1/7. Recurrent transient ischemic attacks as the initial presenting manifestation of type A aortic dissection.A case is reported of an 84-year-old woman with recurrent episodes of aphasia and right-sided weakness with spontaneous complete resolution associated with hypotension. She subsequently developed lower gastrointestinal bleeding, ischemic toes, and anuria without associated chest pain. An emergent transesophageal echocardiography showed a type A aortic dissection with aortic valve insufficiency and tamponade. Emergent thoracotomy was performed, which confirmed a severe acute type A aortic dissection. This is a reported case of acute painless aortic dissection presenting initially as recurrent transient ischemic attacks. The etiology of focal neurologic deficits should be crucially determined by an experienced clinician prior to thrombolytic administration. This case illustrates the importance of aortic disease in the etiology of acute stroke syndromes.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/7. Huge prosthetic mitral valve thrombus: use of serial transesophageal echocardiography guidance in resolution.The case is presented of a 35-year-old woman with major thrombotic obstruction of a 29-mm St. Jude Medical mitral valve prosthesis. The thrombi were treated with successive intravenous fibrinolysis under transesophageal echocardiographic guidance, without complication. One large and obstructive thrombus with a long and mobile component, and other smaller and mobile thrombi were detected. These were gradually lysed after two successive administrations of streptokinase (1.5 x 10(6) units over 24 h), and one session of recombinant tissue type plasminogen inhibitor (100 mg over 6 h).- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/7. Neurologic and cardiac progression of glycogenosis type VII over an eight-year period.Little is known about the progression of phosphofructokinase deficiency (glycogenosis type VII, Tarui's disease). We describe a 66-year-old woman who had this disease diagnosed in 1997. Initial manifestations had included simple partial seizures since 1977, anginal chest pain since 1982, and muscle cramps since 1983. To prevent recurrent myocardial infarction, anticoagulation therapy with phenprocumon was initiated. Cardiac involvement progressed over an 8-year period, manifesting as low-voltage electrocardiogram (ECG), ectopic supraventricular tachycardia, thickened mitral valve, mitral valve insufficiency, enlarged left atrium, left ventricular hypertrophy, and diastolic dysfunction. Progression of neurologic involvement manifested as complex partial seizures, double vision, reduced tendon reflexes, central facial palsy, bradydiadochokinesia, and distal weakness of the upper extremities. Discontinuance of oral anticoagulation after 19 years, initiation of enalapril therapy, and administration of carbamazepine markedly improved the patient's condition.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/7. Infective endocarditis with an aortic periannular abscess extending along the right coronary artery.A 50-year-old male underwent surgery for infective aortic valve endocarditis, which had been refractory to medical treatment. The valve was bicuspid, and involvement of the annular and subannular structures was recognized. A large suppurative discharge was obtained on incising this portion. Although there was no interventricular shunt, the abscess cavity was revealed to extend through the epicardial surface of the right atrioventricular groove. Following extensive debridement and irrigation, the defect was closed by an autologous pericardial patch. A 23 mm mechanical valve was implanted placing some of the stitches deep into the muscular interventricular septum. infection was controlled by six-week administration of cefazolin sodium and gentamicin sulfate, and the patient survived.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/7. pregnancy and successful delivery in a patient with triple heart valve prosthesis.A 42-year-old patient had a history of rheumatic fever in childhood. At 37 years of age, she underwent a triple heart valve replacement; thereafter, she was followed with the administration of warfarin and methyldigoxin. Her third pregnancy occurred with the last menstruation on 12 March 1990. At the 30th gestational week, she was admitted to the Nagoya University Hospital for the control of anticoagulation and rest. She delivered by cesarean section a healthy male infant weighing 2070 g at 34 weeks of gestation. The post-operative course was uneventful. This report shows that a patient with a three heart valve prosthesis tolerated pregnancy well under intense medical supervision.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/7. endocarditis due to pseudomonas aeruginosa in a heroin addict. Successful treatment with trimethoprim-sulfamethoxazole mixture plus colistin.endocarditis of the tricuspid valve due to pseudomonas aeruginosa in a heroin addict failed to respond to therapy with gentamicin, carbenicillin, and amikacin. Clinical and bacteriologic cure was achieved with oral administration of a trimethoprim-sulfamethoxazole mixture plus parenteral therapy with colistin. in vitro synergism was demonstrated for the three drugs at concentrations achievable in the serum. Therapy for endocarditis due to Pseudomonas continues to be a major problem; however, the successful treatment of this patient warrants consideration for instituting therapy with a trimethoprim-sulfamethoxazole misture plus colistin in individuals with this infection who fail to respond to standard therapeutic regimens for severe infections with Pseudomonas.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/7. bradycardia with mitral valve prolapse: a potential mechanism of sudden death.Eleven members of a family with a high prevalence of mitral valve prolapse were investigated. Seven had documented sinus bradycardia, and five had mitral valve prolapse. Three patients with both mitral valve prolapse and bradycardia had recurrent syncope reproduced by simple head-up tilting, and in one patient this resulted in asystole. The hemodynamic response to isoproterenol and phenylephrine administration were normal. Supine plasma norepinephrine levels were normal in all three and increased appropriately in two of three patients after tilting. Atrial pacing studies documented marked prolongation of atrial-His intervals and inability to maintain 1:1 atrioventricular conduction when paced at a rate of 120/min. These findings were reversed by atropine. This family shows a close correlation between mitral valve prolapse and potentially lethal bradycardia. Excessive vagal tone is believed to be responsible for both bradycardia and sinus arrest, which in two patients was prevented by permanent demand pacing.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |