[Typical atypical ECGs and anterior wall infarction : Subtle signs of an acute coronary artery occlucion]. / Typische atypische EKGs bei Vorderwandinfarkt : Subtile Zeichen eines akuten Koronarverschlusses.

The ECG is a very important diagnostic tool if an acute coronary syndrome is suspected. It should be performed immediately when medical staff contacts the patient. If an ST elevation myocardial infarction (STEMI) is diagnosed, immediate reperfusion of the occluded vessel should be the primary goal. Therefore, even subtle signs of an anterior wall infarction diagnosed by the ECG which lead to suspicion of complete occlusion of a coronary artery should be known and diagnosed by all physicians who may have contact with these types of patients. The ECG variations presented in this article can be used as a sample for medical personnel who are not familiar with these changes and do not routinely interpret ECGs.

[Suicide attempt by means of phenobarbital overdose. Effective treatment with continuous veno-venous hemodialysis]. / Phenobarbitalintoxikation in suizidaler Absicht. Kontinuierliche venovenöse Hämodialyse als effektive Therapie.

A 68-year-old woman tried to commit suicide using phenobarbital, which was initially prescribed for her dog that suffered from seizures. At admission she was unconscious and ventilated. Five days of intensive care therapy did not improve her state of consciousness. Subsequent continuous veno-venous hemodialysis accelerated the elimination of phenobarbital compared to endogenous elimination by a factor of five. The patient survived without sequelae. Detailed history taking and well-timed indication for dialysis were crucial.

[Near fatal intoxication with the novel psychoactive substance 25C-NBOMe]. / Lebensgefährliche Intoxikation mit der neuen psychoaktiven Substanz 25C-NBOMe.

BACKGROUND: Effects of overdosing 2-(4-chloro-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25C-NBOMe) have not been previously described. Currently the drug is legal in most parts of the world. CASE REPORT: The case of a 19-year-old man who had nasally administered 2 mg of 25C-NBOMe, a novel psychoactive drug, within 1 h is described. Two hours later, he experienced a generalized seizure. Due to loss of consciousness and low oxygen saturation, he required mechanical ventilation. On day 2, he could be extubated without need for supplemental oxygen and appeared to recover quickly. On day 3, he developed acute kidney failure requiring hemofiltration. His condition continued to deteriorate with development of acute lung failure on day 4. He again required non-invasive and subsequently invasive ventilation with high demands for oxygen and high supporting pressure. On days 7 and 8 his condition became life threatening due to difficulties to achieve sufficient oxygenation even with a FIO2 of 80 %. After 13 days in the intensive care unit, he finally recovered without sequelae. CONCLUSION: In summary, 2 mg of 25C-NBOMe placed a young healthy man in a critical situation both acutely a few hours after ingestion due to a generalized seizure and during the subsequent days due to multiple organ failure.

[Transient global amnesia and Tako-Tsubo cardiomyopathy--coincidence or corollary?]. / Transiente globale Amnesie und Tako-Tsubo-Kardiomyopathie - Zufall oder logische Folge?

HISTORY: A 69-year-old female patient who had been physically and mentally healthy was admitted to our emergency department because of acute onset of amnesia. INVESTIGATIONS: Inconspicuous diagnostic findings led to the diagnosis of transient global amnesia (TGA). Furthermore bradycardia and elevated troponins were detected. Because of these findings a cardiologic workup was performed resulting in the diagnosis of Tako-Tsubo cardiomyopathy. TREATMENT AND COURSE: The patient recovered completely from TGA as well as from the slight reduction of the left-ventricular ejection fraction as part of the Tako-Tsubo cardiomyopathy. CONCLUSION: There are similarities of the two diseases Tako-Tsubo cardiomyopathy and TGA concerning triggers as well as reversibility. Patients presenting with symptoms suggestive for TGA should be considered to undergo additional cardiologic evaluation.

Glucose tolerance in depressed inpatients, under treatment with mirtazapine and in healthy controls.

Impaired glucose tolerance and diabetes have been associated with depression, and antidepressant treatment is assumed to improve impaired glucose tolerance. However, antidepressant treatment is also considered as a risk factor for the development of diabetes. Reports about glucose tolerance under antidepressant treatment frequently lack appropriate control groups. We conducted the oral glucose tolerance test (OGTT) in 10 healthy controls selected from an epidemiological sample with a negative lifetime history of mental Axis I disorder. Controls were carefully matched to a sample of inpatients with major depression that participated in an OGTT before and after antidepressant treatment with mirtazapine. All participants underwent a standard OGTT protocol. In patients, a second (after 2 weeks) and a third (after 4-6 weeks) OGTT was performed under treatment with mirtazapine. Compared to healthy controls, we observed significantly impaired glucose tolerance in acutely depressed patients. Effect size calculation indicated a moderate to large effects on glucose and insulin concentrations in response to an OGTT. Although glucose tolerance improved under mirtazapine treatment, insulin sensitivity was still impaired and remained significantly lower in patients compared to controls.