RESUMO
Percutaneous transluminal renal angioplasty (PTRA) was performed in a patient with bilateral renal artery stenoses diagnosed noninvasively by captopril renal scintigraphy and confirmed by renal arteriography. The captopril renal scintigraphy parameters returned to normal in correlation with improved blood pressure response fifteen days after PTRA. Five months later hypertension reappeared and the repeated captopril renal scintigraphy suggested left renal artery stenosis. PTRA was repeated and a stent was implanted with reversal of blood pressure, and captopril renal scintigraphy findings returned to normal levels. Six months after second PTRA, the blood pressure increased to hypertensive levels, and captopril renal scintigraphy indicated left renal artery stenosis. The renal arteriography, however, revealed a new stenosis at the left renal artery ostium. The PTRA with a second stent implantation was performed successfully. The captopril renal scintigraphic parameters and the blood pressure were again normalized after the last intervention and remained normal for thirteen months of follow-up.
Assuntos
Angioplastia com Balão , Captopril , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/terapia , Rim/diagnóstico por imagem , Captopril/farmacologia , Feminino , Humanos , Pessoa de Meia-Idade , Cintilografia , Circulação Renal/efeitos dos fármacosRESUMO
Various chronic pulmonary diseases can cause hypoxia mediated erythrocytosis. We report on a 46 year old male patient presenting with erythrocytosis, in whom a pulmonary arteriovenous fistula on the basis of a vascular malformation was identified as a rare cause of hypoxic erythrocytosis. Thus, congenital pulmonary vascular malformations can become clinically manifest in advanced age.
Assuntos
Fístula Arteriovenosa/diagnóstico , Hipóxia/etiologia , Pulmão/irrigação sanguínea , Policitemia/etiologia , Fístula Arteriovenosa/sangue , Diagnóstico Diferencial , Hematócrito , Humanos , Hipóxia/sangue , Masculino , Pessoa de Meia-Idade , Policitemia/sangueRESUMO
This case report describes a patient who developed an aneurysmatic dilation of a coronary artery 6 months after successful primary stent implantatIon. The dilation occurred within the stented segment of the artery. To our knowledge, this is the first report of the development of an aneurysm, in the absence of angiographically visible dissection or other possible causative factors.
Assuntos
Aneurisma Coronário/etiologia , Complicações Pós-Operatórias , Stents/efeitos adversos , Adulto , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Doença das Coronárias/cirurgia , Endossonografia , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologiaRESUMO
In a 49-year-old woman with sick sinus syndrome and a permanent VVI pacemaker, severe tricuspid stenosis and its clinical consequences developed 4 years after the attack of endocarditis. Besides the quite unusual occurrence of lead related tricuspid stenosis, successful treatment with balloon dilatation is the unique feature of this case.
Assuntos
Cateterismo , Endocardite Bacteriana/complicações , Marca-Passo Artificial/efeitos adversos , Estenose da Valva Tricúspide/etiologia , Eletrodos Implantados/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome do Nó Sinusal/terapiaRESUMO
OBJECTIVE: To investigate the relation between the degree of ST segment resolution (STR) after thrombolysis and the pressure derived collateral flow index (CFIp), determined using an intracoronary pressure measurement technique in patients with recent myocardial infarction. METHODS: 33 patients were studied. TIMI grade III flow was achieved in the infarct related artery by thrombolysis. A surface ECG was obtained on admission and 90 minutes later. The sum of ST segment elevations was measured by summing all leads with ST elevation on the baseline ECG and on the 90 minute ECG (after thrombolysis) and calculating the percentage recovery. The study population was divided into two groups, with good STR (> or = 50%; group 1) or poor STR (< 50%; group 2). After angiography, a fibreoptic pressure monitoring guidewire was advanced to the stenosis to be dilated. The CFIp was determined as the ratio [coronary wedge pressure - central venous pressure]/[mean aortic pressure - central venous pressure]. RESULTS: The mean STR on the surface ECG was 54.6% and mean (SD) CFIp was 0.25 (0.12) (range 0.10-0.41). There was an inverse correlation between the individually calculated percentage of STR and CFIp (r = -0.64, p < 0.01). The mean CFIp was lower in patients with a good STR than in those with a poor STR (0.18 (0.07) v 0.27 (0.10), p < 0.02). CONCLUSIONS: Although TIMI grade III flow was achieved after thrombolysis, a worse STR on the surface ECG was associated with higher CFIp measured in the infarct related artery. CFIp appears to reflect the degree of microvascular obstruction by quantifying impedance of the microvasculature.
Assuntos
Circulação Coronária/fisiologia , Infarto do Miocárdio/fisiopatologia , Terapia Trombolítica , Pressão Sanguínea/fisiologia , Circulação Colateral/fisiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Microcirculação/fisiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/terapiaRESUMO
Renovascular disease is the cause of less than 1% of patients with hypertension; within this group aneurysm and dissection in renal artery are even rarer causes. It may be not only iatrogenic or traumatic, but may also develop spontaneously from fibromuscular disease or atherosclerotic lesions. We present a 26-year-old male patient with recently developed and progressive hypertension in whom renal angiography showed aneurysmal dilatation and dissection of the right renal artery. With the implantation of two stents in the true lumen, normal renal blood flow and thrombosis of the aneurysmal sac was established. As a result, stent implantation to renal artery dissection is effective, reliable and easy and can be an alternative to surgical treatment.
Assuntos
Dissecção Aórtica/terapia , Hipertensão Renovascular/etiologia , Artéria Renal , Stents , Adulto , Dissecção Aórtica/complicações , Angiografia/métodos , Humanos , MasculinoRESUMO
The short- and long-term outcome of percutaneous transluminal coronary angioplasty were analyzed in 34 patients who had documented coronary artery disease without symptoms. Of the 34 patients, 33 had abnormal stress tests before angioplasty. Angioplasty was successful in 31 patients (91%). Follow-up was 100% for a mean period of 36 +/- 15 months. Follow-up exercise test was normal or improved in 29 of the 31 patients who had successful angioplasty. Follow-up catheterization was performed in 24 of the 31 patients (77%). Restenosis of the previously dilated segment was found in seven patients. Actuarial cardiac survival at 3 years was 100%. Freedom from myocardial infarction, bypass surgery, angioplasty for a new lesion, and death was 87%. We conclude that although the most effective treatment for silent ischemia remains to be determined, our data suggest that coronary angioplasty is a therapeutic option in these patients.
Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Análise Atuarial , Cateterismo Cardíaco , Angiografia Coronária , Doença das Coronárias/diagnóstico , Doença das Coronárias/mortalidade , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Taxa de Sobrevida , Fatores de TempoRESUMO
A 49-year-old woman was admitted with fatigue, dyspnoea, pretibial oedema and decreased daily urination. Seven years ago she was treated with doxorubicin, bleomycin, vinblastine and dacarbazine, alternating with mechlorethamine, vincristine, procarbazine and prednisone and 80 Gy abdominal radiotherapy for Hodgkin's disease. Two years later, malignant hypertension was diagnosed. Angiotensin-2 antagonist and beta-blocker treatment was given. After increased serum creatinine levels were determined, renal angiography was performed and total obstruction in the left renal artery and near total obstruction in the right side was observed. She was admitted to our clinic with oliguria, and acute renal failure was diagnosed. Balloon angioplasty and stent implantation was performed to the right renal artery. After a polyuric period, serum creatinine reduced to near normal levels. Angiotensin-2 antagonist treatment worsened the course in this patient. Patients with resistant hypertension occurring years after abdominal radiotherapy should be evaluated for renal artery stenosis.
Assuntos
Neoplasias Abdominais/radioterapia , Doença de Hodgkin/radioterapia , Lesões por Radiação/complicações , Obstrução da Artéria Renal/etiologia , Artéria Renal/efeitos da radiação , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Two families with Emery-Dreifuss muscular dystrophy (EMD) are described. Several unusual features for EMD are emphasized. One of the patients had severe neuromuscular disability with inability to walk during early childhood. This patient also had mild bifacial paresis. His brothers had the typical slow progression of EMD. In some of the patients, muscle weakness distribution was more widespread than has usually been reported, with prominent involvement of finger extensors. It is suggested that there is a wide phenotypic spectrum in EMD. In both families, the disease segregated with markers spanning the EMD locus in Xq28.
Assuntos
Distrofias Musculares/genética , Distrofias Musculares/fisiopatologia , Cromossomo X , Adolescente , Adulto , Idade de Início , Biópsia , Criança , Mapeamento Cromossômico , Doenças em Gêmeos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos/patologia , Distrofias Musculares/patologia , Linhagem , Gêmeos MonozigóticosRESUMO
To investigate the influence of Global System of Mobile (GSM) telephones on permanent pacemakers, four brands of GSM telephones: Panasonic, Motorola, Nokia, Ericsson, and 24 permanent pacemaker, 17 models of five major brands, were tested in their original sterile packages. Pacemaker brands tested were Pacessetter, Cardiac Pacemakers Inc. (CPI), Vitatron, Medtronic and Intermedics. The effects of switching on and off, ringing and transmission were tested and marker channel recordings were made connuously. Tests were carried out for each model of GSM telephone wile the telephone was immediately on or up to 15 cm above the pacemaker box. No program chagne was noted in any of the pacemakers. All CPI models tested, Synchrony II of Pacesetter, Unity of Intermedics, and Thera SR of Medtronic were unaffected. However all remaining models showed intermittent and/or continuous inhibition of 2-13 seconds and inappropriate triggering of impulse when the telephones were placed on the package. Interference dsppeared beyond 15 cm in all pacemaker models. O ne pacemaker, AFP of Pacesetter implanted 8 years ago, induced VT as long as the patient tried to keep the telephone active over either ear. In conclusion, patients with permanent pacemakers shoud be advised not to use GSM telephones until further tests prove their safety.