RESUMEN
An extremely rare case of type IV dual left anterior descending coronary artery coexisting with myocardial bridging in a 50-year old Caucasian man with acute coronary syndrome is presented. Emergency cardiac catheterisation revealed no coronary atherosclerotic lesions. The potential causal relationship between the type IV dual left anterior descending coronary artery and myocardial ischaemia was discussed. We also summarised the current knowledge on the epidemiology and clinical significance of dual left anterior descending coronary artery in the adult population.
Asunto(s)
Síndrome Coronario Agudo/etiología , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Síndrome Coronario Agudo/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
We report a case of pacemaker endocarditis due to Stenotrophomonas maltophilia in a 22-year-old Caucasian man with d-transposition of the great arteries after atrial switch procedure. S.maltophilia isolated from blood cultures was susceptible to trimethoprim-sulfamethoxazole and amikacin, and resistant to ciprofloxacin and all tested ß-lactam antibiotics. The infected pacemaker system was completely removed by thoracotomy. Simultaneously, a new DDD pacemaker and epicardial electrodes were successfully implanted and selective antibiotic therapy consisting of trimethoprim-sulfamethoxazole (480 mg i.v. q 6 h) and amikacin (250 mg i.v. twice daily) was continued. However, the post-operative course was complicated by septic shock and the patient died on 9th day after surgery. Importantly, S.maltophilia isolated from extracted pacemaker leads was multidrug-resistant including to trimethoprim-sulfamethoxazole, ciprofloxacin, all tested aminoglycosides, and ß-lactams, with the exception of ticarcillin-clavulanate. In conclusion, pacemaker endocarditis due to Stenotrophomonas maltophilia is an extremely rare but serious complication of permanent pacing therapy. The susceptibility of S.maltophilia isolates to antimicrobial agents can change during the course of infection. Despite the inherent resistance of S.maltophilia to most ß-lactam antibiotics, multidrug-resistant strains may be susceptible in vitro to ticarcillin-clavulanate. Further studies are needed to determine the optimal management of patients with pacemaker endocarditis caused by Stenotrophomonas maltophilia.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Infecciones por Bacterias Gramnegativas/diagnóstico , Marcapaso Artificial/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Stenotrophomonas maltophilia , Transposición de los Grandes Vasos/cirugía , Endocarditis Bacteriana/terapia , Infecciones por Bacterias Gramnegativas/terapia , Humanos , Masculino , Infecciones Relacionadas con Prótesis/terapia , Adulto JovenRESUMEN
We present a case of a 56-year-old male who was admitted to our hospital due to cardiac tamponade. A 600 ml of purulent fluid was evacuated from the pericardium. The patient received antibiotics, however, due to recurrent pericardial effusion a pericardial drainage was required. Esophagoscopy and computerised tomography revealed oesophageal carcinoma with oesophago-pericardial fistula.
Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Taponamiento Cardíaco/etiología , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/terapia , Taponamiento Cardíaco/terapia , Diagnóstico Diferencial , Ecocardiografía , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/cirugía , Técnicas de Ventana PericárdicaRESUMEN
There has been reported a case of severe exacerbation of chronic renal failure with bilateral hydronephrosis and urosepsis, which was caused by asymptomatic large urinary bladder stone. Life-threatening symptoms of uraemic syndrome were found, which required temporary hemodialysis treatment. Following removal of the calculus and controlling of severe urinary tract infection the patient was discharged with stable blood serum creatinine concentration 3.8 mg/dl.
Asunto(s)
Fallo Renal Crónico/etiología , Cálculos de la Vejiga Urinaria/complicaciones , Cálculos de la Vejiga Urinaria/cirugía , Creatinina/sangre , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Radiografía , Diálisis Renal , Resultado del Tratamiento , Cálculos de la Vejiga Urinaria/diagnóstico por imagen , Infecciones Urinarias/etiología , Infecciones Urinarias/terapiaRESUMEN
Clinical picture of coronary artery disease is different in men and women. Later incidence of coronary disease in women than in men, presence of less typical symptoms, lower specificity of non invasive diagnostic tests as well as higher mortality during percutaneous or surgical revascularization are underlined. Aim of the study was to examine clinical variables, diagnostic and treatment methods in women with coronary disease on the basis of retrospective analysis of patients hospitalized in the Department of Coronary Artery Disease of the Jagiellonian University Medical School in Cracow between 1991 and 1999. 929 patients aged 31-95 years mean 56.95 +/- 10.02 years were enrolled in the study. Clinical usefulness in women with coronary disease of diagnostic tests: electrocardiographic exercise test, exercise thalium-201 scintigraphy and stress echo-cardiography with dobutamine were analyzed. The highest sensitivity was found in exercise scintigraphy (92.9%) compared to ECG exercise test (80.6%) and stress echocardiography with dobutamine (76.9%). The highest specificity characterized stress echocardiography with dobutamine (76.9%) versus exercise scintigraphy (34.7%) and ECG exercise test (25.9%). Between 1991 and 1999 women with coronary artery disease consisted 19.4% of all patients hospitalized in the Department of Coronary Artery Disease in Cracow. Among patients investigated with coronary angiography there were 18.2% of women. Among percutaneously revascularized patients women constituted 17.8%. In the analyzed period 3.5-fold increase of the number of women with CAD hospitalized in the Department of Coronary Artery Disease in Cracow, 7.5-fold increase of the number of women investigated with coronary angiography and 10.5-fold increase of the number of percutaneously or surgically revascularized women was observed. On the basis of performed diagnostic tests 650 women (69.9%) were treated pharmacologically. In 157 patients (16.9%) percutaneous coronary angioplasty was performed, in 118 patients (12.7%) coronary artery bypass surgery was done. In 4 women (4.3%) heart transplantation was performed.