ABSTRACT
Cocaine abuse is a public health concern with well-documented cardiovascular complications. However, acute limb ischemia remains a rare and underreported consequence. We present a case of a 36-year-old man with acute right lower limb ischemia following heavy cocaine use, successfully managed with systemic heparin and intra-arterial nitroglycerin. The case highlights considering cocaine as a potential cause of acute limb ischemia and the efficacy of endovascular therapy. Further case reports with this diagnosis and their management are crucial for establishing the best strategies and improving outcomes in these scenarios.
Subject(s)
Endovascular Procedures , Heart Diseases , Thrombosis , Humans , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/surgery , Treatment Outcome , Endovascular Procedures/instrumentation , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Heart Diseases/therapy , Male , Device Removal , Gallstones/diagnostic imaging , Gallstones/surgery , Gallstones/therapy , Female , Child , Thrombectomy/instrumentationABSTRACT
The endovascular treatment of acute lower limb ischemia associated with cocaine use is an underexplored topic. This scoping review aims to map existing information and point out potential knowledge gaps for future research. We searched databases with a strategy of terms and keywords (Cocaine, Acute, Lower Limb, and Ischemia) for articles related to acute ischemia in the lower limbs and cocaine use. We established eligibility and exclusion criteria and searched without restrictions on language or date of publication. We obtained five case reports published between 2004 and 2015. Most of the patients were men with an average age of 38 years. Treatments were heterogeneous. Most patients showed improvement after surgical thrombectomy. The sample size and variety of interventions limit the generalizability of the results, so it is necessary to do more studies with robust methodologies to standardize treatments and improve the understanding of the condition.
ABSTRACT
Hypercoagulability related to SARS-CoV-2 infection is one of the main extrapulmonary complications of COVID-19. We present three cases of intrabdominal thrombotic complications related to the state of hypercoagulability of COVID-19 and its tomographic features. Hypercoagulability state should be taking into account in the interpretation of radiological images in all infected patients with COVID-19.
ABSTRACT
La hipertensión arterial afecta a más de 1.200 millones de personas en el mundo y constituye uno de los factores de riesgo más importantes en la incidencia del infarto agudo de miocardio y el accidente cerebrovascular. Solo el 35% de los pacientes hipertensos se encuentran con valores de la presión arterial (PA) controlados con el uso de medicamentos antihipertensivos. Surge una alternativa, la denervación renal como técnica invasiva, la cual ha demostrado disminuir significativamente los valores de la PA en pacientes con hipertensión arterial resistente, y aunque ha sido debatida y controvertida luego de la publicación del estudio SYMPLICITY HTN-3, en el que no se apreció reducción significativa de las cifras de la presión arterial utilizando el Monitoreo Ambulatorio de Presión Arterial (MAPA), como herramienta de evaluación, surgen muchos interrogantes por resolver sobre esta nueva técnica y su aplicación en el campo clínico. El objetivo del presente reporte es describir detalladamente dos casos de hipertensión arterial resistente, tratados mediante ablación con radiofrecuencia con el nuevo dispositivo Vessix® de la compañía Boston Scientific.
Hypertension affects more than 1,200 people in the world, and constitutes one of the most important risk factors for the incidence of acute myocardial infarction and cerebrovascular accident. Only 35% of hypertensive patients show controlled blood pressure (BP) values with the use of hypertensive drugs. Al alternative becomes available: renal denervation as an invasive technique. It has shown to significantly reduce the BP levels in patients with resistant hypertension, and though it was discussed and controversial after the publication of the SYMPLICITY HTN-3 trial, where no significant reduction of BP values using the ambulatory blood pressure monitoring (ABPM) was noted, many questions have yet to be answered regarding this new technique and its application in the clinical field. The motivation for this report is to accurately describe two cases of resistant hypertension treated with radiofrequency ablation with the new Vessix® device from the company Boston Scientific.
Subject(s)
Humans , Female , Middle Aged , Aged , Pulmonary Arterial Hypertension , Catheter Ablation , Angioplasty, BalloonABSTRACT
The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.
La hiperplasia macro nodular bilateral o hiperplasia adrenal nodular bilateral independiente de la hormona adrenocorticotrópica es una de las causas menos frecuentes de hipercortisolismo, su diagnóstico supone un reto y no se tiene claridad de cuál es la mejor aproximación terapéutica. El muestreo venoso adrenal que frecuentemente se utiliza para hacer la distinción del sitio de producción hormonal en el hiperaldosteronismo primario podría ser una herramienta útil en este contexto ya que podría brindar información que pudiera guiar el tratamiento. Presentamos el caso de una paciente con síndrome de Cushing ACTH independiente en quien el uso del muestreo venoso adrenal con algunas modificaciones cambio de manera radical el tratamiento y permitió confirmar una hiperplasia adrenal macro nodular.
Subject(s)
Adrenal Glands/pathology , Adrenocorticotropic Hormone/blood , Cushing Syndrome/diagnosis , Aged , Cushing Syndrome/pathology , Female , HumansABSTRACT
The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.
La hiperplasia macro nodular bilateral o hiperplasia adrenal nodular bilateral independiente de la hormona adrenocorticotrópica es una de las causas menos frecuentes de hipercortisolismo, su diagnóstico supone un reto y no se tiene claridad de cuál es la mejor aproximación terapéutica. El muestreo venoso adrenal que frecuentemente se utiliza para hacer la distinción del sitio de producción hormonal en el hiperaldosteronismo primario podría ser una herramienta útil en este contexto ya que podría brindar información que pudiera guiar el tratamiento. Presentamos el caso de una paciente con síndrome de Cushing ACTH independiente en quien el uso del muestreo venoso adrenal con algunas modificaciones cambio de manera radical el tratamiento y permitió confirmar una hiperplasia adrenal macro nodular.
