ABSTRACT
Right atrial myxomas are rare intracardiac tumors that often pose difficulties in diagnosis. Right ventricular failure and ascites ensuing from tricuspid valve orifice obstruction are potentially dangerous complications. Early diagnosis of cardiac myxoma is important since surgical treatment leads to disappearance of all symptoms with a low rate of recurrence and good long-term survival. Nonspecific extracardiac symptoms, signs, complications, and laboratory findings may be the initial manifestations contributing to misdiagnosis of these rare but totally treatable atrial tumors.
Subject(s)
Heart Neoplasms/complications , Myxoma/complications , Heart Atria , Heart Neoplasms/diagnosis , Humans , Male , Middle Aged , Myxoma/diagnosis , Tricuspid Valve Stenosis/etiology , Ventricular Dysfunction, Right/etiologyABSTRACT
Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre-existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.
Subject(s)
Food Hypersensitivity/etiology , Myocardial Infarction/etiology , Shellfish/adverse effects , Angina Pectoris/blood , Angina Pectoris/etiology , Female , Food Hypersensitivity/blood , Humans , Male , Middle Aged , Myocardial Infarction/blood , SyndromeABSTRACT
BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP) via Holter monitoring in elderly patients older than 70 years of age. METHODS: Holter monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing ERCP and in 30 control subjects undergoing routine chest, abdomen, bone and upper gastrointestinal small bowel follow-through studies. A computerized nontriggered template system was used to analyze the electrocardiograms qualitatively and quantitatively. Arrhythmias, cardiac axis, conduction defects, pauses, ST segment changes, ectopic beats, oxygen desaturation and changes in blood pressure and rate-pressure product were evaluated. RESULTS: Increased heart rate, ST segment changes resulting from myocardial ischemia, oxygen desaturation and transient atrial and ventricular ectopic beats were frequent during ERCP compared with the control group. In one patient, transient left bundle branch block developed and this was attributed to pre-existing hypertension with cardiomegaly. One patient developed ventricular tachycardia and one other sinus bradycardia, but this was attributed to sick sinus syndrome. CONCLUSIONS: Transient myocardial ischemia and various cardiac arrhythmias are frequent in elderly patients undergoing ERCP. Appropriate noninvasive monitoring seems to be justified during this procedure.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Electrocardiography , Aged , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Blood Pressure , Case-Control Studies , Electrocardiography, Ambulatory , Female , Heart Rate , Humans , Incidence , Male , Myocardial Ischemia/epidemiology , Myocardial Ischemia/etiology , Oxygen/bloodABSTRACT
A case in which inspissated barium was retained and produced sigmoid obstruction after one year is described. The patient was elderly and myxoedematous. Prolonged retention of barium producing a bowel obstruction requiring surgery is a rare complication and, to our knowledge, is only the second case described in which the symptoms of obstruction appeared so late after the examination.
Subject(s)
Barium Sulfate/adverse effects , Colonic Diseases/chemically induced , Contrast Media/adverse effects , Intestinal Obstruction/chemically induced , Aged , Colonic Diseases/surgery , Female , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Radiography , Treatment OutcomeABSTRACT
The aim of the study was to evaluate prospectively the performances of colour Doppler sonography for detection of vesicoureteral reflux in adult patients with neurogenic bladder due to spinal cord injury. One hundred eighty-seven adult patients who had developed neurogenic bladder due to spinal cord injury underwent retrograde cystography and sonographic evaluation by B-mode and colour flow Doppler sonography (CFDS). Results of both examinations were analyzed independently by two radiologists. Representative images of the sonographic evaluations were recorded on videotape and CD-Rom. CFDS detected reflux in 20 ureters while retrograde cystography revealed vesicoureteral reflux (VUR) in 25 ureters of a total of 374 ureters, which were examined by both methods. Sonography detected all cases of grades IV and V of reflux, 7 of 8 (87.5%) of grade III, 5 of 6 (83.3%) of grade II, and 4 of 7 (57.14%) of grade I. There were 6 false-positive and 5 false-negative findings with Doppler examination compared with retrograde cystography. Therefore, sensitivity and specificity of sonographic examination were 80 and 98.28%, respectively, with a positive predictive value of 76.92%. Colour flow Doppler sonography can play an important role in detection of VUR in spinally injured adult patients with neurogenic bladder and can be an effective imaging tool for follow-up.