin's lymphoma who was treated with brentuximab and later presented with severe acute pulmonary toxicity; she improved after the discontinuation of brentuximab and administration of antibiotics and glucocorticoid therapy. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique.

8.
Ther Adv Cardiovasc Dis ; 10(2): 103-10, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26864121

RESUMO

Submassive (intermediate risk) pulmonary embolism (PE) continues to be a significantly morbid disease process that remains unrecognized, inadequately risk stratified and suboptimally treated. Appropriate early clinical and imaging-based risk stratification represents the cornerstone for adequate therapeutic decision making, particularly for the selection of candidates who may benefit the most from systemic thrombolysis. The relevance of estimating clinical prognostic scores, in combination with imaging data, for accurate assessment of right ventricular function and laboratory biomarkers, indicative of myocardial injury for identification of normotensive patients at intermediate risk for an adverse short-term outcome are emphasized in this review. Recent clinical trials have demonstrated improvement in hemodynamics and mortality with the use of systemic thrombolysis among intermediate risk patients; however, it came at the cost of a significantly increased risk of major bleeding. Catheter-based therapies have garnered considerable clinical interest in recent years; of particular note is the ultrasound accelerated catheter-directed thrombolysis which has emerged as a novel and attractive alternative therapeutic modality with an increasing number of single center studies and ongoing randomized trials. Our review focuses on the major trials and studies involved in submassive PE in the recent literature including the role of thrombolytic therapy. We include major trials with reasonable sample size and extensive review of the potential side effects, such as major bleeding.


Assuntos
Fibrinolíticos/administração & dosagem , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Doença Aguda , Cateterismo/métodos , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Seleção de Pacientes , Embolia Pulmonar/patologia , Fatores de Risco , Terapia Trombolítica/efeitos adversos
9.
Proc (Bayl Univ Med Cent) ; 28(3): 350-2, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26130886

RESUMO

Pulmonary veno-occlusive disease (PVOD) represents a rare form of precapillary pulmonary arterial hypertension. We present a young patient hospitalized with progressive dyspnea, with initial workup suggestive of pulmonary hypertension and unexplained noncardiogenic pulmonary edema. His subsequent clinical course was consistent with the diagnosis of PVOD.

10.
Proc (Bayl Univ Med Cent) ; 28(2): 188-90, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25829649

RESUMO

Acute myocarditis can be induced by various concomitant disease processes including infections. Most of these cases are viral in origin; however, bacterial infections are also implicated to a lesser degree. Group A streptococcus is a frequent culprit in bacterial-induced myocarditis. Its diagnosis is suspected by the presence of signs and symptoms of rheumatic fever as established by the Jones criteria. The development and refinement of current diagnostic tools has improved our ability to identify specific pathogens. It has been found that group A streptococcus may be responsible for more cases of infection-induced acute myocarditis than previously thought, and often without the clinical features of rheumatic fever. We present the case of a 43-year-old man hospitalized with chest pain that was initially diagnosed as an acute ST-elevation myocardial infarction. Further evaluation confirmed that his chief complaint was due to acute nonrheumatic streptococcal myocarditis.

13.
Cardiovasc Hematol Agents Med Chem ; 11(4): 289-96, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24655213

RESUMO

Over the last decade advanced therapies for the management of pulmonary arterial hypertension have been introduced. These agents have also been effective in reducing pulmonary vascular resistance in patients with Eisenmenger syndrome. Specific guidelines focusing on modern therapies for Eisenmenger syndrome however do not exist to date. More recently, clinical trials in patients with Eisenmenger syndrome demonstrated a significant clinical improvement with favorable safety and tolerability profile. This review aims to summarize newly reported pharmacological agents used in patients with Eisenmenger syndrome.


Assuntos
Complexo de Eisenmenger/tratamento farmacológico , Antagonistas dos Receptores de Endotelina/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostaglandinas/uso terapêutico , Complexo de Eisenmenger/classificação , Complexo de Eisenmenger/etiologia , Antagonistas dos Receptores de Endotelina/administração & dosagem , Antagonistas dos Receptores de Endotelina/efeitos adversos , Humanos , Hipertensão Pulmonar/classificação , Hipertensão Pulmonar/etiologia , Inibidores da Fosfodiesterase 5/administração & dosagem , Inibidores da Fosfodiesterase 5/efeitos adversos , Guias de Prática Clínica como Assunto , Prostaglandinas/administração & dosagem , Prostaglandinas/efeitos adversos
16.
J Natl Med Assoc ; 100(12): 1485-7, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19110922

RESUMO

Diffuse alveolar hemorrhage is a rare but fatal complication in patients with systemic lupus erythematosus. It has rarely been reported to occur as the initial presentation in lupus patients. We report a 55-year-old female Jehovah's witness who presented with diffuse alveolar hemorrhage as the initial manifestation of systemic lupus erythematosus. She responded favorably to early intravenous pulse methylprednisolone and cyclophosphamide along with hemotherapy she accepted once over the course of her hospital stay. Initially, there was clinical improvement, but relapsing of her alveolar hemorrhage 15 days later. It is important to keep in mind that lupus patients can present initially with this lethal pulmonary complication. Early identification and initiation of therapy are crucial in order to affect survival of these patients.


Assuntos
Hemorragia/etiologia , Pneumopatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Alvéolos Pulmonares , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Alvéolos Pulmonares/diagnóstico por imagem , Alvéolos Pulmonares/patologia , Radiografia
17.
J Natl Med Assoc ; 100(6): 734-6, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18595578

RESUMO

Antiphospholipid syndrome is an autoimmune disease characterized pathophysiologically by the presence of antiphospholipid antibodies and > or =1 clinical manifestation, the most common being venous or arterial thrombosis. We describe the case of a 40-year-old male with unexplained severe pulmonary arterial hypertension with a seven-day history of progressive shortness of breath, hemoptysis, chest discomfort and bilateral pedal edema. Electrocardiographic, echocardiographic and imaging studies showed changes consistent with chronic thromboembolic pulmonary hypertension. Further work-up showed positive anticardiolipin antibodies and lupus anticoagulant with negative features for lupus with negative primary thrombophilic studies as well. The patient was managed adequately with oral anticoagulation with improvement of his clinical status and referred to a tertiary care center to be screened for pulmonary thromboendarterectomy. For patients meeting surgical selection criteria, pulmonary thromboendarterectomy has demonstrated positive outcomes with respect to survival, functionality and quality of life. We discuss the pathophysiology and treatment as well as novel therapies in nonsurgical candidates with chronic thromboembolic pulmonary hypertension in the setting of primary antiphospholipid syndrome.


Assuntos
Síndrome Antifosfolipídica/complicações , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/etiologia , Anticorpos Anticardiolipina/sangue , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Biomarcadores/sangue , Doença Crônica , Diagnóstico por Imagem , Endarterectomia , Humanos , Hipertensão Pulmonar/diagnóstico , Inibidor de Coagulação do Lúpus/sangue , Masculino , Embolia Pulmonar/diagnóstico , Fatores de Risco
18.
Cir Cir ; 75(2): 123-30, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-17511909

RESUMO

Chronic thromboembolic pulmonary hypertension occurs in very few patients who have had history of a previous acute thromboembolic episode. However, its incidence has increased in recent years, actually not being so rare at all. Advances have been made in the pathophysiology, diagnostic approach and therapeutic alternatives as well what can be offered to those patients who are not suitable candidates for pulmonary thromboendarterectomy, which is definitive, curative and the treatment of choice in this subtype of pulmonary arterial hypertension. This review focuses on the diagnostic approach and novel pharmacological therapies in patients who are not candidates for surgery.


Assuntos
Hipertensão Pulmonar/etiologia , Embolia Pulmonar/complicações , Algoritmos , Bosentana , Doença Crônica , Gerenciamento Clínico , Embolectomia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/fisiopatologia , Prostaglandinas/uso terapêutico , Embolia Pulmonar/cirurgia , Sulfonamidas/uso terapêutico , Trombectomia
19.
Cir Cir ; 75(2): 131-8, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-17511910

RESUMO

Pulmonary arterial hypertension (PAH) secondary to chronic thromboembolic obstruction is a severe and potentially fatal condition. At the same time, PAH represents a real diagnostic challenge. This is a lethal disease in which the natural progression in the majority of cases may not be modified by medical therapy. It may be the only etiology radically cured by a complex surgical procedure being performed successfully at ten medical centers worldwide: the pulmonary thromboendarterectomy. More than three decades after the first successful thromboendarterectomy, improvements in technique in medical centers such as the University of California San Diego, in addition to the achieved advances in cerebral and myocardial protection on the past decades, guarantees at present a low morbimortality rate, offering excellent long-term results, improving quality of life and survival of patients. This review is mainly focused on the historical perspective of pulmonary thromboendarterectomy, indications, patient selection, surgical approach and improvements and outcomes obtained at the most experienced centers worldwide.


Assuntos
Endarterectomia , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Doença Crônica , Ensaios Clínicos como Assunto , Feminino , Acesso aos Serviços de Saúde , Humanos , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Taxa de Sobrevida
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