Hospital Chronicles (E-Journal)
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Kikuchi-Fujimoto Disease Presenting With Leukocytosis
Get PDFKikuchi-Fujimoto disease (KFD) is a generally benign and self-limited cause of lymphadenitis. It typically presents with cervical lymphadenopathy and systemic manifestations. Leukopenia is a usual finding. We herein report a case of KFD with leukocystosis. It is important to rule out lymphoma or systemic lupus erythematosus as the major and most serious differential diagnosis
A Rare Case of Pseudoaneurysm of the Ascending Aorta Presented as Superior Vena Cava Syndrome
Get PDFPseudoaneurysm of the ascending aorta constitutes a well known entity after thoracic aortic surgery. We present a rare case of a large pseudoaneurysm created five years after primary surgery that provokes a significant compression of the right mediastinal venous system causing superior vena cava syndrome. Perioperative findings showed two rush out points both coming from the distal aortic suture line which was performed five years earlier. The patient underwent reoperation under circulatory arrest facilitating safe exploration and repair of the distal anastomotic leaks
Evaluation and Management of the Child With Failure to Thrive
Get PDFBackground: Failure to thrive (FTT) is a common problem in pediatric practice, affecting 5-10% of children under five years of age in developed countries with a higher incidence in developing countries. Objective: To outline a simplified but detailed approach to determining the etiology of FTT and highlight the need for high-calorie diet for catch-up growth and a careful follow up. Methods: Data were collected using manual search for relevant journals at the University of Benin Medical Library, internet (medline) search and textbooks. Results: The majority of cases of FTT are due to a combination of nutritional and environmental deprivation secondary to parental poverty and/or ignorance. The key to diagnosing FTT is by accurately measuring and plotting a child’s weight, height and head circumference overtime and comparing the results with the appropriate growth charts and then assess the trend. In the evaluation of the child who has failed to thrive, three initial steps are required to develop an economical treatment-centered approach: a thorough history including itemized psychosocial review, careful physical examination, and direct observation of the child’s behavior and of parent-child interaction. Laboratory evaluation should be guided by history and physical examination findings only. Two principles that hold true, irrespective of etiology, are that all children with FTT need a high-calorie diet for catch-up growth and all children with FTT need a careful follow up. Social issues of the family must also be addressed.Conclusion: A multidisciplinary approach is recommended when FTT persists despite intervention or when it is severe. Keywords: Failure to thrive, growth deficiency, undernutrition
Ebstein's Disease With Pulmonic Stenosis in an Elderly Man With Three-Vessel Coronary Artery Disease
Get PDFA case is herein presented of a very rare combined congenital anomaly, that of Ebstein's disease and pulmonary valve stenosis, which remained subclinical for a long time until the patient at the age of 65 years developed worsening and crescendo angina due to severe three-vessel coronary artery disease. The patient was successfully managed with surgical repair of the valvular anomalies and with coronary artery bypass grafting of his coronary disease. ? Key Words: Ebstein anomaly; pulmonic stenosis; coronary artery disease; congenital heart diseas
Transcatheter Aortic Valve Implantation: What Lies Ahead?
Get PDF Ttranscatheter aortic valve implantation (TAVI) is currently reserved for high surgical risk or inoperable patients. In 2007, TAVI actually represented approximately 1.2% of all aortic valve procedures in Europe; this percentage increased to 6.5% in 2008. With an expectation of ~9000 TAVI procedures to be performed in 2009, TAVI may represent nearly13% of all aortic valve procedures. It is forecasted that by 2012 transcatheter valve therapies will account for approximately 40% of the total heart valve procedures performed in Europe. One major limiting factor relates to procedural complications of TAVI. Conduction abnormalities and the need for permanent pacemaker, paravalvular aortic regurgitation, stroke and vascular complications have received particular attention. The future and widespread adoption of TAVI will rely on a number of inter-related factors, including long-term durability and safety data, randomized controlled trials comparing TAVI with surgical aortic valve replacement and reimbursement for the technology
Radiofrequency Ablation of Life-Threatening Supraventricular Tachycardia Due to a Posteroseptal Accessory Pathway in an Infant
Get PDFSupraventricular tachycardia (SVT) in infants may be resistant to multiple medications and cause life-threatening symptoms. Despite the known risks, catheter ablation may be necessary in rare cases. We present a 4-month-old 4.5 kg infant who presented with SVT that was resistant to all antiarrhythmic medications, including a combination of propafenone, amiodarone and propranolol at maximal doses. The infant underwent successful radiofrequency ablation of a posteroseptal accessory pathway. Despite later recurrence, medical therapy with propafenone and propranolol at standard doses resulted in complete control of the tachycardia until one year of age, when all medications were stopped without further recurrences
Two Large Left Ventricular Aneurysms in an Asymptomatic Patient
Get PDFA 54-year-old man, smoker with uncontrolled hypertension, and history of a thromboembolic episode to the ophthalmic artery was subjected to transthoracic echocardiography which revealed very low left ventricular (LV) ejection fraction (20%) with a large dyskinetic- aneurysmatic area involving the middle and apical parts of the LV containing a thrombus. LV angiography showed the anterior aneurysm, as well as a second posterior wall pseudoaneurysm, confirmed by magnetic resonance imaging also filled with mural thrombus. This case, due to the absence of symptoms for over one year, posed a therapeutic dilemma and was treated conservatively
Blood Transfusion After Myocardial Infarction: Friend, Foe or Double-Edged Sword?
Get PDFCombined mechanical and pharmacological interventions constitute the cornerstone of therapy for patients with ST-segment elevation acute myocardial infarction (AMI). These increasingly complex interventions offer morbidity and mortality advantage but are associated frequently with bleeding complications. Major bleeding is probably the most important non-cardiac complication in patients undergoing coronary artery intervention. Prior studies have identified anemia as a strong independent predictor of mortality and adverse cardiac events in this patient population. Limited data are available to guide transfusion decisions in patients with coronary artery disease and anemia either at baseline or after a complication of an angioplasty procedure.The CADILLAC study sought to determine the relationship between red blood cell transfusion and clinical outcomes in patients undergoing primary percutaneous coronary intervention for AMI. Out of 2,060 randomized patients, 82 (3.98%) received red blood cell transfusion during index hospitalization. Transfusion was independently associated with baseline anemia, older age, multivessel disease, and female gender. Patients transfused, versus patients not transfused, had significantly higher rates of one year mortality (23.9% vs. 3.4%), disabling stoke (2.5% vs. 0.5%), reinfarction (7.0% vs. 2.2%) and composite major adverse cardiac events (41.0% vs.16.6%). After multivariable adjustment for potential confounders, red blood cell transfusion was independently associated with mortality at 30 days and one year (hazard ratio 4.71 and 3.16 respectively, both p=0.0005). The authors concluded that red blood cell transfusion after primary angioplasty in the setting of an AMI may be harmful or alternatively transfusion could be a marker of markedly increased risk, with further randomized studies needed to determine the optimal threshold for red blood cell transfusion in this patient population setting
Brugada Syndrome and Vasovagal Syncope
Get PDFA patient with Brugada syndrome and vasovagal syncope is presented. However, due to the history of syncopal episodes, and the Brugada type I ECG pattern, the patient was referred for an electrophysiology study. Polymorphic ventricular tachycardia was induced and the patient subsequently had an automatic defibrillator (ICD) implanted for prophylaxis from sudden cardiac death
Transradial Approach: Another Way to Success
Get PDFTransfemoral artery (TFA) approach for cardiac catheterization has traditionally been the standard method, approximately for the last 2 decades. Campeau et al first described the radial approach in 1989. Since then, the transradial approach (TRA) has become increasingly common and nowadays is the preferred technique even in primary percutaneous coronary interventions (PCIs) in several catheterization laboratories throughout Europe... (excerpt