scholarly journals Clinical case of a patient with pulmonary capillary hemangiomatosis: rapid progression or lost time?

2021 ◽  
pp. 74-78
Author(s):  
E. A. Devetyarova ◽  
T. V. Martynyuk ◽  
A. A. Dyuzhikov ◽  
E. V. Paschenko ◽  
A. V. Dyuzhikova
Keyword(s):  
Clinical Case ◽  
Final Diagnosis ◽  
Functional Class ◽  
Rapid Progression ◽  
Hemodynamic Parameters ◽  
National Medical ◽  
Pulmonary Capillary ◽  
Pulmonary Capillary Hemangiomatosis ◽  
Specific Symptoms ◽  
Group 1

The article describes a clinical case of a 37-year-old patient with pulmonary capillary hemangiomatosis of functional class IV according to the WHO classification with difficulties of diagnostic search and features of PAH-specific therapy.Pulmonary arterial hypertension - group 1 in the clinical classification is represented by several forms of pathology, including very rare diseases such as pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis.The difficulties of diagnostic search consist in the absence of specific symptoms, a variety of interstitial or focal changes according to spiral computed tomography, and the final diagnosis can be made only after performing a lung biopsy, which is associated with a high risk of possible complications. During the initial treatment and examination of the patient, clinical and hemodynamic parameters did not immediately allow to suspect the presence of pulmonary capillary hemangiomatosis. And only the difficulties of the patient’s management associated with the lack of the expected effect of the therapy with PAH-specific drugs served as the basis for further diagnostic search.Against the background of taking vasodilators, with the normalization of hemodynamic parameters, the progression of respiratory and right ventricular insufficiency was noted in the patient. According to the results of an additional examination, a diagnosis of pulmonary capillary hemangiomatosis was established, therapy was corrected and further tactics of management and treatment of the patient were determined. Currently, the patient is awaiting transplantation at V.I. Shumakov national medical research center and receives specific therapy with riociguate 2.5 mg TID and bosentan 125 mg BID.

scholarly journals Patient with Polyvascular Atherosclerosis Acutely Complicated with Different Major Vascular Events

2019 ◽  
pp. 75-80
Author(s):  
O. Koval ◽  
O. Naras
Keyword(s):  
Risk Factors ◽  
Cardiogenic Shock ◽  
Case Fatality ◽  
Final Diagnosis ◽  
Functional Class ◽  
Rapid Progression ◽  
Vascular Events ◽  
Clinical Burden ◽  
The Right ◽  
Effective Use

Clinical burden of polyvascular atherosclerosis is substantial, with high case fatality. However, although premorbid function is good in the majority of patients and although the vast majority have known vascular disease in other areas and multiple treatable risk factors, premorbid control of risk factors is poor. It is illustrated by a remarkable clinical case. A 54-year-old male patient Sh. was transferred by ambulance with STEMI, Killip II, prior MI (2000, 02/2016), NYHA І, hypertension 3-grade; the patient refused primary PCI. The patient suffers from hypertension for about 10 years, has stable angina II functional class; in 02/2016 underwent thrombolytic therapy (TLT) by streptokinase. (BP 90/60 mmHg) heart rate = PS = 72 bpm. GRACE Score 139 points. Biochemical blood assay: moderate decrease of GFR (53.7 ml/min), total cholesterol 4.0 mmol/l, anemia is absent, WBC 9.5 g/l), other findings are unremarkable. Successful TLT (clinical and ECG) with tenecteplase was performed. In 60 min the common status suddenly was sharply deteriorated: cardiogenic shock, evident signs of acute stroke (GLASGO coma scale – 10 points); taking into consideration previous TLT, neurologist suggested hemorrhagic origin. Because of extremely severe patient’s status, immediate CT and lumbar punction were not performed. All components of antithrombotic treatment were abrupted by neurologist. Just after some status stabilization on the top of intensive inotropic therapy, lumbar punction was performed and did not reveal any hemorrhagic signs. The patient’s status during 3 days remained very severe but stable, the signs of multi-organ failure progrediently increased; neurologist did not renew the antithrombotic therapy. On day 4 the patient one more suddenly experienced sharp deterioration of the circulation in the right leg with the high rapid progression of the foot ischemia. Angiosurgeon decided to restart intravenous infusion of UFH but the patient’s state continuously worsened and the patient died. Final diagnosis coincided with clinical one, but both the treating physician and pathologist did not establish the diagnosis of polyvascular atherosclerosis with multiple complications as the main one, indicating STEMI, cardiogenic shock as such and stroke and foot gangrene as the competitive diagnoses. It is likely that much of the current clinical burden is preventable with early diagnosis using simple, inexpensive but informative methods such as vascular ultrasound with plaque revealing ABI measurement and more effective use of existing preventive antithrombotic treatments, one of the modern choices – the use of low-dose ASA and rivaroxaban.

scholarly journals Early recognition of PIMS-TS: a single centre retrospective review

2021 ◽  
Vol 5 (1) ◽  
pp. e001011
Author(s):  
Roshni Mistry ◽  
Nicola Scanlon ◽  
James Hibberd ◽  
Fionnghuala Fuller
Keyword(s):  
Early Recognition ◽  
Febrile Illness ◽  
Final Diagnosis ◽  
University Hospital ◽  
Single Centre ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Review Reports ◽  
Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

scholarly journals Pulmonary Capillary Hemangiomatosis: The Role of Invasive Cardiopulmonary Exercise Testing

2015 ◽  
Vol 5 (3) ◽  
pp. 580-586 ◽  
Author(s):  
Hilary M. DuBrock ◽  
Richard L. Kradin ◽  
Josanna M. Rodriguez-Lopez ◽  
Richard N. Channick
Keyword(s):  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Capillary ◽  
Pulmonary Capillary Hemangiomatosis

Pulmonary Capillary Hemangiomatosis Associated with Primary Pulmonary Hypertension

Medicine ◽  
2002 ◽  
Vol 81 (6) ◽  
pp. 417-424 ◽  
Author(s):  
PEDRO ALMAGRO ◽  
JOAQUIM JULIÀ ◽  
MARIA SANJAUME ◽  
GUADALUPE GONZÁLEZ ◽  
JAUME CASALOTS ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Primary Pulmonary Hypertension ◽  
Pulmonary Capillary ◽  
Pulmonary Capillary Hemangiomatosis

Usage of 25% albumin solution in the intraoperative and early postoperative periods of liver transplantation from a cadaveric donor.

2021 ◽  
Author(s):  
С.В. Журавель ◽  
Н.К. Кузнецова ◽  
В.Э. Александрова ◽  
П.В. Гаврилов ◽  
А.М. Талызин ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Postoperative Period ◽  
Human Albumin ◽  
Early Postoperative Period ◽  
Hemodynamic Parameters ◽  
Albumin Solution ◽  
Transfusion Therapy ◽  
Group 2 ◽  
Human Albumin Solution ◽  
Group 1

Введение. Терапевтическое использование раствора человеческого альбумина у пациентов в периоперационном периоде трансплантации печени (ТП) представляет интерес в контексте осложнений и исходов операции. Цель исследования: оценить влияние интраоперационной трансфузии 25% раствора человеческого альбумина на течение раннего послеоперационного периода при ортотопической ТП от посмертного донора. Материалы и методы. В исследование включены 47 пациентов, которым была выполнена трупная ТП. Были сформированы 2 группы: пациенты группы 1 (n = 21) получали трансфузию 25% раствора человеческого альбумина в конце операции ТП и через 24 ч после операции; пациенты группы 2 (n = 26) получали трансфузию 25% раствора человеческого альбумина в первые сутки послеоперационного периода. Осуществляли контроль лабораторных параметров крови пациента перед началом оперативного вмешательства, через 24 ч и через 48 ч после операции. Интраоперационно оценивали значения систолического (САД) и диастолического (ДАД) артериального давления, частоту сердечных сокращений (ЧСС), дозу вазопрессоров, объем инфузионно-трансфузионной терапии, кровопотерю и диурез. В послеоперационном периоде фиксировали возможные осложнения, проведенные сеансы заместительной почечной терапии (ЗПТ), а также количество дней в стационаре. Результаты. Оценка значений САД, ДАД и ЧСС в начале и конце операции показала достоверно лучшие показатели гемодинамики и снижение дозировок вазопрессорной поддержки в конце вмешательства в группе 1 по сравнению с группой 2 (p < 0,05). В послеоперационном периоде инфекционные осложнения зарегистрированы у одного пациента группы 1 и у трех пациентов группы 2. Проведение ЗПТ потребовалось двум пациентам из группы 2. Все пациенты обеих групп были выписаны из стационара, при этом число дней госпитализации в группе 2 было статистически значимо больше по сравнению с пациентами группы 1: 26,9 ± 3,9 против 17,2 ± 4,3 (p < 0,05). Заключение. Интраоперационная инфузия 25% раствора альбумина позволяет стабилизировать показатели гемодинамики в конце операции ТП, снизить потребность в кардиотонической поддержке и сократить время госпитализации у пациентов после ТП. Background. The therapeutic use of human albumin solution in patients in the perioperative period of liver transplantation (LT) is of interest in the context of complications and outcomes of surgery. Objectives: to assess the effect of intraoperative transfusion of 25% human albumin solution on the early postoperative period in orthotopic LT from a postmortem donor. Patients/Methods. The study included 47 patients who underwent cadaveric LT. Two groups were formed: patients in group 1 (n = 21) received transfusion of 25% human albumin solution at the end of LT and 24 hours after surgery; patients in group 2 (n = 26) received transfusion of 25% human albumin solution on the first day of the postoperative period. The laboratory parameters of the patient’s blood were monitored before surgery, 24 hours later, and 48 hours after surgery. Intraoperatively, the values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), dose of vasopressors, volume of infusion- transfusion therapy, blood loss and diuresis were assessed. In the postoperative period, possible complications, renal replacement therapy (RRT) sessions performed, and the number of days in the hospital were recorded. Results. Assessment of SBP, DBP and HR values showed significantly better hemodynamic parameters and reduced dosages of vasopressor support at the end of surgery in group 1 compared to group 2 (p < 0.05). In the postoperative period, infectious complications were registered in one patient of group 1 and in three patients of group 2. Two patients from group 2 required RRT. All patients were discharged from the hospital, while the number of hospitalization days in group 2 was statistically significantly greater than in patients in group 1: 26.9 ± 3.9 versus 17.2 ± 4.3 (p < 0.05). Conclusions. Intraoperative infusion of 25% albumin solution allows stabilizing hemodynamic parameters at the end of LT surgery, reducing the need for cardiotonic support and shortening the hospitalization time in patients after LT.

Comorbid conditions - a reason to strengthen antianginai therapy in patients with stable coronary artery disease

2021 ◽  
pp. 49-52
Author(s):  
O. L. Barbarash ◽  
V. V. Kashtalap
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Clinical Case ◽  
Stable Coronary Artery Disease ◽  
Mechanisms Of Action ◽  
Functional Class ◽  
Second Line ◽  
Comorbid Conditions ◽  
Artery Disease

In the article on the example of a clinical case approaches to enhancing antianginal therapy of coronary artery disease were discussed. Arguments were given for prescribing preparations of the second line of antianginal agents (thymetazidine) in the patient with stable angina with high functional class and concomitant hypotonia after a complicated COVID-19. The main mechanisms of action of trimetazidine and results of clinical studies were discussed.

scholarly journals ALAGILLE SYNDROME AS A CHALLENGING CLINICAL CASE IN PEDIATRIC PRACTICE (case report)

2017 ◽  
Vol 4 (2) ◽  
pp. 83-85
Author(s):  
Nigar Hajiyeva
Keyword(s):  
Clinical Case ◽  
Spontaneous Mutation ◽  
Pulmonary Stenosis ◽  
Alagille Syndrome ◽  
Final Diagnosis ◽  
Autosomal Dominant Disorder ◽  
Chronic Cholestasis ◽  
Characteristic Features ◽  
Prolonged Jaundice ◽  
Peripheral Pulmonary Stenosis

Hajiyeva N.A.Alagille syndrome is a multisystem, highly variable, autosomal dominant disorder, which can be triggered by spontaneous mutation. This disease primarily affects the liver (chronic cholestasis), heart (most often peripheral pulmonary stenosis), eyes (posterior embryotoxon), face (characteristic features), and skeleton (butterfly vertebrae). The paper presents the clinical case of prolonged jaundice with an increased liver enzymes in infant and no final diagnosis for a long time.KeyWords: Alagille syndrome, chronic cholestasis, ursodeoxycholic acid СИНДРОМ АЛАЖІЛЯ, ЯК СКЛАДНИЙ КЛІНІЧНИЙ ПРИКЛАД З ПЕДІАТРІЧНОЇ ПРАКТИКИ (клінічний випадок)Хаджієва Н.А.Синдром Алажіля є мультисистемним варіабельним аутосомно-домінантним розладом, який є наслідком спонтанної мутації. Це захворювання перед усім уражує печінку (хронічний холестаз), серце (найчастіше периферичний стеноз легеневої артерії), очі (задні ембріотоксони), обличчя (характерні ознаки) і скелет (хребці у вигляді метеликів). В публікації представлений клінічний випадок тривалої жовтяниці з підвищеням печінкових ферментів у дитини раннього віку, у якої протягом тривалого часу неможливо було встановти клінічний діагноз.Ключові слова: синдром Алажіля, хронічний холестаз, урсодеоксихолєва кислота СИНДРОМ АЛАЖИЛЯ КАК СЛОЖНЫЙ КЛИНИЧЕСКИЙ ПРИМЕР ИЗ ПЕДИАТРИЧЕСКОЙ ПРАКТИКИ (клинический случай)Хаджиева Н.А.Синдром Алажиля является мультисистемным вариабельным аутосомно-доминантным расстройством, которое является следствием спонтанной мутации. Это заболевание прежде всего поражает печень (хронический холестаз), сердце (чаще всего периферический стеноз легочной артерии), глаза (задний эмбриотоксон), лицо (характерные признаки) и скелет (позвонки в виде бабочек). В публикации представлен клинический случай длительной желтухи с повышением печеночных ферментов у ребенка раннего возраста, у которого в течение длительного времени невозможно было установить клинический диагноз.Ключевые слова: синдром Алажиля, хронический холестаз, урсодеоксихолевая кислота

scholarly journals DIAGNOSTIC PROBLEMS ACCOMPANYING BRANHYOGENIC CANCER – A CLINICAL CASE

2020 ◽  
Vol 73 (3) ◽  
pp. 614-618
Author(s):  
Uliana D. Matolych ◽  
Svetlana V. Ushtan ◽  
Victoria V. Pankevych ◽  
Kateryna V. Horytska
Keyword(s):  
Head And Neck ◽  
Morphological Analysis ◽  
Clinical Case ◽  
Ultrasound Examination ◽  
Transitional Cell ◽  
Final Diagnosis ◽  
Surgical Removal ◽  
Invasive Squamous Cell Carcinoma ◽  
Bronchial Cancer ◽  
Neck Vessels

Tumours and tumorous lesions of head and neck account for 10% of all oncological pathologies. Branhyogenic cancer is found in 4.5% of patients with lateral cysts in the neck. The article highlights the results of research the clinical case of branhyogenic cancer, provide its clinical and morphological analysis. The aim of our work was to study the clinical case of bronchial cancer, providing clinical and pathomorphological analysis. Examination and treatment was conducted in accordance with the clinical protocol using the diagnostic criteria necessary for management of patients diagnosed with tumours and tumorous lesions in a particular clinical case. We applied ultrasound examination of the locus, angiography of head and neck vessels with tomohexol and with 3D reconstruction, histological examination of surgical specimens (macroscopy and microscopy). On the basis of clinical investigaton, ultrasound examination, angiography clinical diagnosis was formulated – lateral cyst on the left side of the neck. A radical surgical removal of the mass was conducted. Histopathological conclusion: there is a proliferation of cystic transitional cell epithelium with the locus of invasive squamous cell carcinoma in the cystic wall that suggests malignant transformation of bronchogenic cyst. Final diagnosis: branhyogenic cancer. Thorough examination and analysis of a clinical case demonstrates that the development of branhyogenic cancer, is histo-genetically associated with lateral cysts in the neck. Complexity of diagnosing and high percentage of malignancy induces to more early discovery and removal of lateral cysts in the neck .

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