Subject(s)
Anticoagulants/administration & dosage , Heparin, Low-Molecular-Weight/administration & dosage , Intracranial Hemorrhages/drug therapy , Intracranial Hemorrhages/epidemiology , Pulmonary Embolism/prevention & control , Aged , Anticoagulants/adverse effects , Drug Dosage Calculations , Female , Follow-Up Studies , Hemorrhage/etiology , Hemorrhage/prevention & control , Heparin, Low-Molecular-Weight/adverse effects , Humans , Intracranial Hemorrhages/complications , Intracranial Hemorrhages/mortality , Male , Middle Aged , Pulmonary Embolism/etiology , Risk , Spain , Survival AnalysisABSTRACT
Presentamos el caso de un varón de 36 años con dermatomiositis de reciente comienzo, que desarrolló neumomediastino y enfisema subcutáneo masivo al inicio de una neumopatía intersticial progresiva y severa. En el momento del diagnóstico no había imágenes parenquimatosas quísticas evidentes; sin embargo, la broncoscopia permitió evidenciar una lesión endobronquial de aspecto necrótico que se consideró como probable origen de la fuga aérea. El paciente se trató con corticoides a dosis altas, ciclofosfamida y ciclosporina A, con resolución del neumomediastino y del enfisema subcutáneo. Con el tratamiento se observó una mejoría progresiva de la afección parenquimatosa pulmonar y de la insuficiencia respiratoria, lo que permitió la disminución progresiva de los corticoides (AU)
We have recently observed the case of a 36-year-old man with dermatomyositis of recent onset, who developed masive pneumomediastinum and subcutaneous emphysema at the onset of a progresive and severe pulmonary disease. Although there were no sign of parenchymal cysts, after the bronchoscopy it was possible to observe endobronchial necrotic injury which was considered as the likely source of the air leak. He was treated with high dose of corticosteroids, cyclophosphamide and cyclosporin A which resulted in the disappearance of the pneumomediastinum and subcutaneous emphysema and the progressive improvement of both parenchymal lung disease and respiratory insufficiency, enabled us to progressively taper the dose of corticosteroids (AU)
Subject(s)
Humans , Male , Adult , Mediastinal Emphysema/etiology , Dermatomyositis/complications , Pulmonary Alveoli/physiopathology , Lung Diseases, Interstitial/complicationsABSTRACT
We have recently observed the case of a 36-year-old man with dermatomyositis of recent onset, who developed masive pneumomediastinum and subcutaneous emphysema at the onset of a progresive and severe pulmonary disease. Although there were no sign of parenchymal cysts, after the bronchoscopy it was possible to observe endobronchial necrotic injury which was considered as the likely source of the air leak. He was treated with high dose of corticosteroids, cyclophosphamide and cyclosporin A which resulted in the disappearance of the pneumomediastinum and subcutaneous emphysema and the progressive improvement of both parenchymal lung disease and respiratory insufficiency, enabled us to progressively taper the dose of corticosteroids.
ABSTRACT
INTRODUCTION: The influence of the clinical syndromes of pulmonary embolism (PE) on clinical outcome has not been evaluated. PATIENTS AND METHODS: The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, all enrolled patients with acute PE without preexisting cardiac or pulmonary disease were classified into three clinical syndromes: pulmonary infarction, isolated dyspnea, or circulatory collapse. Their clinical characteristics, laboratory findings, and 3-month outcomes were compared. RESULTS: As of January 2005, 4,145 patients with acute, symptomatic, objectively confirmed PE have been enrolled in RIETE. Of them, 3,391 patients (82%) had no chronic lung disease or heart failure: 1,709 patients (50%) had pulmonary infarction, 1,083 patients (32%) had isolated dyspnea, and 599 patients (18%) had circulatory collapse. Overall, 149 patients (4.4%) died during the first 15 days of therapy: 2.5% with pulmonary infarction, 6.2% with isolated dyspnea (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7 to 3.8), and 6.5% with circulatory collapse (OR, 2.7; 95% CI, 1.7 to 4.2). From days 16 to 90, 31 patients had recurrent PE; 5 of 14 patients (36%) with pulmonary infarction died of their new PE, compared with 5 of 10 patients (50%) with isolated dyspnea, and all 7 patients (100%) with circulatory collapse. CONCLUSIONS: PE patients with pulmonary infarction (50% of the whole series) had a significantly lower mortality rate both during initial therapy and after discharge.
