RESUMEN
Knee pain is a frequent symptom facing the general practitioner. Some of the more severe differential diagnoses include bone infections and malignancy. We present a case report of a ten-year-old sports active and otherwise healthy girl with knee pain, which turned out to be haematogenous osteomyelitis.
Asunto(s)
Osteomielitis , Dolor/etiología , Niño , Diagnóstico Diferencial , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Osteomielitis/complicaciones , Osteomielitis/diagnóstico , Osteomielitis/diagnóstico por imagenRESUMEN
Pulmonary infiltrates on radiological imaging are most often assumed to be a potential lung cancer, although seldom, other malignant intrathoracal tumours can appear. Knowledge of these, their growth pattern and localisation is of significance in order to reach a differential diagnosis and to plan targeted treatment. In mediastinum anterior thymoma is the most frequent form of cancer arising from the thymus epithelium. This case report describes a male patient suspected of lung cancer who happened to have malignant thymoma with atypical dissemination, which challenged the diagnostics.
Asunto(s)
Timoma , Neoplasias del Timo , Adulto , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Timoma/diagnóstico , Timoma/diagnóstico por imagen , Neoplasias del Timo/diagnóstico , Neoplasias del Timo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused treatment is of primary importance. No data from randomised, controlled trials on management exists, and there is not international consensus on treatment regime. We present amatoxin-case contacts to the Danish Poison Centre from 2006-2012 and summarize current knowledge and Danish recommendations in amatoxin poisoning management.
Asunto(s)
Amanitinas/envenenamiento , Proteínas Fúngicas/envenenamiento , Intoxicación por Setas , Amanita , Dinamarca/epidemiología , Humanos , Intoxicación por Setas/complicaciones , Intoxicación por Setas/diagnóstico , Intoxicación por Setas/epidemiología , Intoxicación por Setas/terapia , Factores de TiempoRESUMEN
Osteoprotegerin (OPG) is a member of the tumor necrosis factor receptor superfamily and is known to be among the mediators of the calcification process that has been shown to increase in patients with aortic stenosis (AS). The aim of this study was to characterize the association of OPG with left ventricular (LV) function and remodeling and to evaluate the significance of preoperative OPG on long-term outcome in terms of survival and symptomatic improvement in 124 patients with severe AS scheduled for aortic valve replacement (AVR). Patients were divided according to tertiles of preoperative OPG. Preoperative OPG was associated with age, EuroSCORE, and preoperative functional capacity. Despite similar ejection fraction and diastolic function among groups, longitudinal LV systolic function consistently decreased and markers of filling pressure increased across groups. During median follow-up of 4 years, 41 patients died of a presumed cardiovascular cause or remained in New York Heart Association functional class III or IV. The risk of a poor postoperative outcome after AVR increased with increasing OPG tertiles (15% vs 33% vs 51%, p = 0.002). In a multivariate model containing age, ejection fraction, N-terminal pro-brain natriuretic peptide and left atrial volume index, OPG was still significantly associated with postoperative outcome. In addition, OPG levels associated with cardiovascular mortality during follow-up. In conclusion, OPG is associated with LV and left atrial remodeling in patients with symptomatic severe AS undergoing AVR. Moreover, plasma OPG is associated with long-term postoperative outcome and may identify patients with poor symptomatic improvement after surgery.
Asunto(s)
Estenosis de la Válvula Aórtica/sangre , Prótesis Valvulares Cardíacas , Osteoprotegerina/sangre , Función Ventricular Izquierda/fisiología , Remodelación Ventricular , Anciano , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Periodo Posoperatorio , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement is unknown. METHODS AND RESULTS: A total of 125 patients with severe aortic stenosis and ejection fraction >40% scheduled for aortic valve replacement were evaluated preoperatively and divided into 4 groups according to GLS quartiles. Patients were followed up for 4 years. The primary end points were major adverse cardiac events (MACEs) defined as cardiovascular mortality and cardiac hospitalization because of worsening of heart failure; the secondary end point was cardiovascular mortality. MACE and cardiac mortality were significantly increased in patients with lower GLS. Estimated 5-year MACE was increased: first quartile 19% (n=6) / second quartile 20% (n=6) / third quartile 35% (n=11) / fourth quartile 49% (n=15); P=0.04. Patients with increased age, left ventricular hypertrophy, and left atrial dilatation were at increased risk. In Cox regression analysis, after correcting for standard risk factors and ejection fraction, GLS was found to be significantly associated with cardiac morbidity and mortality. In a stepwise Cox model with forward selection, GLS was the sole independent predictor: hazard ratio=1.13 (95% confidence interval, 1.02-1.25), P=0.04. Comparing the overall log likelihood χ(2) of the predictive power of the multivariable model containing GLS was statistically superior to models based on EuroScore, history with ischemic heart disease, and ejection fraction. CONCLUSIONS: In patients with symptomatic severe aortic stenosis undergoing aortic valve replacement, reduced GLS provides important prognostic information beyond standard risk factors.
Asunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Función Ventricular Izquierda , Anciano , Anciano de 80 o más Años , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/efectos de los fármacos , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Bencimidazoles/uso terapéutico , Fenómenos Biomecánicos , Compuestos de Bifenilo , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Distribución de Chi-Cuadrado , Dinamarca , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Sístole , Tetrazoles/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Función Ventricular Izquierda/efectos de los fármacos , Remodelación VentricularRESUMEN
BACKGROUND: Plasma fibulin-1 levels have been associated with N-terminal pro-B-type natriuretic peptide levels and left atrial size and shown to be predictive of mortality in patients with diabetes. The mechanisms behind these connections are not fully understood but are probably related to its roles as an extracellular matrix protein in cardiovascular tissues. METHODS AND RESULTS: One hundred twenty-five patients with severe aortic stenosis who were scheduled for aortic valve replacement (AVR) were evaluated with preoperative echocardiography and their plasma fibulin-1 levels were determined with ELISA. The cohort was followed for a median of 4 years after AVR. Increased restrictive left ventricular (LV) filling pattern was observed with increased plasma fibulin-1 levels (2% versus 29% versus 24% in low, middle, and high plasma fibulin-1 tertile groups, P=0.004). Likewise, reduced longitudinal systolic LV function (6.6 ± 1.1 versus 6.1 ± 1.3 versus 5.7 ± 1.5 cm/s, P=0.05) and increased LV filling pressures was systolic velocity of the mitral annulus observed with increasing plasma fibulin-1 concentrations (ratio of early transmitral flow velocity to early diastolic flow velocity of the mitral annulus 13 ± 4 versus 15 ± 5 versus 16 ± 6 in the fibulin-1 tertile groups, P=0.04). CONCLUSIONS: In patients with symptomatic severe aortic stenosis undergoing AVR, plasma fibulin-1 is associated with restrictive filling of the LV, decreased longitudinal systolic function of the LV, and increased LV filling pressures. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrial.gov with Identifier: NCT00294775.