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1.
Bratisl Lek Listy ; 121(3): 230-235, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32115982

RESUMEN

OBJECTIVES: The aim of this study was to analyse survival of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) hospitalized due to an acute right heart failure (ARHF) with emphasis on risk factors and effectiveness of treatment following current guidelines. METHODS: We retrospectively analysed 117 hospitalizations of 70 patients (59 PAH patients; 11 CTEPH patients, mean age 53.1 ± 16.77 years, 54 % females) between 2004 and 2013. RESULTS: 96 cases were hospitalized at cardiology wards (CW) while 21 at intensive care unit (ICU). The overall hospital mortality was 12.8 %, CW mortality was 4 %, and ICU mortality was 52.4 %. Higher risk of in-hospital mortality was associated with younger age, lower sodium levels, severe forms of PAH (heritable PAH, CTD-PAH) and need of PAH combination treatment. The one-year survival from the first ARHF hospitalization was 67.6 % (95 % CI 57.1-80 %), the two-year survival was 41.9 % (95 % CI 30.8-56.9 %). The presence of ascites was a predictor of long-term mortality. CONCLUSIONS: Mortality in patients with PH and ARHF remains very high. Identification of its risk factors could be used as basis of risk-adapted therapy (Tab. 5, Fig. 2, Ref. 14).


Asunto(s)
Insuficiencia Cardíaca , Mortalidad Hospitalaria , Hipertensión Pulmonar , Adulto , Anciano , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/mortalidad , Hospitalización , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/mortalidad , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
2.
Perfusion ; 29(6): 534-8, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24669002

RESUMEN

The adequacy of cerebral blood flow and the level of regional oxygen saturation during CPR and early post-resuscitation phases assuring favorable neurological outcome are not known. We demonstrate the feasibility of cerebral blood flow and oxygenation monitoring by a continuous transcranial Doppler combined with cerebral oximetry in a patient with refractory cardiac arrest treated by extracorporeal life support.


Asunto(s)
Circulación Cerebrovascular , Circulación Extracorporea/métodos , Paro Cardíaco Inducido/métodos , Oximetría/métodos , Ultrasonografía Doppler Transcraneal/métodos , Adulto , Velocidad del Flujo Sanguíneo , Humanos , Masculino
3.
Artículo en Inglés | MEDLINE | ID: mdl-39259187

RESUMEN

BACKGROUND: Bridging from temporary microaxial left ventricular assist device (tLVAD) to durable left ventricular assist device (dLVAD) is playing an increasing role in the treatment of terminally ill heart failure patients. Scant data exits about the best implantation strategy. The aim of this study is to analyze differences in dLVAD implantation technique and effects on patient outcomes. METHODS: Data from 341 patients (19 European centers), between 01/2017 and 10/2022, who underwent bridge to bridge implantation from tLVAD to dLVAD were retrospectively analyzed. The outcomes of the different implantation techniques on cardiopulmonary bypass (CPB), extracorporeal life support (ECLS) or tLVAD were compared. RESULTS: Durable LVAD implantation was performed employing CPB in 70% of cases (n = 238, group 1), ECLS in 11% (n = 38, group 2) and tLVAD in 19% (n = 65, group 3).Baseline characteristics showed no significant differences in age (p = 0.140), BMI (p = 0.388), creatinine (p = 0.659), Meld score (p = 0.190) and rate of dialysis (p = 0.110). Group 3 had significantly less patients with preoperatively invasive ventilation and cardiopulmonary resuscitation before tLVAD implantation (p = 0.009 and p < 0.001 respectively). Concomitant procedures were performed more often in group 1 and 2 compared to group 3 (24%, 37% and 5%, respectively, p < 0.001).The 30-day mortality showed a significant better survival after inverse probability of treatment weighting in group 3, but the 1-year mortality showed no significant differences between groups (p = 0.012 and 0.581, respectively).Post-operative complications like rate of RVAD implantation or re-thoracotomy due to bleeding, post-operative respiratory failure and renal replacement therapy showed no significant differences between groups.Freedom from first adverse event like stroke, driveline infection or pump thrombosis during follow-up was not significantly different between groups.Post-operative blood transfusion within 24-hours were significantly higher in groups 1 and 2 compared to surgery on tLVAD support (p < 0.001 and p = 0.003, respectively). CONCLUSIONS: In our analysis, the transition from tLVAD to dLVAD without further circulatory support did not show a difference in post-operative long-term survival, but a better 30-day survival was reported. The implantation by using only tLVAD showed a reduction in post-operative transfusion rates, right heart failure and the re-thoracotomy rate without increasing the risk of postoperative stroke or pump thrombosis. In this small cohort study, our data supports the hypothesis that we could demonstrate dLVAD implantation on tLVAD is a safe and feasible technique in selected patients.

4.
Prague Med Rep ; 114(1): 9-17, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23547721

RESUMEN

The incidence of post infarction ventricular septal rupture (PIVSR) is decreasing in the last years due to aggressive treatment of myocardial infarction with early percutaneous coronary interventions. As a consequence patients with PIVSR are referred to surgery more often with significant heart failure. The aim of this retrospective study was to assess the influence of these on the operative results and to identify the risk factors of operative mortality. A retrospective analysis of prospectively collected data of patients with the PIVSR admitted to our center from November 2004 to February 2012 was performed. Variables were analyzed using two-dimensional correspondence analysis. There were 25 patients (12 males and 13 females) with mean age 70.2 years (47-82) operated on; 17 (68%) presented with anterior and 8 (32%) with posterior PIVSR. Eighteen patients (72%) had acute heart failure, 13 (52%) presented with cardiogenic shock. Before surgery, intraaortic balloon pump (IABP) had 20 (80%) patients; in 4 (16%) a ventricular assist device was used, either Extracorporeal Membrane Oxygenation (ECMO) or centrifugal pumps as biventricular assist. Operative mortality was 40% (10 pts.). Four patients (12%) had small non-significant recurrent shunt on postoperative echocardiography. Although majority of patients with PIVSR have significant heart failure prior to surgery the operative mortality remains comparable to older studies. Predictors of perioperative death were concomitant surgical reconstruction of the left ventricle, renal impairment before operation, male gender, history of coronary artery disease, PIVSR location posterior, and shock at surgery.


Asunto(s)
Rotura Septal Ventricular/cirugía , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
5.
Resuscitation ; 193: 109993, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37806620

RESUMEN

BACKGROUND: Refractory out-of-hospital cardiac arrest (OHCA) has a poor outcome. In patients, who cannot be rescued despite using advanced techniques like extracorporeal cardiopulmonary resuscitation (ECPR), organ donation may be considered. This study aims to evaluate, in refractory OHCA, how ECPR versus a standard-based approach allows organ donorship. METHODS: The Prague OHCA trial randomized adults with a witnessed refractory OHCA of presumed cardiac origin to either an ECPR-based or standard approach. Patients who died of brain death or those who died of primary circulatory reasons and were not candidates for cardiac transplantation or durable ventricle assist device were evaluated as potential organ donors by a transplant center. In this post-hoc analysis, the effect on organ donation rates and one-year organ survival in recipients was examined. RESULTS: Out of 256 enrolled patients, 75 (29%) died prehospitally or within 1 hour after admission and 107 (42%) during the hospital stay. From a total of 24 considered donors, 21 and 3 (p = 0.01) were recruited from the ECPR vs standard approach arm, respectively. Fifteen brain-dead and none cardiac-dead subjects were ultimately accepted, 13 from the ECPR and two from the standard strategy group. A total of 36 organs were harvested. The organs were successfully transplanted into 34 recipients. All transplanted organs were fully functional, and none of the recipients died due to graft failure within the one-year period post-transplant. CONCLUSION: The ECPR-based approach in the refractory OHCA trial is associated with increased organ donorship and an excellent outcome of transplanted organs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01511666. Registered January 19, 2012.


Asunto(s)
Reanimación Cardiopulmonar , Oxigenación por Membrana Extracorpórea , Trasplante de Órganos , Paro Cardíaco Extrahospitalario , Obtención de Tejidos y Órganos , Adulto , Humanos , Paro Cardíaco Extrahospitalario/terapia , Oxigenación por Membrana Extracorpórea/métodos , Reanimación Cardiopulmonar/métodos , Estudios Retrospectivos
6.
Prague Med Rep ; 113(4): 299-302, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23249662

RESUMEN

The authors present a case of massive lung bleeding following pulmonary endarterectomy (PEA) that was treated with peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO). The patient repeatedly underwent bronchoscopy for airway blood clot obstruction and finally was successfully weaned off the support. The authors discuss the indications for ECMO in treatment of the most serious complications following PEA, and emphasize the importance of echocardiographic evaluation of the right ventricular function in relation to the indicated type of extracorporeal support. Anticoagulation strategy for patients shortly after the major surgery connected to ECMO is also discussed.


Asunto(s)
Endarterectomía , Oxigenación por Membrana Extracorpórea , Hemorragia Posoperatoria/terapia , Arteria Pulmonar/cirugía , Endarterectomía/efectos adversos , Femenino , Humanos , Hipertensión Pulmonar/cirugía , Persona de Mediana Edad
7.
Vnitr Lek ; 58(10): 721-9, 2012 Oct.
Artículo en Cs | MEDLINE | ID: mdl-23121057

RESUMEN

INTRODUCTION: The incidence of cardiovascular (CV) diseases and acute myocardial infarction (AMI) in Czech Republic is de-clining. In spite of this in a proportion of patients AMI occurs in young age. The aim of our project was to assess the character of risk factors, precipitating diseases and the quality of care in young AMI survivors. METHODS: We included 132 patients (97 men and 35 women) in whom AIM with ST elevations occurred before age of 45 years in men and age of 50 years in women. Several results were compared to a control group composed of 84 healthy volunteers of comparable age. We assessed the course of the disease, extent of coronary involvement, subsequent therapy and control of risk factors after 3 years from the index event. RESULTS: Smoking represented the main risk factor - 85% patents were active smokers at the time of AMI and 9% were former smokers, 64% patients had a positive family history of CV disease. We found a higher prevalence of dyslipidemia history in men. In spite of high rate of statin use, laboratory examination during follow-up revealed higher triglyceride values and low levels of HDL-cholesterol in both genders. All together 23% of patients had a history of provoking underlying disease or precipitating factors (inflammatory diseases, malignancies, combined thrombophilias, drug abuse). In total 95% of patients underwent coronary angiography during the acute phase of AMI, the median time from pain onset to intervention was 9 hours. Most patients had single vessel disease, 14% had even coronary angiogram without clinically significant stenosis. The subsequent care was satisfactory concerning the rate of drug prescriptions. However, target lipid values were not reached in 78% patients and blood pressure targets in 37%. CONCLUSIONS: In patients who suffered AMI in young age, risk factors are dominated by smoking and positive family history of CV diseases. One fifth of patients suffer from other underlying disease (inflammatory disease, malignancies, combined thrombophilia) or have another precipitating factor (febrile disease, drug abuse). The acute care seems unsatisfactory due to late arrival of most patients to catheterization laboratories (underestimation of the disease, incorrect initial diagnosis). Subsequent therapy is well composed but lacks in intensity.


Asunto(s)
Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Adulto , Angiografía Coronaria , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Factores de Riesgo , Prevención Secundaria
8.
J Crit Care ; 72: 154162, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36219946

RESUMEN

PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.


Asunto(s)
COVID-19 , Síndrome de Dificultad Respiratoria , Humanos , SARS-CoV-2 , Estudios Retrospectivos , COVID-19/terapia , Síndrome de Dificultad Respiratoria/terapia , Obesidad/complicaciones , Corticoesteroides/uso terapéutico
9.
J Cardiovasc Surg (Torino) ; 52(3): 445-51, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21577197

RESUMEN

Extracorporeal membrane oxygenation (ECMO) is an established rescue treatment option for severe respiratory and cardiac failure in infants and neonates and has recently become widely utilised in adults. ECMO support can be initiated rapidly in an emergency setting both by percutanous implantation and surgically; it allows transportation of patients in cardio-pulmonary collapse and bridging of critically ill patients to be recovered, other support measures or transplantation. The aim of this study was to report authors' initial experience after starting an ECMO program in a university-based cardiac center. The institutionally approved ECMO team bears responsibility for adjudication regarding indication and implementation of ECMO in all patients. Since the establishment of the ECMO team in October 2007, one elective and nine urgent patients in deep cardiogenic and/or ventilatory collapse were treated by ECMO support up to December 2008. Three patients suffered severe acute right heart dysfunction, two patients suffered postcardiotomy refractory cardiogenic shock, two patients had a cardiogenic shock due to postinfarction interventricular septal rupture, two patients experienced severe respiratory failure and one had elective ECMO implantation as a back-up support during high-risk percutaneous coronary intervention. Veno-arterial ECMO was used in eight cases and veno-venous in two cases of isolated respiratory failure. In nine patients, ECMO circuit was instituted by peripheral cannulation, in eight out of nine cases by percutaneous puncture. On one occasion central surgical cannulation was used. In urgent patients, immediate hemodynamic and oxygenation improvement was observed. Average support duration was 6.8 days (range 1-16 days). Five (50 %) patients were successfully weaned from ECMO and survived to hospital discharge. The illness severity in urgent patients defined by SOFA score ranged from 10 to 17, patients dying while on ECMO had higher SOFA scores (14.8±1.6 vs. 10.8±1.5; P=0.0065). Complications included mainly bleeding. ECMO support allows treatment of severely ill patients in imminent cardiovascular and/or ventilatory collapse. Therefore, establishment of an ECMO program in university affiliated cardiac center is fully justified. A multidisciplinary approach is essential. Despite adequate training and education of ECMO team members, this highly invasive therapeutic modality bears an inherent risk of complications.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Cardiopatías/terapia , Hospitales de Enseñanza , Insuficiencia Respiratoria/terapia , Adulto , Anciano , Enfermedad Crítica , República Checa , Oxigenación por Membrana Extracorpórea/efectos adversos , Oxigenación por Membrana Extracorpórea/mortalidad , Femenino , Cardiopatías/etiología , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Evaluación de Programas y Proyectos de Salud , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/fisiopatología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
10.
Physiol Res ; 69(4): 609-620, 2020 08 31.
Artículo en Inglés | MEDLINE | ID: mdl-32584136

RESUMEN

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a technique used in patients with severe heart failure. The aim of this study was to evaluate its effects on left ventricular afterload and fluid accumulation in lungs with electrical impedance tomography (EIT). In eight swine, incremental increases of extracorporeal blood flow (EBF) were applied before and after the induction of ischemic heart failure. Hemodynamic parameters were continuously recorded and computational analysis of EIT was used to determine lung fluid accumulation. With an increase in EBF from 1 to 4 l/min in acute heart failure the associated increase of arterial pressure (raised by 44%) was accompanied with significant decrease of electrical impedance of lung regions. Increasing EBF in healthy circulation did not cause lung impedance changes. Our findings indicate that in severe heart failure EIT may reflect fluid accumulation in lungs due to increasing EBF.


Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Insuficiencia Cardíaca/terapia , Pulmón/fisiopatología , Insuficiencia Respiratoria/patología , Animales , Circulación Coronaria/fisiología , Modelos Animales de Enfermedad , Impedancia Eléctrica , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/patología , Hemodinámica , Insuficiencia Respiratoria/etiología , Porcinos
11.
Vnitr Lek ; 54(6): 609-14, 2008 Jun.
Artículo en Cs | MEDLINE | ID: mdl-18672571

RESUMEN

BACKGROUND: Mild hypothermia (MH) in cardiac arrest survivors has became a routine part of early postresuscitative support. Overcooling is a frequent phenomenon with the unknown outcome. AIM OF THE STUDY: To analyze the incidence and outcome ofovercooling below body core temperature (BT) of 32 degrees C. MATERIAL AND METHODS: We performed retrospective analysis of all 56 consecutive cardiac arrest survivors treated by MH who reached therapeutic BT in the 2nd Department of Internal Medicine, General Teaching Hospital, Prague. MH was initiated as soon as possible after the return of spontaneous circulation to reach BT of 33 degrees C followed by maintainance of BT 32-34 degrees C for 12 hours. Patients were cooled by surface cooling via ice-packs and by interavenous infusion of cold crystaloids. RESULTS: Overcooling below BT of 32 degrees C was observed in 23 patients (41%). This group of patients had more frequently asystole as the initial rhythm (34.8 vs 9.1%), more frequently were cooled by combinatory cooling approach (56.5 vs 27.3%), more frequently had lower baseline BT (35.3 +/- 1.3 vs 36.2 +/- 1.2 degrees C), higher cooling rate (the interval required for a decrease of BT by 1 degrees C 61.5 +/- 53.1 vs 90.1 +/- 50.0 min) (all p < 0.05) than patients with proper profile of BT during MH. Overcooling was independent negative predictor of discharge favourable neurological outcome (OR 0.16, 0.022-0.77, p = 0.037). CONCLUSION: Induction of MH by conventional cooling approach is burdened by high risk of overcooling. This phenomenon is probably associated with worse outcome.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco/terapia , Hipotermia Inducida , Anciano , Temperatura Corporal , Femenino , Humanos , Hipotermia Inducida/efectos adversos , Masculino , Persona de Mediana Edad
13.
Cas Lek Cesk ; 145(4): 269-78, 2006.
Artículo en Cs | MEDLINE | ID: mdl-16639926

RESUMEN

The aim of this review is to provide a comprehensive actual overview of the current approach to acute coronary syndromes diagnostics, therapeutics and secondary prevention. Authors stress early diagnosis, risk stratification, indication and timing of interventional therapy. It is not an intention to provide detailed description of all clinical studies implemented recently in the field of acute coronary syndromes.


Asunto(s)
Angina Inestable/diagnóstico , Angina Inestable/terapia , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Angina Inestable/prevención & control , Humanos , Infarto del Miocardio/prevención & control
16.
Cas Lek Cesk ; 144(6): 405-8; discussion 408-9, 2005.
Artículo en Cs | MEDLINE | ID: mdl-16047843

RESUMEN

The authors present an interesting case report of 69-year-old caucasian woman with Takotsubo cardiomyopathy. Takotsubo cardiomyopathy is a relatively recently described heart syndrome that probably develops due to the direct toxic effect of excessively released catecholamines on cardiac adrenoceptors during emotional or physical stress. The typical features include reversible left ventricular apical dyskinesis, chest pain with ST-T changes on ECG, minimal myocardial enzymatic release and the absence of coronary stenosis on coronary angiogram. Early coronary angiographic examination is highly recommended as the clinical picture of this syndrome mimics acute myocardial infarction. Betablockers are considered to be the treatment of choice.


Asunto(s)
Cardiomiopatías/diagnóstico , Disfunción Ventricular Izquierda/diagnóstico , Anciano , Cardiomiopatías/complicaciones , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Disfunción Ventricular Izquierda/complicaciones
18.
Physiol Res ; 64(Suppl 5): S677-83, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26674293

RESUMEN

The aims were to explore the effect of head-up tilt (HUT) to 30 and 60 degrees on hemodynamics and tissue oxygenation in anesthetized healthy swine. The data serve as a reference for a study of resuscitation efficacy at HUT such as during transport. Nine healthy swine (49+/-4 kg) were anesthetized and multiple sensors including myocardial pressure-volume loops catheter, carotid flow probe, blood pressure catheters, near infrared spectroscopy (NIRS) tissue oximetry and mixed venous oximetry (SVO2) catheter were introduced and parameters continuously recorded. Experimental protocol consisted of baseline in supine position (15 min), 30 degrees HUT (15 min), recovery at supine position (15 min) and 60 degrees HUT (5 min). Vacuum mattress was used for body fixation during tilts. We found that 30 and 60 degrees inclination led to significant immediate reduction in hemodynamic and oximetry parameters. Mean arterial pressure (mm Hg) decreased from 98 at baseline to 53 and 39, respectively. Carotid blood flow dropped to 47 % and 22 % of baseline values, end diastolic volume to 49 % and 53 % and stroke volume to 47 % and 45 % of baseline. SVO2 and tissue oximetry decreased by 17 and 21 percentage points. The values are means. In conclusions, within minutes, both 30 and 60 degrees head-up tilting is poorly tolerated in anesthetized swine. Significant differences among individual animals exist.


Asunto(s)
Anestesia General , Hemodinámica , Intolerancia Ortostática/fisiopatología , Postura , Animales , Presión Arterial , Arterias Carótidas/fisiopatología , Modelos Animales , Intolerancia Ortostática/sangre , Oximetría/métodos , Oxígeno/sangre , Consumo de Oxígeno , Flujo Sanguíneo Regional , Espectroscopía Infrarroja Corta , Posición Supina , Porcinos , Pruebas de Mesa Inclinada , Factores de Tiempo
19.
Int J Cardiol ; 66(2): 225-7, 1998 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-9829341

RESUMEN

We present a patient with severe decompensated esophageal achalasia in whom transthoracic echocardiography revealed compression of the left heart chambers caused by the dilated esophagus representing a posterior mediastinal mass. This case also illustrates the ability of echocardiography to monitor success of treatment of decompensated achalasia. An important role of echocardiography in the diagnosis of mediastinal masses is emphasized.


Asunto(s)
Acalasia del Esófago/complicaciones , Acalasia del Esófago/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Adulto , Resultado Fatal , Humanos , Masculino , Ultrasonografía
20.
Wien Klin Wochenschr ; 113(5-6): 208-11, 2001 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-11293952

RESUMEN

Idiopathic myelofibrosis may be accompanied by portal hypertension. The authors report a 56-year-old man with idiopathic myelofibrosis and splenomegaly complicated by hepatopathy, severe portal hypertension and recurrent variceal bleeding. A transjugular intrahepatic porto-systemic shunt (TIPS) was inserted. Variceal bleeding never recurred. A short episode of encephalopathy, which is a known complication of porto-systemic shunting, ceased promptly after conservative treatment. The patient eventually died six months later due to metabolic deterioration and hepatic failure related to his underlying hematological disease. TIPS is a promising treatment modality for alleviating symptomatic portal hypertension in hematological disorders.


Asunto(s)
Hipertensión Portal/cirugía , Derivación Portosistémica Quirúrgica/métodos , Mielofibrosis Primaria/complicaciones , Biopsia , Várices Esofágicas y Gástricas/etiología , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/etiología , Hígado/patología , Masculino , Persona de Mediana Edad , Derivación Portosistémica Quirúrgica/efectos adversos , Mielofibrosis Primaria/cirugía , Esplenomegalia/etiología , Resultado del Tratamiento
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