A case report of stomach perforation during automatic mechanical chest compression following pulseless electrical activity due to cibenzoline intoxication.

BACKGROUND: The current report describes a case of stomach perforation, a rare but serious complication, that occurred during cardiopulmonary resuscitation following severe cibenzoline intoxication. CASE PRESENTATION: A woman aged in her 30s was brought into our hospital while receiving cardiopulmonary resuscitation for pulseless electrical activity. After starting extracorporeal membrane oxygenation (ECMO), her abdominal X-ray examination revealed free air in her abdomen. She was diagnosed with internal gastric perforation. An emergency operation was carried out while the circulation was maintained using ECMO. As the patient's blood cibenzoline concentration on admission was 3,868 ng/mL, she was diagnosed with cibenzoline intoxication caused by the self-intake of twice the prescribed dose. She was successfully weaned off ECMO and discharged alive with full recovery. CONCLUSION: We successfully treated a case of gastric perforation after pulseless electrical activity requiring ECMO support due to cibenzoline intoxication. Abdominal surgery can be carried out even if ECMO support is needed.

Spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma.

We present a case of spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma. A 50-year-old Japanese man was transferred to our hospital diagnosed with ventricular septal lacerations after blunt chest trauma. Electrocardiogram (ECG) at admission showed ST elevations in I, II, III, aVL, aVF, V2-through to V6 were observed. Laboratory data showed elevated creatine kinase. Echocardiogram revealed normal ventricular contraction and a saccular type ventricular septal laceration with an influx blood flow without septal shunt flow. After admission, serial echocardiogram and cardiac computed enhancement tomography showed disappearance of a saccular type ventricular septal laceration. Gadolinium-enhanced magnetic resonance imaging (MRI) was performed at day 30. MRI showed an enhanced scar of saccular type aneurysm with ventricular septal laceration; this image suggested some residual damage of ventricular septal laceration. At discharge, ECG was resolved with normal ST-T level and no Q wave, but persistent complete right bundle branch block and left axis deviation. After one year, repeat MRI showed a scar of saccular type aneurysm with ventricular septal laceration. .

Effective delayed percutaneous coronary intervention for advanced atrial ventricular block in patients with recent myocardial infarction.

We present a case of effective late reperfusion for atrio-ventricular conduction recovery in a patient with recent myocardial infarction complicated by advanced atrio-ventricular block (AVB). A 50-year-old Japanese man was transferred to our hospital with a recent diagnosis of myocardial infarction 44 h after onset. We performed emergent coronary angiography on Day 5 because he developed bradycardia with two to one advanced AVB resistant to atropine without chest pain or ST-T changes. Coronary angiography showed the right coronary artery (RCA) with total proximal occlusion. Emergent percutaneous coronary intervention (PCI) was performed to the RCA. Just after PCI, the PR interval was shortened to 0.25 s. Moreover, the PR interval was shortened to 0.18 s at Day 16. This report shows the new finding that delayed PCI may be effective in patients with recent myocardial infarction complicated by new AVB outside of the usual therapeutic window of 12 h.