[Posttraumatic pseudoaneurysm of the axillary artery after anterior dislocation of the shoulder: a case report]. / Pseudoanevrism posttraumatic al arterei axilare, dupa luxatie anterioara a umarului: prezentare de caz.

We present a case of a young patient, 44 years old, with a pseudoaneurysm of the axillary artery after anterior shoulder dislocation. The early diagnosis of axillary artery lesions after trauma is difficult in some cases. It's important to mention the possibility of accidental vascular surgery during reduction of the shoulder dislocation. In consequence, in all patients with a penetrating or blunt trauma of the shoulder is required a neurological and vascular examination; in any suspicions, an additional arteriography and computer tomography is indicated. Early repairs of vascular and neurological lesions are very important for the outcome of these patients.

Electrophysiologic noninvasives parameters in patients with sick sinus syndrome and syncopal attacks.

21 patients accusing previous syncopal attacks, without myocardial infarction, preexcitation syndrome or severe cardiac failure were submitted to a 24 hrs Holter monitoring with 10 min. of esophageal electrocardiogram. Nine patients were considered as cases of sinus bradycardia (mean HR = 49.5 +/- 4.4 b/min). Other 12 patients with normal basic sinus rhythm were admitted for ventricular premature beats (HR = 65.5 +/- 8.7 b/min.). Fourier transformation analysis (mean method, linear interpolation) was used for determination of the heart rate variability (HRV) and other two variables: variation range (VR)--(longest-shortest cycle/mean basic sinus cycle, %) and differences of sinus cycle length (DSCL = maximal difference of any two consecutive sinus cycle, ms). In all the 9 patients with low sinus rhythm and in 7 patients with normal basic sinus rhythm, at least one episode of critical bradycardia (under 45 b/m) was observed. In 3 of the 9 patients with sinus bradycardia at least two episodes of nonsustained ventricular tachycardia were observed. In all the 12 patients with ventricular premature beats, many episodes of nonsustained ventricular tachycardia were registered. In all the 21 studied patients low and very low frequency HRV was observed. The VR and DSCL presented a significant dependence on age, but this relationship was weaker than the established limits of normality. In the cases of sick sinus syndrome with sinus bradycardia and/or severe ventricular tachyarrhythmias, the noninvasive Holter analysis of HRV can determine the correct diagnosis and indications for permanent cardiac pacing and antiarrhythmic drug therapy.

Complete AV heart block during acute silent myocardial infarction detected only by myocardial perfusion scintigraphy.

Seven patients with complete AV heart block and wide QRS complexes, atypical chest pain and no specific serum enzymes modifications for myocardial necrosis are reported. The patients showed no prior complete AV heart block although myocardial perfusion scintigraphy showed localized uptake demonstrating a small area of acute myocardial necrosis. These cases may be described as "true silent" acute myocardial infarction which could not be clinically recognised without Technetium pyrophosphate scintigraphy.

Atrial flutter with inapparent flutter waves on the surface electrocardiogram.

A case with inapparent flutter waves on surface electrocardiogram are described. Typical atrial flutter activity could be seen on right atrial monophasic action potential recordings, His bundle electrograms and echocardiograms. During long pauses induced by carotid sinus massage the atrial activity on endocavitary tracings and echocardiograms was unchanged while isoelectric lines were recorded on the twelve surface electrocardiographic leads.