RESUMEN
A 39-year-old man with a history of frequent "crack" cocaine use of several years' duration presented with progressive dyspnea. Evaluation revealed bilateral interstitial pulmonary infiltrates and hilar adenopathy, diffuse pulmonary uptake of gallium, and markedly elevated serum angiotensin-converting enzyme activity. Open lung biopsy revealed interstitial and perivascular collections of histiocytes containing refractile, polarizable material, presumably inhaled along with the cocaine. Paratracheal lymph nodes were enlarged, reactive, and contained similar polarizable material. The well-formed, non-necrotizing granulomata characteristic of sarcoidosis were not present in either tissue specimen. To our knowledge, the association of chronic crack cocaine inhalation with this constellation of clinical findings, typically seen in sarcoidosis, has not previously been described.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Cocaína Crack , Enfermedades Pulmonares/inducido químicamente , Enfermedades Pulmonares/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Sarcoidosis Pulmonar/diagnóstico , SíndromeRESUMEN
BACKGROUND: Current literature documents use of the radial artery (RA) for myocardial revascularization only as an alternative conduit in cases where the saphenous veins have been previously harvested or are unsuitable for use. Large-scale routine clinical use of the RA as the conduit of choice has not been reported. METHODS: This prospective study evaluated the harvest of the RA from 933 patients and the subsequent use of the conduit as a preferred coronary artery bypass graft second only to the left internal thoracic artery in 930 of these patients. RESULTS: Unilateral RA harvest was performed in 786 patients and 147 patients had bilateral RA harvest. A total of 1080 RAs were harvested; 214 (19.8%) originated from the dominant forearm. There was a mean of 3.30+/-0.93 grafts per patient of which 2.43+/-0.83 were arterial grafts. The mean number of RA grafts was 1.43+/-0.53. Operative mortality was 2.3% with none due to the RA graft(s). There was no ischemia nor motor dysfunction in the operated hands. Thirty-two (3.4%) patients experienced transient thenar dysesthesia that resolved in 1 day to 6 weeks. CONCLUSIONS: Our results demonstrate that routine total or near total arterial myocardial revascularization may be achieved safely and effectively with the use of one or both RAs in conjunction with the internal thoracic artery.
Asunto(s)
Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Arteria Radial/trasplante , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Angiografía Coronaria , Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The purpose of this paper was to determine the relations between certain digestive tract diseases and essential environmental conditions. Forty parameters, according to a special questionnaire, were compared between the patients suffering from the diseases of pancreas, biliary duct and bowel and the controls. Adverse effects of improper nutrition, smoking and shift-work were found.