scholarly journals Atypical location of Coumel Tachycardia in Adult: Case Report

2020 ◽  
Vol 33 (3) ◽  
pp. 170-175
Author(s):  
Raoni de Castro Galvão ◽  
João Paulo Velasco Pucci ◽  
Ofir Gomes Vieira
Keyword(s):  
Case Report ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Septal Region ◽  
Common Location ◽  
Conduction Pathway ◽  
Patient Reported ◽  
D Region ◽  
The Right ◽  
Retrograde Conduction

Coumel Tachycardia or Incessant Junctional Reentrant (IJRT) generally affects the infant-juvenile population and is characterized by tachycardia due to atrioventricular reentry (AV) mediated by an exclusive, slow, decremental retrograde conduction pathway mostly located in the posterosseptal region of the tricuspid ring. Case report: The present study reported the case of an adult, 49 years old, with IJRT of atypical location. The patient reported feeling palpitations for 5 years with worsening in the last 6 months. After one of his seizures, an electrocardiogram (ECG) documented tachycardia due to AV reentry with a long RP ‘interval. Subjected to an electrophysiological study, an accessory pathway of exclusive retrograde conduction with decreasing characteristics was observed, located in the right mid-septal region. There was easy induction of IJRT, remaining sustained throughout the study. A radiofrequency ablation was performed in the mid-septal D region with interruption of tachycardia, with no more atrioventricular retrograde conduction, the procedure ended without complications. Discussion: Interestingly, the case described differs both in terms of the age range of the most frequent involvement of the IJRT (children and young people), as well as the most common location of the accessory pathway (posterior and postero-septal region of the tricuspid ring). Ablation proved to be effective in this case and is the treatment of choice for IJRT despite the anomalous location of the accessory pathway (Middle-septal D: described in bibliographic reviews in only 7% of IJRT cases) and a potentially dangerous region due to proximity to the trunk of the His beam.

scholarly journals Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway and Atrial Flutter: A Case Report

2022 ◽  
Vol 1 ◽  
Author(s):  
Jogendra Singh ◽  
Dibyasundar Mahanta ◽  
Rudra Pratap Mahapatra ◽  
Debasis Acharya ◽  
Ramachandra Barik
Keyword(s):  
Case Report ◽  
Atrial Flutter ◽  
Mitral Stenosis ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Rheumatic Mitral Stenosis ◽  
Percutaneous Balloon ◽  
Mitral Valvotomy ◽  
The Right

A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had higher refractory period than atrioventricular node.

scholarly journals Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report

2015 ◽  
Vol 23 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Christopher A Harle ◽  
Alyson Listhaus ◽  
Constanza M Covarrubias ◽  
Siegfried OF Schmidt ◽  
Sean Mackey ◽  
...  
Keyword(s):  
Case Report ◽  
Electronic Health Record ◽  
Patient Reported Outcomes ◽  
System Development ◽  
Lessons Learned ◽  
Health Record ◽  
Patient Reported ◽  
Electronic Health ◽  
Clinical Tools ◽  
The Right

Abstract In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden.

scholarly journals Bilateral Paragangliomas in the Setting of Autonomic Dysfunction: A Case Report

2021 ◽  
pp. 790-794
Author(s):  
Jerry Shen ◽  
Angela Ryck ◽  
Iris Chan ◽  
Kaitlin S. McFadden ◽  
Anna D. Hohler
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Neck Pain ◽  
Female Patient ◽  
Arm Movement ◽  
Carotid Bifurcation ◽  
Large Mass ◽  
Unknown Etiology ◽  
Patient Reported ◽  
The Right

In 2018, a 59-year-old female patient presented with hoarseness in her voice, headache, intermittent pain in her right side, difficulty of right arm movement, left side neck pain, difficulty controlling hypertension of unknown etiology, and a large mass on the upper left side of her neck with a smaller mass on the right side. MRI of the neck revealed masses at each carotid bifurcation. These were determined to be bilateral paragangliomas. Paragangliomas are rare tumors, and bilateral ones tremendously so. The patient underwent radiation over 2 years, resulting in the successful shrinking and stabilization of both masses. Since completing radiation, the patient reported improvement in her memory, and her blood pressure has stabilized with medication.

scholarly journals Fibroadenoma in axillary supernumerary breast: case report

2005 ◽  
Vol 123 (5) ◽  
pp. 253-255 ◽  
Author(s):  
Délio Marques Conde ◽  
Renato Zocchio Torresan ◽  
Eiji Kashimoto ◽  
Luiz Eduardo Campos de Carvalho ◽  
Cássio Cardoso Filho
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Outpatient Clinic ◽  
Breast Tissue ◽  
Histopathological Examination ◽  
Local Pain ◽  
Gynecology And Obstetrics ◽  
Patient Reported ◽  
Design Case ◽  
The Right

CONTEXT: Supernumerary breast tissue may be affected by the same diseases and alterations that compromise topical breast tissue. Nevertheless, reports of fibroadenoma in supernumerary breast tissue in the axillae are rare. OBJECTIVE: To describe a case of fibroadenoma in an axillary supernumerary breast. DESIGN: Case report. CASE REPORT: A 39-year-old woman was referred to the gynecology and obstetrics outpatient clinic at Hospital Estadual Sumaré, complaining of bilateral axillary masses. The patient reported cosmetic problems and local pain and discomfort. On physical examination, alterations compatible with bilateral axillary accessory breasts, without palpable nodules, were observed. Supplementary examinations (mammography and ultrasonography) revealed a 1.1 cm mass in the right axillary breast. The patient underwent resection of the supernumerary breasts and histopathological examination revealed fibroadenoma of the right axillary breast tissue.

scholarly journals Infective endocarditis of an aortic bioprosthesis causing life-threatening incessant junctional tachycardia: a case report

2020 ◽  
Author(s):  
Quentin Chatelain ◽  
Andrea Carcaterra ◽  
Florian Rey ◽  
Haran Burri
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Electrophysiological Study ◽  
Atrioventricular Node ◽  
Transoesophageal Echocardiography ◽  
Junctional Ectopic Tachycardia ◽  
First Case ◽  
Intravenous Amiodarone ◽  
The Right

Abstract Background  Infective endocarditis with paravalvular abscess can be complicated by atrioventricular block (AVB), but junctional ectopic tachycardia (JET) has as yet never been described. Case summary  A 68-year-old male recently admitted with Staphylococcal aureus endocarditis of his aortic valve bioprosthesis, presented with a regular tachycardia at 240 b.p.m. with a pre-existent right bundle branch block pattern. Haemodynamic collapse necessitated electrical cardioversion, following which high-grade AVB was observed. Multiple recurrences of the same tachycardia required repeated electrical cardioversions and emergent electrophysiological study, which indicated JET. The tachycardia was unresponsive to overdrive pacing, adenosine and intravenous amiodarone, and external cardioversions. Radiofrequency catheter ablation of the atrioventricular node was performed emergently with interruption of the tachycardia. A temporary external pacemaker was implanted via a jugular route. The tachycardia recurred after 48 h at a slower rate, and the patient underwent redo ablation. Transoesophageal echocardiography revealed a pseudoaneurysm of the right sinus of Valsalva probably corresponding to an evacuated abscess. A permanent pacemaker was implanted after active infection had been ruled out. At 3 months of follow-up, the patient had complete AVB, without arrhythmia recurrence. Discussion  This is the first case report of JET complicating a paravalvular abscess of the aortic valve with concomitant AVB. Junctional ectopic tachycardia is very rare arrhythmia which is usually seen in children as a congenital arrhythmia or following surgical correction of paediatric heart disease. The differential diagnosis is discussed in detail in the article.

Gastric carcinoma metastasis to the palatine tonsil – case report

2020 ◽  
Vol 9 (1) ◽  
pp. 50-53
Author(s):  
Dariusz Kaczmarczyk ◽  
Dawid Zagacki ◽  
Marcin Braun ◽  
Alina Morawiec-Sztandera
Keyword(s):  
Case Report ◽  
Gastric Carcinoma ◽  
Lymph Nodes ◽  
Metastatic Tumor ◽  
Palatine Tonsil ◽  
Medical Documentation ◽  
Histopathological Finding ◽  
Patient Reported ◽  
The Right ◽  
Pharyngeal Tonsil

<b>Aim:</b> The aim of the study is to present a rare case of metastatic tumor localized in pharyngeal tonsil being the first symptom of gastric carcinoma. <br><b>Case report:</b> Retrospective analysis of medical documentation was performed. A 44-years-old men was referred to the Department presenting a complaint of enlarged right pharyngeal tonsil. The mass was not painful. Patient reported tobacco smoking (20/day) for many years. In the intraoral examination a 2 cm right palatine tonsil was present. There was a slight asymmetry between tonsils. Local lymph nodes were not enlarged. FNAC was performed stating suspicion of carcinoma. Patient was qualified for the tonsillectomy under general anesthesia. Histopathological finding was adenocarcinoma (G2) infiltration. Due to no correlation of clinical presentation and histopathological finding PET-CT examination was performed revealing massive gastric infiltration, tumor of the left adrenal gland, increased 18-FDG uptake in epigastrial and para-aortic lymph nodes. Gastroscopy and biopsy was performed. Histopathological material confirmed adenocarcinoma presenting the same immunotype as tonsillar. Patient was qualified for paliative treatment. He died 6 weeks after stating the diagnosis. Metastases to the pharyngeal tonsils constitute rare disease entities. Mostly the primary site is localized in the region of head and neck. In our case the metastatic tumor of the right tonsil was the first sign of the gastric cancer.

scholarly journals Reduction en masse of inguinal hernia after self-reduction: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Khosrow Najjari ◽  
Hossein zabihi Mahmoudabadi ◽  
Seyed Zeynab Seyedjavadeyn ◽  
Reza Hajebi
Keyword(s):  
Case Report ◽  
Inguinal Hernia ◽  
Ct Scan ◽  
Lower Quadrant ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Patient Reported ◽  
History Of ◽  
Old Persian ◽  
The Right

Abstract Background Reduction en mass (REM) is one of the rare complications of inguinal hernia reduction. Although REM can be detected on the basis of specific computed tomography (CT) scan findings, many radiologists are not familiar with its radiological appearance because of the scarcity of this complication, which may cause a delay in diagnosis. Case presentation The patient reported in this article was a 50-year-old Persian man with a history of inguinal hernia, who had been referred with the periumbilical pain that radiated to the right lower quadrant and developed following hernia replacement by the patient himself. REM diagnosis was based on clinical examination and CT scan findings, and surgical treatment was performed by the Lichtenstein repair and mesh implantation. Conclusions Although REM usually occurs after reduction with compression in the inguinal hernia, this unique case report highlighted the possibility of REM after self-reduction. Surgeons and radiologists should consider REM in patients with a history of inguinal hernia presenting with intestinal obstruction symptoms, even without any apparent signs of hernia in the physical examination.

scholarly journals 786 A case of end-stage mitochondrial cardiomyopathy undergoing heart and kidney transplantation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Davide Diana ◽  
Giovanni Diana ◽  
Vincenzo Polizzi ◽  
Fabio Sbaraglia ◽  
Carla Giordano ◽  
...  
Keyword(s):  
Family History ◽  
Right Ventricle ◽  
Systolic Function ◽  
Electrophysiological Study ◽  
Correct Diagnosis ◽  
Accessory Pathway ◽  
Mitochondrial Diseases ◽  
Left Ventricular ◽  
Orthotopic Heart Transplant ◽  
The Right

Abstract Male, 46 year old. Family history: brother affected by deafness and repeated episodes of stroke at a young age. Pathological history: history of competitive sporting activity in which he underwent periodic outpatient checks and reported sporadic myalgic episodes. The patient was suffering from bilateral keratoconus. For the purpose of discovering Wolf–Parkinson–White syndrome with the presence of a right antero-septal accessory pathway, he underwent an electrophysiological study (2003) negative for inducible arrhythmias. During a routine checkup, a renal biopsy was performed to search for elevated blood creatinine, which concluded with acute interstitial nephritis (2005), treated ineffectively with steroids and resulted in dialysis-dependent stage V renal failure (2020). Following light tiredness, he underwent an echocardiographic examination (2009) which revealed the presence of dilated heart disease with reduced left ventricular systolic function. He underwent a cardiac MRI which showed diffuse spots of subepicardial late enhancement as a possible post-myocarditis outcome. At subsequent clinical-echocardiographic checks, progressive biventricular dysfunction, and signs of congestive heart failure were highlighted, for which medical therapy was progressively increased and insertion of an implantable cardioverter defibrillator in primary prevention for sudden cardiac death. At the subsequent clinical re-evaluations, there was evidence of progressive bilateral hearing loss. In consideration of the clinical picture and family history, considering the syndromic nature of the polypathologies to be likely, genetic investigation was required for mitochondrial diseases. Mutations 3242 and 3271mt-RNA and 13513 mtND5, frequent in the MELAS Syndrome, were searched in peripheral venous samples and resulted as negative. In 2020 he underwent an orthotopic heart transplant sec. Shamway followed by a kidney transplant from a compatible donor. In order to perform further diagnostic investigations, the explanted heart was sent to the Pathological Anatomy laboratory of the Umberto I Hospital: macroscopic analysis showed foci of fat replacement at the level of the anterior and posterior wall of the right ventricle (Figure); under microscopy, marked myocardial hypertrophy was observed, associated with cytoplasmic vacuolization of the cardiomyocytes, fibro-adipose substitution of the right ventricle, and replacement fibrosis in minute foci in the left ventricular level. A widespread and marked reduction in the enzymatic activity of cytochrome oxidase in cardiomyocytes and mitochondrial proliferation was demonstrated using histo-enzymatic staining, by staining for succinate dehydrogenase, concluding with mitochondrial disease. Mitochondrial diseases represent a challenge not only from the prognostic–therapeutic point of view but, remarkably, also from a diagnostic one: the patient received a correct diagnosis of the pathology that afflicted him, with almost two decades of delay. The integrated and multidisciplinary approach is desirable in order to obtain an early diagnosis.

scholarly journals Optic neuropathy secondary to probable optic nerve glioma: case report

2021 ◽  
Author(s):  
Mariana Gurgel Carvalho de Souza ◽  
Deibi Solano de Araújo Dantas ◽  
Luciano Gonçalves do Nascimento Júnior ◽  
Paulo Francisco Lucena de Araújo Espínola ◽  
Isabella Wanderley de Queiroga Evangelista
Keyword(s):  
Case Report ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Multidisciplinary Care ◽  
Optic Nerve Glioma ◽  
Patient Reported ◽  
Specialized Care ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Black School

Introduction: Optic neuropathies are a group of pathologies that course with potentially irreversible visual dysfunction. Among compressive causes, optic nerve glioma (GNO) is one of the main ones. Case report: A 12-year-old black school-age female patient seen in February 2020, reported progressive low visual acuity on the right eye (RE) for 6 years. Ectoscopy revealed café au lait spots all over body and hyperchromic nodular lesion in left axilla. Ophthalmologic examination showed acuity of 20/400 in RE and 20/20 in the left eye (LE), relative afferent pupillary defect in RE. At biomicroscopy, irian Lisch nodules. Magnetic resonance imaging (MRI) showed fusiform thickening of intraorbital portion of right optic nerve (ON) with mild enhancement upon gadolinium infusion. Optic neuropathy was secondary to probable GNO. Ophthalmology and neurology management was expectant. Upon return, patient reported intermittent headache and functional and aesthetic discomfort due to axillary lesion, and presented a new MRI with findings similar to the first. Simple retinography showed global pallor in right ON and temporal pallor of left ON. Conclusion: The case presented, in which delay in access to specialized care resulted in blindness, highlights the importance of ophthalmologic screening in NF1. Manifestations resulting from the syndrome, with biopsychosocial repercussions, emphasize importance of multidisciplinary care.

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