ABSTRACT
This paper discusses the case of a female patient treated for chronic obstructive pulmonary disease and hyperthyroidism, who also had takotsubo cardiomyopathy with dyspnea at rest as a dominant clinical manifestation.
Subject(s)
Dyspnea/etiology , Hyperthyroidism/complications , Pulmonary Disease, Chronic Obstructive/complications , Takotsubo Cardiomyopathy/diagnosis , Female , Humans , Hyperthyroidism/drug therapy , Middle Aged , Pulmonary Disease, Chronic Obstructive/drug therapy , Takotsubo Cardiomyopathy/complicationsABSTRACT
Haemobilia is a rare cause of acute upper gastrointestinal bleeding and is often associated with a history of hepatic or biliary tract injury, tumor growth, hepatic artery aneurysm, cholecystitis, or hepatic abscess. We report a case of a 79-year-old women with haemobilia due to acenocoumarol overdosage. She has been, taking 12 mg acenocoumarol by mistake for 5 days before admission because of atrial fibrillation. INR was 20 during an admission. Ultrasonographic evaluation demonstrated hepatomegaly, cholelithiasis, thick sludge in gallbladder represented blood clots and also dilated biliary tract. Cholecystectomy was carried out. The cut section of gall bladder showed stone, haemolysed blood and blood clots. Choledochotomy showed only blood clots within the duct. The treatment lasted long period and patient died because of multiorgan insufficiency in the course of sepsis.
Subject(s)
Acenocoumarol/adverse effects , Anticoagulants/adverse effects , Cholecystectomy , Hemobilia/chemically induced , Medication Errors/adverse effects , Aged , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Cholecystitis, Acute/complications , Cholelithiasis/complications , Cholelithiasis/surgery , Drug Overdose , Fatal Outcome , Female , Hemobilia/diagnosis , Humans , Multiple Organ Failure/complications , Pancreatitis/complications , Polyps/complications , Polyps/diagnosis , Polyps/surgery , Splenectomy , Treatment FailureABSTRACT
Circadian variation of QT interval dispersion (QTd) and heart rate variability spectral indices was evaluated in healthy persons in 24-hour 3-lead electrocardiogram. Mean values, SD, and SD/mean were evaluated for 24 hours, each hour separately and in night, day, and morning periods. Table Curve 2D and multiple regression were applied to find correlations between parameters. In 50% of subjects, a significant negative correlation was revealed between QTd and HF. Also, in 50% of persons, a significant positive correlation was found between QTd and low frequency/high frequency. After adjustment for periods, correlations were only observed during morning hours. With Table Curve 2D, 2 models of correlations between QTd and HF were found. Multiple regression analysis revealed relations between mean QTd and R-R as well as mean QTd and HF. It is possible that it is sympathovagal balance, as reflected in heart rate variability, and not the tone of both autonomic components that affects QTd variability.
Subject(s)
Circadian Rhythm/physiology , Electrocardiography, Ambulatory , Heart Rate/physiology , Adult , Electrocardiography, Ambulatory/classification , Electrocardiography, Ambulatory/statistics & numerical data , Female , Humans , Male , Middle Aged , Signal Processing, Computer-AssistedABSTRACT
Infective endocarditis is the most common condition predisposing a patient to splenic abscess. We report the case of man aged 65 who was admitted to the Internal Medicine Department to diagnose the fever of unknown origin. The fever lasted longer than one year. Clinical status and executed diagnostics, among others: echocardiography, blood cultures, abdominal ultrasonography, abdominal computed tomography allowed to give the diagnosis splenic abscess caused by Acinetobacter Baumanii in the course of infective endocarditis. Patient was treated by splenectomy and antibiotics. As a result of the treatment normalization of temperature and recovery was obtained.
