Arch Intern Med
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Case Reports
Cardiac arrhythmias in acute central nervous system disease. Successful management with stellate ganglion block.
Cardiac rhythm disturbances and ECG wave-form abnormalities have been described with CNS disease or injury in experimental animals and in man. Unilateral sympathetic stimulation has been shown to produce similar changes in ventricular repolarization and reduce the fibrillation threshold. A patient with a ruptured congenital aneurysm of the basilar artery developed an accelerating ventricular tachycardia associated with an episode of active intracranial bleeding. ⋯ By 15 minutes, the rhythm disturbance was abolished. The repolarization abnormalities improved over a period of hours. Successful management with left stellate ganglion block suggests that this form of therapy may have clinical application in arrhythmias associated with CNS disease.
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Actinomycosis continues to elude the clinician. In only four of 57 patients seen at the University of Iowa Hospitals (and in none of 12 since 1958) the disease was correctly diagnosed on admission. The disease is more common in men, but has no seasonal or occupational predilection. ⋯ Fistula and palpable mass are the physical hallmarks, with pain and fever the most frequent symptoms. Definitive identification requires anaerobic culture. Chances for cure are excellent with lengthy antibiotic administration.
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The population of Evans County, Georgia was surveyed, during a cardiovascular disease study, for the prevalence of corneal arcus. Rates varied with race and sex and increased in prelalence with age in all groups. Arcus was positively correlated with serum cholesterol level. In white males, a significantly higher prevalence rate of coronary heart disease was found in those who had corneal arcues, but arcus was not correlated with subsequent coronary heart disease incidence in any race-sex group.
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The designation "pseudomyeloma'' is used to describe three patients who had a clinical picture that closely resembled multiple myeloma and was characterized by severe osteoporosis and a serum monoclonal paraprotein peak. The diagnosis of myeloma could not be made histologically, initally or after three, four, or ten years of observation. The protein abnormalities and the bone marrow picture remained stable. It is not known if this association has pathophysiologic importance or if it represents a chance phenomenon.