Implantation of DDD Pacemaker in a Patient With Dextrocardia and Sick Sinus Syndrome: A Case Report

Abstract Background: Dextrocardia is a congenital abnormal position of the heart in which the main part of the heart is in the right chest and the long axis of the heart points to the lower right, cases with combination of dextrocardia and sick sinus syndrome are rare.Case presentation: A 65-year-old female patient was admitted with palpitations and dizziness for 1 week. Mirror-image Dextrocardia and sick sinus syndrome was diagnosed by electrocardiogram (ECG), echocardiography, Holter monitoring, and X-ray. The rarity of the case and the specificity of anatomy brought great challenges to our interventional treatments. Finally, we successfully implanted a DDD pacemaker into the patient.Conclusion: For dextrocardia, using active fixation leads in both atrial and ventricular leads is easier to find the position with optimal sensing and pacing threshold, which also have a lower and more stable pacing threshold and can reduce the incidence of falling off at the same time. During operation, combine the multiple positions under fluoroscopy to confirm the leads position, which can improve the success rate of implantation.

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Are High Doses of Corticosteroids Protective in COVID-19 Patient With Panhypopituitarism?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1171 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A574-A574

Author(s):

Tina Ticinovic Kurir ◽

Maja Mizdrak ◽

Mladen Krnić

Keyword(s):

Clinical Course ◽

Protective Role ◽

Pathophysiological Mechanism ◽

Oxygen Supplementation ◽

Case Presentation ◽

X Ray ◽

High Doses ◽

Endothelium Damage ◽

The Right

Abstract Introduction: Clinical course of COVID-19 infection is diverse and the best therapeutical guidelines are still lacking. Case Presentation: We present a case of 73 year old male COVID-19 positive patient. In 2017 transnasal hypophysectomy was performed due to prolactinoma. He receives therapy (hydrocortisone 20 + 10 mg/day, levothyroxine 75/50 µg/day, bromocriptine 2.5 mg twice/day). He suffers also from arterial hypertension. Present illness started with intensive dry cough, fever (37.5◦C), diarrhoea and loss of smell. On the first day patient was febrile up to 38.4◦C and later afebrile. Laboratory parameters showed abnormalities in several parameters: D-dimers 13.45 (RR:< 0.50) mg/L, creatinine 110 (49-90) µmol/L, ALT 73 (12-28) U/L, LDH 531 (25-241) U/L, creatine kinase 549 (<177) U/L, GGT 277 (9-35) U/L, CRP 38 (<5 mg/L), sedimentation rate 40 (5-28) mm/3.6ks, procalcitonine 0.07 (<0.05) ng/ml, sodium 128 (137-146) mmol/L, hs-TroponinT 18 (< 14) ng/L, neutrophils 8.56 (2.06-6.49 x109/L), lymphocytes 0.52 (1.19-3.35 x109/L) and pO2 6.1 (11.0-14.4) kPa. At the admission X-ray showed normal presentation, while four days later on the right side pneumonia was noticed as spotty inhomogeneous shading. He was treated with azithromycin, hydrocortisone (50 mg twice/day) and oxygen supplementation. At the beginning of hospitalization he was addicted to O2 10-12 L/min. After 22 days of hospitalization he was discharged without any symptom but with still positive SARS-CoV2 swabs. After a 30 days of follow-up, his swabs are now negative with no laboratory abnormalities. In the meantime, his two brothers, born in 1945 and 1940 died due to COVID-19 infection. They did not receive substitutional corticosteroid therapy. Conclusion: The main pathophysiological mechanism of infection is explained by cytokine storm. Hypercytokinemia causes myelosuppression and vascular endothelium damage. Corticosteroids are potent anti-inflammatory agents. High-doses of corticosteroids might beneficially modulate the host immune response to SARS-CoV2 virus and have protective role in this patient.

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Permanent His-Bundle Pacing in the Right Atrium in a Patient With a Mobitz II Atrioventricular Block: A Case Presentation

10.21203/rs.3.rs-292797/v1 ◽

2021 ◽

Author(s):

Zaiqiang Zhang ◽

Jiawang Ding

Keyword(s):

Sick Sinus Syndrome ◽

Pacemaker Implantation ◽

Promising Alternative ◽

Case Presentation ◽

Right Ventricular Pacing ◽

His Bundle ◽

His Bundle Pacing ◽

History Of ◽

Optimal Approach ◽

The Right

Abstract Background: This case report presents a patient diagnosed with sick sinus syndrome who was successfully treated with permanent His-bundle pacing (PHBP).Case presentation: A 36-year-old man was transferred to our hospital due to recurrent syncope. He was diagnosed with sick sinus syndrome based on the 24-hour Holter and a history of syncope. He was admitted to hospital and successfully treated with PHBP. The postoperative examination showed that the pacing rhythm, pacemaker pacing and perception function were normal. He was discharged without any complications after a successful pacemaker implantation. Conclusions: We described a case in which PHBP may become an optimal approach to the management of patients with sick sinus syndrome. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with sick sinus syndrome.

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Polymicrobial Infection as a Rare Cause of Osteomyelitis: Case Presentation and Review of the Literature

Surgical Case Reports ◽

10.31487/j.scr.2021.03.08 ◽

2021 ◽

pp. 1-5

Author(s):

Mohs Elisabeth ◽

Darwich A ◽

Dally F ◽

Assaf E ◽

...

Keyword(s):

Chronic Osteomyelitis ◽

Hematogenous Spread ◽

Case Presentation ◽

X Ray ◽

Surgical Infection ◽

Infectious Focus ◽

Intravenous Antibiotics ◽

Local Trauma ◽

Oral Pathogens ◽

The Right

This case report presents a 48-year-old patient with suspicion for chronic osteomyelitis caused by oral pathogens including species of Actinomyces, Eikenella and Stenotrophomonas. The symptoms included progressive swelling of the right thigh and hyperpyrexia with up to 41°C. Imaging methods included standard X-ray as well as MRI. Furthermore, two operations were necessary for surgical infection therapy. Histological and microbiological investigations of intraoperative samples showed polymicrobial osteomyelitis. Since local trauma could be excluded as the cause for the disease, the patient’s dental status was evaluated and proved as the possible infectious focus with a hematogenous spread. The patient was treated with intravenous antibiotics for two weeks and oral antibiotics for four further weeks. The patient’s clinical condition drastically improved with that treatment.

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Topiramate-Induced Chest Pain: A Case Report

Journal of Pharmacy Practice ◽

10.1177/0897190017753922 ◽

2018 ◽

Vol 32 (2) ◽

pp. 236-239 ◽

Cited By ~ 1

Author(s):

Jared L. Ostroff ◽

Jessica N. LeClair (Barnet) ◽

Marissa L. Ostroff ◽

Corey S. Laskey

Keyword(s):

Adverse Effect ◽

Case Report ◽

Chest Pain ◽

Probability Scale ◽

Case Presentation ◽

X Ray ◽

Chest X Ray ◽

Basic Metabolic Panel ◽

Complete Blood Counts ◽

Electrocardiogram Ecg

Background: Topiramate, an anticonvulsant used for prophylaxis of migraines and epilepsy, is commonly associated with adverse effects of cognitive dulling and fatigue. Chest pain is a potential adverse effect that to our knowledge has not been reported with the use of topiramate. Case Presentation: We present the case of a 38-year-old female with a seizure disorder who experienced chest pain after the first dose of topiramate. On day 1, she presented to the emergency department, was admitted, and over the course of 3 days had a chest X-ray, electrocardiogram (ECG), and echocardiogram, and her vitals, basic metabolic panel, complete blood counts, troponin, and d-dimer levels were monitored. The chest pain improved when the topiramate was held. No identifiable causes of chest pain were apparent, other than the topiramate. Discussion: The Naranjo probability scale was utilized to determine the causality of topiramate. The resulting score of 3 indicates that it is possible that the chest pain was due to the topiramate. Conclusion: This report demonstrates an example of a patient who experienced chest pain possibly caused by the initiation of topiramate. The objective of this case report is to increase the awareness of chest pain as an adverse effect of topiramate.

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Dementia with aphasia and mirror phenomenon: examination of the mechanism using neuroimaging and neuropsychological findings: a case report

BMC Neurology ◽

10.1186/s12883-020-01994-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Aiko Osawa ◽

Shinichiro Maeshima ◽

Hidenori Arai ◽

Izumi Kondo

Keyword(s):

Parietal Lobe ◽

Underlying Mechanism ◽

Mirror Image ◽

Case Presentation ◽

Frontal Lobe Function ◽

Long Term Follow Up ◽

The Right ◽

Neuropsychological Findings

Abstract Background Aphasia often appears in persons living with dementia; however, aphasia and the mirror phenomenon are rarely present at the same time. Case presentation Here, we report a case of fluent conversation with a person in a mirror or a magazine, and examine the underlying mechanism using brain imaging and neuropsychological findings. We found that the appearance of the mirror phenomenon may be associated with a visuospatial dysfunction caused by a decreased function of the posterior region of the right temporal and parietal lobe. Moreover, active talking to a person in a mirror or a person in a magazine could be associated with disinhibition caused by a decline in bilateral frontal lobe function. Conclusions This case represents a very valuable and interesting presentation because it is the first report of a long-term follow-up of the course of dementia using neurological imaging, and of the neuropsychological analysis of the mechanism of conversation with a mirror image combined with aphasia.

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Some topical aspects of the problem of "athlete’s heart" (review). Part II

Bulletin physiology and pathology of respiration ◽

10.36604/1998-5029-2021-79-127-140 ◽

2021 ◽

pp. 127-140

Author(s):

Yu. V. Vakhnenko ◽

I. E. Dorovskikh ◽

E. N. Gordienko ◽

M. A. Chernykh

Keyword(s):

Cardiovascular System ◽

Sports Medicine ◽

Holter Monitoring ◽

Athlete’S Heart ◽

Connective Tissue Dysplasia ◽

The Right ◽

Intensive Work ◽

Electrocardiogram Ecg ◽

Athlete's Heart ◽

Wolff Parkinson White Syndrome

Electrocardiography occupies a special place among a significant list of other methods for diagnosing the pathology of the cardiovascular system of athletes. Often its results differ significantly from those in the general population, being a consequence of the adaptation of the heart to economical functioning at rest and super-intensive work in training and competitions. This review focuses on the features of the “athlete’s electrocardiogram (ECG)”. in particular, those changes that are not a reason for removing athletes from physical activity, but in combination with known factors can lead to more serious changes up to sudden cardiac death. Fatal rhythm disorders in athletes are described, possible in Wolff-Parkinson-White syndrome, syndrome of ion channel pathology, arrhythmogenic dysplasia of the right ventricle, etc. Particular attention is paid to arrhythmia due to connective tissue dysplasia syndrome. Knowledge of these issues is necessary to choose the right tactics for an athlete with changes to the electrocardiogram and in the protocol of daily Holter monitoring of the electrocardiogram, and a doctor related to sports medicine should be aware of the features of “electrophysiological remodeling” of the athlete’s heart, normal and pathological “sports electrocardiogram”, about conditions accompanied with the development of serious rhythm disorders and algorithms for examining the cardiovascular system of the athlete.

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Permanent His-bundle pacing in the right atrium in a patient with a Mobitz II atrioventricular block: a case presentation

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01747-w ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Zai-Qiang Zhang ◽

Jia-Wang Ding

Keyword(s):

Sick Sinus Syndrome ◽

Pacemaker Implantation ◽

Promising Alternative ◽

Case Presentation ◽

Right Ventricular Pacing ◽

His Bundle ◽

His Bundle Pacing ◽

History Of ◽

Optimal Approach ◽

The Right

Abstract Background This case report presents a patient diagnosed with sick sinus syndrome who was successfully treated with permanent His-bundle pacing (PHBP). Case presentation A 36-year-old man was transferred to our hospital due to recurrent syncope. He was diagnosed with sick sinus syndrome based on the 24-h Holter and a history of syncope. He was admitted to hospital and successfully treated with PHBP. The postoperative examination showed that the pacing rhythm, pacemaker pacing and perception function were normal. He was discharged without any complications after a successful pacemaker implantation. Conclusions We described a case in which PHBP may become an optimal approach to the management of patients with sick sinus syndrome. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with sick sinus syndrome.

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Low temperature x-ray microanalysis of frozen-hydrated tobacco leaves

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100111537 ◽

1984 ◽

Vol 42 ◽

pp. 284-285

Author(s):

S. Edith Taylor ◽

Patrick Echlin ◽

May McKoon ◽

Thomas L. Hayes

Keyword(s):

Low Temperature ◽

Lemna Minor ◽

Root Tips ◽

Tobacco Leaves ◽

X Ray ◽

Whole Cells ◽

Carbon Coated ◽

The Right ◽

Beam Currents ◽

The University

Low temperature x-ray microanalysis (LTXM) of solid biological materials has been documented for Lemna minor L. root tips. This discussion will be limited to a demonstration of LTXM for measuring relative elemental distributions of P,S,Cl and K species within whole cells of tobacco leaves.Mature Wisconsin-38 tobacco was grown in the greenhouse at the University of California, Berkeley and picked daily from the mid-stalk position (leaf #9). The tissue was excised from the right of the mid rib and rapidly frozen in liquid nitrogen slush. It was then placed into an Amray biochamber and maintained at 103K. Fracture faces of the tissue were prepared and carbon-coated in the biochamber. The prepared sample was transferred from the biochamber to the Amray 1000A SEM equipped with a cold stage to maintain low temperatures at 103K. Analyses were performed using a tungsten source with accelerating voltages of 17.5 to 20 KV and beam currents from 1-2nA.

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CLINICAL CASE OF A MALIGNANT PECOMA OF THE LUNG

Problems in oncology ◽

10.37469/0507-3758-2019-65-5-756-759 ◽

2019 ◽

Vol 65 (5) ◽

pp. 756-759

Author(s):

Mikhail Postolov ◽

Nadezhda Kovalenko ◽

K. Babina ◽

Stanislav Panin ◽

Yelena Levchenko ◽

...

Keyword(s):

Good Condition ◽

Lung Neoplasm ◽

Rare Condition ◽

Epithelioid Cell ◽

X Ray ◽

Perivascular Epithelioid Cell ◽

Mesenchymal Neoplasm ◽

Preoperative Ct ◽

Lymph Duct ◽

The Right

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm characterized by expression of both mela-nocytic and smooth muscle markers. Only 10 primary malignant lung PEComas have been reported up to date. We report a 59-year-old male who presented with a lung neoplasm, found during the routine X-ray examination. Preoperative CT-scan revealed the 3,5-cm-sized mass, located at the border of the upper, middle and lower lobes of the right lung. Patient underwent a thoracotomy, resection of the upper, middle and lower lobes of the right lung accompanied with mediastinal lymphadenectomy. After surgery, chylothorax was revealed. Conservative treatment was unsuccessful, so we performed laparoscopic clipping of the thoracic lymph duct. Patient was dismissed from hospital on the 10-th day after the second operation in good condition. In this report, we intend to increase the limited knowledge relating to natural history and optimal treatment of such a rare condition as a primary malignant lung PEComa.

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Embolization of the false lumen using IMPEDE-FX embolization plugs as part of treatment of an infrarenal post-dissection aneurysm: a case report

CVIR Endovascular ◽

10.1186/s42155-020-00183-6 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Anne-Jet S. Jansen ◽

Paul M. van Schaik ◽

Jasper M. Martens ◽

Michel M. P. J. Reijnen

Keyword(s):

Case Report ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

False Lumen ◽

True Lumen ◽

Case Presentation ◽

Type A Dissection ◽

Prospective Trials ◽

The Right ◽

Embolization Procedure

Abstract Background This case report demonstrates the value of IMPEDE-FX plugs in an embolization procedure of a false lumen of an infrarenal post-dissection aneurysm. Case presentation A 69-year-old patient was treated with mitral valve replacement, complicated by a Stanford type-A dissection. After 9 years he presented with an enlarging infrarenal post-dissection aneurysm. The false lumen was embolized using multiple IMPEDE-FX plugs as part of the treatment in addition to embolization of the inferior mesenteric artery and overstenting of the re-entry in the right iliac artery. At 15 months the CTA showed a fully thrombosed false lumen and remodeling of the true lumen. Conclusions The false lumen of an infrarenal post-dissection aneurysm can successfully be embolized using IMPEDE-FX embolization plugs as part of the treatment strategy. Prospective trials on patients with non-thrombosed false lumina are indicated.

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