Upper airway obstruction is a potentially life-threatening emergency often encountered in the acute care, perioperative, and critical care settings. One important complication of acute obstruction is negative-pressure pulmonary edema (NPPE). We describe two cases of acute upper airway obstruction, both of which resulted in flash pulmonary edema complicated by acute hypoxic respiratory failure. Though NPPE was suspected, these patients were also found to have Takotsubo syndrome (TTS). Neither patient had prior cardiac disease, and both subsequently had a negative ischemic workup. Because TTS is a condition triggered by hyperadrenergic states, the acute airway obstruction alone or in combination with NPPE was the likely explanation for TTS in each case. These cases highlight the importance of also considering cardiogenic causes of pulmonary edema in the setting of upper airway obstruction, which we suspect generates a profound catecholamine surge and places patients at increased risk of TTS development.
Background: Gastric cancer is one of the main important causes of cancer death in Chile. Objective: To report the results of adjuvant radiochemotherapy in advanced gastric cancer. Material and Methods: Between 2000 and 2018, 214 subjects aged 23-85 (median, 62) years with lymph node and/or serosa involvement were treated with adjuvant chemoradiotherapy after curative resection. Results: With a median follow-up of 41 months, overall 3-and 5-year survival was 54.9% and 40.85%, respectively. On multivariate analysis, the factors associated with lower survival were aged >65 years, stage group and number of lymph nodes involved. Conclusion: In patients with locoregionally advanced gastric cancer treated with curative intent with surgery and adjuvant radiochemotherapy, the overall 5-year survival reported from local clinical practice is similar to that reported in randomised series and supports its use as an effective treatment for this type of patients in our country.
Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, affecting 1 in 500 individuals. It is characterized by unexplained myocardial hypertrophy with the underlying pathology of myofibrillar disarray and interstitial fibrosis. Complications of this disease include sudden cardiac death due to ventricular tachyarrhythmias and heart failure, both of which may be related, at least in part to the underlying fibrosis in the myocardium.Cardiac magnetic resonance imaging (CMR) is the only imaging technique available to identify myocardial fibrosis in vivo with the technique of late gadolinium enhancement. Both the presence and extent of LGE have been shown to be associated with adverse cardiac outcome in HCM. However, few studies have examined progression of LGE in HCM. Little is known about the initial development of LGE. In this case report, we present a case of development of LGE in a young adult with HCM.
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