RESUMO
Myxomas are the most common benign cardiac tumors, which are considered emergency surgery. The resection should not be delayed because 8-9% of affected patients may die due to intracardiac blood flow obstruction. We presente a clinical case of a 47 year old female, history of dyslipidemia. Disease starts with retrosternal oppression feeling, dyspnea on moderate exercise, dizziness, pain in joints hands. Arrhytmic heart sounds, diastolic mitral murmur II/IV, breth sounds present, no lymph. Laboratory: hemoglobin 11.0, leucocyte 9000, glucose 96 mg/dL, chest RX medium arch prominence cardiac silhouette. ECO transthoracic LVEF 60 %, with left atrial intracardiac tumor 13x11 cm, pedicle fixed the interatrial septum, the mitral valve bulges, with mild mitral valve. Half sternotomy is performed intracardiac tumor resection, pericardial placement interatrial with extracorporeal circulation support 65', aortic clamping time of 40'. Intracardiac tumor surgical findings interatrial septum fixed to left side, pedicle, rounded, yellow, multiloculated, soft, 13x10 cm in diameter. Histopathological diagnosis cardiac myxoma. We conclude that the tumor resection was carried in a timely manner with satisfactory evolution.
Los mixomas son los tumores cardiacos benignos más frecuentes. Se consideran urgencias quirúrgicas. La resección no debe ser demorada ya que el 8-10% de los pacientes afectados pueden morir debido a la obstrucción intracardiaca del flujo sanguíneo. Se presenta el caso clínico de una mujer de 47 años, con antecedente de dislipidemia. Inicia padecimiento con sensación de opresión retroesternal, disnea de medianos esfuerzos, mareo, dolor en articulaciones de manos. Ruidos cardiacos arrítmicos, soplo mitral diastólico II/IV, ruidos respiratorios presentes, no ganglios. Laboratoriales: HB 11.0, leuc 9000, glucosa 96 mg/dL. Rx de tórax con prominencia de arco medio en silueta cardiaca. ECO TT: FEVI 60% con tumoración intracardiaca en aurícula izquierda: 13x11 cm, fijo y pediculado al septum interatrial, protruye a la válvula mitral, válvula mitral con insuficiencia leve, PSP 30 mm Hg. Se realiza esternotomía media, resección de tumor intracardiaco, colocación de parche de pericardio interatrial, con apoyo de circulación extracorpórea tiempo de DCP de 65 minutos, pinzamiento aórtico 40 minutos, hallazgos transoperatorio: tumor intracardiaco fijo a septum interatrial lado izquierdo pediculado, redondeado, amarillo, multiloculado blando, 13x10 cm de diámetro. Diagnostico histopatológico: mixoma cardiaco. Se concluye que la resección del tumor se llevó a cabo en tiempo y forma con evolución satisfactoria.
Assuntos
Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Feminino , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Humanos , Pessoa de Meia-Idade , Mixoma/diagnóstico , Mixoma/patologiaRESUMO
OBJECTIVE: To compare body temperature measurements using tympanic, skin and digital axillary thermometers. METHOD: Hospitalized or outpatient children from the General Hospital Celaya, ISSSTE Hospital Clinic and General Hospital No. 4 IMSS, and the pediatric private service in Celaya, Guanajuato, from 1 day of life until 16 years old, were recruited over a one month period, after their parents signed the consent form. The order of each institution was selected by simple randomization. Body temperatures were measured in triplicate using tympanic, skin and digital axillary thermometers. RESULTS: The sample consisted of 554 children. The Pearson r between the tympanic and digital axillary thermometers was 0.57 to 0.65, with a positive linear relationship (P<.05); between the skin and the digital axillary thermometers, it was between 0.47 and 0.52 with a positive linearrelationship (P<.05). The intra-observer Kappa for the tympanic thermometer was 0.86, and for the inter-observer was 0.77; for the skin thermometer it was 0.82 and 0.67, respectively, and for the digital axillary thermometer it was 0.86 for intra-observer reliability and 0.78 for inter -observer reliability. CONCLUSION: Tympanic and axillary thermometers showed better precision in measuring the body temperature in children than skin thermometers.
Assuntos
Temperatura Corporal , Termômetros , Adolescente , Axila , Criança , Pré-Escolar , Orelha Média , Desenho de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , PeleRESUMO
Atrial fibrillation (AF) is associated with long-term increase in the incidence of cerebrovascular disease, heart failure and mortality. The incidence of ischemic stroke in patients with non-valvular atrial fibrillation averages 5 % per year, from two to seven more frequent than in patients without atrial fibrillation (AF). One in six ischemic stroke occurs in patients with AF. The detection and accurate diagnosis and timely therapeutic intervention have shown a decrease in morbidity and mortality associated with this arrhythmia. The above data by themselves justify the development of a management guide and care for these patients. The purpose of this guide is to provide health professionals recommendations based on the best available evidence with the intent to standardize actions: diagnosis and identification of patients with atrial fibrillation; risk stratification and treatment according to the classification of atrial fibrillation; identification of the risk of thromboembolism and its prevention; and treatment guidelines to determine which patient will require to be referred promptly.