Electrocoagulation Of Vascular Abnormalities Of The Large Bowel
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
This patient is thought to be bleeding from vascular abnormalities outside the large bowel. Because of his age and general medical condition, an attempt at eradicating them will not be made unless his anemia cannot be controlled with iron therapy. Case 11 : This 65-year-old woman was referred because of passing dark-red blood per rectum. The patient had suffered two myocardial infarctions, 6 and 4 years previously. Physical examination of the heart showed it to be enlarged with diminished heart sounds and no murmur. A colon X-ray was nondiagnostic. The electrocardiograph was abnormal because of right bundle-branch block. Colonoscopy showed a 5 mm bright-red lesion just below the ileocecal valve and somewhat lateral. A white fleck at the center suggested that it was eroded (Figure 6). The lesion was biopsied and destroyed in the usual fashion. Microscopic examination showed angiectasis. In addition, the ulcerated surface was confirmed. She has had no bleeding for 2½ years.
Acute Coronary Syndromes
Karim Ratib, Gurbir Bhatia, Neal Uren, James Nolan in Emergency Cardiology, 2010
In extensive anterior STEMI with involvement of the septum, ischaemic damage to the bundle of His may lead to left or right bundle branch block on the surface EGG. The development of left bundle branch block usually indicates that extensive myocardial necrosis has occurred, with associated significant left ventricular dysfunction and a poor prognosis. Right bundle branch block can occur with less extensive infarction, as can involvement of only the anterior fascicle of the left bundle, leading to left axis deviation. Patients who develop left bundle branch block in combination with a long PR interval, or the combination of right bundle branch block, left axis deviation and a long PR interval, have suffered extensive damage to their conduction system; such patients should be discussed with a senior colleague, as prophylactic temporary pacing may be indicated to avert the need for pacemaker insertion in a compromised patient if sudden complete heart block with a slow escape rhythm develops.
α1-Antitrypsin deficiency
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
Pulmonary disease is the most common expression of the PIZZ phenotype [29] (Figure 107.2). As many as 90 percent develop emphysema. It is classically early in onset, occurring at 20–40 years of age in smokers and 55 in nonsmokers [5, 30, 31]. It is referred to as chronic obstructive pulmonary disease or COPD. The earliest symptom is dyspnea on exertion. Cough develops in about half of the patients, and recurrent pulmonary infections are common. On examination, the patient may be thin, but the diameter of the chest is increased. Breath sounds are diminished, and the chest film reveals hyperinflation, especially in the bases. The diaphragms may be flattened. Pulmonary function tests are typical of severe emphysema consistent with a loss of pulmonary elastic recoil. Total lung capacity is impaired, as is residual volume. Air flow is limited, and diffusion capacity and maximum transpulmonary pressure are reduced. Mild hypoxemia at rest may increase with exercise. Hypocarbia and respiratory alkalosis may be associated with mild pulmonary hypertension. Electrocardiograms may show chronic strain on the right heart with right axis deviation and right atrial hypertrophy. There may be a right bundle branch block.
Assessment of the QT interval in right bundle branch block
Published in Acta Cardiologica, 2023
Patients with a diagnosis of ‘intermittent right bundle branch block’, that were confirmed by a reading cardiologist, were selected via an electronic search of an ECG data base, MUSE™ version 9.0 SP6 (General Electric, Milwaukee, WI, USA), during an arbitrarily selected 14-year period from 1 January 2004 to 31 March 2018. There were 322, 743 unique individuals in the data base during this time period. The diagnostic criteria for identification of RBBB were those of the algorithm in MUSE™TM version 9.0 SP6 (General Electric, Milwaukee, WI, USA). Inclusion criteria consisted of 12-lead ECGs with both narrow QRS complexes (<120 ms) as well as wide QRS complexes with RBBB morphology. Exclusion criteria consisted of ECGs rendering QT measurement unreliable specifically atrial fibrillation, atrial flutter or atrial tachycardia, artifacts, T-wave changes that rendered QT measurements unreliable, only one complex with normal QRS duration or RBBB morphology, or electronic pacemaker complexes.
Dorsolateral Prefrontal Cortex Impairment in Methoxetamine-Induced Psychosis: An 18F-FDG PET/CT Case Study
Published in Journal of Psychoactive Drugs, 2019
Lorenzo Moccia, Anna Tofani, Marianna Mazza, Marcello Covino, Giovanni Martinotti, Fabrizio Schifano, Luigi Janiri, Marco Di Nicola
One day, his mother found him unconscious in his room. He was immediately brought to the Emergency Department (ED), where physical examination and laboratory analysis revealed a state of acute kidney (serum creatinine: 2.34 mg/dL; serum cystatin C: 1.42 mg/dL; Urea: 55.8 mg/dL; CPK 17.000 U/L) and respiratory failure (arterial PaO2: 52 mmHg; arterial PaCO2: 50 mmHg). ECG also showed an incomplete right bundle branch block. Blood and urine samples were negative for ethanol, benzodiazepines, cannabinoids, cocaine, amphetamine, methadone, opioids, and tricyclic compounds. He was first managed with supportive care, including tracheal intubation and mechanical ventilation. Symptoms resolved after two weeks of treatment with atenolol 100 mg/d, clonidine 150 mg/d, nitrosorbide 40 mg/d, and hemodialysis. A 10 mL serum (kept at –20°C) sample collected at the ED was sent to the Pavia Poison Control Center, which used gas chromatography mass and liquid chromatography tandem mass spectrometry techniques to identify possible NPSs. MXE traces were confirmed within the patient’s blood serum at a dosage of 0.29 μg/ml, a concentration comparable with previous reports of nonfatal MXE intoxications (Zanda et al. 2016).
Limb-girdle muscular dystrophy type 2I: two Chinese families and a review in Asian patients
Published in International Journal of Neuroscience, 2018
Dan-Ni Wang, Zhi-Qiang Wang, Yu-Qing Chen, Guo-Rong Xu, Min-Ting Lin, Ning Wang
The patient displayed proximal muscle weakness starting at six years old. He fell down easily and exhibited difficulty in climbing stairs. His clinical course progressed slowly over the next two decades. He visited a primary hospital at the age of 16 and was considered as BMD without any treatments. He walked with a waddling gait at 24 years old, and came to visit our hospital. On the neurological examination, his neck flexion strength was grade 3/5. Muscle strength of upper limbs was grade 4∼5−/5 in the proximal muscles. Proximal muscle of lower limbs, especially the iliopsoas muscle and gluteus maximus, suffered severe weakness with the muscle strength grade 3−∼5−/5. The distal muscles of the limbs and neck extensor were normal. He had muscle atrophy in the shoulder girdle and the pelvic girdle limbs. Tongue and calf hypertrophy were also noted. The deep tendon reflexes were decreased diffusely. His 6 MWD was 409.5 meters. The serum CK level was 9425 U/L. Electrophysiological studies revealed normal peripheral motor and sensory conduction. Bilateral tibialis anterior, right quadriceps femoris, right deltoideus and right biceps brachii showed low amplitude and short duration of MUAPs on needle electromyography. The right tibialis anterior, right quadriceps femoris, right deltoideus and right biceps brachii showed an interference pattern of MUAP recruitment. Electrocardiogram showed complete right bundle branch block. Echocardiography revealed left ventricular dilatation with normal contractile function (LVEF: 56%). The patient never received any drugs for treatment. His parents were non-consanguineous. Neither his parents nor his three older sisters had ever been referred with evident muscle symptoms.
Related Knowledge Centers
- Bundle of His
- Congenital Heart Defect
- Purkinje Fibers
- Right Ventricular Hypertrophy
- Ventricle
- Cardiac Muscle
- Heart Block
- Cardiac Conduction System
- Bundle of His
- Qrs Complex
- Right Heart Strain