ABSTRACT
Myxoma is the most common type of cardiac tumor, accounting for 30-50% of all primary cardiac tumors. Clinically, patients usually present with at least one of the classic triad of obstructive cardiac, embolic, and constitutional signs. The case is reported of a large atrial myxoma in the left atrium which caused mitral valve obstruction, leading to severe pulmonary hypertension and right heart failure, mimicking rheumatic mitral stenosis. Postoperatively, a fall occurred in the patient's pulmonary artery pressure and she showed clinical improvement.
Subject(s)
Heart Neoplasms/complications , Heart Valve Diseases/etiology , Hemodynamics , Hypertension, Pulmonary/etiology , Mitral Valve/physiopathology , Myxoma/complications , Cardiac Surgical Procedures , Diagnosis, Differential , Echocardiography, Transesophageal , Female , Heart Atria/diagnostic imaging , Heart Failure/etiology , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/physiopathology , Heart Neoplasms/surgery , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/physiopathology , Heart Valve Diseases/surgery , Humans , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/surgery , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Stenosis/diagnosis , Myxoma/diagnostic imaging , Myxoma/physiopathology , Myxoma/surgery , Severity of Illness Index , Treatment OutcomeABSTRACT
Clozapine has been used as an attempt to manage levodopa complications in advanced Parkinson's disease (PD). To investigate the use of clozapine in this context in a Brazilian sample, a retrospective chart review was carried out at the Movement Disorders Clinic from the Federal University of Minas Gerais. This study enrolled 43 PD patients who used or were in use of clozapine. Patients had a mean age of 64 years and a mean UPDRS score of 55. Clozapine was indicated for dyskinesias in 17 patients, for psychosis in 15 and for both reasons in 11. The average maximum dose was 70 mg/day. Twenty six patients used it for a mean of 3.5 years. Twenty nine presented an improvement of their condition, 9 remained clinically stable. Twenty subjects interrupted the use of clozapine, being 9 due to adverse effects. Clozapine may play a role in the management of motor and psychiatric complications in PD, but it is associated with low tolerability.
Subject(s)
Antipsychotic Agents/therapeutic use , Clozapine/therapeutic use , Dyskinesia, Drug-Induced/drug therapy , Parkinson Disease/drug therapy , Psychoses, Substance-Induced/drug therapy , Adult , Aged , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Drug Therapy, Combination , Dyskinesia, Drug-Induced/etiology , Female , Humans , Levodopa/adverse effects , Levodopa/therapeutic use , Male , Middle Aged , Parkinson Disease/psychology , Psychoses, Substance-Induced/etiology , Retrospective StudiesABSTRACT
Clozapine has been used as an attempt to manage levodopa complications in advanced Parkinson's disease (PD). To investigate the use of clozapine in this context in a Brazilian sample, a retrospective chart review was carried out at the Movement Disorders Clinic from the Federal University of Minas Gerais. This study enrolled 43 PD patients who used or were in use of clozapine. Patients had a mean age of 64 years and a mean UPDRS score of 55. Clozapine was indicated for dyskinesias in 17 patients, for psychosis in 15 and for both reasons in 11. The average maximum dose was 70 mg/day. Twenty six patients used it for a mean of 3.5 years. Twenty nine presented an improvement of their condition, 9 remained clinically stable. Twenty subjects interrupted the use of clozapine, being 9 due to adverse effects. Clozapine may play a role in the management of motor and psychiatric complications in PD, but it is associated with low tolerability.
A clozapina vem sendo utilizada na doença de Parkinson (DP) avançada para controle das complicações causadas pela levodopa. Com o objetivo de investigar o emprego da clozapina nesse contexto em amostra de pacientes brasileiros, um estudo retrospectivo foi realizado no Ambulatório de Distúrbios do Movimento da Universidade Federal de Minas Gerais. Este estudo incluiu 43 pacientes que usaram clozapina, apresentando idade média de 64 anos e uma média de 55 pontos no UPDRS. A clozapina foi indicada para discinesias em 17 pacientes, para psicose em 15 e para ambos os motivos em 11. A média da dose máxima empregada foi de cerca de 70 mg/dia. Vinte e seis pacientes usaram a medicação por uma média de 3,5 anos. Houve melhora do quadro clínico em 29 pacientes, 9 permaneceram com quadro clínico estático. O tratamento foi interrompido em 20 pessoas, sendo 9 por efeitos adversos. Apesar de a clozapina ser eficaz no controle das complicações motoras e psiquiátricas na DP, seu uso está associado com baixa tolerabilidade.