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2.
Ann Cardiol Angeiol (Paris) ; 66(1): 42-47, 2017 Feb.
Artigo em Francês | MEDLINE | ID: mdl-27842710

RESUMO

Hypertension is the most important preventable cause of heart disease and stroke worldwide. More than 1 in 5 adults worldwide have raised blood pressure - a condition that causes around half of all deaths from stroke and heart disease. Complications from hypertension account for 9.4 million deaths worldwide every year. During the last decade, the association between blood pressure reduction from above-normal initial values and cardiovascular-risk has been documented in a large number of randomized trials. However, recent results from the SPRINT study could challenge current therapeutic strategies. This article is a literature review about the relationship between hypertension and coronary artery disease.


Assuntos
Doença das Coronárias/etiologia , Doença das Coronárias/prevenção & controle , Hipertensão/complicações , Adulto , Causas de Morte , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Humanos , Hipertensão/mortalidade , Hipertensão/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco
3.
J Epidemiol Community Health ; 70(12): 1236-1241, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27325868

RESUMO

BACKGROUND: Periodontopathogens antibodies have been shown to be associated with primary myocardial events, but little is known regarding their impact on major adverse events after a prior acute myocardial infarction (AMI). The present prospective study evaluates the association between antibody levels of 4 periodontopathogens and the risk of all-cause death or non-fatal myocardial infarction (MI) at 1 year in 975 patients admitted for acute ST segment or non-ST segment elevation MI in French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI), a nationwide French survey. METHODS: Multiserotype ELISAs were performed to assess levels of IgG and IgA against Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia and Tannerella forsythia. RESULTS: Adjusted HRs indicate the lack of association between IgG-anti-Po. gingivalis levels (0.96 (0.78 to 1.18)), IgA-anti-Po. gingivalis levels (1.13 (0.90 to 1.42)) and the risk of all-cause death or non-fatal MI at 1 year. Additionally, no significant association was found between the occurence of an event at 1 year and immunoglobulins levels against the others periodontopathogens. CONCLUSIONS: The present data indicate that circulating levels of periodontopathogens antibodies are not associated with an increased risk of major adverse events in patients with a prior AMI. Studies dealing with bacterial and clinical data are needed to assess the role of oral health in comprehensive cardiac rehabilitation programmes.

4.
Ann Cardiol Angeiol (Paris) ; 64(6): 427-33, 2015 Dec.
Artigo em Francês | MEDLINE | ID: mdl-26547524

RESUMO

Data on regional variations in the characteristics, management and early outcome of patients admitted with ST-elevation myocardial infarction (STEMI) in France are limited. We used data from the FAST-MI 2010 registry to determine whether regional specificities existed, dividing the French territory into 6 larger geographical regions. Variations in the patients' characteristics were found, partly related to regional variations in demography. Acute reperfusion strategy showed more use of primary percutaneous coronary intervention in the greater Paris area, compared to other regions, which would be expected owing to geography and local availability of catheterization laboratories. Overall, however, in-hospital management showed more similarities than differences across regions. Complications, and in particular in-hospital mortality, did not differ significantly among regions.


Assuntos
Sistema de Condução Cardíaco/fisiopatologia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Reperfusão Miocárdica/métodos , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Quimioterapia Combinada , Feminino , França/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Intervenção Coronária Percutânea/métodos , Prevalência , Fatores de Risco , Resultado do Tratamento
5.
Ann Cardiol Angeiol (Paris) ; 63(4): 262-4, 2014 Sep.
Artigo em Francês | MEDLINE | ID: mdl-24834992

RESUMO

Approximately 50% of patients admitted for ST-elevation myocardial infarction (STEMI) have multi-vessel disease. Current guidelines recommend revascularization of the culprit lesion only during the initial procedure except in cardiogenic shock. Benefits of revascularization of associated functional lesions are not debate. However, timing of the procedure is not clear. This article is a review over timing of secondary revascularization in STEMI patients with multi-vessels disease.


Assuntos
Eletrocardiografia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/normas , Humanos , Fatores de Tempo
6.
Clin Microbiol Infect ; 20(3): O197-202, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24520879

RESUMO

The aim of this study was to describe the features of a large cohort of patients with postoperative mediastinitis, with particular regard to Gram-negative bacteria (GNB), and assess their outcome. This bicentric retrospective cohort included all patients who were hospitalized in the Intensive Care Unit with mediastinitis after cardiac surgery during a 9-year period. Three hundred and nine patients developed a mediastinitis with a mean age of 65 years and a mean standard Euroscore of six points. Ninety-one patients (29.4%) developed a GNB mediastinitis (GNBm). Of the 364 pathogens involved, 103 GNB were identified. GNBm were more frequently polymicrobial (44% versus 3.2%; p <0.001). Being female was the sole independent risk factor of GNBm in multivariate analysis. Initial antimicrobial therapy was significantly more frequently inappropriate with GNBm compared with other microorganisms (24.6% versus 1.9%; p <0.001). Independent risk factors for inappropriateness of initial antimicrobial treatment were GNBm (OR = 8.58, 95%CI 2.53-29.02, p 0.0006), and polymicrobial mediastinitis (OR = 4.52, 95%CI 1.68-12.12, p 0.0028). GNBm were associated with more drainage failure, secondary infection, need for prolonged mechanical ventilation and/or use of vasopressors. Thirty-day hospital mortality was significantly higher with GNBm (31.9 % versus 17.0%; p 0.004). GNBm was identified as an independent risk factor of hospital mortality (OR = 2.31, 95%CI 1.16-4.61, p 0.0179).


Assuntos
Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Mediastinite/microbiologia , Mediastinite/mortalidade , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Causas de Morte , Feminino , Bactérias Gram-Negativas/classificação , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos
7.
Ann Cardiol Angeiol (Paris) ; 63(1): 28-31, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23987800

RESUMO

Percutaneous coronary intervention (PCI) of small coronary vessels represents a real challenge for myocardial revascularization because of the high risk of stent-restenosis and increased risk of adverse clinical events. Moreover, small coronary arteries supply small myocardial territories therefore questioning the clinical significance of small-vessel stenoses. The definition of small-vessel disease and PCI-strategies used are very heterogeneous across studies. The present review will focus on percutaneous coronary revascularization in patients with small vessel coronary artery disease.


Assuntos
Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/patologia , Intervenção Coronária Percutânea , Humanos , Tamanho do Órgão
8.
Ann Cardiol Angeiol (Paris) ; 63(2): 99-101, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23830566

RESUMO

A 44-year-old patient, with personal history of AIDS, was referred to our emergency unit with tachycardia and moderate signs of right-sided heart failure. The cardiac MRI study showed an impairment of the right ventricular free and inferior wall and the interventricular septum. The mass was characterized by notable heterogeneity with mixed areas of hypo- and hypersignal intensity in SSFP and T2-weighted images with fat saturation. There was global hyperenhancement of the mass after gadolinium contrast injection on T1-weighted images with and without fat saturation. The entire right coronary artery was included into the infiltrative mass. One day after the admission, the patient suddenly presented a paroxysmal third degree atrioventricular block, permanently corrected by an implanted cardiac pacemaker. Endomyocardial biopsy conformed the diagnosis of B-cell lymphoma. The patient died 4months after the diagnosis of acute heart failure with multi-organ dysfunction, after a short period of improvement under chemotherapy. We present this case to highlight the importance to consider that a large, solitary, right atrial mass in conjunction with pericardial effusion in a patient with HIV infection should lead to consider, as soon as possible, the diagnosis of lymphoma. MRI has explained the conduction disorders by showing the septal extension of the mass, and by demonstrating right coronary artery involvement.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Insuficiência Cardíaca/diagnóstico , Neoplasias Cardíacas/diagnóstico , Hospedeiro Imunocomprometido , Linfoma Relacionado a AIDS/diagnóstico , Imageamento por Ressonância Magnética , Adulto , Antineoplásicos/uso terapêutico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Meios de Contraste , Desfibriladores Implantáveis , Evolução Fatal , Gadolínio , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/tratamento farmacológico , Humanos , Linfoma Relacionado a AIDS/complicações , Linfoma Relacionado a AIDS/tratamento farmacológico , Masculino , Marca-Passo Artificial , Fatores de Tempo , Falha de Tratamento
10.
Ann Cardiol Angeiol (Paris) ; 62(4): 221-6, 2013 Aug.
Artigo em Francês | MEDLINE | ID: mdl-23920136

RESUMO

AIM: To assess gender differences in characteristics, management, and hospital outcomes in patients participating in the French FAST-MI 2010 registry. POPULATION: Three thousand and seventy-nine patients hospitalised for ST-elevation (STEMI) or non-ST-elevation (NSTEMI) myocardial infarction in 213 French centres during a 1-month period at the end of 2010. RESULTS: Women account for 27% of the population and more frequently present with NSTEMI. They are 9 years older than men on average, although 25% of women with STEMI are less than 60 years of age. Management of STEMI is similar, after adjustment for baseline characteristics. However, fewer women are treated with primary percutaneous coronary angioplasty. In NSTEMI, although use of coronary angiography is similar, fewer women get treated with angioplasty. Most medications are used in a similar way in men and women, except thienopyridines, with fewer women receive prasugrel. After adjustment, in-hospital mortality is similar for men and women. CONCLUSION: Myocardial infarction is not specific to men: one out of four patients admitted for myocardial infarction is a woman. Initial management is rather similar for men and women, after taking into account differences in baseline characteristics. Percutaneous coronary angioplasty, however, remains less frequently used in women. In-hospital complications have become rarer and do not differ according to sex.


Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Sistema de Condução Cardíaco/fisiopatologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Eletrocardiografia , Feminino , França/epidemiologia , Mortalidade Hospitalar , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Distribuição por Sexo , Fatores de Tempo , Resultado do Tratamento
11.
Ann Cardiol Angeiol (Paris) ; 62(2): 89-94, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23245394

RESUMO

Randomized controlled trials have shown improved short-term bleeding outcomes for bivalirudin compared to other anticoagulant in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). This study analyzed the cost/efficacy profile of bivalirudin-based anticoagulation strategy versus non bivalirudin-based anticoagulant strategy without use of GP IIb/IIIa inhibitors in routine clinical practice. From January 2009 to December 2010, 216 patients who underwent PCI for ACS at hospital Georges-Pompidou without GP IIb/IIIa inhibitors were studied. Of these patients, 24 (11%) received bivalirudin and 192 (88%) received others anticoagulants (mainly unfractionated heparin or low molecular weight heparin). Ischemic events and bleeding or transfusion were slightly lower in bivalirudin group (0 vs. 4.2%, P=0.60 and 4.2 vs. 8.9%, P=0.70, respectively). In spite of a higher cost of the medication, the overall cost of the bivalirudin strategy was slightly lower (9167±3688 € vs. 14,016±14,749 €, P=0.23), in relation with a shorter average duration of the hospital stay. In conclusion, in this limited, single-center, population of patients with ACS, the clinical efficacy and safety of bivalirudin appeared at least as good as that of reference anticoagulants in real world clinical practice, with no increase in overall costs.


Assuntos
Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/terapia , Antitrombinas/economia , Custos de Medicamentos , Hirudinas/economia , Fragmentos de Peptídeos/economia , Intervenção Coronária Percutânea , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/economia , Antitrombinas/uso terapêutico , Análise Custo-Benefício , Feminino , Heparina/economia , Hospitais Universitários , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Paris , Fragmentos de Peptídeos/uso terapêutico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Estudos Prospectivos , Proteínas Recombinantes/economia , Proteínas Recombinantes/uso terapêutico , Sistema de Registros , Resultado do Tratamento
12.
Ann Cardiol Angeiol (Paris) ; 60(3): 148-53, 2011 Jun.
Artigo em Francês | MEDLINE | ID: mdl-21272858

RESUMO

Most patients undergoing a catheterization did not have any previous non-invasive testing. Therefore, most decisions about revascularization are taken solely on the basis of the angiogram. Nowadays, it is possible to gain reliable functional information during catheterization by measuring fractional flow reserve (FFR). FFR is obtained by simple pressure measurements distal to the stenosis during maximal hyperemia. FFR-guided revascularization provides better clinical outcomes than angiographically-guided decisions. This is especially relevant in patients with multi-vessel disease and mild to moderate coronary plaque burden. FFR is able to determine the hemodynamic significance of each lesion individually and enables therefore guidance of the revascularization treatment. The case of a 62-year-old man with stable angina is reported. He underwent percutaneous coronary intervention of the left anterior descending 10 years ago. Repeat coronary angiogram revealed multi-vessel disease with a moderate stenosis in all main coronary arteries. Non-invasive functional assessment by myocardial perfusion imaging was inconclusive to evaluate presence or absence of ischemia. The use of FFR in this clinical scenario may be very useful to determine treatment strategy.


Assuntos
Angiografia Coronária , Reestenose Coronária/fisiopatologia , Reestenose Coronária/terapia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Angina Pectoris/terapia , Angioplastia Coronária com Balão , Reestenose Coronária/diagnóstico , Técnicas de Apoio para a Decisão , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Prognóstico , Sensibilidade e Especificidade
13.
Ann Cardiol Angeiol (Paris) ; 59(4): 196-204, 2010 Aug.
Artigo em Francês | MEDLINE | ID: mdl-20708171

RESUMO

Drug-eluting stents (DES) are known to dramatically reduce restenosis. However, they are more expansive than bare-metal stents (BMS) and they require prolonged dual antiplatelet therapy. In France, the French Society of Cardiology and the "Haute Autorité de santé" have defined recommendations for the use of DES (restricted to patients in high-risk group). The aim of this work was to evaluate our practice (whether these recommendations were well respected or not in our center). Between November 2007 and January 2008 then November 2008 and January 2009 we evaluated all Percutaneous Coronary Interventions (PCI). Two hundred and sixteen (216) patients (mean age 65 ± 13 years, 164 (76 %) were males and, 41 (19 %) were diabetics) had a PCI for stable angina or silent ischemia (47 %), unstable angina or acute coronary syndrome (ACS) ST- (26 %), ACS ST+<48 hours (24 %) or ACS ST+>48 hours-1 month (3 %). Two hundred and seventy six (276) stents were used, including 35 % of DES. The recommendations were well respected in 82 % of cases. However, 27 % of BMS were implanted in patients in whom DES were indicated. The French recommendations for DES are a reference to help practitioners, but they require to be adapted to each patient, depending on clinical state and their ability to be treated with prolonged dual antiplatelet therapy.


Assuntos
Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão , Stents Farmacológicos , Fidelidade a Diretrizes , Inibidores da Agregação Plaquetária/uso terapêutico , Padrões de Prática Médica , Idoso , Feminino , França , Humanos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Resultado do Tratamento
14.
Ann Cardiol Angeiol (Paris) ; 59 Suppl 2: S37-41, 2010 Dec.
Artigo em Francês | MEDLINE | ID: mdl-21237321

RESUMO

In France, the incidence of myocardial infarctions leading to hospitalisations can be estimated between 60,000 and 65,000 each year. With the addition of cases of unstable angina, about 80,000 to 100,000 hospital stays each year are caused by acute coronary syndromes. Cases of out-of-hospital cardiac arrest of ischaemic origin should also be taken into account when estimating the annual incidence of myocardial infarction. In Europe, a North-South gradient, and even more an East-West gradient is observed for the incidence of ischaemic heart disease, with the highest figures found in central and eastern European countries. A consistent trend to a decrease in the incidence of myocardial infarction is observed on both sides of the Atlantic. In parallel, progress in the management of acute coronary syndromes has led to a marked decrease in early case fatality rates. Overall, these trends explain the spectacular decrease in cardiovascular mortality observed over the past 25 years in most European countries. Acute coronary syndromes, however, remain severe clinical conditions, which carry a high mid-term and long-term morbi-mortality and deserve further efforts to develop new therapeutic tools.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Europa (Continente)/epidemiologia , França/epidemiologia , Humanos , Incidência
15.
Ann Cardiol Angeiol (Paris) ; 59(3): 168-71, 2010 Jun.
Artigo em Francês | MEDLINE | ID: mdl-20003961

RESUMO

Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. The options for treatment are dictated by patient stability, nature of dissection of the coronary vessel, ability to restore the coronary circulation and extent of aortic dissection. Usually localized aortic dissections have been managed conservatively or treated by sealing the entry with a coronary stent. Extensive dissections may require a surgical intervention. We report the case of a 52-year-old man with iatrogenic dissection of the right coronary artery ostium and extension of the dissection to the ascending aorta during intraluminal angioplasty of an obstructive lesion in the first portion of the right coronary artery. The patient was managed conservatively without stenting (failure stenting of the right coronary artery) and without surgery. Aortic dissection was monitored by means of transesophageal echocardiography. Serial computed tomography scans demonstrated spontaneous resolution of the dissection. The evolution of the patient was satisfactory. Causes, frequency and treatment procedures of this iatrogeny are discussed.


Assuntos
Angioplastia Coronária com Balão , Aorta/lesões , Vasos Coronários/lesões , Complicações Intraoperatórias , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade
16.
Ann Cardiol Angeiol (Paris) ; 59(1): 25-30, 2010 Feb.
Artigo em Francês | MEDLINE | ID: mdl-19969283

RESUMO

Most of percutaneous coronary interventions are performed on stabilized patients. Although these procedures have recently been challenged for this type of patient following the publication of the recent Courage study in 2007 (which in fact has only confirmed previous studies), their efficacy is now well established for lowering the frequency of episodes of angina and increasing the performance under load in stabilized high risk patients. In practice, the evaluation of patients (case by case) is essential to establish their risk (low, intermediate or high) in order to offer the most suitable treatment. The aim of this paper is to overview the indications, limitations and results of coronary angioplasties performed in stabilized patients in France in 2009.


Assuntos
Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão , Síndrome Coronariana Aguda/classificação , Síndrome Coronariana Aguda/diagnóstico , Angina Pectoris/classificação , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Cateterismo Cardíaco , Angiografia Coronária , Avaliação da Deficiência , Teste de Esforço , Indicadores Básicos de Saúde , Humanos , Prognóstico , Resultado do Tratamento
17.
Rev Med Interne ; 29(9): 741-3, 2008 Sep.
Artigo em Francês | MEDLINE | ID: mdl-18692276

RESUMO

Antimalarial agents are routinely used in the management of connective tissues diseases and various skin disorders. Ophthalmologic, neurological and digestive side effects of antimalarial agents are well known. However, cardiac toxicity is uncommon. We report a 49-year-old patient, treated with chloroquine for 21 years for a systemic lupus erythematosus and a discoid lupus, who presented a complete atrioventricular block that required implantation of a cardiac pacemaker in emergency. This patient did not have significant cardiovascular past medical history. Investigations excluded known causes of atrioventricular block and chloroquine toxicity was diagnosed. This case report illustrates the cardiotoxicity of synthetic antimalarial agents. A regular cardiovascular monitoring (especially with electrocardiogram) could be useful in patients receiving long-term treatment with antimalarial agents.


Assuntos
Antimaláricos/efeitos adversos , Bloqueio Atrioventricular/induzido quimicamente , Cloroquina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
18.
Ann Cardiol Angeiol (Paris) ; 57(4): 195-200, 2008 Aug.
Artigo em Francês | MEDLINE | ID: mdl-18550024

RESUMO

OBJECTIVES: We have examined the immediate and long-term patient outcomes following angioplasty of unprotected left main coronary artery stenoses. BACKGROUND: Coronary disease of the unprotected left main artery is considered as an absolute contraindication for percutaneous intervention. Recently, several studies have reported good results with unprotected left main coronary artery stenting when surgical revascularization was contraindicated. METHODS: From October 2004 to June 2006, 24 patients with a contraindication to surgery and with unprotected left main coronary artery stenoses received stents. Patients were surveyed at one, six and 12 months with telephone interviews. RESULTS: The procedure's success rate was 100%. The percentage of stenosis and minimum lumen diameter (MLD) were respectively 63.4% (+/-15.4) and 1.1mm (+/-0.5) before procedure; 13.8% (+/-10.2) and 3.2mm (+/-0.5) after angioplasty. The size of stents averaged 3.79 mm (+/-0.46) with an average 1.04 stents per patient. During follow up, two deaths occurred (8.3%). No intrastent restenosis was found. CONCLUSIONS: Stenting of unprotected left main coronary artery stenoses may be a safe and effective alternative to coronary artery bypass especially when surgical revascularization is contraindicated. However, further studies with larger patient populations are needed to assess the late outcome and to clarify the relevance of percutaneous intervention compared to surgery.


Assuntos
Angioplastia Coronária com Balão , Estenose Coronária/cirurgia , Stents , Idoso , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
19.
Ann Fr Anesth Reanim ; 26(1): 81-4, 2007 Jan.
Artigo em Francês | MEDLINE | ID: mdl-17095183

RESUMO

We are reporting the case of a 39-year-old male, without notable previous history except for an important alcoholic and tobacco consumption, who suffered a bicycle accident resulting in a minor wound on the left elbow. The neglected wound evolved extremely rapidly towards a necrotizing fasciitis, which underwent further complications consisting of a heat shock and multivisceral failure that necessitated reanimation procedures. The patient benefited a triple antibiotic therapy (amoxicillin-clavulanic acid, ornidazole and levofloxacin) and an extensive surgical debridement. The progression was then slow but favourable. The patient is now in functional reeducation. This observation illustrates the rate of evolution of the lesions caused by necrotizing fasciitis and reminds on the importance of prompt therapy.


Assuntos
Antibacterianos/uso terapêutico , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/etiologia , Adulto , Ciclismo/lesões , Quimioterapia Combinada , Fasciite Necrosante/complicações , Humanos , Lacerações/complicações , Masculino , Insuficiência de Múltiplos Órgãos/etiologia
20.
Rev Med Interne ; 16(11): 843-6, 1995.
Artigo em Francês | MEDLINE | ID: mdl-8570941

RESUMO

Muscular hypertrophy, rarely reported in muscular sarcoidosis, is usually associated with the myositic, myopathic and nodular types. We report a case with an isolated localised muscular hypertrophy simulating a tumor formation developed after repetitive efforts, in a familial context of sarcoidosis. MRI shows muscular high intensity lesions in the thighs and calves, and after treatment, central areas of low intensity signal. Muscular biopsy confirms diagnosis of sarcoidosis. Gallium-67 scintigraphy shows systemic extension of disease. This case highlights the usefulness of recent imaging techniques in diagnostic strategy and follow up.


Assuntos
Músculos/patologia , Sarcoidose/genética , Adulto , Feminino , Granuloma/etiologia , Granuloma/patologia , Humanos , Hipertrofia , Imageamento por Ressonância Magnética , Sarcoidose/complicações , Sarcoidose/patologia
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