Internal medicine
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We herein report a 47-year-old woman who developed migraine-like headache with aura and subsequent multiple cerebral infarcts, likely due to severe iron deficiency anemia (IDA) from menorrhagia. The progression from IDA to ischemic stroke involves several pathophysiological mechanisms, including reduction of erythrocyte deformability, reactive thrombocytosis, and anemic hypoxia. ⋯ This case highlights the transition from migraine-like headache to ischemic stroke. New-onset migraine-like headache is a warning of impending ischemic stroke, and IDA may be a potential underlying cause.
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We herein report a case in which diazoxide was effective in treating reactive hypoglycemia caused by late dumping syndrome in a patient with end-stage renal disease (ESRD). A 50-year-old man with ESRD and a history of gastrectomy underwent hemodialysis. ⋯ When he began diazoxide treatment, the reactive hypoglycemia improved. The dose was gradually increased with no apparent side effects, and the hypoglycemic attacks disappeared one year after the start of treatment.
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Case Reports
Infected Aortic Aneurysm Secondary to Pyogenic Flexor Tenosynovitis from Streptococcus pyogenes.
Infected aortic aneurysms are rare, and have a high mortality rate. Although not a major pathogen, Streptococcus pyogenes has been reported to cause infected aortic aneurysms. ⋯ Because of their rapid enlargement, these aneurysms were treated with in situ reconstruction. Although rare, the possibility that S. pyogenes is the causative pathogen of infected aortic aneurysms should be considered.
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Case Reports
A Super-elderly Case of Suspected New-onset Vasospastic Angina Complicated by Myocardial Bridge.
A 90-year-old man experienced chest oppressive sensation at 12:30 AM for the first time. Electrocardiography showed a newly developed inversion of the terminal T-wave in the V2-5 leads. A left coronary angiogram showed no significant atherosclerotic stenosis. ⋯ Myocardial scintigraphy with 123I beta-methyl 15-para-iodophenyl 3(R,S)-methylpentadecanoic acid revealed a reduced uptake in the apical and septal areas. Based on these findings, we suspected new-onset vasospastic angina complicated by a myocardial bridge in the territory of the LAD. He remained in good condition without recurrent anginal attacks after nifedipine was started before bedtime.
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Review Case Reports
Lethal Arrhythmia Induced by Severe Hypokalemia with Primary Aldosteronism: A Case Report and Literature Review.
A 26-year-old woman experienced sudden loss of consciousness with respiratory arrest while engaged in a heated conversation shortly after consuming a carbohydrate-rich meal; she was resuscitated immediately. Severe hypokalemia became evident and was deemed to have caused lethal arrhythmia. ⋯ Primary aldosteronism is frequently complicated by hypokalemia; however, hypokalemia-induced lethal arrhythmias are rare. Clinicians should recognize that primary aldosteronism can potentially cause sudden death in apparently healthy individuals; hence, an early diagnosis and proper treatment are critical.