Internal medicine
-
We herein report a 61-year-old woman with a history of mitral valve replacement for rheumatic fever who presented with crural edema and ascites. Computed tomography showed massive left atrial (LA) calcification involving the interatrial septum, termed "coconut atrium." Catheterization revealed not only pulmonary artery hypertension but also a large V-wave in the pulmonary artery wedge pressure waveform and a dip-and-plateau pattern of right ventricular pressure. Three-dimensional transthoracic echocardiography confirmed the early attainment of peak LA volume and a decreased LA expansion index. Stiff LA syndrome due to coconut LA results in the development of restrictive right ventricular physiology.
-
We herein report a 64-year-old man with heparin-induced thrombocytopenia accompanied by anaphylactoid reaction during hemodialysis. The patient was admitted to our hospital with acute myocardial infarction and developed acute kidney injury after percutaneous coronary intervention. When maintenance hemodialysis with heparin was initiated, the patient developed an anaphylactoid reaction with dyspnea, hypotension, nausea, and vomiting. ⋯ Immunoglobulin G antibodies to heparin-platelet factor 4 complexes were positive, and a functional assay showed heparin-independent platelet activation. These results provide a definitive diagnosis of heparin-induced thrombocytopenia. The onset timing supported a diagnosis of 'rapid-onset' heparin-induced thrombocytopenia.
-
A 41-year-old woman diagnosed with seronegative myasthenia gravis struggled to maintain remission for a decade, facing crises every 3 months for several years. After repeated apheresis using a non-tunneled non-cuffed central venous dialysis catheter (NTNCC), complications such as catheter-related thrombus in the internal jugular veins and morbid obesity from steroids made the insertion of NTNCC increasingly difficult, leading to consideration of an alternative permanent vascular access (VA) approach. Thus, we created a subcutaneously superficialized brachial artery as the VA, which allowed the patient to undergo safe and uninterrupted apheresis therapy.
-
Anterior, lateral, and posterior cutaneous nerve entrapment syndromes have been proposed as etiologies of trunk pain. However, while these syndromes are analogous, comprehensive reports contrasting the three subtypes are lacking. We therefore reviewed the literature on anterior, lateral, and posterior cutaneous nerve entrapment syndrome. ⋯ These syndromes are usually diagnosed based solely on unique history and examination findings; however, the diagnostic process may be prolonged, and multiple re-evaluations are required. The most common first-line treatment is trigger point injection; however, the management of refractory cases remains unclear. Awareness of this disease should be expanded to medical departments other than general medicine.