RESUMEN
In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.
Asunto(s)
Angioplastia de Balón , Procedimientos Endovasculares , Hipertensión Renovascular/cirugía , Riñón , Nefrectomía/métodos , Hemorragia Posoperatoria , Obstrucción de la Arteria Renal , Arteria Renal , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/métodos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Femenino , Humanos , Hipertensión Renovascular/diagnóstico , Hipertensión Renovascular/etiología , Riñón/irrigación sanguínea , Riñón/cirugía , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Hemorragia Posoperatoria/diagnóstico , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/cirugía , Arteria Renal/diagnóstico por imagen , Arteria Renal/patología , Arteria Renal/cirugía , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/cirugía , Reoperación/métodos , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex/métodosRESUMEN
Cerebral venous thrombosis (CVT) has usually been ascribed to prothrombotic conditions, oral contraceptives, pregnancy, malignancy, infection, head injury or mechanical precipitants. The case reported here illustrates two rare causes of CVT observed in the same patient: the presence of antiphospholipid antibodies associated with an asymptomatic cryptogenic organising pneumopathy (COP) which were considered the origin of the venous cerebral thrombosis and heparin-induced thrombocytopenia (HIT) which was responsible for the worsening of the thrombosis observed a few days after the introduction of treatment. Moreover, we provide here additional positive experience in the treatment of both, CVT and HIT, by fondaparinux with bridging to warfarin given their successful evolution under this anticoagulant option.
Asunto(s)
Síndrome Antifosfolípido/complicaciones , Neumonía en Organización Criptogénica/complicaciones , Trombosis Intracraneal/etiología , Trombocitopenia/complicaciones , Trombosis de la Vena/etiología , Anciano , Anticoagulantes/efectos adversos , Femenino , Heparina/efectos adversos , Humanos , Índice de Severidad de la Enfermedad , Trombocitopenia/inducido químicamenteRESUMEN
INTRODUCTION: Chronic venous insufficiency (HVI) is manifested by the progressive signs of venous stasis. This disorder is treated by: compressive bandaging, medicaments, sclerotherapy, surgery, etc. AIM: Prospective study of the effects of semisynthetic diosmin (clinical signs, quality of life, local biochemical parameters) on patients with HVI to whom no other method of treatment has previously been administered. METHOD APPLIED: This prospective study analysed the presence of risk factors and personal history of 80 patients with HVI. Diagnosis of HVI was based on the clinical apperance and the color duplex scan. Each patient's clinical signs (pain, oedma, feeling of heaviness and tightness in the lower leg), quality of life (physical, social, and psychological), and CEAP stage were assessed prior to and 30 days after the treatment with Phlebodia 600. For 15 patients with unilateral varicose veins, local values of lactates and gass analysis were taken under the conditions before and following the static load, and venous control samples were taken from the healthy leg. The acquired data were processed by means of descriptive statistics, while the significance of nonparametric features was measured by Wilcoxon test. RESULTS: HVI is somewhat more frequent among females than among mails, on the left than on the right leg, and at the average age of 52.3 +/- 10.5. The patients with HVI are basicly engaged in professions with static load and have positive family history. The patients mainly started medical treatment 12.5 +/- 8.6 years after the first symptoms of the disease. Clinical improvement was recorded on the state of 65/80 patients. After the treatment numerical values of some of the clinical signs were statisticaly lower compared to the values before the administration of semisynthetic diosmin: oedema (0.94:1.50), pain (1.10:1.84), feeling of heaviness (1.20:1.96), and tightness (1.14:1.78). After the administration of the tested medication, parameters of physical, social, and psychological quality-of life were significantly improved (p<0,0001), accompanied with significantly improved (p<0,0001) CEAP stage of HVI (3.00:3.40). Local biochemical parameters had not been significantly changed. CONCLUSION: Administration of semisynthetic diosmin during 30 days results in significant improvement of clinical signs, quality of life and CEAP stage of HVI.
Asunto(s)
Diosmina/uso terapéutico , Insuficiencia Venosa/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Insuficiencia Venosa/sangre , Insuficiencia Venosa/diagnósticoRESUMEN
Different mechanisms of blunt trauma producing carotid artery false aneurysms are described in literature. We report one such case caused by combination of two mechanisms: accidental hyperextension of the neck, and subsequent sudden forceful hit by a ball during the water polo match.
Asunto(s)
Aneurisma Falso/etiología , Traumatismos de las Arterias Carótidas/complicaciones , Arteria Carótida Común/patología , Heridas no Penetrantes/complicaciones , Adulto , Aneurisma Falso/patología , Angiografía de Substracción Digital , Traumatismos en Atletas , Traumatismos de las Arterias Carótidas/etiología , Traumatismos de las Arterias Carótidas/patología , Humanos , Masculino , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex , Heridas no Penetrantes/patologíaRESUMEN
Polymedication is frequent in geriatric everyday practice and often leads to unwanted drug-drug interactions. Physicians must be aware of the potential interaction-induced with intoxications or therapeutic ineffectiveness. The clinical case presented here illustrates the importance of entertaining the possibility of such an interaction every time that the expected therapeutical effect of a substance is not reached. Our patient had refractory arterial hypertension despite taking five different antihypertensive drugs in hospital, while on carbamazepine for a facial neuralgia. This substance induces the cytochrome P450, which catalyse the metabolism of most of the antihypertensives used. After the discontinuation of carbamazepine and on tritherapy, the blood pressure profile has significantly improved.