RESUMO
A 32-year-old recent Russian immigrant, mother of a 20-month-old son, presented with right hip pain. She had a history of peptic ulcer disease and a positive Helicobacter pylori serology. Her pain was not relieved by analgesics. Spine and pelvic films were unremarkable. A bone scan was consistent with metastatic disease. She underwent several diagnostic tests including computed tomography of the chest and abdomen, magnetic resonance imaging of the spine, mammogram, and breast ultrasound. A bone marrow biopsy revealed adenocarcinoma, primary site unknown. An upper endoscopy performed eight weeks after her initial presentation showed an ulcerating gastric carcinoma. She was treated with chemotherapy but died two months after diagnosis. Our patient had an uncommon presentation of a common disease. Recognizing her country of origin, and other risk factors, may have facilitated an earlier diagnosis.
Assuntos
Adenocarcinoma/diagnóstico , Artralgia/etiologia , Articulação do Quadril , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Anamnese , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapiaRESUMO
This article will address the general approach to management of the typical patient >75 years of age with atrial fibrillation. Emphasis will be placed on optimizing the benefit and reducing the risk of anticoagulation in this important and expanding group of patients.
Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Acidente Vascular Cerebral/etiologia , Idoso , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Humanos , Medição de Risco , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêuticoRESUMO
The incidence of atrial fibrillation is greater in men than in women, but this gap closes with advancing age. More women with atrial fibrillation have underlying valvular disease, and more men with this condition have underlying coronary artery disease. Atrial fibrillation increases mortality and the incidence of stroke in both sexes. However, women in particular (especially those over 75 years old) may be at increased risk for embolism and long-term mortality. Gender is also an important feature affecting the selection of antiarrhythmic drugs for atrial fibrillation, because women are more likely to develop drug-induced arrhythmias. Stroke prevention with anticoagulation in chronic atrial fibrillation is a priority in both men and women; however, women derive the most benefit from it.
