ABSTRACT
We report a case of a 7-year-old girl with atriofascicular Mahaim (AFM) pathway concomitant with Ebstein's anomaly. The QRS wave showed left bundle branch block pattern on electrocardiogram. Holter electrocardiogram showed prolongation of the PR interval and QRS morphological change during sinus tachycardia. An electrophysiological study demonstrated that the distal His potential appeared earlier than the proximal His potential, which suggested retrograde His conduction toward the atrioventricular node. Conduction from the Mahaim fiber to the His bundle was faster than that from the atrioventricular node towards the His bundle. The findings of this important case allowed a differential diagnosis between AFM and Wolff-Parkinson-White (WPW) syndrome.
ABSTRACT
We conducted this study to identify the clinical features and risk factors for atypical acute post-streptococcal glomerulonephritis (APSGN). Thirty-five cases of atypical APSGN treated at Srinagarind Hospital during 2002-2009 were compared with 27 typical cases. The clinical symptoms, anti-streptococcal antibody titers, and laboratory data at the first hospital visit were compared between the two groups. A marked elevation in anti-streptolysin O (ASO) titer was seen more commonly in the atypical APSGN group than in the typical APSGN group (p=0.025). Significantly more patients in the atypical APSGN group had a high urine specific gravity, hematuria and pyuria than patients in the typical APSGN group (p<0.01, p<0.031, and p<0.046, respectively). A high ASO titer, high urine specific gravity, severe hematuria and pyuria early in the illness were suggestive of a higher risk for an atypical presentation.