ABSTRACT
Resumen La arteritis de Takayasu es una enfermedad de etilogía un poco incierta por la diversidad de factores que pueden afectarla. Sus manifestaciones radican en la afección vascular que produce, en cuyo caso la aorta y sus grandes vasos son los más afectados. Esta vasculitis parece más prevalente en el suroeste asiático, y a pesar de llevar varios años de su descripción, en Europa y América solo se encuentran series de casos de la misma, lo que podría indicar un posible subdiagnóstico. Es importante conocer esta vasculitis ya que su manejo oportuno puede evitar el avance de la enfermedad y la presentación de complicaciones vasculares. El tratamiento de un paciente con arteritis de Takayasu seguirá siendo un desafío para los clínicos ya que no se cuenta con un estándar de manejo; por consiguiente, las decisiones generalmente se basan en recomendación de expertos, por lo cual cada caso deberá individualizarse con el objetivo de ofrecer el manejo más adecuado a los pacientes y disminuir la aparición de complicaciones.
Abstract Takayasu's arteritis is a disease of uncertain origin due to the diversity of factors that can be involved. Its manifestions stem from the vascular involvement that occurs, with the aorta and its large vessels being the most affected. This vasculitis seems more prevalent in south-west Asia, and due to the fact that it has been described for years, and only one series of cases of this disease are found in Europe and America, this could indicate a possible under-diagnosis. It is important to know this vasculitis since its timely management may avoid advancement of the disease, and the presentation of vascular complications. The treatment of a patient with Takayasu's arteritis will follow, being a challenge for clinicians since there is no standard management. For this reason, decisions are generally based on the recommendations by experts, therefore each case will be individualised with the aim of providing the patients with the most suitable management and reducing the appearance of complications.
Subject(s)
Humans , Adult , Vasculitis , Takayasu Arteritis , Cardiology , Hemodynamics , HypertensionABSTRACT
A pesar de la eficacia comprobada acerca del uso de warfarina como terapia anticoagulante, las múltiples interacciones, el estrecho margen terapéutico y la necesidad de monitorización seriada han planteado el escenario para el desarrollo de nuevos medicamentos como dabigatran, rivaroxaban y apixaban que ofrecen nuevas alternativas para el tratamiento del paciente anticoagulado. El conocimiento de las características farmacológicas y farmacocinéticas así como el contexto específico en el cual pueden usarse se convierten en una necesidad para los médicos que se enfrentan a este tipo de pacientes.
Despite the proven efficacy on the use of warfarin as anticoagulant therapy, the multiple interactions, narrow therapeutic index and the need for serial monitoring have raised the need for the development of new drugs such as dabigatran, rivaroxaban and apixaban, that offer new alternatives for treating the anticoagulated patient. Knowledge of the pharmacologic and pharmacokinetic characteristics and the specific context in which they can be used become a necessity for physicians faced with these patients.
Subject(s)
Arrhythmias, Cardiac , Cardiology , PharmacologyABSTRACT
JUSTIFICATIVA E OBJETIVOS: O sarcoma primário da artéria pulmonar é uma doença rara. O conhecimento dos aspectos clínicos e do seu diagnóstico tem impacto no prognóstico do paciente.O objetivo deste estudo foi descrever e discutir aspectos clínicos e de exames complementares deste tumor. RELATO DO CASO: O paciente foi internado para ser submetido à embolectomia cirúrgica de artéria pulmonar. Entretanto,na sala de cirurgia notou-se presença de tumor que invadia a artéria pulmonar direita, estruturas do mediastino, veia cava superior e artéria aorta. Nesse momento não foi realizada a ressecção tumoral.Exames complementares revelaram sarcoma primário da artéria pulmonar. O paciente foi tratado com quimioterápicos,com planejamento de cirurgia após o seu término. CONCLUSÃO: Houve boa resposta a terapêutica e melhora clinica.Infelizmente, após a quimioterapia, o paciente não aceitou cirurgia para ressecção do tumor.
BACKGROUND AND OBJECTIVES: The primary pulmonary artery sarcoma is a rare tumor. The knowledge of the characteristics of this kind of tumor has impact on patients' survival. We aimed tod escribe and discuss a couple of characteristics of this cancer. CASE REPORT: The patient came in hospital to be submitted to embolectomy from pulmonary artery surgery. At operating room the tumor was discovered invading the right pulmonary artery,mediastinal structures, the superior vena cava and the aorta.It was therefore decided not to perform a tumor resection. We have decided to treat the patient with chemotherapy. It was our idea to perform surgery after the chemotherapy. CONCLUSION: The patient experienced good tolerance to the therapy and indicated clinical improvement. Unfortunately, at this time he does not accept surgery.