Infarto miocárdico inferior e choque associado a obstrução da via de saída do ventrículo esquerdo / Inferior myocardial infarction and shock associated with left ventricular outflow tract obstruction

Relatamos o caso de um paciente admitido no setor de emergência do nosso serviço com infarto agudo do miocárdio em parede inferior, submetido a angioplastia primária, complicado com choque não responsivo a administração de catecolaminas e a balão de contrapulsação intra-aórtico. A utilização do ecocardiograma transesofágico foi crucial na demonstração da movimentação sistólica anterior da valva mitral obstruindo a via de saída do ventrículo esquerdo.

Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases

The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4 percent) out of 322 patients reported fever at admission to hospital and 55 (17.1 percent) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8 percent). Tuberculosis (32.7 percent), Pneumocystis carinii pneumonia (10.9 percent), and Mycobacterium avium complex (9.1 percent) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5 percent), sinusitis (3.6 percent), Salmonella-S. mansoni association (3.6 percent), disseminated histoplasmosis (3.6 percent), neurosyphilis (1.8 percent), and isosporiasis (1.8 percent). Four patients had non-Hodgkin's lymphoma (7.3 percent). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.