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Concomitant pulmonary embolism and aortic dissection: approach to anticoagulation
Get PDFOs autores descrevem um caso de uma doente admitida após episódio pré-sincopal
associado a precordialgia e cujo ecocardiograma sumário feito no Servic¸o de Urgência demonstrou alterac¸ões compatíveis com tromboembolismo pulmonar, tendo a doente sido submetida
a terapêutica fibrinolítica, após episódio de paragem cardiorrespiratória. Na angiotomografia
de tórax feita posteriormente para confirmac¸ão diagnóstica demonstra-se a presenc¸a não só de
trombos no nível da artéria pulmonar, mas também de dissec¸ão da aorta Stanford B, tendo-se
optado pela manutenc¸ão de anticoagulac¸ão terapêutica e a doente evoluído de forma favorável.The authors describe a case of a patient admitted with a pre-syncopal episode and precordial discomfort, and whose cardiac ultrasound performed in the Emergency Room was suggestive of Pulmonary Embolism. The patient was submitted to fibrinolytic therapy after cardiac arrest. The computerized tomography done after this episode not only confirmed the presence of pulmonary embolism but had also shown a Stanford Type B Aortic Dissection. The option was to maintain the therapeutic anticoagulation, having the patient evolved favourably.info:eu-repo/semantics/publishedVersio
A pressão coronária (às vezes) mente. . .
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Comparative analysis of fractional flow reserve and instantaneous wave-free ratio: Results of a five-year registry. [Rev Port Cardiol. 2018]info:eu-repo/semantics/publishedVersio
Can We Really Discuss About RRT Starting Time Before We Have a Recovery Biomarker?
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Explicit design of transfer functions for volume-rendered images by combining histograms, thumbnails, and sketch-based interaction
No full textVisual quality of volume rendering for medical imagery strongly depends on the underlying transfer function. Conventional Windows–Icons–Menus–Pointer interfaces typically refer the user to browse a lengthy catalog of predefined transfer functions or to pain-staking refine the transfer function by clicking and dragging several independent handles. To turn the standard design process less difficult and tedious, this paper proposes novel interactions on a sketch-based interface that supports the design of 1D transfer functions via touch gestures to directly control voxel opacity and easily assign colors. User can select different types of transfer function shapes including ramp function, free hand curve drawing, and slider bars similar to those of a mixing table. An assorted array of thumbnails provides an overview of the data when editing the transfer function. User performance is evaluated by comparing the time and effort necessary to complete a number of tests with sketch-based and conventional interfaces. Users were able to more rapidly explore and understand volume data using the sketch-based interface, as the number of design iterations necessary to obtain a desirable transfer function was reduced. In addition, informal evaluation sessions carried out with professionals (two senior radiologists, a general surgeon and two scientific illustrators) provided valuable feedback on how suitable the sketch-based interface is for illustration, patient communication and medical education.info:eu-repo/semantics/publishedVersio
Linfohistiocistose hemofagocítica, infeção por Leishmania e Epstein-Barr: uma associação incomum
No full textIntroduction: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of
abnormal excessive immune activation, with signs and symptoms of excessive
inflammation.
Case report: 18-months-old girl admitted for persistent fever for the past
two months. No other symptoms associated. History of a trip to the north of
Portugal with contact with dogs. On examination: ill-appearance, pale and
hepatosplenomegaly. Laboratory findings revealed pancytopenia progressively
worst, associated with elevated ferritin (828ng/mL), hypertriglyceridemia
(490 mg/dL), elevated soluble interleukin-2-receptor (11045 U/mL), which lead
to the diagnosis of HLH. Etiologic investigation: IgM VCA-EBV positive (99U/mL),
IgG VCA-EBV negative (<20U/mL), IgG EBNA negative (<3U/mL) and PCR for EBV
negative; immunofluorescence and immunoblot serologies for Leishmania spp.
were positive. Bone marrow examination did not reveal hemophagocytosis and
PCR for Leishmania and EBV was negative. Treatment was initiated with lipossomic
amphotericin with progressive improvement of the clinical condition.
Discussion: Although serology for Leishmania is not the gold standard for
diagnosis, it’s positivity in this case and the epidemiologic history lead to a
favourable outcome.info:eu-repo/semantics/publishedVersio
A Rare Cause of Abdominal Pain in a Patient with Acute Necrotizing Pancreatitis.
Get PDFINTRODUCTION:
Walled-off necrosis (WON) is a potentially lethal late complication of acute pancreatitis (AP) and occurs in less than 10% of AP cases. It can be located in or outside the pancreas. When infected, the mortality rate increases and can reach 100% if the collection is not drained. Its treatment is complex and includes, at the beginning, intravenous antibiotics, which permit sepsis control and a delay in the therapeutic intervention, like drainage. Nowadays, a minimally invasive approach is advised. Depending on the location of the collection, computed tomography (CT)-guided drainage or endoscopic necrosectomy are the primary options, then complemented by surgical necrosectomy if needed. Infected WON of the abdominal wall has been rarely described in the literature and there is no report of any infection with Citrobacter freundii.
CASE:
We present the case of a 61-year-old man with necrotizing AP complicated by WON of the left abdominal wall, infected with Citrobacter freundii that was successfully treated with CT-guided percutaneous drainage and intravenous antibiotics.
CONCLUSION:
Infected WON accounts for considerable mortality and its location in the abdominal wall is rare; it can be treated with antibiotics and CT-guided drainage with no need for further intervention.info:eu-repo/semantics/publishedVersio
Direct Transfer to Angio-Suite to Reduce Workflow Times and Increase Favorable Clinical Outcome.
No full textBackground and Purpose- Time to reperfusion is fundamental in reducing morbidity and mortality in acute stroke. We aimed to demonstrate that direct transfer to angio-suite (DTAS) of patients with suspected large vessel occlusion stroke improves workflow times and outcomes. Methods- A case-control matched study of the first 79 DTAS patients with confirmed large vessel occlusion (cases) and 145 no-DTAS patients (controls). DTAS protocol included a cone beam computed tomography in the angio-suite to rule out intracerebral hemorrhage for those patients with no prior neuroimaging in a referring center. Cases and controls were matched by location of vessel occlusion, age, baseline National Institutes of Health Stroke Scale (NIHSS) score and time from symptoms onset to Comprehensive Stroke Center arrival. Dramatic clinical improvement was defined as a decrease in NIHSS score of >10 points or final NIHSS score of ≤2. Favorable outcome was defined as modified Rankin Scale score of ≤2 at 90 days. Results- During an 18 months period a total of 97 patients were directly transferred to the angio-suite after admission: 11 (11.6%) showed an intracerebral hemorrhage on cone beam computed tomography, 7 (7.2%) did not have a large vessel occlusion on initial angiogram, and 79 (76.3%) had a large vessel occlusion and received endovascular treatment (cases). There were no differences in age, baseline NIHSS score, level of occlusion and time from onset-to-door between cases and controls. The median door-to-groin time (16 [12-20] versus 70 [45-105] minutes; P<0.01) and onset-to-groin times (222 [152-282] versus 259 [190-345] minutes; P<0.01) were shorter in the DTAS group. At 24 hours, DTAS patients presented lower NIHSS score (7 [4-16] versus 14 [4-20]; P=0.01), higher rate of dramatic improvement (50.6% Vs. 31.7%; P=0.04), and higher rate of favorable clinical outcome at 90 days (41% versus 28%; P=0.05). A logistic regression model adjusting for all matching variables showed that DTAS protocol was independently associated with 3 months favorable outcome (odds ratio, 2.5; 95% CI, 1.2-5.3; P=0.01). Conclusions- DTAS is an effective strategy to reduce workflow time which may significantly increase the odds of achieving a favorable outcome.info:eu-repo/semantics/publishedVersio
