Asunto(s)
Aorta/patología , Insuficiencia Cardíaca/etiología , Hemangioendotelioma Epitelioide/complicaciones , Hemangioendotelioma Epitelioide/diagnóstico , Neoplasias Vasculares/complicaciones , Neoplasias Vasculares/diagnóstico , Constricción Patológica/etiología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Immediately after balloon dilation of a fresh thrombotic coronary lesion, 5 patients had angina, ST segment elevation, and a striking reduction of blood flow in the dilated artery. A mean (SEM) pressure gradient across the dilated lesion of only 3(1) mm Hg and an average minimum lesion diameter of 1.7 mm indicated that the decline in resting blood flow was not due to obstruction at the site of the original lesion. Neither distal vascular emboli nor side branch occlusions were visible on the angiogram. An increase in distal coronary artery pressure during a subsequent balloon inflation suggested that the site of vasoconstriction was distal to the origin of collateral vessels. The syndrome lasted 48-80 min and was not reversed with nitroglycerin or thrombolytic drugs. Papaverine lessened the syndrome transiently on one occasion. Such microvascular constriction, caused by release of potent vasoconstrictors from the clot, may partly explain the failure of emergency angioplasty to reduce infarct size in acute myocardial infarction.
Asunto(s)
Angioplastia de Balón/efectos adversos , Enfermedad Coronaria/terapia , Trombosis Coronaria/terapia , Vasos Coronarios , Enfermedad Aguda , Adulto , Anciano , Angina de Pecho/etiología , Angioplastia de Balón/métodos , Presión Sanguínea , Constricción Patológica , Angiografía Coronaria , Trombosis Coronaria/fisiopatología , Electrocardiografía , Frecuencia Cardíaca , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Estudios Retrospectivos , Síndrome , Factores de TiempoRESUMEN
Two patients, aged 24 and 19 years, who had undifferentiated lymphoma, developed the acute onset of focal neurologic deficits 10 days after treatment with moderate-dose methotrexate (2.76 g/m2 by 42-hour intravenous infusion) and 12.5 mg of intrathecal methotrexate. Prior chemotherapy also included intravenous cyclophosphamide, doxorubicin, vincristine, oral prednisone, and intrathecal cytosine arabinoside. Dysarthria with left hemiparesis was noted in one patient and inability to speak and quadriparesis in the other. Cerebrospinal fluid and cranial computerized tomography results were normal; however, EEGs showed focal abnormalities in both patients. Full neurologic recovery occurred within 48 hours. These symptoms developed early in the course of treatment and have not recurred in one patient who continued to receive the same regimen. The mechanism for this neurologic dysfunction is unclear. A similar picture has been reported in patients receiving high-dose methotrexate (8-10 g/m2) for osteogenic sarcoma.
