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1.
Anaesth Intensive Care ; 38(6): 1090-3, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21226443

RESUMO

We present the case of a 52-year-old female admitted with fever and multiple organ failure, initially treated for presumed sepsis. However the combination of multiple organ failure, hyperthermia and vascular instability raised the suspicion of a phaeochromocytoma multisystem crisis. An emergency abdominal ultrasound in the intensive care unit disclosed a large tumour of the right adrenal. Despite specific medical treatment for the presumed adrenal emergency and multiple organ failure, the patient succumbed. Postmortem examination verified the diagnosis of phaeochromocytoma.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Febre/etiologia , Insuficiência de Múltiplos Órgãos/etiologia , Feocromocitoma/complicações , Sepse/complicações , Feminino , Humanos , Pessoa de Meia-Idade
2.
Heart ; 92 Suppl 1: i27-38, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16543599

RESUMO

In patients with congenital heart disease the right ventricle (RV) may support the pulmonary (subpulmonary RV) or the systemic circulation (systemic RV). During the last 50 years evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. Despite major progress being made, assessing the RV either in the subpulmonary or the systemic circulation remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and occasionally invasive assessment with angiography). This review discusses the implications of volume and pressure loading of the RV in the context of congenital heart disease and describes the most relevant imaging modalities for monitoring RV function.


Assuntos
Cardiopatias Congênitas/complicações , Disfunção Ventricular Direita/etiologia , Ecocardiografia/métodos , Cardiopatias Congênitas/patologia , Cardiopatias Congênitas/fisiopatologia , Comunicação Interatrial/complicações , Comunicação Interatrial/fisiopatologia , Humanos , Angiografia por Ressonância Magnética/métodos , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/patologia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/patologia , Volume Sistólico , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia , Disfunção Ventricular Direita/patologia , Disfunção Ventricular Direita/fisiopatologia , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/patologia
3.
Circulation ; 112(7): 961-8, 2005 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-16087793

RESUMO

BACKGROUND: Dilatation of the aortic root is a known feature in tetralogy of Fallot (TOF) patients with pulmonary stenosis (PS) or pulmonary atresia (PA). We hypothesized that intrinsic histological abnormalities of the aortic wall present since infancy are an important causative factor leading to aortic root dilatation. METHODS AND RESULTS: We examined the aortic histology of 17 cases with TOF and PS/PA from our cardiac morphology archive and compared them with a control group of normal aortas. Measured circumference of the aortic root at the sinotubular junction and at the ascending aorta was indexed to the left ventricle. Aortic walls were studied by light microscopy with the use of various stains. Seventeen TOF cases (7 with PS, 10 with PA) including 7 infants, 2 children, and 8 adults were compared with 11 hearts with normal aorta. Aortic root circumference to left ventricular index and ascending aortic circumference to left ventricular index were 1.24+/-0.25 and 1.37+/-0.24, respectively, in the TOF group versus 0.89+/-0.10 and 0.88+/-0.11, respectively, in the control group (P<0.001). Histological changes of grade 2 or 3 were present in 29% (medionecrosis), 82% (fibrosis), 35% (cystic medial necrosis), and 59% (elastic fragmentation) in the ascending aorta of the TOF group. Histology grading scores were significantly higher in the TOF group (median score, 7; range, 1 to 12) compared with normal controls (median score, 2; range, 0 to 6) and correlated with the ascending aortic circumference to left ventricular index (r=0.525, P=0.03). CONCLUSIONS: There are marked histological abnormalities in the aortic root and ascending aortic wall of patients with TOF present from infancy, suggesting a causative mechanism for subsequent aortic root dilatation.


Assuntos
Aorta/patologia , Cardiopatias Congênitas/patologia , Tetralogia de Fallot/patologia , Adulto , Cadáver , Criança , Pré-Escolar , Cardiopatias Congênitas/cirurgia , Humanos , Pessoa de Meia-Idade , Necrose , Cuidados Paliativos , Seio Aórtico/patologia , Tetralogia de Fallot/cirurgia , Túnica Média/patologia
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