Revista de medicina de la Universidad de Navarra
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We present a case of adenoid cystic tracheal carcinoma detected by computerized tomography (64-MDCT) with cyto-histological correlation in a patient with hemoptysis. In this article we review the differential diagnosis of solitary focal tracheal lesions as they appear in computerized tomography (CT). In this case, image methods suggested the diagnosis but underestimated the tracheal wall invasion, which was established by histologycal examination of the resected tumor.
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Giving bad news is inherent to the practice of medicine. Development of guidelines for this task has great value, although the orientations are only general and should be adapted to each case, allowing for the cultural idiosyncrasy of the people involved. ⋯ Doctors' own professional past experience is a central factor in the way bad news is given, and so self-development mechanisms constitute an important challenge.
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Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. ⋯ The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations.
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Rev Med Univ Navarra · Apr 2003
[Right heart support during coronary artery bypass grafting without cardiopulmonary bypass].
Exposure of lateral and inferior coronary vessels during off-pump coronary artery bypass grafting may cause significant hemodynamic compromise due to right ventricular compression when tilting the heart. Some new right ventricular assistance devices have been developed in order to avoid this problem but only a few series have been published. A preliminary experience with a right heart circulatory support system is reported. ⋯ The use of right heart support devices is a simple and low risk procedure which may facilitate surgical anastomoses on lateral and inferior epicardial vessels during off-pump coronary artery surgery.
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In cases of acute or progressive development in a few hours of bilateral sciatica, severe foot and occasional quadriceps weakness and/or retention or incontinence of urine with perineal hypalgesia or anesthesia, acute compression of the cauda equina should be suspected, which is usually due to a lumbar disc herniation. Cauda equina syndrome requires emergency spinal surgery. ⋯ Decompression within 24-48 hours significantly improves the neurological and urological outcome. We present the case of a patient who had previously been treated for low back pain who developed a cauda equina syndrome a few days later.