A case report of a patient with wide complex tachycardia due to Wolff–Parkinson–White syndrome mimicking ventricular tachycardia

Abstract Background Wide complex tachycardia (WCT) associated with syncope as manifestation of an underlying, life-threatening arrhythmia might potentially be the harbinger of sudden cardiac death. Identifying the aetiology of a WCT is imperative to provide appropriate treatment and prevent recurrence. Case summary We report the case of a 22-year-old male who had been experiencing haemodynamically significant WCT leading to syncope at the age of 13 years. As the patient and the family rejected an electrophysiological (EP) study, he had received an implantable cardioverter-defibrillator (ICD) for secondary prevention. After 7 years of experiencing multiple shocks, the patient finally gave consent to an EP study, which identified a left-sided accessory atrioventricular pathway that was successfully ablated during the same procedure. Discussion The differential diagnosis of WCT might be challenging and includes both ventricular and supraventricular tachycardias. In young patients without structural heart disease experiencing WCT, an EP study should be offered before ICD implantation to make a final diagnosis with the potential to provide definitive treatment.

Download Full-text

A Surprising Twist to an Old Problem: Sigmoid Volvulus in a 19-Year-Old Man

The American Surgeon ◽

10.1177/000313480707300319 ◽

2007 ◽

Vol 73 (3) ◽

pp. 284-286 ◽

Cited By ~ 2

Author(s):

Nathan L. Salinas ◽

Shamus R. Carr ◽

Dale Han ◽

Najjia N. Mahmoud

Keyword(s):

Nonoperative Management ◽

Young Patients ◽

Sigmoid Volvulus ◽

Definitive Treatment ◽

Adolescent Patient ◽

Abdominal Ct ◽

Abdominal Ct Scan ◽

Life Threatening ◽

Complicating Factors ◽

Eighth Decade

Sigmoid volvulus classically presents in the seventh or eighth decade, therefore, diagnosis of sigmoid volvulus in an adolescent may be delayed or missed. This life-threatening diagnosis should be considered in young patients presenting with abdominal pain, nausea, vomiting, and constipation. Intraoperative findings in a 19-year-old man with a sigmoid volvulus highlight the importance of considering further studies, such as an abdominal CT scan, which goes beyond the typical obstruction evaluation in the adolescent patient. When nonoperative management fails to decompress the volvulus, complicating factors should be considered, and laparotomy is indicated to provide definitive treatment for this condition.

Download Full-text

Specific diseases: arrhythmias

ESC CardioMed ◽

10.1093/med/9780198784906.003.0642 ◽

2018 ◽

pp. 2668-2670

Author(s):

Evi Christodoulou ◽

Susanna Price

Keyword(s):

Cardiac Rhythm ◽

Surgical Stress ◽

Perioperative Complications ◽

Structural Heart Disease ◽

Conduction Disturbances ◽

Multiple Factors ◽

Periprocedural Management ◽

Cardiac Implantable Electronic Devices ◽

Appropriate Treatment ◽

Life Threatening

Arrhythmias and conduction disturbances are common in the perioperative setting of non-cardiac surgery, as multiple factors can contribute to transient physiological imbalance during surgical stress. They represent an important cause of perioperative complications and increase the length and cost of hospitalization. Arrhythmias are usually of supraventricular origin and the patient should be investigated for underlying primary cardiac aetiology and structural heart disease according to the arrhythmia’s origin and risk stratification. Most are benign, without significant haemodynamic consequences and do not require treatment. Others can be life-threatening, where immediate pharmacological treatment and/or cardioversion is mandatory. The ideal perioperative management derives from a multidisciplinary approach but this is often not feasible. As a result, anaesthesiologists and other perioperative physicians need to be equipped with the knowledge and ability to differentiate cardiac rhythm patterns as well as to be able to associate them with the effects of anaesthetic pharmacology and other periprocedural interventions. Decisions regarding appropriate treatment should be based on knowledge of the risks and benefits of antiarrhythmic drugs and other antiarrhythmic practices. Periprocedural disturbances of rhythm and conduction and their basic management are analysed in this chapter as well as basic principles of periprocedural management of cardiac implantable electronic devices.

Download Full-text

Abdominal Pain

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000042 ◽

2014 ◽

Vol 25 (3) ◽

pp. 266-278 ◽

Cited By ~ 1

Author(s):

Helen F. Brown ◽

Lynn Kelso

Keyword(s):

Abdominal Pain ◽

Patient Outcomes ◽

Systematic Approach ◽

Acute Abdominal Pain ◽

Final Diagnosis ◽

Multiple Organ ◽

Appropriate Treatment ◽

Organ Systems ◽

Life Threatening ◽

Cardinal Symptom

Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician’s goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.

Download Full-text

Management of Patient with Aggressive Periodontitis by Orthodontic and Prosthodontic Collaboration

DENTA ◽

10.30649/denta.v11i1.132 ◽

2017 ◽

Vol 11 (1) ◽

pp. 80

Author(s):

Chaterina Diyah Nanik K ◽

Anindita Apsari

Keyword(s):

Orthodontic Treatment ◽

Young Patients ◽

Interdisciplinary Approach ◽

Aggressive Periodontitis ◽

Definitive Treatment ◽

Dental Arch ◽

Preliminary Treatment ◽

Young Adult Patient ◽

Anterior Teeth ◽

Long Span Bridge

Background: One of the most common inflammation disease in the oral cavity for the past few years is the aggressive form of periodontitis. Common signs of aggressive periodontitis is the mobility of teeth especially in incisive and first molars, and occuring mostly in young patient. Young patients whose losing her anterior teeth, are a real challenge for dentist and prosthodontist. Prosthodontist need to consider both functional and esthetic aspects. Objective: Rehabilitation of young adult patient with aggressive periodontitis by an interdisciplinary approach of orthodontist and prosthodontist. Case Description: A young woman, suffered from aggressive periodontitis with major complain of her teeth mobility, especially incisive and first molar in mandible. She had undergone periodontal treatment, but the result was failed. The anterior teeth in mandible need to be extracted, therefore patient wished not to be in edentulous state. As preliminary treatment, we choose immediate denture to replace the anterior mandible teeth. We faced difficulties in mandible, because her right canine weren’t in the proper dental arch. So we asked orthodontist to place fixed orthodontics in mandible, to get the canine back in the proper arch. We’ve chosen orthodontic treatment,because we didn’t want to extract the canine teeth. We evaluated in six months and after the canine back in the proper arch, we proceed to long span bridge in mandible as our definitive treatment. Conclusion: By not extracting the canine teeth, we got some advantages, especially patient psychically was happier with her own teeth. The collaboration with another dentistry field, provides us better treatment for patient. After treatment, patient had no complaints and was happy with her new smile.Keywords: Prosthodontic rehabilitation, aggressive periodontitis, orthodontic treatment, esthetic.Correspondence: Chaterina Diyah Nanik. K; Department of Prostodontitics, Faculty of Dentistry, Hang Tuah University, Arif Rahman Hakim 150, Surabaya; Phone 031-5912191, Email: <a href="mailto:[email protected]">[email protected]</a>

Download Full-text

Of Love and Laetrile: Medical Decision Making in a Child's Best Interests

American Journal of Law & Medicine ◽

10.1017/s0098858800005013 ◽

1979 ◽

Vol 5 (3) ◽

pp. 269-294

Author(s):

Eve T. Horwitz

Keyword(s):

Decision Making ◽

Medical Treatment ◽

Burden Of Proof ◽

State Intervention ◽

Convincing Evidence ◽

State Agency ◽

Best Interests ◽

Medical Decision ◽

Appropriate Treatment ◽

Life Threatening

AbstractTwo recent cases have raised important questions concerning the appropriateness of state intervention in parental choices of unorthodox medical treatment for children with life-threatening conditions. This Note first discusses whether, and if so, when, state intervention in a child's treatment selection by its parents is appropriate, and then analyzes the tests a court should apply in deciding upon an appropriate treatment. The Note recommends a decision-making approach that requires the appropriate state agency to prove, by clear and convincing evidence, that the parents' choice of medical treatment either is directly or is indirectly harming their child. Under this approach, if the state meets its burden of proof the court then must apply the ‘best interests’ test, rather than the ‘substituted judgment’ test, to choose an appropriate medical treatment for the child.

Download Full-text

An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

Archives of Physiotherapy ◽

10.1186/s40945-021-00099-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lorenzo Storari ◽

Valerio Barbari ◽

Fabrizio Brindisino ◽

Marco Testa ◽

Maselli Filippo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Visceral Pain ◽

Signs And Symptoms ◽

Final Diagnosis ◽

Outpatient Setting ◽

Direct Access ◽

Life Threatening ◽

Medical Referral

Abstract Background Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. Case presentation A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. Conclusion This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.

Download Full-text

Pyriform sinus rupture caused by blunt trauma

The Neuroradiology Journal ◽

10.1177/1971400920975165 ◽

2020 ◽

pp. 197140092097516

Author(s):

Emil Jernstedt Barkovich ◽

M Reza Taheri

Keyword(s):

Blunt Trauma ◽

Pyriform Sinus ◽

Significant Heterogeneity ◽

Cervical Trauma ◽

Specific Location ◽

Appropriate Treatment ◽

Threatening Condition ◽

Pharyngeal Perforation ◽

Life Threatening ◽

Foreign Body Impaction

Hypopharyngeal perforation (HP) is a potentially life-threatening condition most associated with iatrogenic injury and foreign body impaction. Additionally, a number of cases of posterior HP have been reported following blunt cervical trauma. We present a case of a construction accident causing lateral hypopharyngeal rupture. Visceral perforation was initially diagnosed on computed tomography (CT) imaging and managed conservatively. We speculate this region may be particularly vulnerable to injury due to an anatomic transition in adjacent fascial support. A review of 29 prior cases suggests that this may be the first reported case of blunt trauma causing rupture of the pyriform sinus. However, significant heterogeneity exists in diagnostic approach. Radiography and CT are rapid, sensitive modalities for suggesting pharyngeal perforation, while fluoroscopy and endoscopy can better assess injury size and location and monitor resolution. Early radiologic recognition of hypopharyngeal injury is essential to initiate appropriate treatment. In certain cases, including our own, both the presence and specific location of perforation may be identified on initial CT images.

Download Full-text

Report of a Rare Case of Trauma-Induced Thyroid Storm

Ear Nose & Throat Journal ◽

10.1177/014556130208100820 ◽

2002 ◽

Vol 81 (8) ◽

pp. 570-574 ◽

Cited By ~ 16

Author(s):

Neil M. Vora ◽

Fred Fedok ◽

Brendan C. Stack

Keyword(s):

Nervous System ◽

Rare Case ◽

Hepatic Dysfunction ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Definitive Treatment ◽

Thyroid Storm ◽

Vehicle Accident ◽

Hyperthyroid State ◽

Life Threatening

Thyroid storm is a potentially life-threatening endocrinologic emergency characterized by an exacerbation of a hyperthyroid state. Several inciting factors can instigate the conversion of thyrotoxicosis to thyroid storm; trauma is one such trigger, but it is rare. Patients with thyroid storm can manifest fever, nervous system disorders, gastrointestinal or hepatic dysfunction (e.g., nausea, vomiting, diarrhea, and/or jaundice), and arrhythmia and other cardiovascular abnormalities. Treatment of thyroid storm is multimodal and is best managed by the endocrinologist and medical intensivist. Initial medical and supportive therapies are directed at stabilizing the patient, correcting the hyperthyroid state, managing the systemic decompensation, and treating the underlying cause. Once this has been achieved, definitive treatment in the form of radioactive ablation or surgery should be undertaken. We describe a case of thyroid storm in a young man that was precipitated by a motor vehicle accident.

Download Full-text

Developmental Anomalies of Permanent Lateral Incisors in Young Patients

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.33.3.c74j49r738676671 ◽

2009 ◽

Vol 33 (3) ◽

pp. 211-216 ◽

Cited By ~ 9

Author(s):

Yuko Fujita ◽

Akiko Hidaka ◽

Ikuko Nishida ◽

Kazumasa Morikawa ◽

Daisuke Hashiguchi ◽

...

Keyword(s):

Young Patients ◽

Pediatric Dentistry ◽

Optimal Time ◽

Prevalence Rates ◽

Supernumerary Tooth ◽

Japanese Children ◽

College Hospital ◽

Developmental Anomalies ◽

Dental Clinics ◽

Appropriate Treatment

Objective: To elucidate the prevalence of developmental anomalies of permanent lateral incisors among young patients in Japan. Study deign: A total of 1375 patients were observed between 1990 and 2008 at the Department of Pediatric Dentistry in the Kyushu Dental College Hospital and four private pediatric dental clinics in Kitakyushu City. Panoramic and periapical radiographs were examined for all those patients aged 5 to 19 years. Results: The prevalence of agenesis of the lateral incisors was 7.3% (100 patients), with more girls than boys being affected. The prevalence rates of absent upper and lower lateral incisors were 2.7 and 4.8 % (34 and 63 patients), respectively. Nine (0.7 %) of the total patients had microdontia. Eruption disturbance was present in five patients (0.4 %). Two of five patients presented with a disturbed eruption owing to an odontoma or a supernumerary tooth. Conclusion: In our study, the prevalence of agenesis of the lateral incisors was higher in Japanese children than in other populations, and eruption disturbance occurred less frequently than agenesis and microdontia. Nevertheless, the early differential diagnosis of an eruption disturbance is important in order to begin appropriate treatment at the optimal time.

Download Full-text

Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

Case Reports in Medicine ◽

10.1155/2017/4895736 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Shih Yea Sylvia Wu ◽

Bridget Faire ◽

Edward Gane

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Kidney Injury ◽

Complete Recovery ◽

Final Diagnosis ◽

Community Acquired Pneumonia ◽

Drug Induced ◽

First Case ◽

Life Threatening

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

Download Full-text