WMJ : official publication of the State Medical Society of Wisconsin
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Stroke is an occasional devastating complication of cardiac surgery. Transient atrial fibrillation (AF) is a frequent complication of cardiac surgery. Emboli originating from the fibrillating left atrium are a known cause of stroke in the non-surgical setting. The purpose of this quality improvement initiative, conducted by the Wausau Heart Institute, was to characterize strokes after cardiac surgery and to investigate the relationship between AF and the occurrence of postoperative strokes. ⋯ Most strokes complicating cardiac surgery occur in patients without significant carotid disease, and are acquired after the patient awakens neurologically intact. The high incidence of postoperative AF in these patients suggests a possible embolic cause for some of the strokes. As such, some postoperative strokes may be preventable.
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Case Reports
Myeloneuropathy from nitrous oxide abuse: unusually high methylmalonic acid and homocysteine levels.
A 23-year-old patient developed diffuse paresthesias and sensory loss. He had mildly reduced serum vitamin B12 (B12) concentration with unusually high levels of methylmalonic acid (MMA) and homocysteine and no evidence of B12 malabsorption. ⋯ After halting N2O abuse his homocysteine level normalized. This case demonstrates the importance of serum homocysteine level measurements in cases of suspected N2O toxicity [corrected].
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Strangulation accounts for 10% of all violent deaths in the United States. Many people who are strangled survive. These survivors may have minimal visible external findings. ⋯ Accurate documentation in the medical chart is essential to substantiate a survivor's account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings.