ABSTRACT
A 62-year-old man was hospitalized for acute rheumatic fever. He had previously suffered from rheumatic fever at 15 years of age. The rheumatic fever was complicated by carditis, which caused valve disease that required surgical treatment. The incidence of rheumatic fever has decreased in most developed countries with improvements in sanitary conditions. The low incidence of this disease makes a timely and accurate diagnosis difficult. Due to the fact that both the first occurrence and recurrence of acute rheumatic fever can occur in the elderly and adults, this potential disease should not be overlooked when making a differential diagnosis.
Subject(s)
Rheumatic Fever/diagnosis , Age of Onset , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/surgery , Diagnosis, Differential , Echocardiography, Doppler, Color , Heart Valve Prosthesis Implantation , Humans , Japan , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Recurrence , Rheumatic Heart Disease/diagnosis , Rheumatic Heart Disease/diagnostic imagingABSTRACT
This is a case of a thrombo-occlusion occurring below an inferior vena cava (IVC) filter inserted in a patient with polycythemia vera and deep vein thrombosis. The patient was a 48-year-old man with polycythemia vera and a chief complaint of swelling, redness, and bursting pain in his right leg. After admission, contrast-enhanced computed tomography scanning demonstrated a pulmonary artery thrombus and deep vein thrombosis. We inserted a Gunther tulip vena cava filter on day 1 for the prevention of pulmonary embolism (PE), and started anticoagulation therapy based on the guideline of the Japanese Circulation Society for DVT. In addition to intravenous anticoagulants, we started therapeutic phlebotomy to improve the hypercoagulability state. On day 4, our patient complained of back pain caused by thrombo-occlusion below the IVC filter, despite the anticoagulation therapy and two therapeutic phlebotomies. From this case, we concluded it is important to lower hemoglobin level and hematocrit as early as possible for IVC-filter-insertion in patients with polycythemia vera.
Subject(s)
Polycythemia Vera/complications , Polycythemia Vera/therapy , Pulmonary Embolism/etiology , Vena Cava Filters/adverse effects , Vena Cava, Inferior , Venous Thrombosis/etiology , Anticoagulants/administration & dosage , Hematocrit , Hemoglobins , Humans , Male , Middle Aged , Phlebotomy , Polycythemia Vera/blood , Pulmonary Embolism/prevention & control , Treatment Outcome , Venous Thrombosis/prevention & controlABSTRACT
The patient is a 64-year-old male who had been implanted with a DDD-pacemaker for sick sinus syndrome in 2003. In January 2006, he experienced palpitations and visited a local hospital on the second day of occurrence. After an electrocardiography (ECG) revealed atrial flutter (AFL) during palpitation, which was resistant to administered verapamil, the patient was admitted to our hospital for curative treatment. Electrophysiological study revealed a common AFL (AFL1) initiated by atrial burst pacing. We performed isthmus radiofrequency (RF) ablation against AFL1 successfully, after which another common AFL (AFL2) with differing atrial rate was detected. A second ablation operation with standard catheterization techniques was successful, suggesting that two pathways with differing conduction times existed.
Subject(s)
Atrial Flutter/diagnosis , Atrial Flutter/surgery , Catheter Ablation/methods , Defibrillators, Implantable , Heart Conduction System/physiopathology , Sick Sinus Syndrome/therapy , Electrocardiography , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Reoperation , Risk Assessment , Severity of Illness Index , Sick Sinus Syndrome/diagnosis , Treatment OutcomeABSTRACT
A 29-year-old man visited our office after experiencing palpitations at night. The electrocardiogram revealed premature ventricular contractions (PVCs), and he was admitted to our hospital for further tests. The echocardiography revealed paradoxical motion of the interventricular septum. After considering results from a previous cardiac catheter test, we suspected that the patient may have a congenital absence of the pericardium. A CT scan and magnetic resonance imaging were inconclusive, but through echocardiography and ECG performed during three positional changes we diagnosed a congenital absence of the pericardium.
Subject(s)
Echocardiography, Doppler/methods , Heart Defects, Congenital/diagnostic imaging , Pericardium/abnormalities , Pericardium/diagnostic imaging , Ventricular Premature Complexes/diagnosis , Adult , Follow-Up Studies , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Humans , Magnetic Resonance Imaging/methods , Male , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Tomography, X-Ray Computed/methods , Ventricular Premature Complexes/etiologyABSTRACT
We reported a 52-year-old woman with oculopharyngeal muscular dystrophy (OPMD) harboring expanded (GCG) 13 mutation of the poly (A) binding protein 2 gene. She presented not only ptosis and dysphagia but distal dominant muscle atrophy in four extremities. CT demonstrated distal muscle atrophy with marked fat replacement in the biceps femoris, semitendinosus, membraneous, soleus, and gastrocnemius muscles. Although OPMD is considered to be a muscle disease, this patient showed even neurogenic features in the electrophysiological and pathological findings. Although previous reports indicate that OPMD is genetically homogeneous disease, some cases with OPMD may show some atypical features associated with neurogenic involvement.
