- Email: [email protected]
ANALYSIS OF IMMEDIATE AND LATE COMPLICATIONS OF TREATING UPPER AIRWAY OBSTRUCTION (UAO) USING INTERVENTIONAL PULMONOLOGY TECHNIQUES
S28
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
received Pioglitazone (15mg). Clinical and lab data were collected on the first visit, 2 and 4 months after treatment. Results: Total of 29 patients completed the study. Baseline lipid profile parameters of patients between two groups were not significantly different but parameters significantly changed after 4 months of treatment. Pioglytazone decreased the mean Low Dose Lipoprotein from 99.86 to 88.73 mg/dl (p=0.024), triglyceride from 86.0 to 76.40 mg/dl (P=0.001) and total cholesterol from 169.13 to 156.60 mg/dl (P=0.001). High Dose Lipoprotein increased insignificantly in both groups. Conclusion: Pioglitazone therapy improved lipid profile in PCOS patients in contrast to conventional cyproterone compound therapy. It should be taken in to consideration in the treatment of PCOS patients.
ANALYSIS OF IMMEDIATE AND LATE COMPLICATIONS OF TREATING UPPER AIRWAY OBSTRUCTION (UAO) USING INTERVENTIONAL PULMONOLOGY TECHNIQUES Ana Milagrosa Escribano Duepas1, Carmen Manzano Badva2, Olga Murillo Martinez3, Luis Manuel Entrenas Costa4, Francisco Javier Lopez Pujol4. 1Costa Del Sol Hospital; 2Ocaña II Prison; 3Primary Center Guardamar; 4Reina Sofía Hospital Background: Upper airway obstruction (UAO) is an increasingly common disease. Nonpathological causes include prolonged intubation and tracheotomy, and pathological causes include bronchogenic and metastatic carcinoma and lymphoma. Interventional pulmonology techniques (rigid bronchoscopy, laser, stenting, etc) are used to treat these types of stenosis. Methods: A prospective follow-up study of the patients diagnosed with UAO. Data sources included a database, therapeutic and follow-up fibreoptic bronchoscopy performed within 72 hours, at 3 months, 6 months and every 6 months thereafter until the end of follow-up. Results: Series of 63 patients (46, male). Immediate complications: All bleedings occurred in males (11 cases) and all vocal chord lesions in females (3 cases). Immediate complications occurred more frequently in patients with a malignant etiology (37.5%); the majority of the bleedings occurred in patients in this category. There were more complications with laser (29.6% vs 9.1%) and stenting (28.8% vs 18.1%). Late complications: these occurred mainly in women (granuloma formation and stent migration). In-stent obstruction due to secretions always occurred in smokers (7.7%). Patients with a malignant etiology presented fewer long-term complications (9.7%). Granuloma was the most common in subglottic stenosis and in the upper third of the trachea (18.8%). There were no complications of the mainstem bronchi in 95.2% of patients. Conclusions: The most common immediate complication was bleeding, which usually occurred in patients with a malignant etiology. Early complications were not associated with the subsequent development of late complications.
STOMACH CANCER CASES IN AN INTERNAL MEDICINE UNIT AT A REFERENCE HOSPITAL, PORTUGAL: STATISTICAL REPORT Catarina Espírito Santo1, Francisco Tortosa2, Alba Acabado1, Paulo Cantiga1, José Braz Nogueira1. 1Department of Internal Medicine 1, Hospital de Santa Maria/Centro Hospitalar de Lisboa Norte - Faculdade de Medicina de Lisboa, PT; 2 Department of Anatomical Pathology, Hospital de Santa Maria/Centro Hospitalar de Lisboa Norte, PT Background: Gastric cancer is one of the most common malignancies worldwide and it is associated with a high death rate. Portugal places itself among the developed countries with the highest prevalence of this disease. The authors analysed the prevalence of stomach cancer cases in an Internal Medicine Unit in a Reference Hospital (Portugal). Methods: This report consists of a retrospective study of gastric neoplasia cases diagnosed in an infirmary of Internal Medicine in a University General Hospital in Lisbon, between July 2006 and June 2011. All data was collected from patient files. Tumours were classified histologically according to WHO recommendations. Associated risk factors and prevalence rates were compared to those of other West European countries. Results: Forty-three patients were diagnosed with stomach cancer; mean age was 75, and 51% were men. Thirty-eight cases (88%) were adenocarcinomas,
most of which were Tubular type; the remaining 12% of cases were of signetring cell carcinoma or lymphoma. The most frequent clinical sign was anemia and the majority of patients presented with an advanced stage of the disease. Conclusions: In spite of a downhill trend in its incidence, gastric carcinoma seems to still be frequent in Portugal, mostly amongst the older cohorts. Our results suggest a lingering insufficiency of screening methods for stomach cancer in Portugal.
A CASE OF ACUTE COCAINE INTOXICATION Margarida Eulálio1, Lourdes Cabezuelo1, Arsénio Santos1, Maria Augusta Cipriano2, Rui Santos1, Nascimento Costa1. 1Hospitais da Universidade de Coimbra – EPE, Internal Medicine Department; 2Hospitais da Universidade de Coimbra – EPE, Pathology Department Acute cocaine intoxication is severe and potentially lethal. Cocaine is a dose and time-dependent hepatotoxin in mice, with numerous reports attesting its hepatotoxic potential in humans. Associated features include rhabdomyolysis, hypotension, hyperpyrexia, disseminated intravascular coagulation and renal failure. A 29-year old male with prior history of drug use was admitted with acute renal failure with metabolic acidosis, rhabdomyolysis and severe acute hepatitis following iv injection of cocaine and heroin. At the time of admission, the patient was restless, anxious, sweaty, dehydrated, pale, hypotensive, tachycardic and presented miotic pupils and a right foot drop. Analysis results showed: creatinine - 3.74 mg/dL, potassium - 8.9 mmol/L, AST - 9199 IU/L, ALT - 4683 IU/L, GGT - 402 IU/L, alkaline phosphatase - 141 IU/L, CK >85340 IU/L, myoglobin >10864 IU/L, LDH – 7106 IU/L, prothrombin time - 24.9s (control 13.6s). Serological assays were positive for HBsAg, anti-HBc IgM, HBeAg and anti-HCV. The HBV-DNA was >170x10^6 IU/ml and HCV-RNA was undetectable. All serological markers were negative 6 months earlier. Therapy with entecavir was started, and the patient underwent hemodialysis for two weeks. By day 27, the patient developed acute myopericarditis (LVEF: 37%), treated with ibuprofen, which was suspended after 4 days due to aminotransferases increase. A liver biopsy, performed at day 47, showed hepatitis with moderate portal fibrosis, lobular activity and acidophile bodies. Liver markers and renal function progressively normalized. HBeAg was negative after 5 months, HBsAg and HBV-DNA after 12 months. HCV RNA remained undetectable. The patient made a parcial neurological and cardiac recovery.
A CASE OF FEET THROMBOEMBOLISM IN NEWLY RECOGNIZED ATRIAL FIBRILLATION Spyridon Thanellas, Sotirios Evangelou, Konstantinos Koutsianas, Anastasia Mihail, Helen Exarhou, Evangelos Arhontis. B’ Department Of Internal Medicine, General Hospital Of Karditsa, Greece Background: We report the case of an 84-year-old white Caucasian man with a history of a previously stroke attack, arterial hypertension and psoriasis that presented on the emergency department with a prior fall to the floor episode with loss of consciousness. There was cyanosis of the toes and ischemic emboli areas of the feet that, by the relatives’ statement, does not existed the previous day. The electrocardiogram pattern at the time of presentation was normal. Methods: We performed full blood test analysis, urine analysis, computed tomography of the brain, echocardiography study, abdominal ultrasound study, triplex ultrasound study of the aorta, inferior limbs artery system and of carotid and vertebral arteries. Results: By the blood analysis we found a platelet count number of 145 k/Pl, CRP of 3.4, R.A test of 42.5, INR of 0.97, d-dimers of 8.89, fibrinogen of 511.57. The C.T scan revealed ischemic ictus in the area of the parietal lobe. The ultrasound studies did not show any pathological abnormality. During hospitalization the patient presented arrhythmia concomitant with atrial fibrillation (A.F) that was not known from the medical history therefore the diagnosis of paroxysmal A.F was established. Arrhythmia was considered to be the cause of the emboli to the patient’s feet and toes. Conclusions: Thromboembolism is a potentially devastating consequence of A.F, a raremanifestation of which is described above. The problem consists of the early recognition of this rhythm disturbance so as to allow the appropriate therapy and prevent its progression.
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
received Pioglitazone (15mg). Clinical and lab data were collected on the first visit, 2 and 4 months after treatment. Results: Total of 29 patients completed the study. Baseline lipid profile parameters of patients between two groups were not significantly different but parameters significantly changed after 4 months of treatment. Pioglytazone decreased the mean Low Dose Lipoprotein from 99.86 to 88.73 mg/dl (p=0.024), triglyceride from 86.0 to 76.40 mg/dl (P=0.001) and total cholesterol from 169.13 to 156.60 mg/dl (P=0.001). High Dose Lipoprotein increased insignificantly in both groups. Conclusion: Pioglitazone therapy improved lipid profile in PCOS patients in contrast to conventional cyproterone compound therapy. It should be taken in to consideration in the treatment of PCOS patients.
ANALYSIS OF IMMEDIATE AND LATE COMPLICATIONS OF TREATING UPPER AIRWAY OBSTRUCTION (UAO) USING INTERVENTIONAL PULMONOLOGY TECHNIQUES Ana Milagrosa Escribano Duepas1, Carmen Manzano Badva2, Olga Murillo Martinez3, Luis Manuel Entrenas Costa4, Francisco Javier Lopez Pujol4. 1Costa Del Sol Hospital; 2Ocaña II Prison; 3Primary Center Guardamar; 4Reina Sofía Hospital Background: Upper airway obstruction (UAO) is an increasingly common disease. Nonpathological causes include prolonged intubation and tracheotomy, and pathological causes include bronchogenic and metastatic carcinoma and lymphoma. Interventional pulmonology techniques (rigid bronchoscopy, laser, stenting, etc) are used to treat these types of stenosis. Methods: A prospective follow-up study of the patients diagnosed with UAO. Data sources included a database, therapeutic and follow-up fibreoptic bronchoscopy performed within 72 hours, at 3 months, 6 months and every 6 months thereafter until the end of follow-up. Results: Series of 63 patients (46, male). Immediate complications: All bleedings occurred in males (11 cases) and all vocal chord lesions in females (3 cases). Immediate complications occurred more frequently in patients with a malignant etiology (37.5%); the majority of the bleedings occurred in patients in this category. There were more complications with laser (29.6% vs 9.1%) and stenting (28.8% vs 18.1%). Late complications: these occurred mainly in women (granuloma formation and stent migration). In-stent obstruction due to secretions always occurred in smokers (7.7%). Patients with a malignant etiology presented fewer long-term complications (9.7%). Granuloma was the most common in subglottic stenosis and in the upper third of the trachea (18.8%). There were no complications of the mainstem bronchi in 95.2% of patients. Conclusions: The most common immediate complication was bleeding, which usually occurred in patients with a malignant etiology. Early complications were not associated with the subsequent development of late complications.
STOMACH CANCER CASES IN AN INTERNAL MEDICINE UNIT AT A REFERENCE HOSPITAL, PORTUGAL: STATISTICAL REPORT Catarina Espírito Santo1, Francisco Tortosa2, Alba Acabado1, Paulo Cantiga1, José Braz Nogueira1. 1Department of Internal Medicine 1, Hospital de Santa Maria/Centro Hospitalar de Lisboa Norte - Faculdade de Medicina de Lisboa, PT; 2 Department of Anatomical Pathology, Hospital de Santa Maria/Centro Hospitalar de Lisboa Norte, PT Background: Gastric cancer is one of the most common malignancies worldwide and it is associated with a high death rate. Portugal places itself among the developed countries with the highest prevalence of this disease. The authors analysed the prevalence of stomach cancer cases in an Internal Medicine Unit in a Reference Hospital (Portugal). Methods: This report consists of a retrospective study of gastric neoplasia cases diagnosed in an infirmary of Internal Medicine in a University General Hospital in Lisbon, between July 2006 and June 2011. All data was collected from patient files. Tumours were classified histologically according to WHO recommendations. Associated risk factors and prevalence rates were compared to those of other West European countries. Results: Forty-three patients were diagnosed with stomach cancer; mean age was 75, and 51% were men. Thirty-eight cases (88%) were adenocarcinomas,
most of which were Tubular type; the remaining 12% of cases were of signetring cell carcinoma or lymphoma. The most frequent clinical sign was anemia and the majority of patients presented with an advanced stage of the disease. Conclusions: In spite of a downhill trend in its incidence, gastric carcinoma seems to still be frequent in Portugal, mostly amongst the older cohorts. Our results suggest a lingering insufficiency of screening methods for stomach cancer in Portugal.
A CASE OF ACUTE COCAINE INTOXICATION Margarida Eulálio1, Lourdes Cabezuelo1, Arsénio Santos1, Maria Augusta Cipriano2, Rui Santos1, Nascimento Costa1. 1Hospitais da Universidade de Coimbra – EPE, Internal Medicine Department; 2Hospitais da Universidade de Coimbra – EPE, Pathology Department Acute cocaine intoxication is severe and potentially lethal. Cocaine is a dose and time-dependent hepatotoxin in mice, with numerous reports attesting its hepatotoxic potential in humans. Associated features include rhabdomyolysis, hypotension, hyperpyrexia, disseminated intravascular coagulation and renal failure. A 29-year old male with prior history of drug use was admitted with acute renal failure with metabolic acidosis, rhabdomyolysis and severe acute hepatitis following iv injection of cocaine and heroin. At the time of admission, the patient was restless, anxious, sweaty, dehydrated, pale, hypotensive, tachycardic and presented miotic pupils and a right foot drop. Analysis results showed: creatinine - 3.74 mg/dL, potassium - 8.9 mmol/L, AST - 9199 IU/L, ALT - 4683 IU/L, GGT - 402 IU/L, alkaline phosphatase - 141 IU/L, CK >85340 IU/L, myoglobin >10864 IU/L, LDH – 7106 IU/L, prothrombin time - 24.9s (control 13.6s). Serological assays were positive for HBsAg, anti-HBc IgM, HBeAg and anti-HCV. The HBV-DNA was >170x10^6 IU/ml and HCV-RNA was undetectable. All serological markers were negative 6 months earlier. Therapy with entecavir was started, and the patient underwent hemodialysis for two weeks. By day 27, the patient developed acute myopericarditis (LVEF: 37%), treated with ibuprofen, which was suspended after 4 days due to aminotransferases increase. A liver biopsy, performed at day 47, showed hepatitis with moderate portal fibrosis, lobular activity and acidophile bodies. Liver markers and renal function progressively normalized. HBeAg was negative after 5 months, HBsAg and HBV-DNA after 12 months. HCV RNA remained undetectable. The patient made a parcial neurological and cardiac recovery.
A CASE OF FEET THROMBOEMBOLISM IN NEWLY RECOGNIZED ATRIAL FIBRILLATION Spyridon Thanellas, Sotirios Evangelou, Konstantinos Koutsianas, Anastasia Mihail, Helen Exarhou, Evangelos Arhontis. B’ Department Of Internal Medicine, General Hospital Of Karditsa, Greece Background: We report the case of an 84-year-old white Caucasian man with a history of a previously stroke attack, arterial hypertension and psoriasis that presented on the emergency department with a prior fall to the floor episode with loss of consciousness. There was cyanosis of the toes and ischemic emboli areas of the feet that, by the relatives’ statement, does not existed the previous day. The electrocardiogram pattern at the time of presentation was normal. Methods: We performed full blood test analysis, urine analysis, computed tomography of the brain, echocardiography study, abdominal ultrasound study, triplex ultrasound study of the aorta, inferior limbs artery system and of carotid and vertebral arteries. Results: By the blood analysis we found a platelet count number of 145 k/Pl, CRP of 3.4, R.A test of 42.5, INR of 0.97, d-dimers of 8.89, fibrinogen of 511.57. The C.T scan revealed ischemic ictus in the area of the parietal lobe. The ultrasound studies did not show any pathological abnormality. During hospitalization the patient presented arrhythmia concomitant with atrial fibrillation (A.F) that was not known from the medical history therefore the diagnosis of paroxysmal A.F was established. Arrhythmia was considered to be the cause of the emboli to the patient’s feet and toes. Conclusions: Thromboembolism is a potentially devastating consequence of A.F, a raremanifestation of which is described above. The problem consists of the early recognition of this rhythm disturbance so as to allow the appropriate therapy and prevent its progression.