Hippokratia
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Case Reports
Unusual case of stroke related to Kocuria Kristinae endocarditis treated with surgical procedure.
We report the case of a 35-year-old man with stroke related to infective endocarditis (IE) caused by Kocuria kristinae. ⋯ The patient with chronic hepatitis C virus infection and a former intravenous drug user developed a stroke suddenly, after three months duration of fever and malaise. Duplex ultrasonography of the carotid arteries (zero level diastolic flow, diastolic reversed flow) focused attention to cardiac valve pathology and endocarditis (definite confirmation was made by transesophageal echocardiography). Kocuria kristinae was grown from the blood culture and antibiotic therapy administered, according to the antibiogram, did not cure the infection and the patient underwent an aortic valve replacement with a mechanical prosthesis and debridement of the mitral valve. One year after the surgery, the patient had no subjective problems and neurological findings were normal. Conclusion: To our knowledge, this is the first case of IE caused by Kocuria kristinae, which was diagnosed after the development of stroke, where IE was suspected based on Duplex ultrasonography of the carotid arteries. This is the second case of infection by this bacterium which could not be cured by antibiotics only and had to be submitted to surgical intervention. Hippokratia 2016, 20(3): 231-234.
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Chronic myelogenous leukemia (CML) is a hematological malignancy that originates in an abnormal pluripotent bone marrow stem cell. CML is consistently associated with the expression of the BCR-ABL1 fusion gene, generated by the t(9;22) chromosomal translocation, thus creating the Philadelphia chromosome, a target for protein tyrosine kinase inhibitor (TKI) therapy. There is no published data, demonstrating increased risk for development of second cancers, associated with the exposure to TKIs. ⋯ We report this case as we consider that any secondary neoplasia developing in patients treated with TKIs should be reported for assessment and further detailed analyzes. Hippokratia 2016, 20(3): 241-243.
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Parachute mitral valve (PMV) is commonly associated with mitral valve stenosis but may occasionally be associated with mitral valve regurgitation. ⋯ Cardiovascular imaging with the use of transoesophageal echocardiogram and cardiac magnetic resonance were essential tools for the diagnosis and quantification of the severity of mitral valve regurgitation. Hippokratia 2016, 20(3): 238-240.
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Case Reports
Ipsilateral radial and ulnar artery cannulation during the same coronary catheterization procedure.
Switching to femoral after a failed radial approach carries an increased risk of bleeding complications since the femoral artery puncture is performed in patients already anticoagulated. Moreover, dedicated radial operators find it more and more difficult to use the femoral approach, and ulnar artery cannulation provides them with the opportunity to further reduce its use. Our objective was to evaluate the feasibility and safety of ipsilateral radial and ulnar artery cannulation during the same coronary catheterization procedure. ⋯ Ipsilateral radial and ulnar artery catheterization proved to be feasible and safe, without any serious complications. Hippokratia 2016, 20(3): 249-251.
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The most common histological types of invasive breast carcinomas are the invasive ductal carcinoma (IDC) and the invasive lobular carcinoma (ILC). The purpose of our study was to evaluate the role of the diffusion-weighted imaging (DWI) and the in vivo proton magnetic resonance spectroscopy (1H-MRS ) at 3 Tesla magnet in invasive breast cancer and correlate them with the dynamic contrast enhancement (DCE) and pathologic findings. ⋯ Our results are consistent with previous findings that both ADC values and choline detection in the spectrum play a significant role in establishing the final diagnosis of malignancy, especially when the kinetic pattern of enhancement is misleading. Hippokratia 2016, 20(3): 192-197.