Internal medicine
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Case Reports
Dynamic electrocardiographic changes due to cardiac compression by a giant hiatal hernia.
A 79-year-old woman was admitted due to chest pain with T wave inversion and anasarca. Echocardiography demonstrated a mass compressing the heart and computed tomography revealed a giant hiatal hernia within the intrathoracic stomach located just behind the heart. ⋯ After surgical correction of the hiatal hernia, the ST segment elevation returned to a nearly normal level. The changes in the compressed heart induced by hiatal hernia may cause pericarditis resulting in electrocardiographic changes.
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Editorial Comment
Interstitial lung disease associated with leflunomide.
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Case Reports
Successful weaning using noninvasive positive pressure ventilation in a patient with status asthmaticus.
In the treatment of severe asthma attack, acute application of non-invasive positive pressure ventilation is shown to be beneficial in some selected patients, while endotracheal intubation and mechanical ventilation is required in the remaining cases. Management with invasive ventilation in status asthmaticus is often associated with complications such as excessive mucus production and atelectasis, which may lead to prolonged hypoxemia and may increase mortality. We present a case of status asthmaticus who developed refractory atelectasis during invasive mechanical ventilation but had a dramatic resolution as well as successful weaning when non-invasive positive pressure ventilation was instituted.
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We encountered a case of wide QRS tachycardia with chronic atrial fibrillation in Wolff-Parkinson-White syndrome. Unique features were late onset of syncope attacks associated with this tachycardia at an advanced age of 72 years old without previous documentation of Wolff-Parkinson-White syndrome on electrocardiogram. ⋯ Catheter ablation using CARTO system easily led to a successful ablation of the accessory pathway. The mechanism of late onset of the wide QRS tachycardia was attributed to possible changes of electrophysiologic properties including the atrio-ventricular node and/or the accessory pathway, and the unique location of the accessory pathway.
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We report 3 patients with alcoholic ketoacidosis (AKA). All had a history of excessive intake and abrupt termination of alcohol. They showed tachypnea, tachycardia, abdominal tenderness, and epigastralgia. ⋯ All patients were successfully hydrated with electrolyte, glucose and thiamine. Complications such as liver dysfunction, lactic acidosis, acute pancreatitis, Wernicke's encephalopathy, rhabdomyolysis and heart failure were present. Attention should be paid to multiple complications in the treatment of AKA.