RESUMO
La epistaxis, es un síntoma frecuente en la consulta de otorrinolaringología. Dentro de las causas posibles encontramos la telangiectasia hemorrágica hereditaria (síndrome de Rendu Osler Weber), que corresponde a un desorden autosómico dominante caracterizado por sangrados nasales y gastrointestinales asociados a malformaciones arteriovenosas sistémicas. Su manifestación más frecuente es la epistaxis, presentándose más frecuentemente en personas mayores de 40 años, sin predilección por género. Se presenta el caso de un paciente de sexo masculino de 46 años quien consulta por epistaxis a repetición y severa. Durante la hospitalización se efectúa el tratamiento convencional de la epistaxis, diagnóstico retroactivo del síndrome de Rendu Osler Weber y manejo multidisciplinario de la patología. Se realiza revisión de la literatura y discusión del manejo del paciente que cursa con esta enfermedad.
Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Epistaxe/etiologia , Telangiectasia Hemorrágica Hereditária/cirurgia , Epistaxe/cirurgiaRESUMO
We report a 81 years old female with a severe aortic insufficiency, treated with diuretics and antidepressants admitted due to recurrent syncopal episodes. During the first syncopal episode, an atrioventricular block was detected and an endocavitary demand pacemaker implanted. Two years later, she had a new syncope without evidences of pacemaker failure. The EKG during pacemaker rhythm showed a prolonged QT interval. During hospital monitoring, she presented a self limited polymorphic ventricular tachycardia (Torsade de Pointes). Consequently, the pacemaker was programmed at a greater frequency, and the QT interval shortened from 0.73 to 0.56 sec. Thereafter, the patient no longer had tachycardia or syncopal episodes, after one year of follow up.
Assuntos
Marca-Passo Artificial/efeitos adversos , Torsades de Pointes/etiologia , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Síndrome do QT Longo/complicações , Torsades de Pointes/fisiopatologiaRESUMO
A 38 year-old woman had an anterolateral wall myocardial infarction and acute left ventricular failure 11 days after a cesarean section. Coronary angiography performed 14 days later because of recurrent angina disclosed dissection of the left main coronary artery. She subsequently underwent aorto coronary bypass surgery uneventfully. Spontaneous coronary artery dissection is a rare entity that mainly affects women in peripartum periods and presents a high mortality rate.
Assuntos
Dissecção Aórtica/complicações , Infarto do Miocárdio/etiologia , Complicações Cardiovasculares na Gravidez/etiologia , Transtornos Puerperais/etiologia , Adulto , Dissecção Aórtica/cirurgia , Feminino , Humanos , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Transtornos Puerperais/cirurgia , Ruptura EspontâneaAssuntos
Ferricianetos/uso terapêutico , Insuficiência da Valva Mitral/tratamento farmacológico , Nitroprussiato/uso terapêutico , Cardiopatia Reumática/tratamento farmacológico , Adulto , Idoso , Ensaios Clínicos como Assunto , Avaliação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PIP: The health risks of pregnancy to mother and fetus can be represented schematically by the diagram of an iceberg. Its tip represents the level of risk encountered at the hospital level which has obviously been conditioned by biological, socioeconomic, and psychological factors at a lower level. This lower level of factors that determine risk can only be understood if specifically investigated at the level of the consulting clinic, prior to any hospitalization. 2 groups of patients attending such a clinic in Chile were studied: 1 with pregnancy complications and 1 characterized by normal pregnancy. The purposes were to determine the prevalence of pathology at the clinic livel, to relate the biological factors that condition risk and the pathology of the particular gestational period, and to relate pregnancy complications, the characteristics of labor, the puerperium, and the newborn. 6 factors were traced that condition risk at pregnancy: age, place of residence, abortion history, parity, height, and control of pregnancy. In turn, these were related to each specific period of gestation and birth. The data collected and tabulated show that the different factors analyzed exercise a differential effect on the various periods of pregnancy and labor. The greatest risk factors are those of maternal age, parity, abortion history, height, and pregnancy complications such as urinary infection, toxemia, and anemia.^ieng