RESUMO
Se describe el caso de una mujer de 51 años, nunca fumadora y sin antecedentes médico-quirúrgicos de interés, profesora de informática. Fue remitida a consultas de neumología por un estridor espiratorio de dos meses de evolución, que interfería parcialmente en su trabajo, bajo la sospecha de posible asma bronquial. La exploración física únicamente reveló dicho estridor espiratorio
Assuntos
FemininoRESUMO
Introduction: Continuous home oxygen therapy (CHOT), along with smoking cessation, is the first treatment that has been shown to increase the survival of patients with chronic obstructive pulmonary disease (COPD) and chronic hypoxemia. Objective: To determine survival in a cohort of COPD patients receiving CHOT and to analyze the main causes and risk factors associated with their mortality. Methods: Prospective study of a cohort of COPD patients receiving CHOT. Numerous variables, including survival and cause of death at the end of follow-up, were collected. Results: A total of 409 COPD patients receiving CHOT were included (85.6% men; mean age: 71.27 ± 9.74 years). Mean time of CHOT follow-up was 5.86 ± 3.24 years and median survival was 6 years (95% CI: 5.47-6.53). Mortality at the end of follow-up was 75.8%, the leading cause of death being respiratory (36.9%). Longer survival was significantly associated with lower age, correct CHOT compliance, absence of exacerbations in the previous year, use of long-acting anticholinergics (LAMA), less severe COPD, presence of sleep apnea-hypopnea syndrome/obesity hypoventilation syndrome (SAHS/SHO), absence of malignant disease, heart disease, cerebrovascular disease, and kidney disease. Conclusions: The survival of COPD patients receiving CHOT was very long. The main causes of mortality were respiratory (36.9%). Independent predictors of mortality were age, presence of exacerbations in the previous year, previous diagnosis of cancer, and presence of cerebrovascular and renal disease.
Assuntos
Asma/diagnóstico , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antiasmáticos/uso terapêutico , Asma/complicações , Asma/tratamento farmacológico , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Progressão da Doença , Feminino , Humanos , Pulmão/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Fenótipo , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Síndrome , Resultado do TratamentoRESUMO
La neuralgia amiotrófica es una neuropatía infrecuente caracterizada por la aparición de un dolor intenso unilateral en el hombro. Es rara la afectación aislada o concomitante de otros nervios motores periféricos derivados del plexo cervicobraquial, como el nervio frénico o el laríngeo. Su etiología es desconocida, aunque se han planteado varios factores que pueden condicionar su aparición. La afectación del nervio frénico, unilateral o bilateral, es aún más infrecuente. El diagnóstico se basa en la historia clínica, la exploración funcional, técnicas de imagen y en los hallazgos del electromiograma. Presentamos el caso de una mujer de 48 años con antecedentes de trasplante renal por glomerulonefritis proliferativa y rechazo posterior del mismo, que fue definitivamente diagnosticada de neuralgia amiotrófica con afectación frénica bilateral, que precisó ventilación mecánica no invasiva de forma prolongada (AU)
Amyotrophic neuralgia is an uncommon neuropathy characterized by severe unilateral shoulder pain. Isolated or concomitant involvement of other peripheral motor nerves depending on the brachial plexus such as phrenic or laryngeal nerves is unusual. Its etiology is unknown, yet several explanatory factors have been proposed. Phrenic nerve involvement, either unilateral or bilateral, is exceedingly rare. Diagnosis relies on anamnesis, functional and imaging investigations and electromyogram. We report the case of a 48-year-old woman with a past history of renal transplantation due to proliferative glomerulonephritis with subsequent transplant rejection, who was eventually diagnosed with amyotrophic neuralgia with bilateral phrenic involvement, and who required sustained non-invasive mechanical ventilation (AU)
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Neurite do Plexo Braquial/tratamento farmacológico , Neurite do Plexo Braquial/fisiopatologia , Neurite do Plexo Braquial , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Paralisia/complicações , Insuficiência Respiratória/complicações , Analgésicos/uso terapêutico , Neurite do Plexo Braquial/reabilitação , Eletromiografia , Radiografia Torácica , Tomografia Computadorizada de Emissão/métodos , Espirometria/métodos , ImobilizaçãoRESUMO
Amyotrophic neuralgia is an uncommon neuropathy characterized by severe unilateral shoulder pain. Isolated or concomitant involvement of other peripheral motor nerves depending on the brachial plexus such as phrenic or laryngeal nerves is unusual(1). Its etiology is unknown, yet several explanatory factors have been proposed. Phrenic nerve involvement, either unilateral or bilateral, is exceedingly rare. Diagnosis relies on anamnesis, functional and imaging investigations and electromyogram. We report the case of a 48-year-old woman with a past history of renal transplantation due to proliferative glomerulonephritis with subsequent transplant rejection, who was eventually diagnosed with amyotrophic neuralgia with bilateral phrenic involvement, and who required sustained non-invasive mechanical ventilation.