3 research outputs found
Polymorphic ventricular tachycardia due to Prinzmetal angina. A case report
No full textIntroduction: Prinzmetal angina, or vasospastic angina, is a rare kind of angina, representing about two out of a hundred cases. It is frequently associated with coronary artery disease (CAD) and patients with normal coronary arteries are rare. The angina is caused by a vasospasm of the coronary arteries, which dramatically reduces the coronary blood flow. This usually leads to transmural myocardial ischemia, typically manifested by ST segment elevation on the electrocardiogram (ECG). Patients with vasospastic angina and normal coronary arteries have good prognosis, but when associated with CAD there is a risk of life-threatening ventricular arrhythmias and sudden cardiac death (SCD). The purpose of this report is to present a rare clinical case of Prinzmetal angina resulting in polymorphic ventricular tachycardia (PVT).Materials and methods: A case of a 76-year-old man with a history of CAD, chronic ventricular ectopics Lown class V, six days after successful percutaneous coronary intervention (PCI) is presented. The patient presented with a new onset of angina in rest, followed by syncope. Standard ECG at admission didn`t show ischemic ST-T changes. Monitoring and Holter ECG revealed recurrent episodes of transient ST elevations, followed by non-sustained PVT, during which the patient suffered angina and dizziness.Results: This was considered to be a case of vasospastic angina, associated with life threatening ventricular arrhythmias. Antiarrhythmic therapy with Amiodarone and optimal anti-ischemic therapy with vasodilators was started. Three days later, the patient suffered an episode of sustained ventricular tachycardia, degenerating into ventricular fibrillations, terminated with external defibrillation. Automatic implantable cardioverter defibrillator (AICD) was implanted for secondary prevention of SCD.Conclusion: Prinzmetal angina is a rare kind of angina, frequently associated with CAD, life-threatening arrhythmias and risk of SCD. Secondary prevention with AICD implantation and optimal anti-ischemic therapy is indicated
Recurrent Cushing`s syndrome with no morphological substrate after transsphenoidal pituitary adenomectomy
No full textIntroduction: Cushing`s syndrome (CS) is caused by prolonged exposure to increased levels of endogenous or exogenous glucocorticoids. Endogenous hypercortisolism is a rare condition which manifests itself with a number of specific morphological features and can lead to hypertension, osteoporosis and diabetes. A number of laboratory analyses and diagnostic procedures are usually required to distinguish between adrenocorticotropic hormone (ACTH)-dependent (pituitary microadenoma, hypothalamus hyperfunction, ectopic secretion of ACTH or corticotropin-releasing hormone) and ACTH-independent (adrenal tumor, macronodular adrenal hyperplasia) etiologies of CS.Materials and methods: A 53-year-old woman is presented with a typical clinical constellation of CS - centripetal obesity, muscle weakness, hypertension, moon face, facial plethora, buffalo hump, purple striae and hirsutism. The laboratory tests displayed increased serum and urine concentrations of cortisol. Computed tomography scan revealed a nodule in the left adrenal gland. Contrast-enhanced MRI showed evidence of pituitary microadenoma and transsphenoidal adenomectomy was performed.Results: High serum and urine cortisol levels persisted postoperatively while ACTH value was within the reference range. The 8-mg dexamethasone suppression test demonstrated a decrease in the morning cortisol levels to 209,37 nmol/l, although not reaching the target cut-off (50 nmol/l). Data for recurrent pathologies in the pituitary gland or change in the nodule size were not detected. Further examination included an invasive diagnostic procedure - bilateral inferior petrosal sinus sampling (BIPSS), which indicated elevated levels of ACTH in the right inferior petrosal sinus - 138 pg/ml (compared to 30,2 pg/ml in the serum). BIPSS proved the central genesis of CS. As a therapeutic opportunity, palliative adrenalectomy was discussed.Conclusion: CS often presents a clinical and diagnostic dilemma. BIPSS is an invasive and hard to perform specialized procedure. Although being useful for establishing the source of ACTH production, it has to be performed only in high technology centers
Structured classification and database integration of medical simulators for educational efficiency
Full text linkIntroduction: Simulation-based education is an essential component of healthcare training, providing a safe environment for acquiring clinical skills. Despite the widespread use of simulators, there is a lack of consistency in terminology and classification, which hampers their effective integration into curricula.Aim: This study aims to analyze the existing classification of medical simulators and propose an improved structure based on their typology and functionality.Materials and Methods: A literature review was conducted to examine the various classifications of medical simulators. The analysis was supported by QDA Miner Lite software for text analysis, which facilitated the identification and categorization of terms and concepts related to the simulators.Results: Twenty-two publications were analyzed, revealing a wide variety of terms used for simulators. Two terms stood out for their frequent use: high-fidelity simulators (66.7%) and simulated or standardized patients (100%). Five main categories of simulators were proposed: high-fidelity simulators, complex task trainers, basic task trainers, software-based simulators, and standardized patients. Definitions were developed for each category to standardize their use and ensure clarity in educational settings.Conclusion: The findings emphasize the need for standardizing the terminology and classification of medical simulators. The proposed classification system offers clear definitions and can be used to more effectively integrate simulators into healthcare educational programs
