Résumé
Infective endocarditis related to pacemaker implantation is a rare complication. However, it is a potentially lethal complication with a mortality rate of 30 to 35%. Infective endocarditis associated with pacemaker implantation usually involves the right heart and tricuspid valve. Conservative treatment without complete removal of the entire pacing system is prone to fail (i.e. result in infection relapse or development of sepsis). Therefore, the total extraction of the entire pacemaker system should be considered as standard therapy for most patients with pacemaker-related endocarditis and for many patients with local infectious symptoms at the site of pacemaker implantation to achieve complete recovery. We report a case of a 42-year-old man with documented pacemaker related left-sided endocarditis that was associated with multiple embolic events. Also, we review the literature regarding pacemaker-related endocarditis and local wound infection, in particular with respect to the modalities of treatment.
Sujets)
Adulte , Humains , Valve aortique , Endocardite , Endocardite bactérienne , Coeur , Mortalité , Récidive , Valve atrioventriculaire droite , Infection de plaieRésumé
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.
Sujets)
Adulte , Humains , Mâle , Maladies du côlon/anatomopathologie , Coloscopie virtuelle par tomodensitométrie , Muqueuse intestinale/anatomopathologie , Pneumatose kystique de l'intestin/anatomopathologieRésumé
A duodenal diaphragm is rare congenital anomaly among the duodenal obstructions. Its symptoms and signs usually appear from birth if the obstruction is complete. However, a diagnosis may be delayed until the patient reaches adulthood in cases of an incomplete obstruction. Treatment of an adult duodenal diaphragm is usually surgical. To our knowledge, there are few reports of the endoscopic treatment of an adult duodenal diaphragm but none in Korea. We report a duodenal diaphragm in a 26- year-old female with epigastric pain, who was treated with an endoscopic membranotomy using an insulated tip knife.
Sujets)
Adulte , Femelle , Humains , Diagnostic , Muscle diaphragme , Occlusion duodénale , Corée , ParturitionRésumé
Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.
Sujets)
Humains , Angioplastie par ballonnet , Bras , Veines brachiocéphaliques , Cathétérisme , Cathéters , Voies veineuses centrales , Circulation collatérale , Sténose pathologique , Incidence , Veines jugulaires , Phlébographie , Dialyse rénale , Endoprothèses , Veine subclavière , Syndrome de la veine cave supérieure , Veines , Veine cave supérieureRésumé
Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.