RESUMO
Atrial myxoma has been diagnosed on the basis of a characteristic M mode echocardiographic pattern of a mass of echoes appearing, with a lag phase, beneath the anterior leaflet of the mitral or tricuspid valve in diastole. However, this pattern is not specific for an atrial tumor. Two patients are described with tricuspid leaflet endocarditic vegetations whose M mode echocardiograms were strikingly similar to the M mode tracing from a patient with a large right atrial myxoma. In a fourth patient, artifact, resulting from the failure of lateral resolution of the atrial wall, was also capable of producing a mass of echoes appearing, with a lag phase, beneath the anterior tricuspid valve leaflet in diastole. In each patient, two dimensional echocardiography confirmed the presence or absence of a right-sided mass lesion and defined more precisely the location of the echocardiographic density relative to the right atrium and tricuspid valve. Because two dimensional echocardiography is capable of detecting anatomic relations in two distance dimensions and of visualizing movement of intracardiac structures relative to one another in real time, it can play an important role in the identification and differential diagnosis of intracardiac mass lesions.
Assuntos
Ecocardiografia , Endocardite Bacteriana/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Valva Tricúspide , Adulto , Endocardite Bacteriana/fisiopatologia , Feminino , Átrios do Coração , Neoplasias Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/fisiopatologia , Valva Tricúspide/fisiopatologiaRESUMO
This report documents a pulmonary infarction secondary to an angiographically proven pulmonary embolus with complicating aseptic cavitation and pneumothorax. These two rare complications of pulmonary infarction have not previously been clinically or radiographically documented to occur simultaneously. The patient recovered uneventfully.
Assuntos
Pneumotórax/etiologia , Embolia Pulmonar/complicações , Adolescente , Adulto , Idoso , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , RadiografiaRESUMO
The need for routine supplementation of total parenteral nutrition solutions with selenium (Se) has not been clearly defined. Although clinical selenium deficiency in patients on prolonged total parenteral nutrition has been reported, it is rarely observed in the United States. We report a 19-year-old woman with cystic fibrosis who developed muscle pain and weakness after 3 months on total parenteral nutrition which was not supplemented with Se. Coincident with her onset of symptoms, markedly elevated serum creatine kinase values were observed compared to baseline levels. Subsequent evaluations revealed undetectable (less than 0.02 microgram/ml) serum and urine Se levels in this patient. In addition, electromyographic evidence of myositis and nonspecific membrane irritability was documented. Therapy with oral Se rapidly reversed her symptoms and normalized with serum creatine kinase values over a 10-day period. Prolonged treatment with Se was required to achieve normal values of Se in the serum. Patients with severe pancreatic insufficiency, such as cystic fibrosis, may be at risk for clinical Se deficiency if on prolonged total parenteral nutrition without supplementation. Elevated creatine kinase levels should alert physicians to the possibility of Se deficiency in such patients.
Assuntos
Fibrose Cística/terapia , Assistência Domiciliar , Miosite/etiologia , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral/efeitos adversos , Selênio/deficiência , Adulto , Creatina Quinase/sangue , Feminino , Humanos , Miosite/tratamento farmacológico , Selênio/uso terapêutico , Fatores de TempoAssuntos
Curare/efeitos adversos , Glicosídeos Digitálicos/intoxicação , Adulto , Idoso , Fibrilação Atrial/tratamento farmacológico , Edrofônio/efeitos adversos , Eletrocardiografia , Feminino , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Síndrome de Abstinência a SubstânciasAssuntos
Angina Pectoris/terapia , Circulação Assistida , Ponte de Artéria Coronária , Infarto do Miocárdio/prevenção & controle , Adulto , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/fisiopatologia , Angiografia , Arteriosclerose/fisiopatologia , Pressão Sanguínea , Débito Cardíaco , Angiografia Coronária , Eletrocardiografia , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Circulação PulmonarAssuntos
Viscosidade Sanguínea , Corrida Moderada , Corrida , Medicina Esportiva , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Plasma/fisiologia , gama-Globulinas/análiseRESUMO
There has been a marked decline in mortality due to rheumatic fever in the United States. We present evidence for the important role of penicillin in changing the severity of rheumatic carditis, beginning about 1946. Since that year, mortality due to rheumatic carditis has rapidly decreased to zero at the hospital we studied (House of the Good Samaritan, Boston), the rate of loss of all murmurs in patients at the study hospital accelerated simultaneously and exceeded 40 percent by 1970, and the rates of decline in national mortality due to rheumatic carditis accelerated fourfold with the advent of antibiotics. These data, together with reports of recent outbreaks of rheumatic fever, emphasize the importance of continued efforts to diagnose and treat Group A streptococcal pharyngitis.