RESUMO
Resumen Se presenta un caso de manejo complicado y decisiones difíciles. Un paciente con antecedente de disección aórtica tipo A y dilatación residual de la aorta descendente de hasta 60 mm es ingresado por un síndrome coronario agudo sin elevación del ST. La coronariografía pone de manifiesto una marcada ectasia coronaria y unos defectos de perfusión de dudoso origen. ¿Trombos o falsas imágenes por flujo muy lentificado? Asumiendo que pudiera tratarse de trombos, el paciente es tratado con anticoagulación repitiéndose la coronariografía al cabo de dos meses. En este segundo estudio se observa la completa desaparición de las imágenes, confirmándose el origen trombótico de las mismas. En este momento se plantea ¿cuál debe ser el tratamiento crónico del paciente? No hay evidencia científica disponible acerca del tratamiento de la ectasia coronaria y se trata de un paciente de alto riesgo por su antecedente de disección aórtica. Finalmente se decide, de forma empírica, mantener la anticoagulación de forma indefinida. Tras dos años y seis meses de seguimiento no ha habido incidencias clínicas.
Abstract A case with complicated management and difficult decision-making is presented. A patient with history of type A aortic dissection and residual dilatation of the descending aorta up to 60 mm is admitted for acute coronary syndrome without ST elevation. Coronary angiography reveals a marked coronary ectasia and perfusion defects of unclear origin. Thrombosis or fake images due to flow reduction? Assuming that it could be caused by thrombosis the patient is treated with anticoagulant therapy and the coronary angiography is repeated after two months. This second study shows complete clearing of imaging findings, confirming the thrombotic origin. At this stage considerations are taken so as to plan a chronic treatment for the patient? There is no scientific evidence regarding the treatment for coronary ectasia and this is a high-risk patient because of his aortic dissection history. Finally it is empirically decided to indefinitely keep anticoagulant therapy. After two years and six months of follow-up there has been no clinical incidents.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Trombose , Doença das Coronárias , Aorta , Dilatação Patológica , Síndrome Coronariana Aguda , AnticoagulantesRESUMO
CONTEXT: Stem and leaves infusion of Chuquiraga spinosa (R&P) Don. (Asteraceae) is used in the Peruvian traditional medicine for its anti-inflammatory properties and for the treatment of vaginal infections. OBJECTIVE: This study evaluated the antioxidant, anti-inflammatory and antifungal activities of C. spinosa for the first time. MATERIALS AND METHODS: Extracts of methanol, 50% methanol and water were obtained from C. spinosa aerial parts. Antioxidant activity of the extracts was evaluated (DPPHË, ABTSË(+) and superoxide radical-scavenging activity). The correlation between these results and total polyphenolic content was determined by Pearson's Correlation Coefficient. Anti-inflammatory activity of 50% methanol extract was evaluated with the rat model of carrageenan-induced acute inflammation and mouse model of TPA-induced acute inflammation. The antifungal activity of the extracts against Cladosporium cucumerinum and Candida albicans was studied by direct bioautography, and antifungal activity against phytopathogenic fungi was performed by culture in potato dextrose agar plates. RESULTS: All the extracts showed high antioxidant activity, and there was correlation between the activity and total polyphenolic compounds. As 50% methanol extract was administered orally, the paw edema in rats was reduced significantly (52.5%). This extract, by topical administration, produced a reduction of 88.07% of the edema TPA-induced in ear of mice. The aqueous and 50% methanol extracts were active against C. albicans (minimum inhibitory concentration of 2.5 and 6.25 µg, respectively). The aqueous extract showed antifungal activity against C. cucumerinum (MIC: 2.5 µg). DISCUSSION AND CONCLUSION: Preliminary phytochemical screening and the analysis of the three extracts by high-performance liquid chromatography diode-array detection showed the majority compounds are flavonoids and phenolic acid derivatives. These compounds may be responsible of the radical-scavenging activity of these extracts as well as responsible of anti-inflammatory effect in vivo of 50% methanol extract. Several authors have demonstrated the antioxidant and anti-inflammatory properties of some flavonoids and phenolic acids. The antifungal activity of the extracts obtained from aerial parts of C. spinosa has been investigated here for the first time. Other studies are necessary to determine the mechanism of action and to identify the bioactive compounds of this plant.