RESUMEN
Arterial prosthetic graft infection is one of the most challenging issues in vascular surgery. We report a case of an infected descending thoracic aorta endograft, presenting itself several years after placement, with hemoptysis and back pain as referred symptoms. The patient was successfully treated by removing the thoracic aorta and replacing the infected endografts with a cryopreserved aortic allograft, running from the left subclavian artery to the aortic diaphragmatic hiatus.
Asunto(s)
Aorta Torácica/cirugía , Aorta/trasplante , Bioprótesis , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Criopreservación , Procedimientos Endovasculares/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Stents , Aorta Torácica/diagnóstico por imagen , Aortografía/métodos , Dolor de Espalda/etiología , Implantación de Prótesis Vascular/instrumentación , Remoción de Dispositivos , Procedimientos Endovasculares/instrumentación , Hemoptisis/etiología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/etiología , Reoperación , Tomografía Computarizada por Rayos X , Trasplante Homólogo , Resultado del TratamientoRESUMEN
We report a case of repeated delayed pain after cystoscopy under spinal lidocaine anaesthesia, which may be caused by transient radicular irritation. The possible aetiology of the symptoms is discussed.
Asunto(s)
Anestesia Raquidea/efectos adversos , Anestésicos Locales/efectos adversos , Lidocaína/efectos adversos , Radiculopatía/inducido químicamente , Anciano , Cistoscopía , Humanos , MasculinoRESUMEN
BACKGROUND AND OBJECTIVE: The control of well-known atherosclerotic risk factors represents the optimal strategy in the prevention of acute coronary syndromes. It was the aim of this work to analyze the effects of a long-term cardiac rehabilitation program on the changes of fibrinolysis parameters and plasma lipid profile in coronary patients. DESIGN AND METHODS: The study was carried out in 30 (M/F:22/8, mean age 47 years) survivors of a first acute myocardial infarction (AMI) and in 30 healthy controls who underwent a cardiac rehabilitation program (9 months duration). Samples were taken before, at 3 and 9 months after the beginning of the program to measure: tissue-type plasminogen activator (t-PA) antigen and plasminogen activator inhibitor (PAI-1) activity and antigen. A lipid profile including cholesterol (both HDL and LDL) and lipoprotein(a) was also assessed. The Wilcoxon and Mann-Whitney tests were used for statistical comparisons. RESULTS: There was a marked decrease of functional PAI-1 after 3 and 9 months as compared with baseline in AMI patients (p < 0.01). Results showed a significant increase of HDL-cholesterol (p < 0.01) and decrease of lipoprotein(a) levels after the exercise program (p < 0.01). INTERPRETATION AND CONCLUSIONS: The cardiac rehabilitation program improved fibrinolysis, by reducing the functional levels of PAI-1, and ameliorated the lipid profile by decreasing lipoprotein(a) and increasing HDL-cholesterol in patients with AMI. A long-term cardiac rehabilitation has positive effects on some risk factors for coronary disease.
Asunto(s)
Fibrinólisis , Lípidos/sangre , Infarto del Miocardio/rehabilitación , Enfermedad Aguda , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Factores de Riesgo , Factores de TiempoRESUMEN
The frequency and clinical significance of intracardiac thrombi after orthotopic heart transplantation are still not fully understood. The aim of this article is to present five patients with heart transplants with intracardiac thrombi and to subject the possible cause, methods of diagnosis, and treatment of this phenomenon to scrutiny. The frequency of intracardiac thrombi may well be higher than anticipated, with emboli occurring only in a small proportion of cases. Hematologic, anatomic, and hemodynamic factors seem to have a bearing on thrombogenesis. Further multicenter studies are required to gain a better understanding of this disorder.
Asunto(s)
Atrios Cardíacos , Trasplante de Corazón/fisiología , Ventrículos Cardíacos , Complicaciones Posoperatorias/diagnóstico , Trombosis/diagnóstico , Acenocumarol/administración & dosificación , Adulto , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Trombosis/tratamiento farmacológico , Trombosis/etiología , Tomografía Computarizada por Rayos XRESUMEN
Stress techniques for inducing myocardial ischemia in patients with coronary atherosclerosis have been widely studied. The most frequently used are those requiring physical effort, increasing their diagnostic efficiency with radioisotopes and echocardiographic monitoring. Patients unable to make physical exercise and with suspected ischemic heart disease may undergo nonexercise stress test. Transesophageal atrial stimulation and pharmacological stress tests with dipyridamol, dobutamine and adenosine are good alternatives, provided a strict methodology is used.