RESUMEN
INTRODUCTION: Acute tension pneumopericardium due to gastric perforation is a rare and often lethal condition. Only a few case reports have been described in the literature. Diagnosis based on clinical evaluation is difficult and it is usually made incidentally upon computed tomography (CT) or plain radiography of the chest. Since cardiac tamponade caused by pneumopericardium is life-threatening, immediate diagnosis and emergent therapy is vital. CASE REPORT: We report a 75-year-old male with peptic ulcer disease associated with perforation of the pericardium and acute shock. It is the first reported case with a series of two computed tomograms performed during the 72 h preceding the acute onset of tension pneumopericardium. No radiographic evidence of ulcer perforation was present in the three days prior to the acute event. DISCUSSIONS: Gastric ulcer perforation into the pericardium is rare and could not be detected by CT scan prior the deletorious event. Pneumopericardium seems to be fateful and could not be foreseen by clinical or radiological findings.
RESUMEN
Drug eluting stents (DES) have significantly reduced restenosis when compared to BMS and are considered the standard of care in the treatment of symptomatic coronary artery disease. However, late stent thrombosis has emerged as a major concern with the use of first generation DES. Pathologic studies of patients dying from late DES thrombosis (first generation sirolimus-eluting stents and paclitaxel-eluting stents) showed that DES are associated with delayed healing characterized by poor endothelialization of stent struts and persistence of fibrin as compared to BMS. Additional risk factors for LST include long lesions, left main coronary artery, bifurcation stenting, ruptured plaques, and hypersensitivity reactions. Currently, the next generation DES are being developed to optimize the three major components of DES: the stent platform, the polymer coating and the drug. New technologies include biodegradable polymers and stents, polymer free drug delivery and prohealing approaches. Further preclinical testing and evaluation through large clinical trials are needed to determine the safety and efficacy of future DES in clinical practice.
