RESUMEN
Detailed analysis of 21 patients suffering from arterial hypertension complicated by aortic dissection, who were treated non-surgically was performed. Signs and symptoms of aortic dissection appeared the most frequently in the age between 50 and 69. In 14 (66.7%) cases proximal (type A) and in 7 (33.3%) distal (type B) dissection were diagnosed. During acute phase 15 patients complained of pain and 6 did not. Smoking and family history of arterial hypertension were the commonest risk factors in this group. Proximal dissection was more frequently connected with painful course of the dissection whereas distal with painless. Detailed analysis of clinical data and non-invasive treatment during acute phase (first 14 days since onset of pain) was performed. During ambulatory observation which lasted 3-75 month (mean 34.3 month) 5 (25%) patients died, 15 (75%) are still alive.
Asunto(s)
Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Torácica/complicaciones , Disección Aórtica/complicaciones , Hipertensión/etiología , Adulto , Anciano , Atención Ambulatoria , Disección Aórtica/mortalidad , Disección Aórtica/terapia , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/terapia , Aneurisma de la Aorta Torácica/mortalidad , Aneurisma de la Aorta Torácica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Fumar/efectos adversos , Tasa de SupervivenciaRESUMEN
UNLABELLED: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. IN CONCLUSION: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.
Asunto(s)
Aneurisma de la Aorta/tratamiento farmacológico , Disección Aórtica/tratamiento farmacológico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Adulto , Anciano , Disección Aórtica/diagnóstico , Disección Aórtica/etiología , Disección Aórtica/fisiopatología , Angiografía de Substracción Digital , Antihipertensivos/uso terapéutico , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/fisiopatología , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Colesterol/sangre , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ácido Úrico/sangreRESUMEN
We investigated the psychiatric history of patients with severe Darier's disease and a control group, which consisted of patients with comparably severe dermatologic disorders of keratinization. Three patients with Darier's disease reported either a suicide attempt (one patient) or a specific suicide plan (two), compared with one patient in the control group. Of 11 patients with Darier's disease, 7 had a history of suicidal thoughts, compared with 3 of 11 patients in the control group. Thus suicidal ideation is a potential problem in patients with cutaneous illnesses, particularly those with chronic disfiguring disorders such as severe Darier's disease.
Asunto(s)
Enfermedad de Darier/psicología , Suicidio/psicología , Adolescente , Adulto , Anciano , Enfermedad de Darier/patología , Depresión/diagnóstico , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Antihipertensivos/uso terapéutico , Clopamida/uso terapéutico , Hemodinámica/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Pindolol/uso terapéutico , Propanolaminas/uso terapéutico , Adulto , Anciano , Combinación de Medicamentos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Thirty-two patients with cardiomyopathy, 25 with hypertrophic and 7 with dilated form were examined by cardiac catheterisation, left ventriculography, selective coronary angiography and ungated cardiac computed tomography. Diffuse hypertrophy, localized hypertrophy and dilated cardiomyopathy were diagnosed and assessed quantitatively based on CT linear, surface and volumetric parameters of cardiac morphology. Absolute septal thickness and left ventricular mass measured in CT image are the most discriminative attributes.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Corazón/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Cardiomegalia/diagnóstico por imagen , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Femenino , Tabiques Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A group of 43 patients with cardiomyopathy was assessed clinically and hemodynamically. Disturbances in the electric myocardial activity and hemodynamic changes concerning the duration of the different phases of left ventricular systole were observed. Despite the presence of these changes, in the early atypical forms no impairment of the myocardial contractility was found. In the advanced forms (hypertrophic cardiomyopathy and congestive cardiomyopathy) the myocardial contractility was impaired, this contributing to the development of heart failure manifestations.