Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
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Pheochromocytoma is a catecholamine-secreting tumor, for which the treatment of choice is complete surgical resection, when possible. Some form of preoperative pharmacological preparation is indicated. ⋯ The authors report three different cases in which doxazosin was used: as preoperative preparation of a patient with pheochromocytoma, as preparation for therapy in I-131-MIBG of a patient with a malignant pheochromocytoma, and as a pre-cesarean preparation in a pregnant woman with multiple endocrine neoplasia type 2A (MEN-2A). Doxazosin provided a safe alternative to phenoxybenzamine in the three cases described, with some advantages that the authors summarize.
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Pediatric cardiology and telemedicine: seven years' experience of cooperation with remote hospitals.
A telemedicine program was initiated in November 2000 between the Pediatric Cardiology Department of a tertiary care hospital in Lisbon and pediatricians and obstetricians from three remote Portuguese hospitals: two in mainland Portugal and one in the Azores. Images were transmitted by a telemedicine link over three integrated service digital network (ISDN) lines to a regional pediatric cardiology unit for interpretation by a consultant pediatric cardiologist. ⋯ In our experience, real-time telemedicine with on-line echocardiography, conducted by a pediatric cardiologist, is an important tool in the diagnosis or exclusion of pediatric cardiovascular diseases in patients admitted to remote hospitals. It plays an important role in continuous medical training for the staff of those hospitals, especially in the field of pre-and post-natal echocardiography. Telemedicine has significant medical, economic and social benefits for patients, families and institutions in remote areas, particularly in the field of pediatric cardiology.
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Estimation of individual risk and choice of initial therapeutic approach for patients with pulmonary embolism (PE) remains controversial. The three key components for risk stratification in PE are clinical evaluation, cardiac biomarkers and assessment of right ventricular size and function. The aim of this study was to assess the ability of admission troponin I (TnI) levels to predict short-term mortality and complicated clinical course in patients with PE. ⋯ Elevated TnI levels are associated with higher risk for in-hospital mortality and complicated clinical course. Additional studies are needed to assess whether troponin levels, alone or in conjunction with other tests, can be used to guide therapeutic strategy and improve the prognosis of patients with PE.
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Higher values of red ceildistribution width (RDW) may be associated with adverse outcomes in patients with heart failure and in those with stable coronary artery disease. We assessed the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS). ⋯ RDW is an easily determined predictor of outcome after ACS. We found a graded independent association between higher RDW values and adverse outcomes in patients with ACS.
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Comparative Study
Octreotide--additional conservative therapy for postoperative chylothorax in congenital heart disease.
Chylothorax is a rare but serious postoperative condition in children with congenital heart disease. Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative chylothorax. ⋯ Octreotide is safe and effective in the treatment of postoperative chylothorax in children with congenital heart disease. It is a useful adjunctive therapy to the conventional treatment of this complication.