Hospital Chronicles (E-Journal)
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Taeniasis Caused Appendicitis Without Local Tenderness: a Rare Case
Get PDFA case is herein presented with atypical features of appendicitis found to have a parasitic infection (taeniasis) suspected to have been causally involved in the appendiceal disease as suggested by the histopathological findings obtained at appendectomy
Therapeutic Intervention in Acute Ischemic Stroke: a Paradigm Shift
Get PDFStrokes are classified as ischemic or hemorrhagic. Acute ischemic strokes (AIS) are more common than hemorrhagic and they refer to thrombosis or embolism. They are classified into large artery infarctions, small vessel or lacunar infarctions and cardioembolic infarctions. As timely restoration of blood flow (reperfusion) using thrombolytic therapy or percutaneous intervention is the key and most effective strategy for salvaging ischemic myocardial tissue in acute myocardial infarction, the same principle applies to AIS. There is a narrow therapeutic window during which this can be accomplished, since the benefit of reperfusion continually decreases over time. During the acute phase of ischemia, be it myocardial or cerebral, a rapid determination and triaging of patients who are eligible for reperfusion is key to the success of such a salvaging strategy (... excerpt
Pre-Therapy With Statins in Percutaneous Coronary Interventions
Get PDFStatins present a number of beneficial effects on endothelial function and atherosclerotic plaque, modulating oxidative stress and inflammation. The benefits of long-term statin treatment in the entire spectrum of atherosclerotic vascular disease can largely be explained by its cholesterol-lowering effects and the associated reduction of the progression of atherosclerosis. The short-term benefits of statins use are most likely due to their non-lipid, pleiotropic effects. Myocardial injury during percutaneous coronary intervention (PCI) occurs in 10-40% of cases and is often characterized by a slight increase in the markers of myocardial necrosis, sometimes without symptoms, electrocardiographic changes or impairment of cardiac function. Periprocedural myocardial infarction is associated with a worse outcome on long term follow-up. Several randomized trials have suggested a beneficial effect of pre-treatment with statins in the outcome of the procedure. Myocardial protection by statin pre-therapy in PCI has been studied in several trials published over the last decade. The mechanisms underlying the beneficial pleiotropic effects of statins may be an anti-inflammatory action reducing myocardial injury necrosis due to microembolization, an improvement in endothelial function on microcirculation, and direct myocardial protection. This article reviews the major randomized trials which have studied the use of statins as pre-treatment in PCI and explores future perspectives. Key words: statins, percutaneous coronary intervention, acute coronary syndrome
Ciprofloxacin-Induced Cardiac Arrest
Get PDFPolymorphic ventricular tachycardia in the form of torsade des pointes occurred in a patient on chronic therapy with amiodarone and a baseline prolonged QT interval, only when ciprofloxacin was added for treatment of urinary tract infection and did not recur after discontinuation of the antibiotic. Key Words: polymorphic ventricular tachycardia; torsade des pointes; ciprofloxacin; acquired long QT syndrome; amiodaron
A Flail Tricuspid Valve
Get PDFA 30-year-old man was admitted to the hospital because of palpitations. He had a life-threatening liver rupture five years earlier, after a massive uncontrolled explosion of a big bunch of fireworks. Transthoracic echocardiography revealed severe tricuspid regurgitation due to a flail anterior leaflet of the tricuspid valve. Transesophageal echocardiography had an additive imaging value in demonstrating additionally a flail posterior leaflet. Flail tricuspid valve causing severe regurgitation is usually due to mechanical trauma. Since it is well tolerated for years, the diagnosis may be delayed or missed entirely. Echocardiography has allowed easier diagnosis of this condition resulting in earlier and, hence, more effective treatment
New Oral Anticoagulants Poised to Usurp the Throne of Vitamin K Antagonists After Over Half a Century
Get PDFOnly after the elapse of over half-a-century of warfarin's reign are we witnessing significant progress in anticoagulation therapy with the advent of new anticoagulants with predictable pharmacologic profile obviating the need for the routine and burdening coagulation monitoring unlike therapy with vitamin K antagonists. Furthermore, these novel agents are devoid of any food interactions and have limited drug-drug interactions since they are minimally metabolized via the cytochrome P450. These unique pharmacokinetic properties have ushered in a new era in anticoagulation therapy with the continuing development of specific direct factor IIa (thrombin) and factor Xa inhibitors. An overview of these novel anticoagulant agents is herein attempted
Takotsubo Cardiomyopathy and Acquired Long-QT Syndrome
Get PDFA 55-year-old woman developed acute myocardial infarction while grieving for the death of her pet. The initial ECG showed T-wave inversion in leads I, aVL, V2, and V3, and a corrected QT (QTc) interval of 529 ms. Cardiac enzymes were mildly elevated. Cardiac catheterization revealed normal coronary arteries with akinesis of the anterior wall with ballooning during systole, findings compatible with an atypical form of Takotsubo cardiomyopathy. The patient responded to medical therapy. The second day, the QTc interval was reduced to 476 ms and then gradually normalized. Echocardiography at 7 days showed complete resolution of the anterior wall motion abnormalities
Microvolt T-Wave Alternans in Patients with a Biventricular Implantable Defibrillator
Get PDFBackground/Aim: Microvolt T-wave alternans (MTWA) has been found to be associated with cardiac electrical instability. The aim of this study was to investigate the effects of biventricular pacing on MTWA in comparison with other pacing modalities.Methods: The study group consisted of 50 patients with dilated or ischemic cardiomyopathy with a cardiac resynchronization therapy device. MTWA was measured during several pacing modalities.Results: Overall, 181 MTWA studies were performed in 50 patients. Seventy-nine studies (44%) were negative, 81(45%) were positive and 21 (12%) were indeterminate. With right atrial (RA) pacing, 45% of the MTWA tests were negative. With right ventricular (RV) pacing, 30 % were negative, with left ventricular (LV) pacing 44 % were negative and with biventricular pacing 52% of the tests were negative (P=0.15). The results of TWA testing were concordant between RA pacing and biventricular pacing (K=0.46, P=0.007).Conclusion: MTWA during biventricular pacing correlates with MTWA during atrial pacing and left ventricular pacing
Hemophagocytic Syndrome Associated with Hematologic Malignancies
Get PDFHemophagocytic syndromes may occur in patients of all age groups. Secondary HS is more frequent than primary (familial) and is usually described in patients with an underlying immune disorder. This clinicopathological entity is the result hemophagocytosis of hemopoetic cells due to activation of morphologically benign macrophages in the bone marrow. Clinical symptoms include fever, hepatosplenomegaly, severe cytopenias, dyslipidemia, and frequent coangulopathy. The prognosis is dismal. Hematologic malignancies are often involved in HS, which may present at any disease phase. Non-Hodgkin lymphomas and less frequently Hodgkin disease have been associated with HS. Lymphoma associated hamophagocytic syndrome (LAHS) accounts for 40-50% of HS where an underlying condition can be defined. NK/T and T peripheral lymphomas are responsible for 80% of LAHS. As far as B-cell lymphomas are concerned, intravascular usually present with LAHS. The pathogenesis of HS is not fully understood, but it seems to differ between T- and B-cell lymphomas. EBV is thought to have an important part in the pathogenetic procedure, since it has been detected both in Hodgkin and Non-Hodgkin lymphomas presenting with HS. Treatment decisions depend upon the underlying condition and its phase. However the most acceptable treatment option is currently immunochemotherapy followed by myeloablative stem cell transplantation