RESUMEN
A 62-year-old man was hospitalized for acute rheumatic fever. He had previously suffered from rheumatic fever at 15 years of age. The rheumatic fever was complicated by carditis, which caused valve disease that required surgical treatment. The incidence of rheumatic fever has decreased in most developed countries with improvements in sanitary conditions. The low incidence of this disease makes a timely and accurate diagnosis difficult. Due to the fact that both the first occurrence and recurrence of acute rheumatic fever can occur in the elderly and adults, this potential disease should not be overlooked when making a differential diagnosis.
Asunto(s)
Fiebre Reumática/diagnóstico , Edad de Inicio , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Diagnóstico Diferencial , Ecocardiografía Doppler en Color , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Japón , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Recurrencia , Cardiopatía Reumática/diagnóstico , Cardiopatía Reumática/diagnóstico por imagenRESUMEN
This is a case of a thrombo-occlusion occurring below an inferior vena cava (IVC) filter inserted in a patient with polycythemia vera and deep vein thrombosis. The patient was a 48-year-old man with polycythemia vera and a chief complaint of swelling, redness, and bursting pain in his right leg. After admission, contrast-enhanced computed tomography scanning demonstrated a pulmonary artery thrombus and deep vein thrombosis. We inserted a Gunther tulip vena cava filter on day 1 for the prevention of pulmonary embolism (PE), and started anticoagulation therapy based on the guideline of the Japanese Circulation Society for DVT. In addition to intravenous anticoagulants, we started therapeutic phlebotomy to improve the hypercoagulability state. On day 4, our patient complained of back pain caused by thrombo-occlusion below the IVC filter, despite the anticoagulation therapy and two therapeutic phlebotomies. From this case, we concluded it is important to lower hemoglobin level and hematocrit as early as possible for IVC-filter-insertion in patients with polycythemia vera.
Asunto(s)
Policitemia Vera/complicaciones , Policitemia Vera/terapia , Embolia Pulmonar/etiología , Filtros de Vena Cava/efectos adversos , Vena Cava Inferior , Trombosis de la Vena/etiología , Anticoagulantes/administración & dosificación , Hematócrito , Hemoglobinas , Humanos , Masculino , Persona de Mediana Edad , Flebotomía , Policitemia Vera/sangre , Embolia Pulmonar/prevención & control , Resultado del Tratamiento , Trombosis de la Vena/prevención & controlRESUMEN
The patient is a 64-year-old male who had been implanted with a DDD-pacemaker for sick sinus syndrome in 2003. In January 2006, he experienced palpitations and visited a local hospital on the second day of occurrence. After an electrocardiography (ECG) revealed atrial flutter (AFL) during palpitation, which was resistant to administered verapamil, the patient was admitted to our hospital for curative treatment. Electrophysiological study revealed a common AFL (AFL1) initiated by atrial burst pacing. We performed isthmus radiofrequency (RF) ablation against AFL1 successfully, after which another common AFL (AFL2) with differing atrial rate was detected. A second ablation operation with standard catheterization techniques was successful, suggesting that two pathways with differing conduction times existed.
Asunto(s)
Aleteo Atrial/diagnóstico , Aleteo Atrial/cirugía , Ablación por Catéter/métodos , Desfibriladores Implantables , Sistema de Conducción Cardíaco/fisiopatología , Síndrome del Seno Enfermo/terapia , Electrocardiografía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación , Medición de Riesgo , Índice de Severidad de la Enfermedad , Síndrome del Seno Enfermo/diagnóstico , Resultado del TratamientoRESUMEN
A 29-year-old man visited our office after experiencing palpitations at night. The electrocardiogram revealed premature ventricular contractions (PVCs), and he was admitted to our hospital for further tests. The echocardiography revealed paradoxical motion of the interventricular septum. After considering results from a previous cardiac catheter test, we suspected that the patient may have a congenital absence of the pericardium. A CT scan and magnetic resonance imaging were inconclusive, but through echocardiography and ECG performed during three positional changes we diagnosed a congenital absence of the pericardium.
Asunto(s)
Ecocardiografía Doppler/métodos , Cardiopatías Congénitas/diagnóstico por imagen , Pericardio/anomalías , Pericardio/diagnóstico por imagen , Complejos Prematuros Ventriculares/diagnóstico , Adulto , Estudios de Seguimiento , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Complejos Prematuros Ventriculares/etiologíaRESUMEN
We reported a 52-year-old woman with oculopharyngeal muscular dystrophy (OPMD) harboring expanded (GCG) 13 mutation of the poly (A) binding protein 2 gene. She presented not only ptosis and dysphagia but distal dominant muscle atrophy in four extremities. CT demonstrated distal muscle atrophy with marked fat replacement in the biceps femoris, semitendinosus, membraneous, soleus, and gastrocnemius muscles. Although OPMD is considered to be a muscle disease, this patient showed even neurogenic features in the electrophysiological and pathological findings. Although previous reports indicate that OPMD is genetically homogeneous disease, some cases with OPMD may show some atypical features associated with neurogenic involvement.
