A 29-year-old man, having a firearm wound, with a missile lodged in the heart. He arrived at the hospital in hemodynamic stable condition. The transesophageal echocardiogram (TE) effectuated on the diagnosis and reveled on the missile location. After 18 days, he underwent an elective off-pump cardiac surgery for extract of a bullet from the right ventricle (RV) wall and interventricular septum (IVS), having an uneventful postoperative evolution. The authors discuss the therapeutic options to follow, based on data of related literature, concluding that some individualized asymptomatic patients with a missile embedded in the heart should undergo surgery to remove it. Resumo Paciente do sexo masculino, 29 anos, apresentando ferimento por arma de fogo, com projétil alojado no coração e que chegou ao hospital hemodinamicamente estável. O diagnóstico, evidenciando a localização da bala, foi feito pelo ecocardiograma transesofágico (ET). Após 18 dias, foi submetido à cirurgia eletiva, sem circulação extracorpórea (CEC), para retirada do projétil encravado em parede anterior do ventrículo direito (VD) e septo interventricular (SIV), com sucesso. Os autores discutem a conduta terapêutica para os projéteis retidos no coração, com base na literatura consultada, concluindo que a cirurgia para remoção dos mesmos pode ser indicada em pacientes assintomáticos individualizados. Descritores: Ferimentos por arma de fogo, cirurgia. Corpos estranhos, cirurgia. Traumatismos cardíacos. Septo cardíaco, lesão, cirurgia. Ventrículos cardíacos, lesão, cirurgia.
Abordagem terapêutica dos projéteis retidos no coraçãoManagement of bullets lodged in the heart
This work describes the evaluation of metals and (metallo)proteins in vitreous humor samples and their correlations with some biological aspects in different post-mortem intervals (1-7 days), taking into account both decomposing and non-decomposing bodies. After qualitative evaluation of the samples involving 26 elements, representative metal ions (Fe, Mg and Mo) are determined by inductively coupled plasma mass spectrometry after using mini-vial decomposition system for sample preparation. A significant trend for Fe is found with post-mortem time for decomposing bodies because of a significant increase of iron concentration when comparing samples from bodies presenting 3 and 7 days post-mortem interval. An important clue to elucidate the role of metals is the coupling of liquid chromatography with inductively coupled plasma mass spectrometry for identification of metals linked to proteins, as well as mass spectrometry for the identification of those proteins involved in the post-mortem interval.
Two quite dyspneic HIV positive patients were admitted to the Emergency Room; they presented clinical signs and images suggesting pericardial effusion. The analysis of an initial liquid puncture did not show any specificity and the patients did not exhibit any clinical improvement. Both patients were submitted to a subxiphoid pericardial window, all the effusion liquid was drained, and a biopsy of the pericardium tissue was completed, revealing a granulomatous process. Immediately after the onset of specific treatment, the patients showed a good evolution. Such findings draw attention to a high possibility of pericardial suffusion in AIDS patients being tuberculosis, particular if one considers the high prevalence of this disease in Brazil. The results also showed that the opening of a subxiphoid pericardial window and the specific triple scheme was a procedure that led to good therapeutic evolution in these patients. (J Pneumol J Pneumol J Pneumol J Pneumol 2003;29(2):98-100)
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