ABSTRACT
La oclusión total del tronco coronario común izquierdo (TCI) es un hallazgo infrecuente en la cateterización cardiaca y más aún en pacientes con IAM con SDST, en este último contexto se presenta clínicamente con shock cardiogénico, arritmias malignas y/o muerte. Si bien en el paciente estable la cirugía continúa siendo la primera opción terapéutica1, en las oclusiones agudas dado el riesgo vital y la necesidad de reperfusión lo más precoz posible, la angioplastia primaria se considera como una opción real de salvataje. A continuación presentamos un caso clínico de un paciente con infarto agudo al miocardio con oclusión aguda del TCI tratado con angioplastía primaria.
The total occlusion of the left main coronary artery is a rare finding in the cardiac catheterization and even more so in patients with Acute Myocardial Infarction with ST-segment elevation. These patients presented clinically with cardiogenic shock, malignant arrhythmia and/or death. While in the patient is stable, the surgery remains the first choice therapy (1), but in acute occlusion given the risk to life and the need for the earliest possible reperfusion, primary angioplasty is considered as a real option bailout. The following is a case of a patient with acute myocardial infarction and acute occlusion of left main coronary artery treated with primary angioplasty is considered as real option bailout. The following is case of a patient with acute myocardial infarction and acute occlusion of left main coronary artery treated with primary angioplasty.
Subject(s)
Humans , Male , Adult , Angioplasty, Balloon, Coronary , Coronary Stenosis/diagnosis , Coronary Stenosis/therapy , Acute Disease , Coronary Disease/diagnosis , Coronary Disease/therapyABSTRACT
Background: Mesenteric vein thrombosis (MVT) is uncommon and accounts for 5-10percent of all mesenteric ischemic events. In 80percent of cases, an etiologic factor is found. The clinical presentation varies and the diagnosis is made based on imaging studies. The treatment involves anticoagulation alone or in combination with surgery. Aim: To describe the clinical characteristics of patients with MVT. Patients and methods: Retrospective and prospective review of all cases with MVT, treated between 1995-2001. The clinical presentation, imaging studies, treatment and outcome were evaluated. Results: 29 cases of MVT were reviewed (14 females, age 56 ± 15 years). Twenty two patients (76percent) had recognizable risk factors. The main symptoms were abdomianl pain (86percent) and vomiting (55percent). The diagnosis of acute mesenteric ischemia was suspected on admission only in 6 patients (21percent). Thirteen patients underwent transabdominal color Doppler ultrasonography and the diagnosis was confirmed for 11 of these (85percent). Twenty out of 24 patients (85percent) studied with computed tomography, had positive signs of MVT. Twenty one patients (72percent) recieved anticoagulation, 10 of whom also underwent surgery. Four patients (14percent) received surgical treatment alone. Four patients were not treated. Seven patients (24percent) died. Conclusions: MVT is difficult to identify. It is necessary to have a high degree of suspicion in patients who have risk factors. The diagnosis is made with imaging studies. The treatment consists of early anticoagulation and surgical intervention when indicated.
Subject(s)
Adult , Male , Humans , Female , Aged , Mesenteric Vascular Occlusion/surgery , Mesenteric Vascular Occlusion/diagnosis , Mesenteric Vascular Occlusion/drug therapy , Venous Thrombosis/surgery , Venous Thrombosis/diagnosis , Venous Thrombosis/drug therapy , Anticoagulants/therapeutic use , Prospective Studies , Retrospective Studies , Risk FactorsABSTRACT
Neumonía comunitaria es una enfermedad vista en todas las edades y que demanda importantes recursos de salud. La mortalidad promedio es de 13 por ciento que llega al 50 por ciento en los pacientes de las unidades críticas a pesar de la importante navegación, más del 50 por ciento de los casos queda sin resolver su real agente patógeno, y en las décadas pasadas se han tratado de uniformar su manejo, se han propuesto en cambio en la clasificación de la neumonía típica y atípica debido a la poca utilidad de algunas. Además que consideran los problemas de edad, riesgo y patología asociada. El Streptococo neumonía sigue siendo el germen más permanente. El presente artículo revisa los factores de mayor riesgo asociado a la evolución de la neumonía