RESUMEN
While treatment of pulmonary infections by Mycobacterium tuberculosis is currently only rarely the cause of iatrogenic complications, treatment of atypical mycobacterial infections often requires prolonged treatment duration, which can lead to toxic optic neuropathies. This review summarizes the indications for such prolonged treatment and risk factors for toxic optic neuropathies when using ethambutol, isoniazid and/or linezolid and proposes customized screening recommendations.
Asunto(s)
Etambutol , Neuropatía Óptica Tóxica , Antituberculosos/efectos adversos , Etambutol/efectos adversos , Humanos , Isoniazida , Linezolid/efectos adversosRESUMEN
The purpose of this study was to assess the Record Power Profile (RPP) of cyclists, i. e., the relationship between different record Power Output (PO) and the corresponding durations through a whole race season. We hypothesized that PO of different effort durations could differ according to the cyclist's category and race performance profile. 17 cyclists (9 professionals and 8 elites) performed all trainings and competitions during 10 months with a mobile power meter device (SRM) mounted on their bike. The results show that the cyclists' RPP is a hyperbolic relationship between the different record PO and time durations. It significantly reflects the characteristics of different skills: (1) sprinters have the highest record PO within zone 5, (2) climbers present the highest record PO within zones 2-3 and, (3) climbers and flat specialists have higher zone 1 record PO than sprinters. These results suggest that the RPP represents "a signature" of the cyclists' physical capacity and that it allows the determination of different training intensities. The RPP appears as a new concept that is interesting for coaches and scientists in order to evaluate performance in cycling.
Asunto(s)
Rendimiento Atlético/fisiología , Ciclismo/fisiología , Resistencia Física/fisiología , Adulto , Humanos , Factores de Tiempo , Adulto JovenRESUMEN
To evaluate incorporation of peripheral artery stents into the arterial wall, we performed angioscopy on 13 patients fitted with Palmaz endoluminal stents. Of the 15 stents inspected, 5 were in the iliac artery, 9 in the femoral artery and 1 in the popliteal artery. The indications for placement were occlusion in 4 cases and high-grade stenosis in 11 cases including 3 restenosis after balloon dilatation and 1 restenosis after surgery. In 9 cases prosthesis insertion was preceded by laser treatment (Trimedyne Nd:YAG Cardiolase 4000). The decision to use a stent was based on radiologic findings in 3 cases (residual stenoses, dissections) and on angioscopic visualization in 7 cases (2 dissections, 5 flaps). In the remaining cases stent placement was performed electively. The only postoperative treatment was antiplatelet therapy (Ticlopidin). At the time of examination, the mean duration of placement was 6 months (extremes: 2 and 12 months). Inspection was made using Sopro-Meadox angioscope with a 0.75 mm probe mounted on an occlusive balloon for stents in the iliac artery and with a 2.2 mm probe with a working channel and sometimes a deflecting device for stents in the femoral or popliteal artery. Angioscopy was successful in all cases. Angiography was always performed at the same time as endoscopy. Endothelialization was observed in all cases. It appeared as a uniform and smooth whitish layer with a thickness proportional to the duration of placement. Endothelialization was most rapid in femoropopliteal arteries, total coverage being achieved within 4 months. Endothelialization took the longest on medial side of the iliac artery which may remain partially exposed after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Prótesis Vascular , Arteria Femoral , Arteria Ilíaca , Claudicación Intermitente/cirugía , Stents , Endoscopía , Endotelio Vascular/fisiología , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Grado de Desobstrucción Vascular/fisiologíaRESUMEN
Rare abnormalities of systemic venous return may be encountered during the implantation of endocardiac pacemakers such as persistent left superior vena cava. Our patient, a 66 year old female, had, primary cardiomyopathy with sinus node dysfunction, left bundle branch block and a cardiothoracic ratio of 0,70. After left subclavian venous puncture the catheter seemed to advance down the left border of the cardiac shadow and a false route was suggested? Angiocardiography was performed immediately and showed a double superior caval system and allowed identification of the right ventricular apex. The electrode was positioned via a left SVC, coronary sinus, right atrium, right ventricle trajectory. Control angiocardiography was performed 1 year later and showed both the left SVC and coronary sinus to be still patent. The follow-up period is now 20 months. There have been 13 other reports of implantation using the left SVC; they include 4 short term failures, one late failure at 23 months, and one fatality after 2 months due to massive thrombosis of the coronary sinus. Seven good results were confirmed with follow-up of 3 to 16 months. The use of "tined" ventricular electrodes reduces the risk of secondary electrode displacement.
Asunto(s)
Marcapaso Artificial , Vena Cava Superior/anomalías , Anciano , Angiocardiografía , Femenino , Estudios de Seguimiento , Humanos , Cuidados Intraoperatorios , Marcapaso Artificial/efectos adversosRESUMEN
The authors report a case of false aneurysm of the posterior subaortic region of the left ventricle after a technically difficult surgical decalcification in a case of aortic stenosis. At reoperation, the surgeon used the femoral artery and both vena cavae for canulation. A direct approach of this "vascular" tumour, which was exterior to the great vessels, confirmed the diagnosis and enabled the localisation of the internal orifice inside the left ventricle. This was closed simply by suturing. No previous cases of this kind were found in the literature. This report underlines the necessity of taking the greatest care when decalcifying this region in order to avoid this type of serious complication.
Asunto(s)
Aneurisma de la Aorta/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Aorta Torácica , Aneurisma de la Aorta/cirugía , Estenosis de la Válvula Aórtica/cirugía , Femenino , Ventrículos Cardíacos , Humanos , Persona de Mediana Edad , ReoperaciónRESUMEN
The value of azygography for detecting extension of cancer of the middle third of the esophagus was assessed in 24 patients. The examination was conducted using the retrograde approach, and results were compared with those obtained by the esophagogram and on tracheobronchial fibroscopy. Compression of the azygos vein is a good indicator of the size of the tumor, which can also be evaluated from esophageal transit examinations. The vein can be invaded or even thrombosed due to severe regional spread but this does not mean that excision of the tumor is impossible. The results of azygography alone, therefore, are not a valid reason for contra-indicating esophagectomy. In case of doubt, tracheobronchial fibroscopy appears to be more suitable for deciding whether the tumor is operable, but azygography can assist in making this decision.
Asunto(s)
Vena Ácigos/diagnóstico por imagen , Neoplasias Esofágicas/diagnóstico , Vena Ácigos/patología , Broncoscopía , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Esófago/diagnóstico por imagen , Femenino , Tecnología de Fibra Óptica , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radiografía , Trombosis/diagnóstico por imagenRESUMEN
An inflatable balloon catheter of the Gruntzig type was used to dilate the urethra of 25 patients. The procedure involves atraumatic catheterization by a vascular catheter under televised urethroscopy, followed by introduction on a flexible guide of the balloon catheter which is then inflated. The stenosis is visible on the balloon and the rapidity with which it "yields" can readily be appreciated. Control of dilatation is effected by voiding urethrography. This method entails much less discomfort than conventional urethral dilatation. No complication was observed in this series. Stenosis recurred in 3 patients who subsequently underwent a second balloon dilatation.
Asunto(s)
Estrechez Uretral/terapia , Cateterismo Urinario/instrumentación , Dilatación/métodos , HumanosRESUMEN
The inferior vena cava (IVC) is a retroperitoneal key organ whose location and integrity must be checked in every scan. Computerized tomography (CT) of IVC provides interesting diagnostic elements which are complementary to the angiographic study: congenital abnormalities, even if they scarcely occur, are nevertheless important to detect, in order to prevent any mistake in the interpretation of the scan. Acquired abnormalities, are frequent. Today CT seems to be the most accurate method of exploration of neoplastic involvement in primary IVC tumors or external compression by retroperitoneal fibrosis. It is a non traumatic method allowing the visualization of the head of a caval thrombus inprecisely defined by phlebo-cavography. To summarize, a good scanning knowledge of the IVC and its abnormalities appears necessary, either to prevent any mistaken interpretation or to specify a pathological element with regard to a vascular exploration.
Asunto(s)
Enfermedades Vasculares/diagnóstico por imagen , Vena Cava Inferior/anomalías , Humanos , Riñón/irrigación sanguínea , Riñón/diagnóstico por imagen , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/diagnóstico por imagen , Leiomiosarcoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vena Cava Inferior/diagnóstico por imagenRESUMEN
The method of treating urethral strictures described in this article is inspired from the technique for percutaneous angioplasty, using an inflatable catheter. It provides good immediate results in 80% of cases, regardless of the localization of the stricture and the previous treatment.
Asunto(s)
Estrechez Uretral/terapia , Dilatación/instrumentación , Humanos , MasculinoRESUMEN
The catheter of an implantable chamber migrated into the pulmonary infundibulum in a patient given chemotherapy for bronchogenic cancer. Current management of such cases is to remove the catheter under pulmonary angiography control using a basket system.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Migración de Cuerpo Extraño/diagnóstico , Bombas de Infusión Implantables/efectos adversos , Antineoplásicos/administración & dosificación , Humanos , Pulmón , Masculino , Persona de Mediana EdadAsunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Hipertensión/etiología , Feocromocitoma/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/complicaciones , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/patología , Humanos , Hiperplasia , Feocromocitoma/complicaciones , Tomografía Computarizada por Rayos XAsunto(s)
Estenosis de la Válvula Aórtica/cirugía , Calcinosis/cirugía , Aneurisma Cardíaco/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Complicaciones Posoperatorias/etiología , Diagnóstico Diferencial , Circulación Extracorporea/efectos adversos , Femenino , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos , Humanos , Persona de Mediana Edad , ReoperaciónRESUMEN
Among the several methods used for the exploration of supra-aortic vessels, none is perfect. The intra-arterial digital subtraction angiography is a secure method. The transbrachial approach for this purpose is a safe and efficient technique. The possible risks at the level of humeral artery can be reduced by applying the method described in the text. We present our experience among 200 patients, using mostly the right brachial artery. The quality of image was good in 3/4 of cases. Humeral artery thrombosis occurred only once. Failure was almost nil. We also suggest preliminary heparinization to reduce the rate of hematoma formation.
Asunto(s)
Atención Ambulatoria , Arteria Braquial , Cateterismo Periférico , Angiografía Cerebral/métodos , Femenino , Humanos , Masculino , Intensificación de Imagen Radiográfica , Técnica de SustracciónRESUMEN
To study the diagnostic possibilities and mechanisms involved in sinus node dysfunction (SND), 26 patients with sick sinus syndrome were evaluated by basic electrophysiological tests before and after autonomic blockade, and by Holter monitoring. Based on intrinsic heart rate (IHR), two groups, a normal and a pathologic one, were separated. With Holter recordings, significant differences were manifested in minimal heart rate during sleeping and also in sinus cycles averaged for 24 h between the two groups. In patients with pathological IHR (n = 9) abnormal intrinsic rhythmicity were verified by electrophysiological means, while we found positive ECGs referring to sinoatrial dysfunction during the first 24 h of rhythm recording. The group of normal IHR (n = 17) covers patients with intrinsic SND (intrinsic SA block, 3/17 patients) and patients (14/17) where the electrophysiologic properties of the pacemaker cells were normal: normal intrinsic recovery time, gradual return to the stable intrinsic sinus cycle length in the postpacing secondary cycles, biphasic postextrasystolic patterns with a well-estimated intrinsic sinoatrial conduction time. Repeated Holter recording (total 26 X 24 h) revealed severe bradycardia (2 cases), SA block (4 cases), SA arrest (2 cases), tachybradyarrhythmia (1 case). Electrophysiological studies have a low diagnostic value in autonomic SND; repeated rhythm monitoring is obviously the best complementary method for appreciating the role and significance of autonomic tone in sick sinus syndrome.
Asunto(s)
Estimulación Cardíaca Artificial , Electrocardiografía , Bloqueo Cardíaco/fisiopatología , Síndrome del Seno Enfermo/fisiopatología , Bloqueo Sinoatrial/fisiopatología , Nodo Sinoatrial/fisiopatología , Adulto , Anciano , Bradicardia/fisiopatología , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Propranolol/farmacologíaRESUMEN
This is a comparative study in 183 patients of the treatment of urethral stenoses by two-stage urethroplasty, internal endoscopic urethrotomy and urethrotomy via the Olbert catheter. Urethroplasty (39 patients) was preferentially carried out in patients with moniliform stenosis greater than 2 cm long in the penile and penoscrotal urethra. There was no significant difference in the indications for the two forms of urethrotomy. Good results were obtained for the 3 techniques in about 80% of cases but there was significantly higher complication rate with surgical urethroplasty. The failure rate of the 3 techniques did not differ significantly. The cost of treatment, on the other hand, greatly differed depending on the technique. Surgical urethroplasty was 2.8 times more costly than internal endoscopic urethrotomy and 10.4 times more costly than Olbert catheter urethrotomy. Olbert catheter urethrothomy was 3.7 times cheaper than internal endoscopic urethrotomy.
Asunto(s)
Complicaciones Posoperatorias , Uretra/cirugía , Estrechez Uretral/cirugía , Humanos , Tiempo de Internación/economía , Métodos , Persona de Mediana Edad , Recurrencia , Reoperación , Estrechez Uretral/economíaRESUMEN
The authors report a case of pheochromocytoma of Zuckerkandl's organ revealed by permanent hypertension. Angiography, combined with the clinical and biological data suggesting a catecholamine secreting tumor, made the diagnosis of pheochromocytoma of Zuckerkandl's organ prior therapy.
Asunto(s)
Sistema Cromafín/diagnóstico por imagen , Cuerpos Paraaórticos/diagnóstico por imagen , Feocromocitoma/diagnóstico por imagen , Angiografía , Femenino , HumanosRESUMEN
Renal angioplasty was performed in twenty hypertensive patients, and good immediate results were obtained in 18 cases. One unsuccessful result was due to insufficient dilatation of a stenosed renal artery, and another from an accident during dissection of the aortic wall in contact with the renal ostium. Repeated dilatation was necessary in two cases following recurrence of stenosis. A high percentage improvement in the hypertension was obtained: 12 cases recovered and there was marked improvement in 4 other patients, treatment being effective, therefore, in 16 of the 20 patients operated upon. The published literature is reviewed, and emphasis placed on the need for treatment by surgeons experienced in angiography examinations, in close collaboration with the medical and surgical team, the later being ready to intervene if the slightest complication of a surgical nature develops.
Asunto(s)
Angioplastia de Balón/métodos , Hipertensión Renal/terapia , Hipertensión Renovascular/terapia , Obstrucción de la Arteria Renal/terapia , Angiografía , Angioplastia de Balón/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors present their experience of Computed Tomography in the staging of abdominal sub-diaphragmatic extension in 144 cases of malignant lymphoma of the lymph nodes (76 cases of Hodgkin's disease and 68 non-Hodgkin lymphomas). The method provides accurate information on sub-mesocolic lymph node involvement, particularly when hypertrophy is pronounced. It may also be used to assess supra-mesocolic extension of the disease, which is inaccessible to lymphography, and to study the size and, mainly, the structure of the liver and spleen tissues. Easy to perform reliable and non-invasive, the scanner constitutes a new and important means of assessing the extension, course and response to treatment of malignant lymphomas.