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1.
Pacing Clin Electrophysiol ; 45(6): 811-814, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35067955

RESUMO

The premature ventricular contractions (PVCs) have usually good prognosis in patients without structural heart disease. In case of left ventricular ejection fraction depression or symptoms, antiarrhythmic drugs or cardiac ablations could be an option for management. We present a case of a patient with high burden of PVC admitted for cardiac ablation. Preoperative assessment revealed hyperkalemia and metabolic acidosis which ended up with type-4 renal tubular acidosis (RTA). Its rare cause and management may draw attention to the possibility of type -4 RTA as the cause of the PVC, and hyperkalemia.


Assuntos
Acidose Tubular Renal , Ablação por Cateter , Hiperpotassemia , Complexos Ventriculares Prematuros , Humanos , Acidose Tubular Renal/complicações , Acidose Tubular Renal/diagnóstico , Acidose Tubular Renal/cirurgia , Hiperpotassemia/etiologia , Hiperpotassemia/cirurgia , Volume Sistólico , Função Ventricular Esquerda , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/cirurgia
2.
World Neurosurg ; 119: 25-29, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29935324

RESUMO

BACKGROUND: Osteopetrosis (OP) is a varied clinical condition caused by malfunction or insufficient development of osteoclasts, or both. Neurologic findings can occur because of osteopetrotic conditions restricting neural foramina through which the spinal cord, cranial nerves, or major vascular structures traverse the skull. Renal tubular acidosis (RTA) is a well-documented condition with OP. However, Chiari I malformation is rarely reported concomitantly with OP. CASE DESCRIPTION: We present a patient with a known RTA who was admitted with a rapid progressive tetraparesis within 24 hours. Clinical and radiologic evaluation of the patient revealed OP with RTA together with Chiari I malformation and holocord hydromyelia. Management of the patient was started with correction of severe hypokalemia (K: 1.4 mEq/L), which resulted in dramatic improvement in tetraparesis. Two days later, a posterior fossa bone decompression with ventriculoperitoneal shunt placement during the same session led to prominent decrease in size of the ventricles and the hydromyelia on long-term follow-up. CONCLUSIONS: Patients with OP can exhibit many clinical conditions. However, our case involved an unusual and rapid progressive tetraparesis, which could confuse the management as necessitating an emergent posterior fossa decompression. Stabilizing the metabolic status of the patient facilitated elective surgery, which further improved patient's neurologic findings and diminished hydromyelia on long-term follow-up.


Assuntos
Acidose Tubular Renal/complicações , Acidose Tubular Renal/cirurgia , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia , Osteopetrose/complicações , Osteopetrose/cirurgia , Acidose Tubular Renal/diagnóstico por imagem , Malformação de Arnold-Chiari/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Humanos , Masculino , Procedimentos Neurocirúrgicos , Osteopetrose/diagnóstico por imagem
4.
Kidney Int ; 71(8): 795-801, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17264873

RESUMO

To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients. The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked. Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present. In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis. Patients with brushite (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts. Patients with dRTA often present a radiographic picture of nephrocalcinosis. Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function. In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.


Assuntos
Acidose Tubular Renal/patologia , Cálculos Renais/patologia , Córtex Renal/patologia , Medula Renal/patologia , Acidose Tubular Renal/diagnóstico por imagem , Acidose Tubular Renal/cirurgia , Adulto , Idoso , Biópsia , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Córtex Renal/diagnóstico por imagem , Córtex Renal/cirurgia , Medula Renal/diagnóstico por imagem , Medula Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia
7.
Dtsch Med Wochenschr ; 114(51-52): 2001-5, 1989 Dec 22.
Artigo em Alemão | MEDLINE | ID: mdl-2689127

RESUMO

Treatment-resistant hypokalaemia (2.27 mmol/l) developed in a 43-year-old woman. Plasma renin activity was depressed (0.24 ng/ml.h), aldosterone and hydroxycorticosterone concentrations were elevated (123 ng/dl and 688 ng/dl, respectively). Mean blood pressure value (30 readings) was 133/88 mm Hg. An adrenal adenoma was diagnosed by ultrasound, computed tomography and subtraction angiography and then removed. Postoperatively the signs of hyperaldosteronism (Conn's syndrome) regressed and the average blood pressure was 112/76 mm Hg. Blood-gas analysis, which preoperatively had shown a minimal metabolic alkalosis, now revealed a mild metabolic acidosis. Preoperatively present bilateral renal calcifications in the region of the papillary tips were confirmed by computed tomography. An acid loading test revealed diminished renal acid secretion, making the diagnosis of distal renal-tubular acidosis. The latter, in combination with the primary hyperaldosteronism, may have been the cause of the low blood pressure, unusual in Conn's syndrome.


Assuntos
Hiperaldosteronismo/complicações , Hipertensão/complicações , 18-Hidroxicorticosterona/sangue , Acidose Tubular Renal/complicações , Acidose Tubular Renal/cirurgia , Adenoma/complicações , Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Aldosterona/sangue , Angiografia Digital , Pressão Sanguínea , Feminino , Humanos , Hiperaldosteronismo/cirurgia , Hipopotassemia/complicações , Renina/sangue , Tomografia Computadorizada por Raios X , Ultrassonografia
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