RESUMO
Coronary artery aneurysms and arterio-venous fistulae are uncommon malformations. We report the case of a 58-year-old woman with a large aneurysmal fistula arising from the left coronary tree and involving the entire coronary sinus venous system, resulting in significant left-to-right shunt. We discuss the management of aneurysmal fistulae of the coronary arteries, and the merits of prophylaxis for thrombotic complications of large aneurysms. We recommend consideration of warfarinisation in addition to aspirin of such patients post-operatively.
Assuntos
Fístula Arteriovenosa/complicações , Aneurisma Coronário/etiologia , Ponte de Artéria Coronária/métodos , Seio Coronário/anormalidades , Trombose Venosa/complicações , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To characterize the effects of severe hypoglycemia on the developing brain in children with early-onset type 1 diabetes mellitus (T1DM). STUDY DESIGN: Children diagnosed with T1DM before age 6 years were studied. Those with prospectively monitored severe hypoglycemia (coma/seizure; n = 32) were compared with age-matched peers (n = 30) with no history of such events using magnetic resonance imaging. Glycemic control (evaluated based on glycated hemoglobin [HbA(lc)] level), episodes of diabetic ketoacidosis (DKA), and clinical variables were monitored continuously since diagnosis in all subjects. RESULTS: Mean HbA(lc) from diagnosis and the duration of T1DM were similar in those with and without a history of severe hypoglycemia (9.0% +/- 0.9% vs 8.8% +/- 0.9%; 7.2 +/- 2.7 years vs 6.7 +/- 2.3 years). A high prevalence of central nervous system (CNS) structural abnormalities was detected (29%), and mesial temporal sclerosis (MTS) was detected in 16% of the total sample (n = 62). The presence of MTS was not associated with a history of severe hypoglycemia or DKA. Analysis of brain matter volumes suggested relatively less gray matter density in those subjects with a history of severe hypoglycemia. CONCLUSIONS: Early age of onset of T1DM per se is associated with a high incidence of CNS abnormalities, particularly MTS, suggesting hippocampal damage. Early-onset severe hypoglycemia may have an effect on gray matter volume.
Assuntos
Doenças do Sistema Nervoso Central/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Idade de Início , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/etiologia , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Seguimentos , Hemoglobinas Glicadas/metabolismo , Humanos , Imageamento por Ressonância Magnética , Masculino , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Austrália Ocidental/epidemiologiaRESUMO
OBJECTIVE: The objective of our study was to describe a combination of features on MRI specific to cardiac amyloidosis. CONCLUSION: Cardiac amyloidosis is a common cause of infiltrative heart disease. The combination of subtle widespread heterogeneous myocardial enhancement on delayed postcontrast inversion recovery T1-weighted images, which may initially be dismissed as a technical error, with ancillary features of restrictive cardiac disease is highly suggestive of cardiac amyloidosis.
