RESUMO
AIM: To identify adult patients with single-ventricle congenital heart disease and Fontan procedure palliation who have been misdiagnosed with or incompletely evaluated for pulmonary embolism. Additionally, this study was designed to demonstrate that simultaneous, dual-injection of contrast medium into an upper and lower extremity vein is superior to single-injection protocols for CT angiography (CTA) of the chest in this population. MATERIALS AND METHODS: Patients included in the study were retrospectively selected from the Adult Congenital Heart Disease (ACHD) database. Search criteria included history of Fontan palliation and available chest CT examination. Patients were evaluated for (1) type of congenital heart disease and prior operations;(2) indication for initial CT evaluation;(3) route of contrast medium administration for the initial CT examination and resulting diagnosis;(4) whether or not anticoagulation therapy was initiated; and (5) final diagnosis and treatment plan.Results: The query of the ACHD database resulted in 28 individuals or patients with Fontan palliation (superior and inferior venae cavae anastomosed to the pulmonary arteries). Of these, 19 patients with Fontan physiology underwent CTA of the pulmonary circulation, and 17 had suboptimal imaging studies. Unfortunately, seven of these 17 patients (41%) were started on anticoagulation therapy due to a diagnosis of pulmonary embolism that was later excluded. CONCLUSION: Patients with single-ventricle/Fontan physiology are at risk of thromboembolic disease. Therefore, studies evaluating their complex anatomy must be performed with the optimal imaging protocol to ensure diagnostic accuracy, which is best achieved with dual-injection of an upper and lower extremity central vein.
Assuntos
Angiografia/métodos , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Iohexol , Masculino , Cuidados Paliativos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto JovemRESUMO
Contrary to expectations, a study of 81 adolescent drug and/or alcohol addicts produced results quite similar to those found among an adult addicted population (Griffin-Shelley, 1986). On the Bem Sex-Role Inventory (Bem, 1974), these young people rated themselves, in descending order, Undifferentiated (43.2%), Masculine (23.5%), Androgynous (18.5%), and Feminine (14.8%). Despite their exaggerated "macho" and "seductive" attitudes and behaviors, which resemble their adult counterparts, chemically dependent adolescents suffer similarly from low self-esteem and poor adjustment. Addictions appear to have already damaged these young people in areas of self-worth and sex-role perception.
Assuntos
Alcoolismo/psicologia , Identidade de Gênero , Desenvolvimento da Personalidade , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Alcoolismo/reabilitação , Feminino , Humanos , Masculino , Inventário de Personalidade , Desenvolvimento Psicossexual , Estereotipagem , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
Sixty-two anxious patients were treated under double-blind conditions for 4 weeks with either clorazepate or lorazepam. Two-thirds of each treatment group were then switched abruptly to placebo for 2 weeks, while one-third continued to receive active medication. Two major findings were obtained. About 70% of the patients maintained improvement during the 2-week placebo period. Some patients, however, experienced rebound anxiety, which appeared to be more intense and occurred earlier when placebo was substituted for a benzodiazepine with a short half-life (lorazepam) than for one with a long half-life (clorazepate). The clinical relevance of these findings is discussed.
Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Clorazepato Dipotássico/uso terapêutico , Lorazepam/uso terapêutico , Síndrome de Abstinência a Substâncias/etiologia , Adulto , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/psicologia , Ensaios Clínicos como Assunto , Clorazepato Dipotássico/efeitos adversos , Clorazepato Dipotássico/farmacocinética , Método Duplo-Cego , Feminino , Meia-Vida , Humanos , Lorazepam/efeitos adversos , Lorazepam/farmacocinética , Masculino , Escalas de Graduação Psiquiátrica , Síndrome de Abstinência a Substâncias/psicologiaAssuntos
Adenoma/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias das Glândulas Salivares/patologia , Glândulas Salivares Menores/patologia , Glândulas Salivares/patologia , Adenoma/ultraestrutura , Núcleo Celular/ultraestrutura , Citoplasma/ultraestrutura , Grânulos Citoplasmáticos/ultraestrutura , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/ultraestrutura , Neoplasias das Glândulas Salivares/ultraestrutura , Glândulas Salivares Menores/ultraestruturaAssuntos
Transtorno Depressivo/tratamento farmacológico , Imipramina/uso terapêutico , Isoquinolinas/uso terapêutico , Nomifensina/uso terapêutico , Adulto , Assistência Ambulatorial , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Imipramina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nomifensina/efeitos adversos , Escalas de Graduação PsiquiátricaRESUMO
Amitriptyline and nortriptyline plasma levels were measured in depressed outpatients 24 hours after a single dose of amitriptyline and following chronic dosing to steady state. Plasma levels of amitriptyline and nortriptyline measured after the single dose correlated highly with steady state plasma levels. Full use as a test to rapidly place patients on a "therapeutic" dosage of drug will need to await a clear delineation of the relationship between blood levels and clinical response for amitriptyline.