ABSTRACT
Approximately 21% of patients with bipolar disorder (BD) also have an additional diagnosis of obsessive-compulsive disorder (OCD). This condition is associated with a more severe prognosis and complicates the treatment of BD. In our case report we provide documentary evidence of our experience with trazodone prolonged release in the treatment of depressive phase in a patient with BD II-OCD comorbidity. Rationality in the choise of treatment was based on the need to manage depressive and obsessive symptoms without facilitating hypomania switches.
Subject(s)
Anti-Anxiety Agents/therapeutic use , Bipolar Disorder/drug therapy , Obsessive-Compulsive Disorder/drug therapy , Trazodone/therapeutic use , Adult , Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Comorbidity , Humans , Obsessive-Compulsive Disorder/complications , Obsessive-Compulsive Disorder/diagnosis , Treatment OutcomeABSTRACT
We describe a case of a man, 42 years old, submitted to successful fibrinolitic strategy with rTPA in acute mitralic prosthesis valve thrombosis and ipomobility of one emidisk. There aren't a consensus agreement in therapeutic strategy but we may support the approach of some authors that employ fibrinolisis in patients without absolute or relative controindications and if thrombus dimension is less than 1 cm otherwise they make use of heparin therapy in non obstructive thrombosis with successive transesophageal echocardiography evaluation for the efficacy and the later indication for thrombolisis or surgery treatment.
ABSTRACT
We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 x 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery.
Subject(s)
Acute Coronary Syndrome/drug therapy , Antibodies, Monoclonal/adverse effects , Anticoagulants/adverse effects , Hemorrhage/chemically induced , Immunoglobulin Fab Fragments/adverse effects , Lung Diseases/chemically induced , Thrombocytopenia/complications , Abciximab , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/surgery , Angioplasty , Chest Pain , Humans , Male , Middle Aged , Thrombocytopenia/chemically inducedABSTRACT
A woman with skin findings of a connective tissue disorder, typical of Ehlers-Danlos syndrome, was admitted to the Cardiology Division because of signs of congestive heart failure. Electrocardiogram showed sinus tachycardia, signs of right ventricular enlargement and hypertrophy. Echocardiogram showed right ventricular dilatation, and severe tricuspid regurgitation with indirect signs of severe pulmonary systolic hypertension. Chest computed tomography revealed bilateral and diffuse involvement of the peripheral pulmonary arteries, with kinking and elongation of the pulmonary vessels associated with multiple stenoses and post-stenotic dilatation. On artery angiography an elongation of the aortic root with kinking and coiling of the carotid and vertebral vessels was also detected. This young patient exhibited features of arterial tortuosity syndrome, an uncommon connective tissue disorder, with peculiar dysmorphism and clinical signs overlapping Ehlers-Danlos syndrome.
Subject(s)
Connective Tissue Diseases/complications , Constriction, Pathologic/diagnosis , Pulmonary Artery/pathology , Adult , Constriction, Pathologic/etiology , Ehlers-Danlos Syndrome , Family Health , Female , Heart Failure , Humans , Hypertension, Pulmonary , Pulmonary Artery/physiopathologyABSTRACT
Arsenic trioxide is an effective treatment for patients with acute promyelocytic leukaemia (APL) who have relapsed from or are refractory to all trans-retinoic acid and anthracycline chemotherapy. Cardiac effects observed include electrocardiographic changes such as QTc prolongation, T-wave abnormalities, torsades de pointes and sudden death. We describe a case of a man, 76 years old, who was admitted to our department for dyspnoea in APL in treatment with arsenic trioxide. Chest radiograph illustrated an enlarged cardiac silhouette and bilateral pleuric effusion and the ECG evidenced QT prolongation. The patient was also submitted to transthoracic echocardiography that revealed moderate pericardial effusion without signs of cardiac tamponade and a normal biventricular function. This condition was considered to be associated with arsenic trioxide polyserosit and the drug therapy was immediately discontinued and steroid drugs started. After 2 weeks of arsenic trioxide therapy suspension there was evidence of complete resolution of pericardial and pleuric effusion and the ECG showed normal QT interval.