ABSTRACT
Introducción: Numerosos factores están relacionados con las complicaciones intrahospitalarias en pacientes con infarto agudo de miocardio, la utilidad del volumen plaquetario medio como factor pronóstico es polémica actualmente. Objetivo: Describir la asociación entre el volumen plaquetario medio en pacientes con infarto agudo de miocardio, con los factores de riesgo cardiovascular y la evolución clínica. Método: Estudio observacional en 188 pacientes con infarto agudo del miocardio, que ingresaron en el servicio de Cardiología del Hospital Militar Central "Dr. Carlos J. Finlay". Fueron vigiladas las siguientes complicaciones: muerte cardiaca, insuficiencia cardiaca, angina postinfarto, reinfarto y todas combinadas. Se determinó el volumen plaquetario mediante hemograma automatizado al ingreso y se utilizaron como valores de corte < 9 fL y ≥ 9 fL. Resultados: Predominó el sexo masculino (69,7 por ciento) y mayores de 50 años (91,5 por ciento). Los pacientes hipertensos, diabéticos y fumadores presentaron mayor volumen plaquetario (82,9 por ciento, p= 0,00; 90,4 por ciento, p= 0,03; 89,1 por ciento, p= 0,00 respectivamente). El 22,3 por ciento presentó complicaciones combinadas; la insuficiencia cardiaca (45,2 por ciento) y la angina postinfarto (3,3 por ciento) fueron las más frecuentes. La insuficiencia cardiaca constituyó la complicación asociada con volumen plaquetario elevado (p= 0,027). El volumen plaquetario ≥ 9 fL constituyó un predictor independiente de eventos adversos (p= 0,00; IC 95 por ciento: 3,89-112,908). Conclusiones: El volumen plaquetario medio elevado estuvo asociado a peor evolución clínica intrahospitalaria y la insuficiencia cardiaca la complicación más prevalente. Se asoció además a la hipertensión arterial, tabaquismo y diabetes mellitus(AU)
Introduction: Numerous factors are related to in-hospital complications in patients with acute myocardial infarction, the usefulness of the mean platelet volume as a prognostic factor is currently controversial. Objective: To describe the association between mean platelet volume in patients with acute myocardial infarction, with cardiovascular risk factors and clinical evolution. Method: Observational study in 188 patients with acute myocardial infarction, who were admitted to the Cardiology Department of the Central Military Hospital "Dr. Carlos J. Finlay ". The following complications were monitored: cardiac death, heart failure, post-infarction angina, reinfarction and all combined. Platelet volume was determined by automated blood count at admission and <9 fL and ≥ 9 fL were used as cut-off values. Results: The male sex (69.7 percent) and over 50 years (91.5 percent) predominated. Hypertensive, diabetic and smoking patients presented higher platelet volume (82.9 percent, p = 0.00; 90.4 percent, p = 0.03; 89.1 percent, p = 0.00 respectively). 22.3 percent presented combined complications; Heart failure (45.2 percent) and post-infarction angina (3.3 percent) were the most frequent. Heart failure was the complication associated with high platelet volume (p = 0.027). Platelet volume ≥ 9 fL was an independent predictor of adverse events (p = 0.00; 95 percent CI: 3.89-112.908). Conclusions: The high mean platelet volume was associated with worse intrahospital clinical evolution and heart failure the most prevalent complication. It was also associated with high blood pressure, smoking and diabetes mellitus(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Mellitus , Mean Platelet Volume , Heart Failure , Hypertension , Infarction/diagnosis , Myocardial Infarction , Observational StudyABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Anticoagulants/therapeutic use , Antithyroid Agents/therapeutic use , Graves Disease/complications , Infarction/diagnosis , Kidney/blood supply , Thyroid Gland/diagnostic imaging , Thyrotoxicosis/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Humans , Female , Aged , Electrocardiography , Infarction/surgery , Infarction/diagnosis , Infarction/rehabilitationABSTRACT
JUSTIFICATIVA E OBJETIVOS: Diabetes mellitus (DM) é uma das doenças mais prevalentes e o conhecimento das suas complicações vasculares garante melhor tratamento aos pacientes.O infarto muscular diabético (IMD) é uma situação pouco reconhecida, que deve entrar no diagnóstico diferencial das lesões tumefactas, dolorosas, restritas a um grupamento muscular.A presença de outras lesões de órgãos-alvo indica maior risco de desenvolver o IMD. O objetivo deste estudo foi apresentar um caso incomum e, deste modo, contribuir para o maior reconhecimento e diagnóstico dessa doença. RELATO DO CASO: Paciente do sexo feminino, 24 anos, apresentando dor e aumento do volume da coxa e joelho esquerdos, iniciados há 15 dias, com piora gradual no período. Os exames de sangue evidenciaram aumento da creatinoquinase para níveis de 601U/L (valor de referência: 26 - 174 U/L) e velocidade de hemossedimentação igual a 126 mm/1ª hora. A ultrassonografia e a ressonância magnética foram sugestivas de um processo inflamatório muscular localizado. A biópsia confirmou o IMD.Tratada com repouso e analgésicos, com melhora completa. Duas recidivas subsequentes apontaram para possível efeito prejudicial do anticoncepcional oral. Feita a sua substituição, bem como otimização das medidas reológicas, sem mais recidivas. CONCLUSÃO: O caso relatado representa o típico IMD, com lesão localizada, autolimitada, conforme previamente publicado.Uma possível associação do IMD com o uso de contraceptivo oral,bem como o beneficio do uso de dois fármacos antiplaquetários,em associação, foram observados no presente caso. O IMD deve ser considerado no diagnóstico diferencial das lesões musculares dolorosas, em pacientes diabéticos. O efeito dos contraceptivos orais no surgimento dessas complicações, bem como o benefício dos agentes antiplaquetários merece investigação adicional.
BACKGROUND AND OBJECTIVES: Diabetes mellitus is one of the most frequent diseases and the awareness of its vascular complications promises a better treatment to the patients.Muscle diabetic infarction (MDI) is one of such situations, usually not recognized, which must be considered on differential diagnosis of edematous, painful lesions, restricted to muscle group.The presence of other target-organ lesions points toward a higher risk of developing MDI. The aims of the present study included the description of an unusual medical condition, thereby contributing to its recognition and diagnosis. CASE REPORT: Female patient, 24 years-old, presenting with pain and edema in the left thigh and knee, started 15 days ago,with progressive worsening. Blood sample examination has shown increased creatinokinase levels of 601U/L (reference range: 26 - 174 U/L) and erythrocyte sedimentation rate of 126 mm/h.Ultrasound and magnetic resonance suggested a localized inflammatory muscle process with areas of necrosis. Muscle biopsy has confirmed MDI. Management was based on bed resting and analgesia,with consequent improvement. Two recurrences in the sequence were possibly associated with oral contraceptive intake.No recurrence has been observed after the contraceptive withdrawal and association of antiplatelets agents. CONCLUSION: The present case is typical once the lesion was restricted to the thighs, recurrent, self-limited, in accordance with data reported elsewhere. The possible association observed between MDI and contraceptive intake as well as the benefit of antiplatelets cannot be confirmed to date, but highlights the need of further observations. MDI should be considered on differential diagnosis of painful and swelling lesions in diabetic patients.The harm of oral contraceptives and the benefit of antiplatelets agents deserve future studies.
Subject(s)
Humans , Female , Adult , Diabetic Angiopathies/diagnosis , Diabetes Mellitus , Infarction/diagnosis , Muscle, Skeletal/blood supplySubject(s)
Adult , Fournier Gangrene/complications , Fournier Gangrene/diagnosis , Histocytochemistry , Humans , Infarction/diagnosis , Infarction/pathology , Male , Microscopy , Mucorales/isolation & purification , Mucormycosis/complications , Mucormycosis/diagnosis , Testicular Diseases/diagnosis , Testicular Diseases/pathology , Testicular Diseases/surgery , Testis/microbiology , Testis/pathologyABSTRACT
Spontaneous aseptic diabetic muscle infarction (DMI) is one of the rare complications of diabetes. We report a case of type 2 diabetes mellitus with advanced microvascular complications presenting with severe muscular pain. She was diagnosed as DMI on the basis of clinical presentation, radiological and histopathological investigations. She was managed conservatively. During 18 months of follow up, she had good improvement but subsequently other muscle groups were involved suggesting recurrent DMI.
Subject(s)
Adult , Diabetes Mellitus, Type 2/complications , Diabetic Neuropathies/complications , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/etiology , Diabetic Neuropathies/therapy , Female , Humans , Infarction/diagnosis , Infarction/etiology , Infarction/therapy , Muscular Diseases/diagnosis , Muscular Diseases/etiology , Muscular Diseases/therapy , RecurrenceABSTRACT
El infarto renal agudo constituye un diagnóstico infrecuente. Ello puede deberse a que sus síntomas son similares a los de los cálculos renales o la pielonefritis aguda. Por esa razón, el síntoma cardinal de dolor de flanco debe ser investigado en forma muy acabada. Esta serie clínica revisa seis casos de infarto renal agudo vistos en esta institución durante el año 2007.
Acute renal infarction represents an uncommon diagnosis. Its symptoms may overlap with other disorders such as renal stones or pyelonephritis. Therefore a thoroughly study of the patient with flank pain is mandatory. This clinical series assess the main diagnostic and etiologic features of patients diagnosed as acute kidney infarction.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Kidney Diseases/diagnosis , Kidney Diseases/etiology , Infarction/diagnosis , Infarction/etiology , Abdominal Pain/etiology , Kidney Diseases/diagnostic imaging , Infarction/diagnostic imaging , Renal Artery Obstruction , Risk FactorsABSTRACT
A 53-year-old woman visited the Department of Rheumatology with a chief complaint of a 3-day history of fever and chills and also presented with pain occuring in both knees at the time of outpatient visit. Based on rheumatologic and hematological lab studies, ultrasonography, and a needle aspiration biopsy of the articular cavity, the patient was diagnosed with reactive arthritis. On hospitalization day 3, consultation with the Department of Ophthalmology was requested regarding decreased visual acuity lasting for 3 days. Upon ophthalmologic examination, the corrected visual acuity was 0.1 in the right eye and 0.05 in the left eye. Upon slit lamp microscopy, there were no abnormal findings in the anterior segment. Upon fundus examination, however, there were yellow-white lesions in the macular area of both eyes. Fluorescein angiographywas performed to assess the macular lesions, and the findings were suggestive of macular infarction in both eyes. Due to a lack of other underlying disease, a past surgical history, and a past history of drug administration, the patient was diagnosed with macular infarction in both eyes associated with reactive arthritis. To date, there have been no other such cases reported. In a patient with reactive arthritis, we experienced a case of macular infarction in both eyes, which occurred without association with a past history of specific drug use or underlying disease. Herein, we report our case, with a review of the literature.
Subject(s)
Female , Humans , Middle Aged , Angiography , Arthritis, Reactive/complications , Diagnosis, Differential , Infarction/diagnosis , Macula Lutea/blood supply , Tomography, Optical CoherenceABSTRACT
El infarto esplénico puede cursar de forma asintomática o frecuentemente presentar dolor abdominal en hipocondrio izquierdo. Debe sospecharse ante determinadas patologías subyacentes, entre ellas la enfermedad tromboembólica. Los medios diagnósticos empleados son la ecografía, la tomografía computada abdominal y la resonancia magnética. Por ultrasonido se visualizarán áreas triangulares, hipoecoicas, de localización periférica. El tratamiento será conservador salvo complicaciones. Se presenta un caso clínico.
Subject(s)
Humans , Male , Aged , Infarction/diagnosis , Infarction/etiology , Infarction , Thromboembolism/diagnosis , Thromboembolism , UltrasonicsSubject(s)
Humans , Male , Infarction/diagnosis , Peritoneal Diseases/diagnosis , Flank Pain/diagnosis , Fever , Syndrome , Pain , Tomography, X-Ray ComputedABSTRACT
An infarction of regenerative nodules in liver cirrhosis is a rare abnormality characterized by their coagulative necrosis. We presume that ischemic necrosis is induced by a sudden reduction in the portal and arterial blood flows after blood loss or shock. Most patients with infarcted regenerative nodules have experienced previous episodes of gastrointestinal hemorrhage. Awareness of the entity of infarcted regenerative nodules and its inclusion in the differential diagnosis of multiple hepatic nodules in liver cirrhosis is important, particularly in patients with an episode of gastrointestinal bleeding. The possible difficulty of differentiating infarcted regenerative nodules in liver cirrhosis from hypovascular hepatocellular carcinoma by initial imaging findings alone means that a liver biopsy and serial imaging might be helpful in the differential diagnosis. We report three cases of multiple infarcted regenerative nodules in liver cirrhosis after gastrointestinal hemorrhage.
Subject(s)
Adult , Humans , Male , Middle Aged , Diagnosis, Differential , Esophageal and Gastric Varices/complications , Gastrointestinal Hemorrhage/complications , Hepatic Artery , Infarction/diagnosis , Liver/blood supply , Liver Cirrhosis/etiology , Liver Regeneration/physiology , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Cerebellum/blood supply , Decompressive Craniectomy , Infarction/diagnosis , Tomography, X-Ray ComputedABSTRACT
La isquemia renal aguda es un evento raro en la práctica clínica urológica. Su baja incidencia, así como lo inespecífico de sus manifestaciones clínicas, son habitualmente responsables de un diagnóstico tardío e incluso de errores diagnósticos, siendo sus síntomas atribuidos a entidades clínicas ciertamente más frecuentes. No existe consenso acerca del tratamiento en la literatura. Se describen manejos conservadores con terapia anticoagulante y medidas de apoyo, y hay quienes plantean alternativas más invasivas como la trombolisis intraarterial e incluso cirugía abierta. Se presentan cuatro casos de infarto renal y una revisión sistemática de la literatura, incorporando elementos de diagnóstico tanto de laboratorio como de imágenes, aspectos terapéuticos y pronósticos.
Renal infarction is a rare event in current clinical practice. The low incidence as well as the low specificity of its clinical manifestations are the main reasons for delayed or wrong diagnoses. There is no consensus in the literature concerning the treatment. Anticoagulant therapy, intra-arterial thrombolysis and surgery are the main approaches. Four cases and a systematic review of the literature on diagnosis and treatment of renal infarction are presented.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Infarction/diagnosis , Infarction/therapy , Kidney/blood supply , PrognosisABSTRACT
Torsion of greater omentum is a rare cause of acute abdomen. However, it should be included in the differential diagnoses in addition to acute cholecystitis, acute appendicitis, cecal diverticulitis, and other variable causes of acute abdomen. Diagnosis is usually made at laparotomy for suspected appendicitis. In some cases, computed tomography demonstrates a successful preoperative detection of omental torsion. We report a case of surgically and pathologically proven torsion with subsequent infarction of greater omentum presented as an acute abdominal pain.
Subject(s)
Adult , Humans , Male , Abdomen, Acute/diagnosis , Diagnosis, Differential , Infarction/diagnosis , Omentum/blood supply , Peritoneal Diseases/diagnosis , Tomography, X-Ray Computed , Torsion Abnormality/diagnosisABSTRACT
Objetivo: Valorar el infarto renal agudo entre los diagnosticos diferenciales de dolor abdominal en flanco. Proponer la incorporación de la tomografía computada (TC) con contraste entre los métodos diagnósticos del dolor abdominal en flanco sin causa aparente. Materiales y métodos: Se presentan los casos de infarto renal agudo (IRA), diagnosticados sobre un total de 120 pacientes recibidos por el Servicio de Guardia con dolor abdominal en flanco de tipo cólico o continuo, en un período de tiempo comprendido entre octubre de 2004 y marzo de 2005. Todos los pacientes fueron estudiados mediante exámenes de laboratorio, radiografía de tórax y simple de árbol urinario. Para descartar otras patologías, se realizó ecografía renal. El paso diagnóstico siguiente consistió en un TC de abdomen sin y con contraste endovenoso. Ante el diagnóstico presuntivo de IRA, la confirmación diagnóstica se estableció con angiografía renal. El análisis estadístico se realizó mediante el programa Epidat 3.0. Resultados: Se diagnosticó IRA en dos pacientes de sexo masculino, de 35 y 58 años de edad. Esta patología presenta una incidencia de 0.28 casos/hab./año, y del 1.6% de los ingresos a la guardia médica por dolor abdominal en flanco de tipo cólico o continuo. Las alteraciones analíticas fueron : leucocitosis, bilirrubinemia, aumento de enzimas hepáticas y microhematuria. Los exámenes radiográficos y ecofráficos fueron normales. La TC con contraste demostró un área renal triangular hipodensa, interpretada como defecto de la vascularización. La angiografía renal demostró los vasos ocluidos. Conclusión: Algunos autores se refieren al IRA como un hallazgo anecdótico en el contexto de otras entidades. En el presente trabajo se sostiene que se trata de una patología más frecuente que lo observado y que, para su diagnóstico, es necesario tenerla en cuenta...
Subject(s)
Humans , Infarction/diagnosis , Kidney/pathology , Ultrasonography , Diagnosis, Differential , Abdominal Pain/etiology , Tomography, X-Ray ComputedABSTRACT
We report a single case of Susac's syndrome wich is a microangiopathy of the brain, retina and cochlea. A 45 years old women developed central retinal artery occlusion in the left eye, associated with bilateral hearing loss that mostly involved low and middle frequencies. MRI of the brain revealed numerous under-cortical, paraventricular and callous lesions. The treatment consisted of anticoagulation and antiplatelet drugs
Subject(s)
Humans , Female , Infarction/etiology , Syndrome , Infarction/diagnosis , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/therapyABSTRACT
Apresenta-se um caso de maculopatia isquêmica, secundária a injeção intravítrea de amicacina em paciente de 38 anos que apresentou endoftalmite após facoemulsificação com implante de lente intra-ocular. O tratamento foi realizado por meio de injeção intravítrea de amicacina, vancomicina e dexametasona. Após a melhora do quadro clínico, observou-se obstrução arteriolar na região macular. Embora a amicacina seja efetiva, por via intravítrea, para o tratamento de endoftalmite, pode causar infarto macular e baixa de acuidade visual significativa.