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Gallo-Bernal S, Patino-Jaramillo N, Calixto CA, Higuera SA, Forero JF, Lara Fernandes J, Góngora C, Gee MS, Ghoshhajra B, Medina HM. Nephrogenic Systemic Fibrosis in Patients with Chronic Kidney Disease after the Use of Gadolinium-Based Contrast Agents: A Review for the Cardiovascular Imager. Diagnostics (Basel) 2022; 12:diagnostics12081816. [PMID: 36010167 PMCID: PMC9406537 DOI: 10.3390/diagnostics12081816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-enhanced cardiac magnetic resonance has revolutionized cardiac imaging in the last two decades and has emerged as an essential and powerful tool for the characterization and treatment guidance of a wide range of cardiovascular diseases. However, due to the high prevalence of chronic renal dysfunction in patients with cardiovascular conditions, the risk of nephrogenic systemic fibrosis (NSF) after gadolinium exposure has been a permanent concern. Even though the newer macrocyclic agents have proven to be much safer in patients with chronic kidney disease and end-stage renal failure, clinicians must fully understand the clinical characteristics and risk factors of this devastating pathology and maintain a high degree of suspicion to prevent and recognize it. This review aimed to summarize the existing evidence regarding the physiopathology, clinical manifestations, diagnosis, and prevention of NSF related to the use of gadolinium-based contrast agents.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Correspondence:
| | - Nasly Patino-Jaramillo
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
| | - Camilo A. Calixto
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Department of Radiology Boston Children’s Hospital, Boston, MA 02115, USA
| | - Sergio A. Higuera
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
| | - Julian F. Forero
- Division of Radiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia;
| | - Juliano Lara Fernandes
- Jose Michel Kalaf Research Institute, Radiologia Clinica de Campinas, São Paulo 13092-123, Brazil;
| | - Carlos Góngora
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; (C.G.); (B.G.)
| | - Michael S. Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | - Brian Ghoshhajra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; (C.G.); (B.G.)
| | - Hector M. Medina
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
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Martínez A, Gallo-Bernal S, Acosta SC, Calixto CA, Isaza N, Isaza D, Jaimes C. Biventricular Takotsubo Cardiomyopathy as the Initial Manifestation of a Pheochromocytoma. CASE 2021; 5:363-367. [PMID: 34993364 PMCID: PMC8712975 DOI: 10.1016/j.case.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodriguez MJ, Gallo-Bernal S, Calixto CA, Medina L, Pardo EJ, Ocampo González M. Multiple Coronary Fistulas After Several Penetrating Chest Wounds: A Rare Case of Refractory Heart Failure. JACC Case Rep 2021; 3:34-38. [PMID: 34317464 PMCID: PMC8305110 DOI: 10.1016/j.jaccas.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
Coronary artery fistulas are rare coronary abnormalities. Most of these fistulas have a congenital origin, and only a few are acquired. We report the case of a patient with late-acquired multiple coronary fistulas secondary to a stab wound, diagnosed in the setting of ischemic heart failure secondary to coronary steal syndrome. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Maria J Rodriguez
- Division of Heart Failure, Fundación Cardioinfantil, Institute of Cardiology, Bogota, Colombia
| | - Sebastian Gallo-Bernal
- Division of Heart Failure, Fundación Cardioinfantil, Institute of Cardiology, Bogota, Colombia
| | - Camilo A Calixto
- Division of Heart Failure, Fundación Cardioinfantil, Institute of Cardiology, Bogota, Colombia
| | - Libardo Medina
- Universidad de Santander, Bucaramanga, Colombia.,Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | | | - Mónica Ocampo González
- Universidad de Santander, Bucaramanga, Colombia.,Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
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Gallo-Bernal S, Calixto CA, Molano-González N, Moreno MPD, Tamayo MF, Contreras JP, Medina HM, Rodríguez MJ. Impact of a pharmacist-based multidimensional intervention aimed at decreasing the risk of hyperkalemia in heart failure patients: A Latin-American experience. Int J Cardiol 2021; 329:136-143. [PMID: 33412183 DOI: 10.1016/j.ijcard.2020.12.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
AIMS Hyperkalemia is a potentially life-threatening condition associated with the use of heart failure (HF) medications, which can lead to increased morbidity and mortality. Novel approaches for hyperkalemia prevention are needed, especially in limited-resource settings. Despite multiple studies showing the beneficial impact of pharmaceutical-counseling in several outcomes, there is a knowledge-gap regarding its impact on hyperkalemia prevention. METHODS A case-control study was performed in patients from the Adult Heart Failure Clinic Registry in our institution. Cases were selected using a definition of serum potassium K+ ≥5.5 mmol/L. To study the association between hyperkalemia and relevant risk factors, we performed a multivariate logistic regression analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) method for variable selection. We also fitted a Classification and Regression Tree (CART) to establish complex interactions and effect modifiers between the selected variables. RESULTS We matched 483 controls (eligible HF patients without hyperkalemia) to 132 cases (eligible HF patients with hyperkalemia based on age and calendar, yielding a total sample size of 615 patients (270 females) for this study. Cases had statistically significant lower odds of receiving a pharmacist-based multidimensional intervention (PBMI) (OR 0.57; 95% CI, 0.43-0.80) or having HF with reduced ejection fraction (OR 0.56; 95% CI, 0.18-0.72). On the other hand, patients who presented hyperkalemia had statistically significant higher odds of having a history of chronic kidney disease stage 4 (OR 4.97; 95% CI, 2.24-11.01) or 5 (OR 6.73; 95% CI, 1.69-26.84) and being on enalapril at doses =40 mg/day (OR, 9.90; 95% CI 5.81-16.87). CONCLUSIONS PBMI is a practical approach to prevent hyperkalemia in HF patients in a limited-resource setting. However, clinical trials are needed to assess its effectiveness.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Camilo A Calixto
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | | | - María Fernanda Tamayo
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia
| | | | - Hector M Medina
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - María Juliana Rodríguez
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia.
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Pitanguy I, Fiazza G, Calixto CA, Muller PM, Caldeira AM, Alexandrino A. Prominent ears--Pitanguy's island technique: long-term results. Head Neck Surg 1985; 7:418-26. [PMID: 3870817 DOI: 10.1002/hed.2890070511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Through the analysis of 300 cases of prominent ears operated by Pitanguy's technique with a follow-up of 1-15 years we observed the preservation of the aesthetic aspect as well as the cephaloauricular angle. We call attention to its easy performance and almost no incidence of early or late complications.
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Affiliation(s)
- I Pitanguy
- Department of Plastic Surgery of the Catholic University of Rio de Janeiro, Brazil
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Abstract
We report on the histologic and anatomopathologic aspects of cutaneous hemangiomas, stressing the involutive and noninvolutive aspects of these malformations. We analyze its clinical evolution, approaching the propedeutic and therapeutic methods, and present a detailed commentary on the conservative methodology of a series of 473 consecutive patients, encompassing a follow-up of 1 to 18 years.
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