Observation on Uncommon Complications of Acute Pancreatitis.

Acute pancreatitis is a sudden inflammation of pancreas that lasts for a short time. It may range from mild discomfort to a severe, life threatening illness. Abdominal pain which is the major symptom of acute pancreatitis may be accompanied by nausea, vomiting and abdominal distension.1 There may be low grade fever with features of shock which is not unusual.2 Most people with acute pancreatitis recover completely after getting the right treatment. About 80% of cases of acute attack are self-limited and recover spontaneously within a week after the treatment. But in severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection and cyst formation. Severe pancreatitis can also harm other vital organs such as heart, lungs and kidneys. Transient hypotension, transient myocardial ischemia reflected by ST-T changes in ECG and associated with diastolic dysfunction and ARDS are uncommon complications of acute pancreatitis. This study was conducted to evaluate their incidence and prognostic significance in acute pancreatitis.METHODSThis study was conducted in Patna Medical College Hospital, Patna, on admitted cases during the period august 2018 – august 2019. A total of 30 cases were included in this study who were diagnosed as acute pancreatitis and gave written consent for the same. Patients with association or history of stroke, head injury, CNS infection, features of demyelination, acute coronary syndrome, cardiogenic pulmonary oedema and established liver disease were excluded.RESULTSThe incidence of transient hypotension, transient myocardial ischemia and ARDS in this study was found to be 13.3%, 6.6% and 6.6% respectively and they were all associated with high mortality.CONCLUSIONSThe commonest risk factor of acute pancreatitis was seen to be Gall Stone followed by Alcoholism, hyperlipidaemia and smoking in this study also. The overall mortality (13.3%) in this study was slightly lower than other studies. and this may be due to small sample size and variation of mortality with time of admission. Transient hypotension, transient myocardial ischemia reflected by ST-T changes in ECG, associated with diastolic dysfunction and ARDS were observed as uncommon complications of acute pancreatitis. Their incidence in this study were 13.3%, 6.6% and 6.6% respectively and they were all associated with high mortality. The clinical significance of their early detection is that the early mortality can be reduced with intensive medical and surgical management.a

Circadian rhythms of myocardial ischemia and chronotherapy / 药学实践杂志

The occurrence of the clinical manifestations of myocardial ischemia shows clear circadian rhythmicity ,and they are unevenly distributed during the 24 h with higher morbidity during the initial hours of the daily activity span and in the late afternoon or early evening .Such temporal patterns result from circadian rhythms in pathophysiological mechanisms plus cyclic environmental stressors that trigger these clinical events .β‐receptor antagonist medications ,oral nitrate ,and calcium channel blocker have been shown to be influenced by the circadian time of their administration .Here we briefly review the char‐acteristics of circadian rhythmicity in MI ,the pathophysiological mechanisms as well as the current chronotherapy ,and then discuss the future treatment strategies .

A Case Of Rheumatoid Arthritis Accompanied By Severe Eosinophilia / 대한류마티스학회지

Wegener's granulomatosis (WG) is a syndrome characterized by necrotizing granulomatosis lesions in the upper and lower respiratory tracts, glomerulonephritis, and generalized vasculitis involving both arteries and veins. This syndrome usually affects the upper and lower respiratory tract and the kidneys. Some patients with WG have cardiac involvement such as pericarditis, myocarditis, valvulitis, arrhthymia, coronary arteritis, and rarely cardiomyopathy. Ocular manifestations include keratitis, conjuntivitis, scleritis, retro-orbital granuloma with proptosis. Uncommonly, blindness may occur due to retinal vasculitis and optic neuritis. We report a 45-year-old female patient with WG who had sinusitis and lung nodules. She complained of sudden chest pain. Electocardiography and nuclear myocardial perfusion study suggested transient myocardial ischemia. During the active course of the disease, she complained of severe pain in the right eye-ball with decreased visual acuity. Subsequently, she developed monocular blindness probably due to retinal vasculitis.

A Relation between Transient Myocardial Ischemia and Ventricular Arrhythmias on Holter Monitoring after Acute Myocardial Infarction

BACKGROUND: Transient myocardial ischemia that is recorded on Holter monitoring after a myocardial infarction is known to be a risk factor of myocardial reinfarction or death. However, it is still uncertain whether transient myocardial ischemia is a cause of ventricular arrhythmias or is simply an indicator of severe coronary artery disease. Therefore, we have studied the relation of ventricular arrhythmias to transient myocardial ischemia detected on Holter monitoring after a myocardial infarction. METHOD: We studied 40 patients with acute myocardial infarction who were performed Holter monitoring, 7 to 14 days after an attack. On Holter monitoring, we analyzed the prevalence, characteristics of transient myocardial ischemia and its relation to ventricular arrhythmias. RESULTS: 1) Among 40 patients(32 men, 8 women, mean age 53+/-13), transient myocardial ischemia was recorded in 13 patients(33%). ST elevation was observed in 2 patients, and ST depression, in 11 patients. Total episodes of transient myocardial ischemia were 65, of which only one episode was accompanied by chest pain, and total daily episodes were 4.8+/-1.4. Total daily duration of transient myocardial ischemia was 61.4+/-15.5 minutes and the duration of each transient myocardial ischemia was 15.8+/-2.1 minutes. 2) There were no significant differences in frequencies of single ventricular premature beast, bigeminy, trigeminy, ventricular couplets, and ventricular tachycardias between two groups with and without transient myocardial ischemia. CONCLUSION: It is concluded that transient myocardial ischemia on Holter monitoring after myocardial infarction is not a cause of ventricular arrhythmias.