RESUMEN
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Asunto(s)
Humanos , Femenino , Anciano , Atrios Cardíacos/patología , Atrios Cardíacos/efectos de la radiación , Endocarditis/diagnóstico por imagen , Endocarditis/cirugía , Válvula Mitral/trasplante , Ecocardiografía Transesofágica/métodos , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/tratamiento farmacológico , Staphylococcus aureus , Staphylococcus aureus/aislamiento & purificaciónAsunto(s)
Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Anciano , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Endocarditis Bacteriana/cirugía , Femenino , Humanos , Hemorragias Intracraneales/inducido químicamente , Insuficiencia de la Válvula Mitral/cirugía , Infecciones Estafilocócicas/cirugíaRESUMEN
OBJECTIVE: To evaluate the results of a user satisfaction questionnaire on a new type of lever-propelled wheelchair designed to avoid the discomfort and potential repetitive strain injuries related to conventional hand-rim propulsion. METHODS: Seventeen participants filled out a questionnaire to rate their conventional wheelchair and the prototype (after 2 days' use) in terms of comfort, adjustability, steering/ride, manoeuvrability, stability when crossing obstacles, safety, weight, size, portability and appearance. Overall satisfaction was also scored. RESULTS: According to the user questionnaire results, the lever-propelled prototype chair was rated as significantly superior than conventional wheelchairs in terms of comfort, safety and overall satisfaction. The prototype was rated significantly inferior in terms of size, adaptability, appearance and crossing obstacles. CONCLUSION: We conclude that the prototype wheelchair is highly acceptable and comfortable and can be recommended to disabled sportspersons. The prototype's weak points are mainly related to ergonomic aspects, which could be improved in future models.
Asunto(s)
Personas con Discapacidad/psicología , Silla de Ruedas , Adulto , Amputación Quirúrgica/psicología , Amputación Quirúrgica/rehabilitación , Atletas , Trastornos de Traumas Acumulados/prevención & control , Diseño de Equipo , Ergonomía , Femenino , Humanos , Pierna/cirugía , Masculino , Paraplejía/etnología , Paraplejía/etiología , Paraplejía/psicología , Satisfacción del Paciente/estadística & datos numéricos , Proyectos Piloto , Poliomielitis/psicología , Poliomielitis/rehabilitación , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Drug-induced sialadenitis is uncommon and unrecognized. Drugs such as nitrofurantoïn, nifedipine and methimazole have been reported to induce sialadenitis. However, phenylbutazone and oxyphenbutazone are the most frequently implicated agents. We describe a case of phenylbutazone-induced parotitis and submaxillitis with cutaneous and hepatic involvement. CASE REPORT: A 51 year-old woman who had received phenylbutazone for the past 6 days was hospitalized for diagnosis of Quincke's oedema. Clinical examination in fact revealed bilateral parotitis and submaxillitis. The patient had contracted mumps in infancy. Improvement was noticed 8 days after stopping the drug and treatment by glucocorticosteroid. Nevertheless a pruritic eruption with fever appeared. Laboratory data showed leukocytosis with neutrophilia, ESR of 75 mm/hr, hepatic cholestasis and cytolysis. Infectious and autoimmune causes were ruled out. The eruption spontaneously disappeared after 5 days. Laboratory studies 3 weeks later were normal. DISCUSSION: Quincke's edema diagnosis had been established too fast on "allergic past history" and patient interrogation. Complete clinical examination revealed the correct diagnosis of sialadenitis. This observation shows similarities with other publications: unbearable xerostomia appearing before sialadenitis and with a long course, parotitis with sub-maxillitis, 6 days delay after the first administration of phenylbutazone before fever, local evolution without complication, inflammatory biological syndrome with neutrophilia and absence of infectious cause. Pruritic maculo-papulous eruption and biological hepatic abnormalities are however rare. An hypersensibility mechanism is discussed.
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Angioedema/inducido químicamente , Fenilbutazona/efectos adversos , Sialadenitis/inducido químicamente , Angioedema/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Diagnóstico Diferencial , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/patología , Femenino , Fiebre de Origen Desconocido/inducido químicamente , Humanos , Persona de Mediana Edad , Glándula Parótida/patología , Fenilbutazona/uso terapéutico , Sialadenitis/diagnóstico , Glándula Submandibular/patologíaRESUMEN
1. In the patient with renal insufficiency before dialysis, the phosphocalcic disorders appear insidiously. They are dominated by hyperparathyroidism which will be diagnosed on the initially yearly determination of plasma intact PTH as soon as creatinine clearance decreases below 60 ml/min, eventhough there is still no modification in plasma concentrations of calcium and phosphate. Its diagnosis should lead to initiate the therapeutic measures in order to prevent the irreversible thining of the corticals by endosteal resorption and later the occurrence of histological and radiological osteitis fibrosa favoring fractures. 2. Hyperparathyroidism prevention relies on two main measures: prevention of phosphate retention and hypocalcemia is implemented by progressive phosphate and protein restriction (from 1 g/kg/day when Ccr < 60 ml/min to 0.6 g/kg/day when Ccr < 20 ml/min) and administration of CaCO3 (1.5 g at lunch and dinner to better complex the phosphate) as soon as PTH is above normal; optimal vitamin D repeletion will be implemented by systematic supplementation of native vitamin D or 25OH vitamin D3 in order to bring P25OHD between 30-60 ng/ml (75-150 nmol/l) or more generally around the upper limit of the epidemiologic range of the laboratory; these measures should aim at maintaining plasma intact PTH in its optimal range variable with the degree of renal insufficiency: 0.5-1; 1-2.5 and 2-3 folds the upper limit of normal for creatinine clearance respectively at 60-30; 30-10 and < 10 ml/min. 3. Because of their hyperphosphatemic and hypercalcemic effect, 1 alpha-hydroxylated vitamin D derivatives will be regularly efficient and safe only when non-calcemic non-aluminic phosphate binder will be available and proven to be without side-effects. 4. Instrumental (surgical or by alcohol injection) parathyroidectomy should be considered when plasma intact PTH is > 5 to 7 times the upper limit of normal in the presence of hypercalcemia (> 2.60 mmol/l) and/or hyperphosphatemia (> 1.70 nmol/l) in spite of the above measures, the decision being reinforced by coexistence of bone radiologic abnormalities and metastatic calcifications. 5. Adynamic bone diseases are rare before hemodialysis in the absence of aluminum exposition by the drinking water or the aluminum-phosphate binders. In absence of aluminum it will be prevented by maintaining PTH in its optimal range. 6. Osteomalacia before hemodialysis is mainly due, in the absence of aluminum exposition, to vitamin D deficiency, hypocalcemia and acidosis. It is readily cured by physiological doses of native vitamin D or 25OH vitamin D3 bringing plasma 25 OHD above 16 ng/ml, in association with alkaline salts of calcium and if necessary of sodium bicarbonate.
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/prevención & control , Diálisis Renal , Insuficiencia Renal/terapia , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Humanos , Hiperparatiroidismo/diagnóstico , Hiperparatiroidismo/prevención & control , Hiperparatiroidismo/cirugía , Hipocalcemia/prevención & control , Hormona Paratiroidea/sangre , Paratiroidectomía , Fosfatos/metabolismo , Insuficiencia Renal/complicaciones , Vitamina D/uso terapéuticoRESUMEN
A case of pseudoxanthoma elasticum of the left internal mammary artery from a 61-year-old male who underwent coronary artery bypass grafting is reported. Intraoperative evaluation of the left internal mammary artery revealed partial stenosis. Histologically, the stenotic portion showed pseudoxanthoma elasticum. This represents the first reported case of pseudoxanthoma elasticum in the internal mammary artery.
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Arterias Mamarias/patología , Seudoxantoma Elástico/patología , Angina de Pecho/patología , Angina de Pecho/cirugía , Puente de Arteria Coronaria , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana EdadRESUMEN
This article reviews the clinical, biological, radiological, and pathological procedures and their respective indications for the practical diagnosis of the following various histological patterns of renal osteodystrophy: osteitis fibrosa due to parathyroid hormone (PTH) hypersecretion: osteomalacia or rickets due to native vitamin D deficiency and/or aluminum overload; and adynamic bone disease (ABD) due to aluminum overload and/or PTH secretion oversuppression. Our advice regarding bone biopsy is to restrict it to patients with symptoms and hypercalcemia, especially those who have been previously exposed to aluminum. In other cases, we propose relying merely on the determination of the plasma concentrations of calcium, protide, phosphate, bicarbonate, intact PTH, aluminum, 25(OH)D3, and alkaline phosphatase (total and bony if hepatic disease is associated) to choose the appropriate treatment. Because of the danger of the desferrioxamine treatment necessary to chelate and remove aluminum, the suspicion of aluminic bone disease (osteomalacia or ABD) will always be confirmed by a bone biopsy. In the case of nonaluminic osteomalacia, correction of the vitamin D deficiency by native vitamin D or 25(OH)D3, and of the calcium deficiency and acidosis by alkaline salts of calcium and if necessary sodium bicarbonate are sufficient to cure the disease. In the case of nonaluminic ABD, the stimulation of PTH secretion by the discontinuation of 1alpha hydroxylated vitamin D and the induction of a negative calcium balance during dialysis by decreasing the calcium concentration in the dialysate will allow an increase of the CaCO3 dose to correct for hyperphosphatemia without inducing hypercalcemia. For hyperparathyroidism, i.e., plasma intact PTH levels greater than two- or four-fold the upper limit of normal levels (according to the absence or presence of previous aluminum exposure), the treatment will consist in increasing the CaCO3 dose to correct for hyperphosphatemia together with a decrease of the calcium concentration in the dialysate if the dose of CaCO3 is so high that it induces hypercalcemia. When the hyperphosphatemia has been corrected and there is still a low or normal corrected plasma calcium level, 1alpha(OH)D3 in an oral bolus 2 or 3 times a week should be given at the minimal dose of 1 microg. When the PTH level stays above 400 pg while hypercalcemia occurs and hyperphosphatemia persists, surgical subtotal parathyroidectomy is recommended or the injection of calcitriol into the big nodular hyperplastic parathyroid glands under sonography control in high surgical risk patients. Special recommendations are given for children.
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico , Diálisis Renal , Adulto , Fosfatasa Alcalina/sangre , Aluminio/análisis , Aluminio/sangre , Aluminio/envenenamiento , Bicarbonatos/sangre , Biopsia , Calcifediol/sangre , Calcio/sangre , Calcio/deficiencia , Calcio/uso terapéutico , Carbonato de Calcio/administración & dosificación , Carbonato de Calcio/uso terapéutico , Niño , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/sangre , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico por imagen , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/patología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/fisiopatología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/terapia , Soluciones para Diálisis/uso terapéutico , Displasia Fibrosa Ósea/etiología , Humanos , Hidroxicolecalciferoles/administración & dosificación , Hidroxicolecalciferoles/uso terapéutico , Hipercalcemia/diagnóstico , Hipercalcemia/tratamiento farmacológico , Hiperparatiroidismo/complicaciones , Hipoparatiroidismo/complicaciones , Osteomalacia/etiología , Osteomalacia/terapia , Hormona Paratiroidea/sangre , Hormona Paratiroidea/metabolismo , Paratiroidectomía , Fosfatos/sangre , Fósforo/sangre , Radiografía , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/tratamiento farmacológicoRESUMEN
OBJECTIVE: To evaluate the hypothesis that pulmonary venous congestion and oedema manifested predominantly in the right upper lobe in children with mitral regurgitation occur more frequently than previously thought. MATERIALS AND METHODS: Three radiologists retrospectively and independently reviewed the plain chest radiographs of 54 children (26 girls, 28 boys, age range 2 days-18 years, median 9.5 years) with mitral regurgitation admitted to our institution during a 5-year period. Radiographs showing pulmonary venous congestion and oedema manifested predominantly in the right upper lobe were identified. Clinical records of these patients were studied to exclude other causes of pulmonary disease. RESULTS: Radiographic signs of pulmonary venous congestion and oedema were present in all patients, with redistribution of flow and interstitial oedema in 39 patients (72 %) and alveolar oedema in 15 children (28 %). In 12 (22 %) of 54 children, these findings were localised or predominant in the upper lobe of the right lung; none of the children had predominantly left-sided involvement. CONCLUSIONS: Pulmonary venous congestion and oedema involving predominantly the upper lobe of the right lung in children with mitral regurgitation occur more frequently than previously thought. This finding is useful in the differential diagnosis of right upper lobe abnormalities, such as pneumonia.
Asunto(s)
Insuficiencia de la Válvula Mitral/complicaciones , Edema Pulmonar/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Edema Pulmonar/epidemiología , Edema Pulmonar/etiología , RadiografíaRESUMEN
We present a case of survival as a result of surgical intervention after perforation of the left ventricle during the insertion of a pleural drainage tube. Surgical intervention was facilitated by the fact that the drainage tube responsible for the suspected perforation of the cardiac cavity was clamped and fastened, as opposed to withdrawn. The location of the perforation was established by measuring the pressure curve through the drainage tube.
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Lesiones Cardíacas/etiología , Intubación/efectos adversos , Drenaje/instrumentación , Neoplasias Esofágicas/cirugía , Lesiones Cardíacas/cirugía , Ventrículos Cardíacos/lesiones , Humanos , Masculino , Persona de Mediana Edad , Pleura , Cuidados PosoperatoriosRESUMEN
OBJECTIVE: The symmetric distribution of pulmonary vascular congestion and edema caused by left ventricular heart failure associated with severe mitral regurgitation as seen on chest radiographs is well known. To our knowledge, only eight cases have been reported in which congestion and edema were confined to one lung or a portion of one lung. The purpose of this study was to determine the prevalence of asymmetric findings in these patients. MATERIALS AND METHODS: Three radiologists retrospectively and independently reviewed the plain chest radiographs of 131 patients with severe mitral regurgitation admitted to our institution during a 3-year period. Radiographs showing asymmetric vascular congestion or pulmonary edema were identified. Clinical records of these patients were studied to exclude other causes of pulmonary disease. RESULTS: Radiographic signs of vascular congestion and edema were present in 117 (89%) of the 131 patients. In 12 (9%) of 131 patients, these findings were localized or predominant in the upper lobe of the right lung. None of the patients had predominantly left-sided involvement. CONCLUSION: Pulmonary vascular congestion and edema involving predominantly the upper lobe of the right lung in patients with severe mitral regurgitation occurs more frequently than previously thought. This information is useful in the differential diagnosis of right upper lobe abnormalities, such as pneumonia.
Asunto(s)
Insuficiencia de la Válvula Mitral/complicaciones , Edema Pulmonar/etiología , Anciano , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/patología , Radiografía , Estudios RetrospectivosRESUMEN
A 53-year-old man was diagnosed to have typical hairy cell leukemia. Immunophenotyping of frozen splenic tissue showed clonality of hairy cells for mu lambda, confirmed by the corresponding immunoglobulin gene rearrangements. The patient was successfully treated with interferon-alpha (IF-alpha). In the fifth year of treatment with IF-alpha the morphology of peripheral blood mononuclear cells (PBMC) and of bone marrow infiltration changed with the appearance of numerous small to intermediate shaped lymphocytes of a T-helper phenotype. Frank leukemia, resistant to IF-alpha treatment and ultimately aggressive chemotherapy, developed. Emergence of this second clonal disease was confirmed by rearrangement studies performed on PBMC; rearrangements of both alleles of the TCR beta were identified, whereas the JH and lambda IVS genes were in germline configuration. The outgrowth of a second, malignant T-cell clone paralleled by the disappearance (down-regulation?) of the initial B-cell clone while under cytokine treatment is consistent with the possibility that IF-alpha favoured the emergence of this second clone.
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Interferón-alfa/uso terapéutico , Leucemia de Células Pilosas/terapia , Leucemia de Células T/etiología , Neoplasias Primarias Secundarias/etiología , Médula Ósea/patología , Células Clonales , ADN Viral/análisis , Reordenamiento Génico de Linfocito B , Reordenamiento Génico de Linfocito T , Genes de Inmunoglobulinas , Herpesvirus Humano 4/genética , Humanos , Interferón alfa-2 , Leucemia de Células Pilosas/patología , Persona de Mediana Edad , Neoplasias Primarias Secundarias/patología , Receptores de Antígenos de Linfocitos T alfa-beta/genética , Proteínas RecombinantesRESUMEN
Duplex-sonography has permitted to derive Doppler-signal curves in color. Direction of flow is indicated by blue or red, according to flow from or to the probe. This permits a rapid investigation and yields intelligible images. In liver transplantation, potency and flow through parenchymal arteries and veins can be visualized. Alterations of flow in the suprahepatic venous circulation and in the portal circulation in cirrhotic patients and the development of a collateral circulation are described. With the color-Doppler imaging technique, peripheral parenchymal vessels can be studied, which is of great use in the diagnosis of tumors and in cases of abdominal trauma.