Cardiovascular magnetic resonance in systemic hypertension

Systemic hypertension is a highly prevalent potentially modifiable cardiovascular risk factor. Imaging plays an important role in the diagnosis of underlying causes for hypertension, in assessing cardiovascular complications of hypertension, and in understanding the pathophysiology of the disease process. Cardiovascular magnetic resonance (CMR) provides accurate and reproducible measures of ventricular volumes, mass, function and haemodynamics as well as uniquely allowing tissue characterization of diffuse and focal fibrosis. In addition, CMR is well suited for exclusion of common secondary causes for hypertension. We review the current and emerging clinical and research applications of CMR in hypertension

Aspectos epidemiológicos das lesões no pé e tornozelo do paciente diabético Epidemiological aspects of foot and ankle injury in the diabetic patient

OBJETIVO: Identificar o perfil epidemiológico dos pacientes que procuram tratamento ortopédico das complicações nos pés e tornozelos relacionadas ao diabetes, além de correlacionar à sequência de eventos que culminam na amputação da extremidade. MÉTODO: analisamos os dados de prontuário de 300 pacientes no período compreendido entre março de 1997 a julho de 2006. RESULTADOS: A média de idade foi 61 anos, destes, duzentos e setenta e três pacientes (91%) apresentavam diagnóstico de diabetes do tipo II, onde somente 49 (16,3%) faziam controle regular da glicemia. Quatrocentos e cinco extremidades apresentavam problemas afetando a função do pé ou tornozelo, detacando-se: 102 extremidades (34%) com lesões osteoarticulares relacionadas a neuroartropatia de Charcot; 181 extremidades (60,4%) com ulceração crônica e 97 extremidades (32,4%) com infecção. Após tempo médio de seguimento 14 pacientes (4,6%) foram a óbito. CONCLUSÃO: A ulceração na planta dos pés foi a complicação mais frequente na nossa série de pacientes que, estavam na sétima década de vida, apresentavam diabetes do tipo II, faziam uso irregular de insulina e não realizavam controle adequado da glicemia. A perda da sensibilidade protetora nos pés, em associação com deformidade pré-existente, foi identificada como a principal causa das infecções secundárias culminando com a amputação da extremidade.<br>OBJECTIVE: To identify the epidemiological profile of patients undergoing orthopedic treatment for complications of the feet and ankles due to diabetes, and to try to establish the sequence of events that led to amputation of the limb. METHOD: The medical records of 300 diabetic patients treated from March, 1997 to July, 2006 were systematically reviewed. RESULTS: The mean age of the patients was 61 years. Of these, two hundred and seventy three (91%) were diagnosed with type II diabetes, but only 49 (16.3%) had proper medical supervision and control of their glycemia levels. Problems affecting the function of the foot and ankle were found in 405 limbs, with: 102 osteoarticular deformities associated with Charcot's neuroarthropathy (34%); 181 chronic ulcers (60.4%); and 97 infected limbs (32.4%). After the average follow-up time, 14 patients (4.6%) died. CONCLUSION: Ulceration of the sole of the foot was the most common complication in our series of patients, the majority of whom were in their seventies, presented type II diabetes, were insulin dependent, and did not have adequate control of glycemia. Loss of sensitivity of the foot, associated with pre-existing deformities, were identified as the main causes of secondary infections culminating in amputation of the limb