Asunto(s)
Alcaligenes , Artritis Infecciosa/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones Oportunistas/complicaciones , Macroglobulinemia de Waldenström/complicaciones , Artritis Reumatoide/complicaciones , Femenino , Humanos , Prótesis de la Rodilla/efectos adversos , Persona de Mediana EdadRESUMEN
Achromobacter xylosoxidans is an aerobic gram negative organism that has been infrequently implicated in clinical infections in a variety of anatomical sites. We describe a case of a prosthetic knee infection due to Achromobacter xylosoxidans in a patient with rheumatoid arthritis receiving high dose prednisone.
Asunto(s)
Alcaligenes/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/etiología , Artropatías/etiología , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/epidemiología , Humanos , Incidencia , Artropatías/diagnóstico , Artropatías/microbiología , Articulación de la Rodilla/microbiología , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiologíaRESUMEN
Thirty-eight patients, 27 men and 11 women, mean age 49 +/- 12 yr, suffering from dilated cardiomyopathy were included in this prospective study of prognostic factors. Twenty-two subjects admitted heavy alcohol consumption (greater than 80 g/d, for at least 10 yr). The survival rates for 2, 5 and 7 yr were 87, 35 and less than 20%, respectively. Prognostic factors were evaluated in 34 (22 alcoholic and 12 non-alcoholic) patients: 10 improved or were cured, as determined clinically, radiologically and echocardiographically (group 1); 24 deteriorated, 13 of whom died (group 2). Statistically significant values for group 1 versus group 2 were: echocardiographic left ventricular (LV) end diastolic diameter (3.50 +/- 0.80 vs 4.02 +/- 0.5 cm/m2, p less than 0.026) and LV end systolic diameter (2.97 +/- 0.65 vs 3.43 +/- 0.53 cm/m2, p less than 0.02); hemodynamic LV systolic pressure (113.9 +/- 15 vs 101.82 +/- 17.36 mm Hg, p = 0.045); angiographic LV end diastolic volume (137.8 +/- 57.44 vs 177.85 +/- 55.45 ml/m2, p = 0.057), LV end systolic volume 93 +/- 53.5 s 139.28 +/- 48.99 ml/m2, p less than or equal to 0.036), ejection fraction 0.36 +/- 0.16 vs 0.22 +/- 0.7%, p less than or equal to 0.006) and velocity of fiber shortening (0.79 +/- 0.53 vs 0.36 +/- 0.3 circ/s, p = 0.036). Other electrical, radiological and hemodynamic parameters were not significant and alcohol consumption did not influence the prognosis. The severity of LV functional impairment appears to be the major determinant of a poor prognosis and reduced survival in idiopathic and alcoholic cardiomyopathies.
Asunto(s)
Cardiomiopatía Alcohólica/mortalidad , Cardiomiopatía Dilatada/mortalidad , Adulto , Anciano , Cardiomiopatía Alcohólica/diagnóstico por imagen , Cardiomiopatía Dilatada/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Radiografía , Factores de Riesgo , Volumen SistólicoRESUMEN
Observation of chronic constrictive pericarditis associated with pulmonary asbestosis is reported here. Heart catheterization revealed typical patterns of cardiac constriction. The diagnosis of asbestosis was based on pathologic features associated with a long history of asbestos dust exposure without evidence for tuberculosis. The etiology of this constrictive pericarditis was related to an asbestosis pericarditis involvement.
Asunto(s)
Asbestosis/complicaciones , Pericarditis Constrictiva/etiología , Anciano , Anciano de 80 o más Años , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Enfermedad Crónica , Humanos , Masculino , Pericarditis Constrictiva/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Between November, 1978 and August, 1983, 22 patients aged from 28 to 65 years with idiopathic dilated cardiomyopathy diagnosed on the basis of clinical and haemodynamic criteria were investigated. All these patients, who consumed alcohol in excessive amounts, were followed up for 1 to 58 months. The overall mortality rate was 10 p. 100 at 4 months and 25 p. 100 at 58 months. Six patients were clinically improved with reduction of heart size (group A); 10 patients showed deterioration with 3 deaths (group C) and 6 patients followed an intermediate course (group B). When the characteristics of the groups were evaluated, it was found that compared to group C patients those in groups A and B had a lower cardiothoracic ratio: 0.56 +/- 0.04 (B) vs 0.64 +/- 0.06 (C) (P less than 0.02), a lower indexed end-diastolic diameter and systolic diameter on TM echo: 3.20 +/- 0.50 cm/m2 (A) vs 4.13 +/- 0.39 cm/m2 (C) (P less than 0.02), and 2.72 +/- 0.37 cm/m2 (A) vs 3.57 +/- 0.47 cm/m2 (C) (P less than 0.02) respectively, and a lower indexed end-diastolic volume as evaluated by angiography: 121 +/- 61 ml/m2 (A) vs 202 +/- 65 ml/m2 (C) (P less than 0.06). Dilated cardiomyopathy associated with excessive alcohol consumption has a better prognosis when the patients stop drinking and when their heart dilatation is mild to moderate.
Asunto(s)
Alcoholismo/complicaciones , Cardiomiopatía Dilatada/etiología , Adulto , Anciano , Cardiomiopatía Dilatada/mortalidad , Ecocardiografía , Electrocardiografía , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de RiesgoRESUMEN
From October 1983 to January 1985, 46 patients (38 men and 8 women; average age, 60 years; range, 37 to 83 years) underwent peripheral vascular surgery of either the internal carotid artery or the arteries of the lower limbs. Each patient had a thorough clinical examination, an ECG, and a dipyridamole-thallium-201 myocardial scan before operation. On the basis of results, they were divided into two groups: 20 patients with and 26 patients without chronic ischemic heart disease. Three major cardiac events were noted during or after a period of 1 month after surgery: There were two deaths due to cardiac ischemic events and one patient had postoperative unstable angina pectoris. These three patients were classified in the coronary group (NS). When the patients were classified on the basis of whether or not there was thallium redistribution on serial images after infusion of dipyridamole, 14 with redistribution and 32 without redistribution were noted. The three patients who had major cardiac events were in the former group (p less than 0.04). Our data suggest that patients in whom redistribution occurs have a high incidence of postoperative ischemic events. These patients should be considered for particular preoperative coronary care to avoid major postoperative cardiac events and to increase chances of survival.
Asunto(s)
Arterias/cirugía , Arteria Carótida Interna/cirugía , Enfermedad Coronaria/diagnóstico por imagen , Dipiridamol , Pierna/irrigación sanguínea , Radioisótopos de Talio , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Minicomputadores , Infarto del Miocardio/complicaciones , Complicaciones Posoperatorias/etiología , Pronóstico , CintigrafíaRESUMEN
A case of acquired immunodeficiency syndrome associated with myocarditis is reported. The myocarditis was peculiar in that it heralded the syndrome and followed a subacute course. It was most probably of infectious origin, although no pathogen has positively been identified; it may have been caused by a cytomegalovirus or even by the human immunodeficiency virus itself on a background of genetic predisposition. This case shows that while cardiologists are concerned with cardiac disorders occurring during AIDS, they must also consider the possibility of AIDS when confronted with a myocarditis.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Miocarditis/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Adulto , Humanos , Técnicas Inmunológicas , Masculino , Miocarditis/patología , Miocardio/patologíaRESUMEN
Twelve years after mediastinal irradiation for Hodgkin's disease, a 38-years old man developed an infra-hisian atrioventricular block with syncopes. The rarity of this complication of radiotherapy is emphasized. A review of the literature yielded only 6 cases of atrioventricular block associated with cobalt therapy; a pathological examination was performed in two of these patients and an electrophysiological study in two others.
Asunto(s)
Bloqueo Cardíaco/etiología , Enfermedad de Hodgkin/radioterapia , Neoplasias del Mediastino/radioterapia , Radioterapia/efectos adversos , Adulto , Bloqueo Cardíaco/terapia , Humanos , Masculino , Marcapaso Artificial , Factores de TiempoRESUMEN
From October 1983 to January 1985, 46 patients (38 men and 8 women; mean age 60 years, range 37-83) underwent peripheral vascular surgery either of the internal carotid artery or of arteries of the lower limbs. All patients had thorough clinical examination, ECG and thallium dipyridamole myocardial scanning before operation, as a result of which they were divided into 20 with, and 26 without chronic ischemic heart disease. Three major cardiac events were noted during or following a period of one month after surgery: two deaths due to a cardiac ischemic event and one post-operative unstable angina pectoris. The three patients with these complications were classified in the coronary group (NS). When the patients were reclassified according to the presence or absence of thallium redistribution on serial images after dipyridamole, 14 had redistribution and 32 had no redistribution. The three major cardiac events were found to have occurred in the group with redistribution (P less than 0.04). Our study suggests that patients with redistribution have a high incidence of postoperative ischemic events. They should be considered for a particular pre-operative coronary management to avoid post-operative major cardiac events and to improve survival.
Asunto(s)
Enfermedad Coronaria/prevención & control , Dipiridamol , Corazón/diagnóstico por imagen , Procedimientos Quirúrgicos Vasculares/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Cintigrafía , Factores de Riesgo , Radioisótopos de TalioRESUMEN
It has been hypothesized that dilated cardiomyopathy (DCM) is of dysimmune origin. Conventional immunological studies have provided no evidence that a primary disregulation of immune mechanisms is involved. In the present study, the possibility of an individual predisposition to DCM resting on a preferential distribution of HLA system antigens has been investigated. Typing of the HLA system antigens A and B was performed in a group of 38 DCM patients who were heavy drinkers. The results were compared with those obtained in: (a) 57 alcoholic patients without cardiopathy, and (b) a population of 306 healthy subjects. All subjects were caucasians. Compared with alcoholic patients without cardiac disease, DCM patients had a prevalence of B8 allele. The relative risk of developing DCM was 2.83 in the presence of the B8 antigen. This result suggests a genetic predisposition to DCM: the B8 allele, prevalent among our patients, is associated with the phenotype of numerous autoimmune diseases. This study therefore supports the theory that DCM is of dysimmune origin, but this must be confirmed by further investigations conducted on a larger number of cases.
Asunto(s)
Cardiomiopatía Alcohólica/inmunología , Cardiomiopatía Dilatada/inmunología , Antígenos HLA/análisis , Adulto , Anciano , Epítopos/análisis , Femenino , Antígenos HLA-A , Antígenos HLA-B , Humanos , Masculino , Persona de Mediana Edad , FenotipoRESUMEN
We present a case report of a patient suffering of severe hypertension and grade IV hypertensive retinopathy according to the Keith-Wagener classification. Simultaneously hypertensive encephalopathy was present confirming the poor prognosis of discoedema occurring in the course of hypertension when left untreated. Hypertension was related to chronic poisoning with glycyrrhiza, and its hyperaldosteronism like effect. Pathogenesis of discoedema in malignant hypertension is discussed.
Asunto(s)
Ácido Glicirretínico/análogos & derivados , Hipertensión/inducido químicamente , Papiledema/etiología , Enfermedades de la Retina/inducido químicamente , Adulto , Enfermedad Crónica , Angiografía con Fluoresceína , Ácido Glicirretínico/envenenamiento , Ácido Glicirrínico , Humanos , Hipertensión/complicaciones , Masculino , Papiledema/diagnóstico , Enfermedades de la Retina/complicaciones , Enfermedades de la Retina/diagnósticoRESUMEN
Apparently primary dilated cardiomyopathy poses a difficult aetiological problem. There is epidemiological, biological and histological evidence that some of them are the long-term results of acute myocarditis especially due to Coksackie virus. In order to establish whether cytomegalovirus infection could also have the same consequences 67 cases of dilated cardiomyopathy were reviewed to look for inflammatory changes and CMV serology. The results indicate a possible link between acute CMV myocarditis and dilated cardiomyopathy (7 p. 100 of cases) but this is difficult to prove in the chronic stage of the disease.
Asunto(s)
Cardiomiopatía Dilatada/etiología , Infecciones por Citomegalovirus/complicaciones , Adulto , Anciano , Anticuerpos Antivirales/análisis , Cardiomiopatía Dilatada/inmunología , Cardiomiopatía Dilatada/patología , Citomegalovirus/inmunología , Femenino , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Síndromes del Arco Aórtico/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Arteritis de Takayasu/complicaciones , Adulto , Femenino , Humanos , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Radiografía , Cintigrafía , Arteritis de Takayasu/diagnóstico por imagenRESUMEN
Syphilitic aortic insufficiency and coronary ostial stenosis is a rare condition. It was diagnosed in 8 patients referred for surgery. The infection, acknowledged in 3 cases, was contracted over 15 years prior to admission! The operative indication was aortic valve replacement in 6 cases (Stage II to IV dyspnoea) and coronary insufficiency in 2 cases (Stage III angina pectoris). Two cases of ostial stenosis were not identified at coronary angiography, illustrating the potential diagnostic pitfall of a disease which is often unrecognised nowadays. Preoperative echocardiography of the left main coronary artery, especially its intra-aortic segment, may be of value but was not performed in these old cases. Surgery consisted in aortic valve replacement and coronary revascularisation by decortication of the ostia or coronary bypass (1 case). The evolution was excellent in the 6 survivors, especially with respect to the anginal syndrome which was completely cured without associated treatment. A protocol of echocardiographic surveillance of the left main coronary artery has been instituted in these patients to detect any late postoperative changes after ostial decortication.
Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Enfermedad Coronaria/etiología , Sífilis Cardiovascular/complicaciones , Anciano , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/cirugía , Constricción Patológica , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/métodos , Radiografía , Sífilis Cardiovascular/cirugíaRESUMEN
The authors report the case of a pheochromocytoma of the organ of Zuckerkandl in a 46 year old man. The clinical presentation was severe paroxysmal hypertension; the tumour was located by arteriography, CT scanning, and by scintigraphy with iodine labelled benzylguanidine. The blood pressure returned to normal after surgery. The embryological, anatomical and physiological features of the organ of Zuckerkandl are reviewed: the authors discuss briefly the modern methods of diagnosis and localisation of the tumour.