The alternative vagal maneuver; converting atrioventricular nodal re-entrant tachycardia by a rectal thermometer.

Vagal maneuvers are techniques used to increase parasympathetic tone, particularly useful in the management of hemodynamically stable supraventricular tachycardias. If ineffective, adenosine can be attempted. We present a patient with atrioventricular nodal re-entrant tachycardia (AVNRT), who could not effectively perform Valsalva maneuvers and had contraindications for carotid massage and adenosine administration, that converted into sinus rhythm by using a rectal thermometer. This maneuver was reproduced on various occasions. We suggest that rectal vagal maneuver may provide an additional therapeutic modality for selected patients with AVNRT.

Gastric Dilatation Masquerading as Anterolateral ST-Elevation Myocardial Infarction.

A variety of noncardiac conditions mimic the electrocardiographic changes of ST-elevation myocardial infarction (STEMI). Therefore, a physician must maintain a high index of suspicion when evaluating ST-segment elevation (STE). We present a case of epigastric pain secondary to ileus and gastric dilatation masquerading as anterolateral STEMI on an electrocardiogram (ECG). The STE promptly resolved following laparotomy. To the best of our knowledge, this is the first case of anterolateral STE secondary to gastric dilatation.

Extreme Hypercholesterolemia Following a Ketogenic Diet: Exaggerated Response to an Increasingly Popular Diet.

A high-fat, very low-carbohydrate diet, often named the "ketogenic diet," is gaining popularity, particularly among patients with obesity and metabolic syndrome seeking rapid weight loss and improvement in glycemic control. A favorable reduction in triglycerides and an increase in high-density lipoprotein-cholesterol levels is often observed in the ketogenic diet. However, people vary significantly in their low-density lipoprotein-cholesterol (LDL-C) response to the dietary change. Here, we present the case of a 38-year-old normal-weight male with average cholesterol levels showing an extreme fourfold elevation in LDL-C levels, reaching 496 mg/dL after initiating a ketogenic diet. We highlight that a dramatic elevation in LDL-C may manifest following a ketogenic diet in normal-weight people without known genetic dyslipidemias before the dietary change; therefore, increased awareness and close monitoring of blood lipid profile is essential for all individuals following a ketogenic diet. We further discuss the potential mechanisms for the "lean mass hyper-responders" phenotype which has been recently gaining recognition, and suggest that these patients may benefit from ezetimibe therapy, decreasing the absorption of intestinal cholesterol to the liver.

A Patient With Single Coronary Artery and Pectus Excavatum Presenting With Non-ST Elevation Myocardial Infarction.

We report the case of a 51-year-old male with pectus excavatum (PEX) who presented with stress-related chest pain as a symptom of acute non-ST elevation myocardial infarction. Coronary angiography (CAG) revealed a suspected single coronary artery (SCA) anatomy with diffuse atherosclerotic narrowing, without evidence of other coronary ostia in the aortic root. The diagnosis was confirmed on cardiac computed tomography (CCTA) as the SCA of the R-I type by Lipton classification. The percutaneous coronary intervention was performed with good angiographic results and resolution of symptoms.

Pediatric Scoliosis Surgery-A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia.

Background and Objectives: There are currently no data available regarding pediatric scoliosis surgery in Latvia. The aim of this article is to present treatment specific variables, investigate their interrelation, and identify predictors for the length of stay after surgical pediatric scoliosis correction. Materials and Methods: This retrospective study included all surgical pediatric scoliosis corrections in Latvia for the years 2012 to 2016. Analyzed parameters were chosen to portray the patients' demographics, pathology, as well as treatment specific variables. Descriptive, inferential, and linear regression statistics were calculated. Results: A total of 69 cases, 74% female and 26% male, were identified. The diagnostic subgroups consisted of 62% idiopathic (IDI) and 38% non-idiopathic (non-IDI) scoliosis cases. Non-IDI cases had significantly increased operation time, hospital stay, Cobb angle before surgery, and instrumented levels, while IDI cases showed significantly higher Cobb angle percentage correction. For all operated cases, the operation time and the hospital stay decreased significantly over the investigated time period. Early post-operative complications (PCs) occurred in 15.9% of the cases and were associated with increased hospital stay, instrumented levels, and Cobb angle before surgery. The linear regression analysis revealed that operation time and the presence of PCs were significant predictors for the length of the hospital stay. Conclusions: This is the first study to provide comprehensive insight into pediatric scoliosis surgery since its establishment in Latvia. Our regression model offers clinically applicable predictors and further underlines the significance of the operation length on the hospital stay. These results build the foundation for international comparison and facilitate improvement in the field.