ABSTRACT
Spontaneous subarachnoid haemorrhage is a clinical condition that may be attributed to various underlying causes, such as rupture of intracranial aneurysms and arteriovenous malformations (AVMs). Suspected cerebrovascular abnormalities can be detected either with digital subtraction angiography (DSA) or with computed tomography angiography (CTA) combined with postprocessing tools, namely multiplanar reformation, maximum intensity projection, shaded surface display, virtual endoscopy and direct volume rendering. We prospectively studied a group of 205 patients with spontaneous subarachnoid haemorrhage. One-hundred-ninety-eight patients underwent both DSA and CTA, and formed our study group. Patients with intracranial aneurysms underwent surgical or endovascualar treatment. DSA was negative for 35 patients, detected 178/179 aneurysms and 15 AVMs. CTA correctly detected 176/179 aneurysms and all 15 cases of AVMs, whereas it was negative in 35 cases. After 3D reconstruction the size, location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs with the main feeding vessel(s), nidus and draining veins were reliably shown by CTA, although DSA provided more anatomic details related to the anatomy of the adjacent vessels. The accuracy, sensitivity, positive predictive accuracy and negative predictive accuracy for CTA was 98, 97.9, 100 and 94.3% and for DSA was 99, 99.3, 100 and 98%, respectively. It is suggested that CTA is a reliable alternative to DSA in detecting intracranial aneurysms. The role of CTA in demonstrating AVMs can be considered complementary to that of DSA.
Subject(s)
Angiography, Digital Subtraction/methods , Arteriovenous Malformations , Imaging, Three-Dimensional/methods , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Cerebral Arteries/abnormalities , Cerebral Arteries/diagnostic imaging , Early Diagnosis , Female , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Subarachnoid Hemorrhage/etiology , Treatment OutcomeABSTRACT
Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre-existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.
Subject(s)
Food Hypersensitivity/etiology , Myocardial Infarction/etiology , Shellfish/adverse effects , Angina Pectoris/blood , Angina Pectoris/etiology , Female , Food Hypersensitivity/blood , Humans , Male , Middle Aged , Myocardial Infarction/blood , SyndromeABSTRACT
BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP) via Holter monitoring in elderly patients older than 70 years of age. METHODS: Holter monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing ERCP and in 30 control subjects undergoing routine chest, abdomen, bone and upper gastrointestinal small bowel follow-through studies. A computerized nontriggered template system was used to analyze the electrocardiograms qualitatively and quantitatively. Arrhythmias, cardiac axis, conduction defects, pauses, ST segment changes, ectopic beats, oxygen desaturation and changes in blood pressure and rate-pressure product were evaluated. RESULTS: Increased heart rate, ST segment changes resulting from myocardial ischemia, oxygen desaturation and transient atrial and ventricular ectopic beats were frequent during ERCP compared with the control group. In one patient, transient left bundle branch block developed and this was attributed to pre-existing hypertension with cardiomegaly. One patient developed ventricular tachycardia and one other sinus bradycardia, but this was attributed to sick sinus syndrome. CONCLUSIONS: Transient myocardial ischemia and various cardiac arrhythmias are frequent in elderly patients undergoing ERCP. Appropriate noninvasive monitoring seems to be justified during this procedure.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Electrocardiography , Aged , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Blood Pressure , Case-Control Studies , Electrocardiography, Ambulatory , Female , Heart Rate , Humans , Incidence , Male , Myocardial Ischemia/epidemiology , Myocardial Ischemia/etiology , Oxygen/bloodABSTRACT
A patient is presented having simultaneously chronic lymphocytic leukemia with a monoclonal B-lymphocyte population and mycosis fungoides with atypical T-cell population in the skin lesion and in the enlarged lymphoid nodes confirmed by detailed phenotyping.