Sinus node dysfunction complicating viper bite.

Viper venom toxicities comprise mainly bleeding disorders and nephrotoxicity. Cardiotoxicity is a rare manifestation of viper bite. We describe the case of a previously healthy 35-year-old man who developed coagulopathy and sinus node dysfunction following a viper bite. Electrocardiography showed sinus arrest and junctional escape rhythm. This is the first account of sinus node dysfunction caused by a viper bite.

Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre.

BACKGROUND: The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies. METHODS: Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥ 40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study. RESULTS: The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p < 0.05). In the valvular group, DAVD patients had maximum prevalence of CAD (14 patients, 23.4%, p < 0.05). In the group with CAD, the presence of variables such as age >60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries. CONCLUSION: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).

Persistent left superior vena cava draining into left atrium as a cause of persistent systemic desaturation after surgery.

Persistent left superior vena cava (LSVC) is a rare congenital anomaly which usually produces no physiologic derangements if it drains into the right atrium via the coronary sinus, but it may cause significant desaturation when it drains into the left atrium (LA). Failure to diagnose LSVC communicating with the LA preoperatively may lead to serious consequences. We are describing an interesting case of a boy who presented with systemic desaturation due to an undetected LSVC after having undergone corrective surgery for atrioventricular canal defect. We have demonstrated that echocardiography with agitated saline contrast is a simple, accurate, and inexpensive diagnostic modality.

Successful percutaneous removal of broken mitral valvuloplasty coiled tip guidewire.

Complications related to hardware malfunction during balloon mitral valvuloplasty (BMV) are rarely met in catheterization laboratory. However, the consequences can be grave including death. We report an extremely rare complication of fracture of BMV coiled tip guidewire, which was successfully retrieved percutaneously with a relatively simple technique. Finally the procedure was completed without any complication.

Endocrine complications in long-term survivors after allogeneic stem cell transplant.

As survival rates continue to increase after allogeneic stem cell transplant (allo-SCT), the associated long-term complications of transplant need to be taken into consideration. Here, we review the endocrine and metabolic complications associated with transplant survivors, including diabetes, dyslipidemia, hypertension, cardiovascular disease, hypogonadism, vitamin D deficiency, osteoporosis, thyroid disease, adrenal dysfunction, and pituitary disorders, and provide a brief summary of evaluation and treatment of these conditions.

Clinical markers implying the need for treatment in women with gestational diabetes mellitus.

OBJECTIVE: To assess the association of the point-of-care hemoglobin A1c (POC A1C), fasting blood glucose (FBG), and BMI with fetal macrosomia and the need for medication in women with gestational diabetes (GDM). METHODS: POC A1C, FBG, and BMI values at GDM diagnosis and fetal weight at delivery were obtained for women identified from a prospective patient registry. These outcomes were compared between women who did not require medication for GDM and women who did require medication. RESULTS: Mean values of POC A1C, FBG, and BMI in 67 patients who required medication were higher than those in 71 patients who did not require medication (POC A1C: 5.72 ± 0.45% vs 5.35 ± 0.46% [P<.001]; FBG: 97.4 ± 12.3 mg/dL vs 86.4 ± 9.5 mg/dL [P<.001]; BMI: 35.4 ± 6.4 kg/m2 vs 30.4 ± 6.2 kg/m(2) [P<.001]). There was a modest correlation between POC A1C and FBG (Spearman rho 0.4, P<.001) and between POC A1C and BMI (Spearman rho 0.366, P<.001). Maternal POC A1C was not correlated with fetal weight at delivery (Spearman rho -0.010, P = .915). CONCLUSIONS: Higher POC A1C, FBG, and BMI values were associated with the need for medication in women with GDM. The use of clinical markers to assess glycemic control sooner in pregnancy may lead to the earlier identification of women at risk for GDM and earlier intervention to decrease the risk for complications.

Oral cavity metastasis of renal cell carcinoma: a case report.

INTRODUCTION: Despite being reported rarely, renal cell carcinoma is the third most frequent neoplasm to metastasize to the head and neck region preceded only by breast and lung cancer. Little information exists regarding the presentation and work-up of metastatic renal cell carcinoma in the oral cavity. CASE PRESENTATION: We report the case of a 63-year-old Caucasian man presenting with an oral cavity lesion that was painful and that had grown substantially over several months. Biopsy resulted in persistent bleeding requiring cautery and manual pressure. Immunoperoxidase testing was necessary to make the diagnosis of metastatic renal cell carcinoma and rule out other clear cell carcinomas of salivary gland origin. CONCLUSION: Metastatic renal cell carcinoma is part of the differential diagnosis for patients presenting with a new head or neck lesion in the setting of a history of kidney cancer. The physician needs to be prepared for the increased risk of bleeding and understand the importance of immunohistochemical staining to differentiate between metastatic renal cell carcinoma and malignancies of salivary origin. Unfortunately, the prognosis is invariably poor in these patients.

Adenoid cystic carcinoma of the parotid gland with temporal bone invasion.

OBJECTIVE: To present our series of 16 patients with adenoid cystic carcinoma (ACC) of the parotid gland with temporal bone invasion. PATIENTS: All patients treated at our institution between July 1988 and July 2004 with parotid gland ACC with temporal bone invasion. INTERVENTIONS: Preoperative radiographic assessment with combined surgical and radiation therapy treatment. MAIN OUTCOME MEASURES: Postoperative- or radiation-related complications and overall 2-, 5-, and 10-year survival. RESULTS: The most common surgically related complications were new-onset cranial nerve deficits, whereas osteoradionecrosis of the bony external auditory canal was the most frequently noted complication associated with radiation therapy. The overall survival rates at 2, 5, and 10 years were 94, 75, and 60%, respectively. CONCLUSION: Lateral cranial base access should be used in the extirpation of ACC of the parotid gland with temporal bone involvement.