Heart & lung : the journal of critical care
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Case Reports
Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome.
A case of Wolff-Parkinson-White syndrome with atrial fibrillation (AF) is reported in a patient who presented with syncope, tachycardia, and hypotension. The electrocardiogram (ECG) showed a fast irregular rhythm with wide polymorphic QRS tachycardia without the QRS twisting around the isoelectric baseline, diagnostic of AF and Wolff-Parkinson-White syndrome. The patient did not respond to intravenous amiodarone. ⋯ AF was easily induced during the electrophysiologic study, requiring electrical cardioversion for severe hypotension. Successful radiofrequency ablation of the accessory pathway completely prevented further inducible AF. The patient no longer had any evidence of pre-excitation on ECG and remained symptom-free with no medications for 11 months.
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Case Reports
Adult Kawasaki's disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels.
Kawasaki's disease is a disease of unknown cause. The characteristic clinical features of Kawasaki's disease are fever> or =102 degrees F for> or =5 days accompanied by a bilateral bulbar conjunctivitis/conjunctival suffusion, erythematous rash, cervical adenopathy, pharyngeal erythema, and swelling of the dorsum of the hands/feet. Kawasaki's disease primarily affects children and is rare in adults. ⋯ To the best of our knowledge, this is the first report of adult Kawasaki's disease with highly elevated serum ferritin levels. This is also the first report of splenomegaly in adult Kawasaki's disease. We conclude that Kawasaki's disease should be considered in the differential diagnosis in adult patients with rash/fever for> or =5 days with conjunctival suffusion, cervical adenopathy, swelling of the dorsum of the hands/feet, thrombocytosis and otherwise unexplained highly elevated ferritin levels.
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Multicenter Study
An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: a multicenter survey.
Admission in an intensive care unit (ICU) is a major cause of psychologic stress for the patient and the entire family, and liberalization of visitation has been shown to have a beneficial impact. However, despite the data available, practice has not changed much to incorporate these findings. ⋯ Participating ICUs homogeneously reported restricted visiting policies regarding visiting hours and type and number of visitors. According to the evidence available, providing a plea for more liberal visitation, these results may be a first step toward reorganization of visiting policies in Belgian ICUs.
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Case Reports
Persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia due to a linezolid "tolerant" strain.
Antibiotic "tolerance" is a rare cause of antibiotic failure. Antibiotic "tolerance" is defined as an minimal bactericidal concentration (MBC) 32x the minimal inhibitory concentration (MIC) of the isolate. ⋯ We present a case of persistent methicillin-sensitive S. aureus (MSSA) bacteremia due to a linezolid "tolerant" strain unresponsive to daptomycin therapy. We believe this is the first report of persistent MSSA bacteremia due to a linezolid "tolerant" strain.