RESUMO
INTRODUCTION: Soft tissue and bone radionecrosis are rare but serious complications may occur late after radiotherapy. CASE REPORT: We report the case of an 86-year-old woman with a history an infiltrating ductal carcinoma of the left breast, treated by total mastectomy, left axillary dissection and adjuvant radiotherapy. Eighteen years later, the first radionecrosis lesions appeared and grew progressively in a 6-month period. These lesions are deep, involving the anterior aspect of the 4th to the 6th ribs and infiltrating the chest wall to the left cardio-thoracic space communicating largely with the pericardium. During axillary dissection, the neurovascular pedicle of the left latissimus dorsi muscle had been severed. The first part of the operation consisted of performing a left side parietectomy of the thoracic wall with a large resection of pericardial tissue and a small myocardial patch. The second step consisted of repairing the thoracic wall defect with a contralateral musculocutaneous latissimus dorsi flap. CONCLUSION: Due to its significant axis of rotation, the latissimus dorsi muscle flap must be considered in the therapeutic algorithm for covering of contralateral anterior chest wall defects.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Lesões por Radiação/patologia , Lesões por Radiação/cirurgia , Músculos Superficiais do Dorso/transplante , Retalhos Cirúrgicos , Parede Torácica/patologia , Parede Torácica/cirurgia , Idoso de 80 Anos ou mais , Neoplasias da Mama/radioterapia , Feminino , Humanos , Necrose/cirurgiaRESUMO
PURPOSE: The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization. METHODS: We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256). RESULTS: Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16-0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17-0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01-6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20-8.03, P = 0.03) of MRSA AI with the use of P/T. CONCLUSION: Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.
Assuntos
Antibacterianos/uso terapêutico , Clorexidina/uso terapêutico , Intubação/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Mupirocina/uso terapêutico , Infecções Estafilocócicas/prevenção & controle , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Quimioterapia Combinada/métodos , Feminino , França , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Polimixinas/uso terapêutico , Infecções Estafilocócicas/microbiologia , Tobramicina/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Since the first description of Hashimoto's Encephalitis (HE) in 1966 by Lord Brain, the number of reported cases has continued to increase. In addition, cases of status epilepticus have been reported, suggesting a role for intensive care unit (ICU) practitioners in taking care of patients with HE. METHODS: A retrospective cohort study in ICU patients with HE was performed at the University Hospital of Tours, France. RESULTS: Eight HE cases were admitted to the ICU between 1/1/2000 and 1/1/2012. Herein, we describe the characteristics of the patients, with an emphasis on ICU disease management and its outcome. CONCLUSION: ICU practitioners should be aware of this disease, since it can include life-threatening presentations.
Assuntos
Encefalopatias/diagnóstico , Cuidados Críticos/métodos , Doença de Hashimoto/diagnóstico , Estado Epiléptico/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/complicações , Encefalopatias/terapia , Estudos de Coortes , Encefalite , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estado Epiléptico/etiologiaRESUMO
Chronic postsurgical neuropathic pain (CPSNP) is frequent. While prevalence varies considerably according to type of operation and means of evaluation, it can reach 37% following breast surgery. Identification of risk factors related to the procedure and to the patient and taking into account the development of new, minimally invasive surgical techniques is increasingly nerve-sparing and reduces the likelihood of injury. CPSNP diagnosis in daily practice is facilitated by simple and quickly usable tools such as the NP4 4-question test. Management is based on pharmacological (analgesics, antiepileptics, antidepressants, local anesthetics) and non-pharmacological (kinesitherapy, neurostimulation, psychotherapy) approaches. In light of the present review of the literature, the authors, who constitute an expert group specialized in pain management, anesthesia and surgery, express their support for topical treatments (lidocaine, capsaicin) in treatment of localized postsurgical neuropathic pain in adults.
Assuntos
Neuralgia/terapia , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Adulto , Humanos , Medição da Dor , Fatores de RiscoRESUMO
INTRODUCTION: The diagnosis of the pulmonary forms of Goodpasture's syndrome is not easy and requires a renal biopsy when no anti-glomerular basement membrane antibodies are detected, since the disease can lead to spontaneous massive intra-alveolar haemorrhage that can be fatal. Treatment for the pulmonary-renal form combining corticosteroids, cyclophosphamide and plasmapheresis should be applied to the pulmonary form to control haemorrhage and prevent relapse. CASE REPORT: We report the case of a patient suffering from the localised pulmonary form of Goodpasture's syndrome in whom the diagnosis was delayed due to a negative indirect immunofluorescent antibody bioassay. After a serious early relapse remission was achieved with comprehensive treatment and a tobacco withdrawal programme. CONCLUSION: If there is no delay in diagnosis and comprehensive treatment is given, the prognosis for these patients is good with a recovery rate of 80 to 90%.
Assuntos
Doença Antimembrana Basal Glomerular/diagnóstico , Pneumopatias/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Doença Antimembrana Basal Glomerular/terapia , Hemorragia/etiologia , Humanos , Pneumopatias/terapia , Masculino , Plasmaferese , Abandono do Hábito de FumarRESUMO
INTRODUCTION: The presence of a psychiatric disorder during the course of an organic disease is a common cause of delayed diagnosis. CASE REPORT: We report a 16-year-old girl who was admitted with thrombocytopenia and had a two-year history of neuropsychiatric disorder which was attributed to a difficult family situation. Neurological examination showed a frontal lobe disorder and extrapyramidal manifestations. The thrombocytopenia was attributed to liver cirrhosis. These neurological and hepatic injuries were consistent with a metabolic disease, most likely Wilson disease. This was supported by the presence of a corneal Kayser-Fleischer ring and a decreased ceruloplasmin concentration. An urgent liver transplantation was required due to worsening neurological symptoms. CONCLUSION: Wilson disease is a rare genetic disease caused by copper toxicity. It is characterized by combined hepatic and neurologic damage to varying degrees and can develop at any age. Urgent treatment is required, but the diagnosis may be delayed by prevailing psychiatric symptoms.
Assuntos
Equimose/diagnóstico , Degeneração Hepatolenticular/diagnóstico , Adolescente , Diagnóstico Tardio , Diagnóstico Diferencial , Equimose/etiologia , Equimose/terapia , Feminino , Degeneração Hepatolenticular/complicações , Degeneração Hepatolenticular/terapia , Humanos , Transplante de Fígado , Imageamento por Ressonância MagnéticaRESUMO
We report the case of a patient with streptococcal mitral endocarditis discovered following an ischaemic cerebrovascular accident. The clinical evolution was marked by the progressive development of a mycotic aneurysm. Surveillance was performed with repeated angio-MRI which provided an indication for embolisation. We demonstrate the value and the current quality of angio-MRI for the diagnosis of mycotic aneurysms, and the value of active management of these lesions which present a high risk of rupture and which are associated with a significant excess mortality. Embolisation can allow earlier cardiac surgery for haemodynamically unstable patients and for those whose neurological state until now contra-indicated intervention.
Assuntos
Aneurisma Infectado/terapia , Embolização Terapêutica , Aneurisma Intracraniano/terapia , Infecções Estreptocócicas/terapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Management of non-small cell lung cancer (NSCLC) is getting better and results on long-term survival have improved. We reviewed the modifications observed in surgery over a 32-year time period. PATIENTS AND METHOD: Data of 6105 patients who underwent surgery from 1979 to 2010 were analyzed over three equal time-periods: gender, age, type of surgery, histology, pTNM, tobacco addiction, comorbidity and time periods. RESULTS: Age, number of females and high-risk patients with comorbidity (including the history of a previous cancer) increased with time periods. Number of exploratory thoracotomy (7.7 % to 1.6 %) and pneumonectomy (48 % to 18 %) decreased. Number of wedge resection (0.5 % to 6 %) and lobectomy (42 % to 64 %) increased. Rates of the other types of resection were unchanged. Neoadjuvant treatments accounted for more than 20 % of patients in the last time period. Postoperative mortality (4 %) did not vary but non-lethal complication rates increased (16.9 % to 27.7 %). Global 5-year survival rates dramatically increased with time going from 37.4 % to 49.8 % (P<10(-6)). Survival improvement was observed in the different components of the pTNM and whatever the type of treatment. However, survival was affected by increasing age and multiplication of comorbidities but without impairing the general better outcome trend. CONCLUSION: NSCLC itself, its diagnostic and therapeutic management, and patient's characteristics evolved with time. Survival improved in most studied prognosis factors. Time period factor was of paramount importance and might be included in research dealing with NSCLC.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/epidemiologia , Idoso , Carcinoma Pulmonar de Células não Pequenas/classificação , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , História do Século XX , História do Século XXI , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Inverse gas chromatography (IGC) is an alternative technique to determine the specific surface area of natural fibres. Natural fibres have a complex surface chemistry and unique microstructure that challenge the current capabilities to perform surface characterisation. This study investigated the influence of multiple parameters on the measured Brunauer-Emmett-Teller (BET) specific surface area for samples of flax, kenaf and BioMid(®) cellulose fibres using IGC. The BET surface area of kenaf and flax differed with 0.51m(2)g(-1) and 1.35m(2)g(-1) respectively, the former being similar to the cellulose fibres (0.54m(2)g(-1)). The data was calculated under conditions where the BET equation showed good linearity (R(2)⩾0.995). Repeatability was excellent so that two runs sufficed to obtain representative BET surface area values. The findings showed the choice of solvent was important for all specimens to avoid any misleading data comparison due to molecular orientation effects that impact the adsorbent-adsorbate interactions. The higher surface area of the flax sample, and its higher variability, was correlated with a higher surface roughness observed under optical microscopy. Packing the chromatography column with long or chopped fibres produced results that were statistically insignificant.
Assuntos
Celulose/análise , Linho/química , Hibiscus/química , Cromatografia Gasosa/métodos , Propriedades de SuperfícieRESUMO
OBJECTIVES: Non-small cell lung carcinoma (NSCLC) with N1 involvement is associated with 5-year survival rates ranging from 7% to 55%. Numerous factors have been independently reported to explain this heterogeneous prognosis, but their relative weight on long-term survival is unknown. METHODS: Patients who underwent surgical resection for NSCLC in two French centers from 1993 to 2010 were prospectively recorded and retrospectively reviewed. The overall survival (OS) of patients undergoing first-line surgery for pN1 disease was analyzed according to the type of extension, number of metastatic LN, number and anatomic location of metastatic stations. RESULTS: The study group included 450 patients (male 80.2%, mean age 63.3 ± 9.9 years, 5-year overall survival 46%). The number of metastatic station was 1 in 340 (75.6%, single-station disease) and ≥2 in 110 patients (24.4%, multi-station disease). The number of metastatic stations was correlated with the number of metastatic LN (p < .001), and associated with adverse OS (p = .0014). The presence of intralobar metastatic LN (station 12-13-14) was associated with a mechanism of direct extension (p < .001), but did not impact OS (p = .71). The location of metastatic stations was of prognostic significance only in case of multi-station disease, with hilar (station 10) involvement being associated with adverse OS (p = .005). The 110 patients with multi-station pN1 disease and the 134 patients operated on for single-station pN0N2 (skip-N2) disease during the study period yield comparable outcome (p = .52). CONCLUSIONS: In patients with resected pN1 NSCLC, the number of metastatic stations and their location in case of multi-station disease have a prognostic value.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Linfonodos/patologia , Pneumonectomia , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos RetrospectivosRESUMO
A case of shock and pulmonary embolism in a 57-year-old woman is described in which hemodynamics were unresponsive both to usual therapy (volume loading, dobutamine, thrombolysis) and then to norepinephrine. Epinephrine proved to be effective, above all by strong beta 1-inotropic effect.
Assuntos
Epinefrina/uso terapêutico , Embolia Pulmonar/complicações , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/etiologia , Baixo Débito Cardíaco/etiologia , Dilatação Patológica/etiologia , Dobutamina/uso terapêutico , Feminino , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/etiologia , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Proteínas Recombinantes , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Função Ventricular DireitaRESUMO
Infection with Rhodococcus equi has been described as a cause of cavitary pneumonia in AIDS patients. We report such a case, complicated by bacteremia, tamponade, and possible brain and liver abscesses. Medical treatment was successful with pericardiocentesis and antibiotherapy with teicoplanin, gentamicin, clarithromycin, rifampicin, supplemented by empirical treatment of cerebral toxoplasmosis. Antibiotherapy was terminated after 6 months, without relapse 2 months later.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por Actinomycetales/complicações , Tamponamento Cardíaco/etiologia , Pneumonia Bacteriana/complicações , Rhodococcus equi , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções por Actinomycetales/tratamento farmacológico , Adulto , Antibacterianos , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/terapia , Quimioterapia Combinada/uso terapêutico , Humanos , Masculino , Pericardiectomia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , RadiografiaRESUMO
OBJECTIVE: To report cardiotoxicity of buflomedil. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Five patients admitted to the hospital since 1985 for buflomedil poisoning. The amount ingested was known for only three patients (3-10.8 g). RESULTS: The five young women were admitted to the hospital because of generalized seizures or myoclonic jerks. Cardiac arrest (asystole) occurred for two of them on admission, 1 and 3 h after ingestion. Electrocardiogram revealed atrio-ventricular and intraventricular conduction abnormalities, increased QT interval and flattened T wave, decreasing after sodium bicarbonate infusion in two cases. The patients received mechanical ventilation, gastric lavage, oral activated charcoal, and clonazepam or valproic acid for convulsions or myoclonic jerks. Epinephrine was administered for cardiac arrest. Sodium bicarbonate was infused in one patient on the basis of slightly prolonged QRS duration and in two patients due to cardiac arrest. Clinical outcome was good and without sequelae for all five patients after a few days in the intensive care unit. CONCLUSION: Clinical and electrocardiographic symptomatology of buflomedil poisoning suggests direct cardiotoxicity, which could be related to possible sodium antagonist properties.
Assuntos
Coração/efeitos dos fármacos , Pirrolidinas/intoxicação , Vasodilatadores/intoxicação , Adolescente , Adulto , Coma , Eletrocardiografia , Feminino , Parada Cardíaca/etiologia , Humanos , Pirrolidinas/farmacologia , Convulsões , Vasodilatadores/farmacologiaRESUMO
The authors report a case of refractory non-infectious circulatory shock with catecholamine and massive fluid loading-resistant features related to hypopituitarism. A 76-year-old man was admitted for shock after suffering from gastroenteritis for 3 days. He was pale and had sparse axillary and pubic hair and small testes. Right catheterization showed shock with low preload pressure and a low oxygen extraction ratio relevant for septic shock. Ultrasound tomography revealed a distended gallbladder due to a stone without peritoneal effusion. A non-inflammatory hydrops of the gallbladder was removed surgically. No microorganism was isolated. Cerebral computed tomography (CT) scan showed a pituitary mass. In the post-surgical period the shock became uncontrollable. Cortisol replacement therapy was instituted and clinical and hemodynamic improvement occurred after 2 h. Hormonal screening on admission before catecholamine administration showed a major decrease in all the hypothalamic-pituitary hormone concentrations. The patient died on day 15 with multiple organ failure. Hypopituitarism, probably owing to pituitary adenoma, was the only disease identified in this case. Hormone replacement therapy dramatically improved the clinical and hemodynamic status, although the role of an abdominal sepsis could not be eliminated. Arguments that pituitary hormone deficiency might increase the hemodynamic consequences of adrenal deficiency are discussed.
Assuntos
Adenoma/complicações , Candidíase/complicações , Estado Terminal/terapia , Hipopituitarismo/complicações , Neoplasias Hipofisárias/complicações , Choque Séptico/etiologia , Idoso , Diagnóstico Diferencial , Evolução Fatal , Hemodinâmica , Humanos , Hipopituitarismo/diagnóstico , Masculino , Respiração ArtificialRESUMO
OBJECTIVE: To assess the incidence and to evaluate the feasibility of inter-unit continuous surveillance of intensive care unit (ICU)-acquired infections. DESIGN: Prospective multicentre, longitudinal, incidence survey. SETTING: Five ICUs in university hospitals in western France. PATIENTS: All patients admitted to the ICU during two 3-month periods (1994-1995). MEASUREMENTS AND RESULTS: The main clinical characteristics of the patients, ICU-acquired infections, length of exposure to invasive devices and the micro-organisms isolated were analysed. The study included 1589 patients (16970 patient-days) and the infection rate was 21.6 % (13.1 % of patients). The ventilator-associated pneumonia rate was 9.6 %, sinusitis 1.5 %, central venous catheter-associated infection 3.5 %, central venous catheter-associated bacteraemia 4.8 %, catheter-associated urinary tract infection 7.8 % and bacteraemia 4.5 %. The incidence density rate of ICU-acquired infections was 20.3% patient-days. Ventilator-associated pneumonia and sinusitis rates were 9.4 and 1.5% ventilation-days, respectively. Central venous catheter-associated infection and central venous catheter-associated bacteraemia rates were 2.8 and 3.8% catheter-days, respectively. The catheter-associated urinary tract infection rate was 8.5% urinary catheter-days and the bacteraemia rate 4.2% patient-days. Six independent risk factors for ICU-acquired infection were found by stepwise logistic regression analysis: absence of infection on admission, age > 60 years, length of stay, mechanical ventilation, central venous catheter and admission to one particular unit. A total of 410 strains of micro-organisms were isolated, 16.8 % of which were Staphylococcus aureus (58.0% methicillin-resistant). CONCLUSION: This prospective study using standardised collection of data on the ICU-acquired infection rate in five ICUs identified six risk factors. It also emphasized the difficulty of achieving truly standardised definitions and methods of diagnosis of such infections.
Assuntos
Infecção Hospitalar/epidemiologia , Controle de Infecções/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Relações Interinstitucionais , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/etiologia , Estudos de Viabilidade , Feminino , França , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Fatores de RiscoRESUMO
The mechanisms leading to shunting through a patent foramen ovale include high right-sided cardiac pressures and respiratory factors due to mechanical ventilation and also anatomical changes in the right atrium as described in the platypnea-orthodeoxia syndrome. We report a patient with the adult respiratory distress syndrome (ARDS) who had a right-to-left atrial shunt which decreased in the prone position, after which oxygenation improved. The patient was admitted to the intensive care unit because of ARDS due to an invasive fungal infection. He had a history of chronic lymphocytic leukemia and paradoxical embolisms through a patent foramen ovale. Despite mechanical ventilation and antifungal treatment he developed severe ARDS. He was therefore turned to the prone position. Blood gas values improved dramatically (arterial oxygen tension/fractional inspired oxygen ratio increasing from 59 to 278 torr). Transcranial Doppler sonography was performed with bubble study, which confirmed a massive right-to-left shunt in the supine position and which instantaneously decreased in the prone position. This case suggests that a decrease in right-to-left shunt in patients who have a patent foramen ovale could partly explain the improvement in hypoxemia in the prone position.
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Doenças Arteriais Cerebrais/fisiopatologia , Hipóxia/fisiopatologia , Decúbito Ventral , Respiração Artificial , Síndrome do Desconforto Respiratório/terapia , Idoso , Doenças Arteriais Cerebrais/diagnóstico por imagem , Evolução Fatal , Comunicação Interatrial/complicações , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Masculino , Síndrome do Desconforto Respiratório/complicações , Ultrassonografia Doppler TranscranianaRESUMO
Human paraquat poisoning from accidental or intentional ingestion is very often fatal. According to the amount of paraquat involved, death can occur within hours or weeks following ingestion. The inefficacy of the various treatments undertaken have led to determine prognostic factors based upon the evolution of plasma and urine paraquat concentrations or of usual biochemical parameters. We report one case of acute poisoning which, although the ingested dose of paraquat was not massive (< 50 mg/kg-1) and the severity indices were in favour of a delayed fatal outcome, has ended in an early death. The high blood alcohol level of the patient (3.34 g l-1) seems to be the main cause of the precocity of this death (86th hour).
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Antídotos/uso terapêutico , Etanol/sangue , Herbicidas/intoxicação , Paraquat/intoxicação , Acetilcisteína/uso terapêutico , Consumo de Bebidas Alcoólicas/sangue , Desferroxamina/uso terapêutico , Diuréticos Osmóticos/uso terapêutico , Excipientes/uso terapêutico , Expectorantes/uso terapêutico , Evolução Fatal , Herbicidas/sangue , Humanos , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Paraquat/sangue , Paraquat/urina , Polietilenoglicóis/uso terapêuticoRESUMO
The authors report 3 cases of acromegaly diagnosed while the patients were in hospital for cardiovascular disease: arterial hypertension in two and hypertrophic myocardiopathy in all three. Coronary arteriography was normal in the 3 patients. The exercise-induced dyspnoea observed in these 3 cases was unexplained by right and left cardiac catheterization results (normal pressures, normal or increased cardiac index). It was most probably related to the myocardial hypertrophy and to abnormalities in diastolic function demonstrated by radioisotopic methods in patients 2 and 3. The degree of myocardial hypertrophy present in these 3 patients seemed to correlate with the size of the pituitary adenoma and the plasma level of growth hormone rather than with the duration or degree of arterial hypertension. After excision of the pituitary adenoma hypertension persisted in 1 case, due to associated adrenal gland hyperplasia, and subsided in the other cases. Abnormalities of diastolic function and dyspnoea are gradually regressing but left ventricular hypertrophy has not significantly decreased after 6 post-operative months.
Assuntos
Acromegalia/complicações , Cardiomiopatia Hipertrófica/etiologia , Hipertensão/etiologia , Acromegalia/fisiopatologia , Adenoma/complicações , Adenoma/fisiopatologia , Idoso , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/fisiopatologiaRESUMO
We report the case of a 45 year old patient who presented ischemic stroke due to the migration of a sural thrombus through a patient foramen ovale (PFO) during a Valsalva manoeuvre. The presence of PFO should be systematically evoked in case of ischemic events, especially stroke in younger adults. The diagnosis is facilitated by two-dimensional contrast echography with intravenous administration of an echo-detectable contrast agent. The clinical context and the origin of the venous thrombus in a superficial vein which remained during a stripping procedure with migration through the communicating veins of the leg were exceptional.
Assuntos
Embolia e Trombose Intracraniana/complicações , Ataque Isquêmico Transitório/etiologia , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico por imagem , Pessoa de Meia-Idade , Ultrassonografia , Manobra de ValsalvaRESUMO
Central nervous system involvement in systemic lupus erythematosus (SLE) requires immediate treatment. We report a case in a 30-year-old woman. Clinical features associated asthenia, headache, right nystagmus and coma. A mechanical ventilation was started. The neurologic pattern appeared three months after an initial treatment with pulsed doses of glucocorticoid (500 mg per day for 3 days) and one month after an oral cyclophosphamid regimen (50 mg twice a week). The cerebral involvement was evidenced by MRI and comparative analysis of the antinuclear auto antibodies (ANA) and the complement components in cerebral spinal fluid (CSF), pleural fluid and serum. The MRI slices showed a well-defined meningeal focal lesion. CSF-cell count was normal. CSF-proteins were elevated. ANA were positive, total complement (UI/l) was low, C4 component (g/l) was 0.11, undetectable and 0.25 respectively in plasma, CSF fluid and pleural fluid. The ANA specific pattern was anti-Sm2. We affirmed that specific cerebral injury was present because there were clinical and imaging features and a decrease of the C3 and C4 component in the CSF. The treatment associated in travenous pulsed doses of methylprednisolone (1000 mg per days for 3 days) and cyclophosphamid (500 mg per day for three days). Mechanical ventilation was with drawn one day after the end of the pulse therapy. The diminution of the complement component could help improving cerebral involvement of SLE. More clinical studies are required.