RESUMEN
Pulmonary embolism (PE) is a frequently encountered clinical condition with a high mortality rate that is affected by various factors such as age, hemodynamics, and other comorbidities. Early diagnosis and risk stratification are crucial to achieving a favorable clinical outcome. New risk stratification algorithms have been proposed in order to identify high-risk patients who will benefit from early thrombolytic treatment. Among the various validated diagnostic methods, the role of echocardiography is increasingly accepted. Recent advances in studying right ventricular function have made echocardiography an attractive tool for establishing or excluding the diagnosis of acute PE in the emergency setting and initiating optimal therapy.
Asunto(s)
Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Embolia Pulmonar/diagnóstico por imagen , Enfermedad Aguda , Algoritmos , Técnicas de Apoyo para la Decisión , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Embolia Pulmonar/mortalidad , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/terapia , Medición de Riesgo , Factores de Riesgo , Terapia Trombolítica , Función Ventricular Izquierda , Función Ventricular DerechaRESUMEN
Traumatic dissection of the aorta is a well-documented entity with poor prognosis and broad spectrum of clinical presentations. We report a rare case of an asymptomatic late presentation of aortic dissection after a high-speed vehicle accident. This case highlights the importance of high clinical suspicion for the diagnosis of aortic dissection.
Asunto(s)
Aneurisma de la Aorta/etiología , Disección Aórtica/etiología , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Accidentes de Tránsito , Disección Aórtica/diagnóstico , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Traumatismos Torácicos/diagnóstico , Heridas no Penetrantes/diagnósticoRESUMEN
Little information exists regarding the prevalence of aberrant or ectopic aortic arch vessels in patients with different cardiovascular anomalies. We present a young patient with an aberrant right subclavian artery associated with an ectopic left vertebral artery and a bicuspid aortic valve.
Asunto(s)
Anomalías Múltiples/diagnóstico , Aorta Torácica/anomalías , Válvula Aórtica/anomalías , Aneurisma/diagnóstico , Anomalías Cardiovasculares/diagnóstico , Trastornos de Deglución/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Arteria Subclavia/anomalías , Arteria Vertebral/anomalías , Adulto JovenRESUMEN
Although Brevibacterium species used to be considered as nonpathogenic microorganisms until recently, it seems that they can cause a wide variety of clinical diseases by acting mostly as opportunistic pathogens. The present case is the second reported case of infective endocarditis by Brevibacterium species; however, it is the first reported infected native aortic valve in an immunocompetent patient.
Asunto(s)
Infecciones por Actinomycetales/diagnóstico , Válvula Aórtica , Brevibacterium , Endocarditis Bacteriana/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Válvula Aórtica/microbiología , Quimioterapia Combinada , Endocarditis Bacteriana/microbiología , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Inmunocompetencia , Masculino , Persona de Mediana Edad , Vancomicina/administración & dosificación , Vancomicina/uso terapéuticoRESUMEN
BACKGROUND: Colorectal cancer is the second leading cause of cancer death in European countries. Differences in screening implementation may explain USA vs. European survival differences. The proportion of European primary care physicians advising colorectal screening has been reported to be inconsistent. We therefore hypothesised the presence of a belief-related bias among European physicians regarding who is responsible for cancer screening delivery. OBJECTIVES: To index beliefs in cancer screening implementation among a wide sample of Greek physicians. Study design Cross-sectional survey. METHODS: Three hundred and sixty-six physicians involved in primary care activities in 15 provinces answered a questionnaire about responsibility in cancer screening delivery. Results 22.4% and 7.6% of physicians declared that the health system and the patients, respectively, have the main responsibility for cancer screening implementation, while 70 % advocated patient-health system co-responsibility. Beliefs were statistically correlated to age (p=0.039) and specialisation category (p=0.002). Patients' will was mainly indicated by internists, trainee internists and physicians older than 30, while GPs, trainee GPs and house officers were mainly health system-oriented. Worryingly, when physicians were asked about which specialty should inform the population, 81% indicated family doctor (for-fee-service) while the involvement of free-from-fee specialities was inconsistent. CONCLUSION: A considerable disorientation about responsibilities in cancer screening delivery was observed in our study sample. Continual medical education and clear redefinition of primary care physicians' activities are required.