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1.
Rev. bras. oftalmol ; 80(1): 67-70, jan.-fev. 2021. graf
Article in Portuguese | LILACS | ID: biblio-1251316

ABSTRACT

RESUMO O laser in situ keratomileusis (LASIK) é o método cirúrgico refrativo mais realizado no mundo com excelentes resultados, porém tal método não é isento de riscos. A ectasia pós LASIK é uma complicação grave e se caracteriza por um aumento progressivo da curvatura e afinamento da córnea, resultando em astigmatismo irregular e diminuição da acuidade visual. Sua incidência na literatura atual é de aproximadamente 0,033%. O principal tratamento dessa complicação é o implante de anel intra-estromal com cross-linking. Neste artigo descrevemos um caso de uma mulher de 45 anos submetida a sucessivas tentativas de tratamento de ectasia pós LASIK, com implante de anel intra-estromal bilateral, sem sucesso em um dos olhos. Foi feito o uso do excimer laser topoguiado através do photorefractive keratectomy (PRK) sem o cross-linking, que optamos por não realizar pela estabilidade há anos, pelo risco alto de haze e pela ablação apenas na lamela (que era espessa).A paciente obteve melhorasignificativa da visão e da qualidade de vida. Mantemos o acompanhamento a cada seis meses desde então com a tomografia da córnea.


ABSTRACT The laser in situ keratomileusis (LASIK) is the most widely used refractory surgical method in the world with excellent results, but this method is not without risks. Post-LASIK ectasia is a serious complication and is characterized by a progressive increase in curvature and thinning of the cornea, resulting in irregular astigmatism and decreasing visual acuity. Its incidence in the current literature is approximately 0.033%. The main treatment for this complication is the implantation of an intra-stromal ring with crosslinking. In this article, we describe a case of a 45-year-old woman who underwent successive attempts to treat post-LASIK ectasia, with bilateral intra-stromal ring implantation, with no success in the eyes. Excimer laser was used, made through photorefractive keratectomy (PRK) without cross-linking and the patient obtained significant improvement in vision and in quality of life.


Subject(s)
Humans , Female , Middle Aged , Photorefractive Keratectomy/methods , Keratomileusis, Laser In Situ/adverse effects , Tomography, Optical Coherence/methods , Dilatation, Pathologic/etiology
2.
Rev. bras. oftalmol ; 80(1): 71-76, jan.-fev. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1251315

ABSTRACT

RESUMO O artigo tem como objetivo descrever de forma prospectiva diferentes casos de ectasias altamente assimétricas (very asymmetric ectasia, VAE) para diferenciar formas subclínicas ou "frustas" do ceratocone (forme fruste keratoconus - FFKC) de casos de doença ectásica unilateral. O Caso 1 é um paciente de 39 anos, que admitiu ter coçado intensamente apenas o olho direito (OD) na juventude, se apresentando com ectasia unilateral tratada com sucesso por meio de implante de anel intraestromal em OD. O olho esquerdo (OE) apresentou-se normal ao exame completo por meio de propedêutica multimodal e acuidade visual não corrigida (AVsc) de 20/20, estável por mais de 5 anos, com TBI (tomography and biomechanical index) de 0.02. No Caso 2 é um paciente de 15 anos com ectasia clínica em OD, e OE com topografia normal, mas alterações tomográficas e biomecânicas, incluindo o TBI 0,56, caracterizarando a doença subclínica (FFKC). O Caso 3 é a mãe do paciente do Caso 2, de 46 anos, que se apresentou com presbiopia, sem qualquer histórico oftalmológico relevante. A AVsc foi de 20/20 em cada olho, topografia de Placido com leve encurvamento inferior, mas sem sinais definitivos de ectasia. A avaliação biomecânica e tomográfica revelou sinais de ceratocone em ambos os olhos, com TBI de 1,0 e 0,99. Esses três casos estão de acordo com a definição do consenso global e a hipótese de dois acertos (two-hit hypothesis), que ceratocone é uma doença bilateral, mas ectasia pode ocorrer por causa estritamente mecânica unilateralmente (ou em qualquer olho). A relevância da propedêutica multimodal é destacada, destacando-se a integração do estudo biomecânico e tomográfico com imagens de Scheimpflug.


ABSTRACT The article aims to prospectively describe different cases of highly asymmetric ectasia (very asymmetric ectasia, VAE) to differentiate subclinical or "frustrated" forms of keratoconus (forme fruste keratoconus - FFKC) from cases of unilateral ectatic disease. Case 1 is a 39-year-old patient with unilateral ectasia treated with an intrastromal ring implant. The contralateral eye was normal due to multimodal propaedeutics, stable for more than 3 years, with a TBI of 0.02. The patient admitted to having intensely scratched only his right eye in his youth. In Case 2, a 15-year-old patient with clinical ectasia in the right eye, had a left eye with normal topography and tomographic and biomechanical changes characterizing FFKC. Case 3 is the mother of the case 2 patient, aged 46, who presented with presbyopia, without any relevant ophthalmological history. Uncorrected visual acuity of 20/20 in each eye, Placido topography with slight lower curving, but without definitive signs of ectasia. The biomechanical and tomographic evaluation revealed signs of keratoconus in both eyes. These three cases are in accordance with the definition of the global consensus: keratoconus is a bilateral disease, but ectasia can occur because of strictly mechanical unilateral (in any eye). The relevance of multimodal refractive imaging is highlighted, with a focus on integrating biomechanical and tomographic assessments with Scheimpflug images.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Biomechanical Phenomena , Tomography/methods , Corneal Topography/methods , Dilatation, Pathologic , Keratoconus/diagnosis , Epidemiology, Descriptive
4.
Arq. bras. cardiol ; 116(1): 48-54, Jan. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1152970

ABSTRACT

Resumo Fundamento A ectasia da artéria coronária (EAC) é definida como a dilatação difusa ou localizada do lúmen da artéria coronária com diâmetro de 1,5 a 2,0 vezes o diâmetro da artéria coronária normal adjacente. A relação proteína C-reativa/albumina (CAR, sigla em inglês) é um marcador inflamatório útil que tem sido documentado em doença arterial coronariana. Objetivo Analisar a associação entre a EAC e a CAR. Métodos Um protocolo caso-controle foi utilizado neste estudo. Foram incluídos 102 pacientesconsecutivos com EAC isolada sem estenose (56 homens e 46 mulheres; idade média de 60,4 ± 8,8 anos). O grupo controle era constituido pelo mesmo número de pacientes pareados por sexo e idade com artérias coronárias normais (55 homens e 47 mulheres; idade média de 61,2 ± 9,1 anos). Características clínicas, achados laboratoriais e histórico de uso de medicamentos foram registrados. Foram realizados teste t de Student, teste U de Mann-Whitney, teste do qui-quadrado, análise de regressão linear e logística. Foi considerado estatisticamente significativo p bilateral < 0,05. Resultados A CAR estava aumentada nos pacientes com EAC em comparação com os controles (32 e 16; p < 0,001). Além disso, foi verificado que a CAR era um preditor independente da EAC (razão de chances = 2,202; intervalo de confiança 95%, 1,184 - 5,365; p < 0,001). Conclusão No presente estudo, determinamos que os níveis da CAR estavam significativamente mais altos no grupo EAC que no grupo controle e a CAR estava significativamente correlacionada com a EAC. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Coronary artery ectasia (CAE) is defined as diffuse or localized dilatation of coronary artery lumen with a diameter of 1.5 to 2.0 times the adjacent normal coronary artery. The C-reactive protein to albumin ratio (CAR) is a useful inflammatory marker, which has been documented in coronary artery disease. Objective To analyze the association of CAE and CAR. Methods A case-control protocol was used in this study. We included 102 consecutive patients with isolated CAE without stenosis (56 men and 46 women; mean age 60.4 ± 8.8 years). The control subjects consisted of an equal number of sex and age matched patients with normal coronary arteries (55 men and 47 women; mean age 61.2 ± 9.1 years). Clinical features, laboratory findings, and medication use history were recorded. Student's t test, Mann-Whitney U test, chi-square test, and linear and logistic regression analysis were performed. A 2-sided p < 0.05 was statistically considered significant. Results The CAR was increased in patients with CAE compared to the controls (32 and 16; p < 0.001). In addition, the CAR was found to be an independent predictor of CAE (OR = 2.202; 95% CI 1.184 - 5.365; p < 0.001). Conclusion In the present study, we determined that CAR levels were significantly higher in the CAE group than in the control group, and the CAR was significantly correlated with CAE. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Male , Female , Aged , Coronary Aneurysm , Coronary Artery Disease , C-Reactive Protein , Case-Control Studies , Coronary Angiography , Coronary Vessels/diagnostic imaging , Dilatation, Pathologic , Middle Aged
5.
Repert.Med.Cir ; 30(3): 256-261, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1363534

ABSTRACT

Se presenta el caso de un paciente de sexo masculino de 42 años de edad que cursa con episodio de infarto agudo del miocardio sin elevación del segmento ST, en quien se documenta enfermedad coronaria ectásica moderada a grave y como hallazgo incidental agenesia de la arteria coronaria derecha, entidad poco frecuente. Se realiza una revisión de los aspectos más relevantes de la literatura en ectasia coronaria y una breve descripción del hallazgo incidental.


Herein, we report a 42-year-old male patient with acute myocardial infarction presenting without ST-segment elevation. Moderate to severe coronary ectasia was documented, and a rare case of right coronary artery agenesis was incidentally detected. A literature review on the most relevant aspects of coronary ectasia and a brief description of the incidental finding were conducte.


Subject(s)
Humans , Male , Adult , Coronary Vessels , Dilatation, Pathologic , Myocardial Infarction , Coronary Disease , Myocardium
7.
Arq. bras. oftalmol ; 83(6): 538-542, Nov.-Dec. 2020. graf
Article in English | LILACS | ID: biblio-1153084

ABSTRACT

ABSTRACT Corneal ectasia is one of the main complications of keratorefractive procedures. In this report, we describe a case of corneal ectasia after laser-assisted in situ keratomileusis), which progressed with acute hydrops and aqueous leakage and required a suture for correction.


RESUMO A ectasia corneana é uma das principais complicações das cirurgias refrativas. Neste caso, descrevemos um caso de ectasia corneana induzida por laser-assisted in situ keratomileusis, que evoluiu com hidrópsia aguda e extravasamento de humor aquoso, necessitando de sutura corneana.


Subject(s)
Humans , Cornea/surgery , Corneal Diseases , Corneal Diseases/etiology , Corneal Topography , Keratomileusis, Laser In Situ , Dilatation, Pathologic , Postoperative Complications/etiology , Sutures/adverse effects , Retrospective Studies , Keratomileusis, Laser In Situ/adverse effects
8.
Rev. bras. oftalmol ; 79(6): 420-425, nov.-dez. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1156163

ABSTRACT

Resumo Objetivo: Realizar uma revisão sobre o diagnóstico do ceratocone, com enfoque nos métodos propedêuticos disponíveis. Métodos: Foi realizada uma pesquisa no banco de dados PubMed com as palavras chave: Keratoconus, diagnosis, topography e tomography. Por se tratar de uma revisão, não houve restrição de período para a publicação dos artigos selecionados. Foram também utilizados o manual Prefered Practice Pattern(PPP) da academia americana de oftalmologia, assim como o site "eyewiki.aao.org". Resultados: Dos 641 artigos encontrados no PubMed, assim como os usados como referência para o PPP, 36 foram selecionados por serem considerados mais relevantes para o tema proposto. O site "eyewiki.aao.org" foi utilizado como referência para as figuras. Conclusão: O diagnóstico do ceratocone evoluiu consideravelmente desde quando foi primeiramente descrito. É desejável que seja feito em suas fases precoces devido ao alto potencial de morbidade desta doença. Uma possível integração entre os múltiplos índices diagnósticos, investigação genética, biologia molecular e inteligência artificial é almejado para uma maior acurácia diagnóstica.


Abstract Objective: To Perform a review on the diagnosis of keratoconus, focusing on the available propaedeutic methods. Methods: A search was performed in the PubMed database using the key words: Keratoconus, diagnosis, topography and tomography. As it is a review, there was no restriction regarding the publication period of the selected articles. Furthermore, both the preferred practice pattern(PPP) manual of the American Academy of Ophthalmology, as well as the website "eyewiki.aao.org" were used as reference. The project was submitted to the research ethics committee of the Federal University of São Paulo / UNIFESP / SP 2018 (# 2,568,770). Results: Out of the 641 papers found in PubMed, in adition to those used as a reference for PPP, 36 were selected while considered more relevant to the adopted theme. The website "eyewiki.aao.org" was used as a reference for the images. Conclusion: The diagnosis of keratoconus has evolved considerably since it was first described. It is desirable to diagnose it on the early stages due to its high potential of morbility. A possibility of an integration between the various diagnostic indices, genetic research, molecular biology and artificial intelligence is recommended for greater diagnostic accuracy.


Subject(s)
Humans , Male , Adolescent , Middle Aged , Tomography/methods , Corneal Topography/methods , Keratoconus/diagnosis , Biomechanical Phenomena , Dilatation, Pathologic
9.
Rev. colomb. cardiol ; 27(5): 485-490, sep.-oct. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1289261

ABSTRACT

Resumen La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad.


Abstract Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.


Subject(s)
Humans , Male , Aged , Coronary Vessels , Coronary Aneurysm , Cardiac Catheterization , Dilatation, Pathologic
12.
Rev. chil. pediatr ; 91(4): 591-596, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138676

ABSTRACT

INTRODUCCIÓN: El síndrome de Marfán es un trastorno multisistémico del tejido conectivo de herencia autosómica dominante, de expresión variable. La ectasia dural es un compromiso frecuente, pero poco conocido, que puede asociarse a síndrome de hipotensión endocraneana (SHE). OBJETIVO: Pre sentar un caso de cefalea invalidante secundario a SHE, para advertir de esta rara complicación, que debe tenerse presente en niños portadores de conectivopatías, en especial síndrome de Marfán. CASO CLÍNICO: Adolescente femenina de 13 años, portadora de sindrome de Marfán, de diagnóstico clínico según criterios de Ghent 2010, que consultó por cefalea ortostatica invalidante de 6 meses de evolución. La Resonancia Magnetica (RM) de cerebro mostró múltiples signos de hipotensión endocraneana, mientras que la RM de columna total mostró una ectasia dural que determinó la dilatación del saco tecal y remodelación posterior de los cuerpos vertebrales, especialmente a nivel del sacro. Se realizó tratamiento con parche sanguíneo autólogo epidural con buena respuesta clínica. CONCLUSIONES: La ectasia dural, frecuente en el sindrome de Marfán, es una causa predisponente a fuga de líquido cefaloraquideo (LCR), que podría causar cefalea ortostática segundaria al SHE.


INTRODUCTION: Marfan syndrome is an autosomal dominant, multi-systemic connective tissue di sorder of different presentations. Dural ectasia is a common, but little known complication that can be associated with intracranial hypotension syndrome (IHS). OBJECTIVE: To present a case of severe headache secondary to IHS in order to warn about this rare complication, which must be considered in children carriers of connective tissue diseases, especially Marfan syndrome. CLINICAL CASE: 13-year- old female carrier of Marfan syndrome, clinically diagnosed according to the 2010 Ghent criteria, who consulted due to a 6-months history of severe orthostatic headache. Head magnetic resonance imaging (MRI) showed multiple signs of intracranial hypotension, while whole-spine MRI showed dural ectasia that caused the thecal sac dilation and subsequent remodeling of vertebral bodies, es pecially the sacral ones. Treatment with an autologous epidural blood patch was administered with good clinical response. CONCLUSIONS: Dural ectasia, frequent in Marfan syndrome, is a predisposing cause of cerebrospinal fluid (CSF) leakage, which could cause orthostatic headache secondary to IHS.


Subject(s)
Humans , Female , Adolescent , Intracranial Hypotension/etiology , Dura Mater/pathology , Headache/etiology , Marfan Syndrome/complications , Magnetic Resonance Imaging , Intracranial Hypotension/pathology , Intracranial Hypotension/diagnostic imaging , Dilatation, Pathologic/etiology , Dilatation, Pathologic/diagnostic imaging , Dura Mater/diagnostic imaging , Headache/pathology , Headache/diagnostic imaging
13.
Rev. bras. cir. cardiovasc ; 35(4): 589-590, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137282

ABSTRACT

Abstract Aneurysms of the sinuses of Valsalva are defined as dilatation of the aortic root region between the aortic annulus and the sinotubular junction. Isolated aneurysms of the sinus of Valsalva are rare cardiovascular pathologies. They may be congenital, especially secondary to connective tissue disorders or in conjunction with congenital cardiac defects, or acquired such as secondary to infections or trauma. Small sized aneurysm without rupture in asymptomatic patients may be followed; however, latter cases require intervention and surgery is the gold standard treatment modality. In this report, a 41-year-old male patient was reported with giant aneurysm of the non-coronary sinus of Valsalva whom underwent aortic root sparing surgical aortic sinus of Valsalva reconstruction.


Subject(s)
Humans , Male , Adult , Aortic Aneurysm/surgery , Aortic Aneurysm/diagnostic imaging , Sinus of Valsalva/surgery , Sinus of Valsalva/diagnostic imaging , Heart Defects, Congenital , Aorta , Dilatation, Pathologic
15.
An. bras. dermatol ; 95(3): 347-350, May-June 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130893

ABSTRACT

Abstract Intravascular histiocytosis is a rare condition characterized by the aggregate of histiocytes within dilated dermal vessels. The diagnosis is mainly histophatological and immunohistochemical. We describe a case of a 55 year-old female patient presenting erythematous/purple patches on the breasts, back and limbs. She previously presented ductal carcinoma in the right breast in 2006 which was treated with mastectomy and proceeded to silicone breast implant in 2009. Clinical hypothesis was telangiectatic metastatic carcinoma. Histopathology showed vascular ectasia, thrombosis and recanalization of upper dermis small vessels. On immunohistochemistry, intravascular cells were CD 68+ and negative for estrogen and progesterone receptors, CK7, EMA and AE1/AE3 and endothelial cells were CD64+, leading to the diagnosis of intravascular histiocytosis.


Subject(s)
Humans , Female , Silicones/adverse effects , Histiocytosis/etiology , Histiocytosis/pathology , Skin Diseases, Vascular/etiology , Skin Diseases, Vascular/pathology , Breast Implantation/adverse effects , Immunohistochemistry , Venous Thrombosis/etiology , Venous Thrombosis/pathology , Dilatation, Pathologic , Middle Aged
17.
Arq. bras. cardiol ; 113(6): 1114-1118, Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055056

ABSTRACT

Abstract Background: Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs). Objective: To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions. Methods: Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted. Results: A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI. Conclusions: An important percentage of patients with FEI has coronary artery dilation.


Resumo Fundamento: A dilatação das artérias coronárias é a principal complicação da Doença de Kawasaki (DK) e, além de algumas características clínicas, é comum à DK e a doenças exantemáticas febris (DEFs). Objetivo: Avaliar se crianças com DEF e que não têm critério para DK apresentam alterações nas dimensões das artérias coronárias. Métodos: Foi realizada ecocardiografia nas primeiras duas semanas da doença em crianças com idade inferior a 10 anos, que apresentaram febre e exantema e nenhum outro critério de DK. Para comparar com pacientes com DK, fizemos a revisão de ecocardiogramas e prontuários médicos de pacientes com diagnóstico de DK dos últimos cinco anos. Ectasia coronária foi avaliada usando escore Z das artérias coronárias. As médias das dimensões das artérias coronárias foram comparadas pelo teste z, e um nível de significância de 0,05 foi adotado. Resultados: Foram incluídos no estudo 34 pacientes, 22 (64,7%) com diagnóstico de DEF e 12 (35,2%) com diagnóstico de DK. Usando o escore Z das artérias coronárias, observou-se dilatação em algum dos ramos da artéria coronária em seis (27,2%) pacientes com DEF. Conclusão: Uma porcentagem importante dos pacientes com DEFs apresenta dilatação das artérias coronárias.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Coronary Artery Disease/etiology , Coronary Vessels/physiopathology , Dilatation, Pathologic/etiology , Fever/complications , Coronary Artery Disease/diagnostic imaging , Echocardiography , Coronary Vessels/diagnostic imaging , Dilatation, Pathologic/diagnostic imaging , Exanthema , Mexico
18.
Arq. bras. cardiol ; 113(5): 915-922, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055038

ABSTRACT

Abstract Background: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. Objective: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. Methods: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). Results: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). Conclusion: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.


Resumo Fundamento: A síndrome hepatopulmonar (SHP), presente em pacientes cirróticos, é pouco estudada na esquistossomose hepatoesplênica (EHE) e inclui a ocorrência de dilatações vasculares intrapulmonares (DVP). O ecocardiograma transesofágico com contraste (ETEc) de microbolhas é mais sensível que o ecocardiograma transtorácico com contraste (ETTc) de microbolhas na identificação de DVP na cirrose. Objetivo: Avaliar o desempenho do ETEc comparado ao ETTc na identificação de DVP para diagnóstico de SHP em pacientes com EHE. Métodos: Incluímos 22 pacientes com EHE submetidos a ETEc e ETTc para pesquisa de DVP, além de exames laboratoriais. Os ETEc e ETTc foram realizados empregando-se solução salina agitada, injetada em veia periférica. A visualização tardia das microbolhas em câmaras esquerdas indicava presença de DVP. Os resultados foram comparados entre os dois métodos pelos testes t de Stu dent e qui-quadrado (significância p < 0,05). Resultados: Todos os 22 pacientes realizaram ETEc sem intercorrências. Foram excluídos três pela presença de forame oval patente (FOP), e a análise final foi realizada nos outros 19. A DVP esteve presente ao ETEc em 13 pacientes (68%) e em apenas seis ao ETTc (32%, p < 0,01). Não houve diferenças significativas nos dados clínicos e laboratoriais entre os grupos com e sem DVP, incluindo a diferença alveoloarterial de oxigênio. O diagnóstico de SHP (presença de DVP com alterações gasométricas) ocorreu em cinco pacientes pelo ETEc e em apenas um pelo ETTc (p = 0,09). Conclusão: Em pacientes com EHE, o ETEc foi seguro e superior ao ETTc na detecção de DVP não identificada ao ETTc, o que possibilitou adicionalmente excluir FOP.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Schistosomiasis/diagnostic imaging , Splenic Diseases/diagnostic imaging , Echocardiography/methods , Echocardiography, Transesophageal/methods , Dilatation, Pathologic/diagnostic imaging , Liver Diseases, Parasitic/diagnostic imaging , Sensitivity and Specificity , Contrast Media , Hepatopulmonary Syndrome/diagnosis , Hepatopulmonary Syndrome/diagnostic imaging , Microbubbles , Foramen Ovale, Patent/diagnosis
19.
Rev. bras. oftalmol ; 78(5): 327-329, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1042382

ABSTRACT

Abstract A 26-year-old man, single, business student, reveals a ectasic cornea during corneal topography exam. Among some procedures, the patient chose Orthokeratology to do a corneal reshape and got successfully a good visual acuity, going against the most authors guidance.


Resumo Estudante de 26 anos, masculino, estudante de economia, apresentou ao exame topográfico de córneas, ectasia corneal. Dentre todos os procedimentos apresentados, optou pela ortoceratologia para o remodelamento corneal, e obteve sucesso com melhora da acuidade visual, indo contra a orientação da maioria dos autores.


Subject(s)
Humans , Male , Adult , Cornea/pathology , Dilatation, Pathologic/therapy , Orthokeratologic Procedures , Visual Acuity , Corneal Topography , Dilatation, Pathologic/diagnosis , Keratoconus/diagnosis
20.
Arch. cardiol. Méx ; 89(3): 248-253, jul.-sep. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149074

ABSTRACT

Resumen Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.


Abstract Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.


Subject(s)
Humans , Male , Aged , Thrombosis/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/therapy , Dilatation, Pathologic/diagnostic imaging , Non-ST Elevated Myocardial Infarction/physiopathology
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