WorldWideScience

Sample records for cardiomegaly

  1. Cardiomegaly in tropical Africa.

    Science.gov (United States)

    Tomaszewski, Ryszard

    2012-01-01

    The term "cardiomegaly" is found in 5-7% of chest X-ray film evaluations in tropical Africa. However, "cardiomegaly" is a descriptive term, devoid of any aetiological meaning. Therefore, providing information about the aetiological factors leading to heart enlargement in a group of Africans (Nigerians) was the purpose of this study. In the years 2002-2011, 170 subjects (aged 17-80 years, mean age 42 years) in whom "cardiomegaly" was revealed by chest radiographs were studied at the Madonna University Teaching Hospital, Elele. The patients underwent echocardiography, electrocardiography, and several appropriate laboratory tests. Arterial hypertension was found to be most frequently associated with heart enlargement (39.4%), followed by dilated cardiomyopathy (21.76%), endomyocardial fibrosis (14.1%), valvular defects (9.4%), cardiac enlargement in the course of sickle-cell anaemia (6.47%), and schistosomal cor pulmonale (3.52%). This study is a contribution to a better aetiological elucidation of "cardiomegaly" in the tropics and emphasizes the importance of arterial hypertension as one of its causative factors. The dire need for effective treatment of hypertensive patients becomes evident. A high prevalence of elevated blood pressure seems to reflect an impact of civilization-related factors on the African communities.

  2. Timolipoma simulando cardiomegalia Thymolipoma simulating cardiomegaly

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    Vitório Moscon Puntel

    2000-02-01

    Full Text Available Thymolipoma is a rare benign tumor of the thymus. Because of its large size and pliability the mass usually drapes itself around the heart, conforming to its borders and producing a large radiographic shadow easily mistaken as cardiomegaly. This report describes a 48-year-old man with a chest radiograph strongly suggestive of cardiomegaly. Careful radiological study showed the existence of a large mass in the anterior mediastinum, simulating cardiomegaly. A thymolipoma weighing 2500g was resected through an esternotomy.

  3. Thoracic radiography in the cat: Identification of cardiomegaly and congestive heart failure.

    Science.gov (United States)

    Guglielmini, Carlo; Diana, Alessia

    2015-12-01

    Thoracic radiography is one of the most commonly employed diagnostic tools for the clinical evaluation of cats with suspected heart disease and is the standard diagnostic method in the confirmation of cardiogenic pulmonary edema. In the past, interpretation of feline radiographs focused on a description of the qualitative radiographic features of feline heart disease or the measurement of the cardiac silhouette in healthy cats and cats with different cardiovascular disorders. More recently, studies have begun to critically address the issue of the diagnostic accuracy of thoracic radiography in the diagnostic work-up of cats with heart disease. In these studies, qualitative and quantitative radiographic parameters were compared to echocardiographic findings to evaluate the usefulness of thoracic radiography for the identification of cardiac enlargement and pulmonary edema in the cat. Thoracic radiography is reasonably specific but has a low sensitivity when identifying cardiomegaly in cats with mild structural heart disease. Feline cardiogenic pulmonary edema has a variable radiographic presentation and several specific radiographic findings (i.e., enlargement of the left atrium and the pulmonary veins) can be absent or non-recognizable in affected cats.

  4. A newborn with cardiomegaly

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    Upadhyay Shailendra

    2010-01-01

    Full Text Available An infant with Down′s syndrome was noted to have hypoxemia and tachypnea at birth. The clinical examination, electrocardiogram (ECG and the chest X-ray findings suggested a specific diagnosis that is not usually associated with Down′s syndrome. Despite the extremely rare association of Ebstein′s anomaly with Down′s syndrome, this diagnosis was highly suspected from the initial evaluation. An echocardiogram confirmed the diagnosis of Ebstein′s anomaly in this neonate. So far, only about seven cases of Ebstein′s anomaly associated with Down′s syndrome have been reported in the literature. This case is discussed for its rarity; it also highlights the importance of clinical examination and initial investigations that had suggested the diagnosis well prior to that of the echocardiogram.

  5. Brachygnathia, cardiomegaly and renal hypoplasia syndrome (BCRHS) in Merino sheep maps to a 1.1-megabase region on ovine chromosome OAR2.

    Science.gov (United States)

    Shariflou, M R; Wade, C M; Kijas, J; McCulloch, R; Windsor, P A; Tammen, I; Nicholas, F W

    2013-04-01

    A genome scan was conducted to map the autosomal recessive lethal disorder brachygnathia, cardiomegaly and renal hypoplasia syndrome (BCRHS) in Poll Merino sheep. The scan involved 10 affected and 27 unaffected animals from a single Poll Merino/Merino sheep flock, which were genotyped with the Illumina Ovine SNP50 BeadChip. Association and homozygosity mapping analyses located the disorder in a region comprising 20 consecutive SNPs spanning 1.1 Mb towards the distal end of chromosome OAR2. All affected animals and none of the unaffected animals were homozygous for the associated haplotype in this region. These results provide the basis for identifying the causative mutation(s) and should enable the development of a DNA test to identify carriers in the Poll Merino sheep population. Understanding the molecular control of BCRHS may provide insight into the fundamental genetic control and regulation of the affected organ systems.

  6. Repercussões da cardiomegalia na função pulmonar de indivíduos adultos com insuficiência cardíaca crônica: uma revisão sistemática Repercussions of the cardiomegaly on the pulmonary function of adult individuals with chronic heart failure: a systematic review

    Directory of Open Access Journals (Sweden)

    João Danyell Dantas da Silva

    2011-03-01

    Full Text Available Para analisar as repercussões da cardiomegalia sobre a função pulmonar em indivíduos adultos com insuficiência cardíaca (IC crônica, foram revisados artigos nas bases PUBMED, BIREME, ISI Web of Knowledge e COCHRANE, publicados na última década, estudos observacionais e sem restrição de idioma. Utilizados os descritores "cardiomegaly" e "Respiratory Function Tests", e negada a palavra "exercise". Foram incluídos artigos com IC crônica, de ambos os sexos, entre 19 e 64 anos, incluindo IC congestiva e cardiomiopatia dilatada e excluídos com IC aguda, com avaliações pós-intervenção clínica ou por exercício. Para avaliar a qualidade dos artigos foi utilizada a escala da Agency for Healthcare Research and Quality (AHRQ e aceitos aqueles com escore>50 pontos (0-100. Foram selecionados cinco artigos do total de 1093 e agrupados por parâmetros relacionados aos fluxos e volumes pulmonares, padrão ventilatório e desempenho muscular. Na AHRQ, dois estudos ficaram na faixa de 50-75% e os demais >75%. Eles apontam para redução da capacidade vital inspiratória (CVI, volume expiratório forçado no 1º segundo (VEF1 e pressão inspiratória máxima (PImáx em função da cardiomegalia, com discreta redução na relação VEF1/CVI e na capacidade de difusão para monóxido de carbono (DLCO. Portanto, segundo os estudos, a cardiomegalia leva a um padrão respiratório restritivo, com redução do volume alveolar que interfere na DLCO. As correlações mais fortes envolvem a redução da PImáx, CVI e VEF1.To analyze the repercussions of the cardiomegaly on lung function in adults with chronic heart failure (CHF, the databases PUBMED, BIREME, ISI Web of Knowledge and COCHRANE were considered to review observational studies published in the last decade without language restriction. It was used the descriptors "cardiomegaly" and "respiratory function tests", and denied "exercise". It was included papers with CHF, of both sexes between 19

  7. A robust neuro-fuzzy classifier for the detection of cardiomegaly in digital chest radiographies

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    Fabián Torres-Robles

    2014-01-01

    Full Text Available Presentamos un nuevo procedimiento que determina de forma automática y fiable la presencia de cardiomegalia en radiografías torácicas. El CTR muestra la relación entre el tamaño del corazón y el tamaño del tórax. El esquema propuesto utiliza un clasificador robusto difuso para encontrar los valores correctos del tamaño del tórax y los límites del corazón derecho e izquierdo para medir el agrandamiento del corazón para detectar cardiomegalia. El método propuesto utiliza operaciones clásicas de morfología para segmentar los pulmones proporcionando baja complejidad computacional y el método difuso propuesto es robusto para encontrar las medidas correctas del CTR proporcionando un cálculo rápido porque las reglas difusas usan operaciones aritméticas elementales para desempeñar una buena detección de cardiomegalia. Finalmente, se mejoran los resultados de clasificación del método difuso propuesto utilizando una red neuronal función de base radial (RBF en términos de precisión, sensibilidad y especificidad.

  8. 3 Cases of Heart failure with Cardiomegaly Treatment with Combination of Traditional Chi-nese and Western Medicine%中西医结合治疗心力衰竭伴心脏扩大3例

    Institute of Scientific and Technical Information of China (English)

    曾晶晶; 吕永豪; 温伟琴; 胡小花; 饶珂寒; 项凤梅

    2015-01-01

    目的:总结3例胃肠病就诊的心力衰竭伴心脏扩大患者的中西医结合治疗经验。方法:通过分析3例胃肠病就诊的心力衰竭伴心脏扩大患者治疗经过,总结该病的病因病机及治疗方法及经验。结果:通过益气健脾活血利水治疗,患者的病情均好转。结论:益气活血利水法兼西医对以胃肠病就诊的心力衰竭有效。%Object:3 inpatients with the gastric bowel disease clinic of heart failure were reported to summary the feature of the therapy. Methods:Analyzes the symptom and the therapy method of the 3 patients by trait of the 3 inpatients .Result:Yiqi Huoxue Lishui herb medicine and the Diuretics,Proton-pump inhibitor can improve the Patient's poor appetite and physical,decrease the edema and so on. Conclusion:YiQiHuoXueliShui herb medicine is good for the inpatients with the dilated cardiomyopathy ,heart failure and poor gastroin-testinal function.

  9. Regression of gestational diabetes induced cardiomegaly in offspring of diabetic rat Regressão da miocardiopatia hipertrófica em filhotes de ratas diabéticas

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    Honório Sampaio Menezes

    2009-08-01

    Full Text Available PURPOSE: To compare body weight and length, heart weight and length, heart-to-body weight ratio, glycemia, and morphometric cellular data of offspring of diabetic rats (ODR and of normal rats (control. METHODS: Diabetes was induced in 3 pregnant Wistar rats, bearing 30 rats, on the 11th day after conception by intraperitoneal injection of 50 mg/kg of streptozotocin. Six normal pregnant Wistar rats, bearing 50 rats, made up the control group. Morphometric data were obtained using a scale for the weight, length, heart and body measurements. Morphometric cellular data were obtained by a computer assisted method applied to the measurements of myocytes. Statistical analysis utilized Student's t-test, ANOVA and Levene test. RESULTS: Control offspring had greater mean body weight and length than offspring of diabetic rats (p OBJETIVO: Comparar as medidas cardíacas e a morfometria celular miocárdica dos filhotes de ratas diabéticas (FRD com filhotes de ratas normais (FRN. MÉTODOS: Foram estudados 30 filhotes de 3 ratas Wistar com diabetes gestacional induzido por 50mg/kg de estreptozotocina, no 11° dia após a concepção. O grupo controle foi de 50 filhotes de 6 ratas Wistar normais. As medidas de comprimento, peso corporal e peso cardíaco foram realizadas com paquímetro e balança e as medidas celulares por analisador computadorizado de imagem. A análise estatística usou o Teste t de Student, ANOVA e teste de Levene. RESULTADOS: A média de peso e comprimento dos filhotes, desde o nascimento até os 21 dias de vida, foi significativamente maior (p<0,001 no grupo dos FRN. O peso, tamanho cardíaco e a proporção cardíaca dos FRD, ao nascimento, foi, significativamente, maior (p<0,001, regredindo ao longo dos 21 dias de vida. Os FRD apresentaram uma regressão significativa da área e perímetro nuclear (p<0,01 do nascimento aos 21 dias de vida, o mesmo não ocorrendo no grupo controle. CONCLUSÕES: Os FRD apresentaram, ao nascimento, maior tamanho cardíaco, maior peso cardíaco e maior proporção peso cardíaco-peso corporal do que FRN, havendo igualdade estatística entre os dois grupos a partir do 11° dia de vida. Houve diferença significativa entre o nascimento e o 21º dia de vida nas medidas celulares demonstrando regressão da hipertrofia miocárdica nos filhotes das ratas diabéticas.

  10. Diaphragmatic hernia and right-sided heart enlargement in a Florida manatee (Trichechus manatus latirostris).

    Science.gov (United States)

    Gerlach, Trevor J; de Wit, Martine; Landolfi, Jennifer A

    2012-10-01

    Postmortem evaluation of a Florida manatee (Trichechus manatus latirostris) revealed cold stress lesions and previous watercraft trauma that included broken ribs, a diaphragmatic hernia, an enlarged vena cava, and right-sided cardiomegaly. We discuss these findings and present a possible pathogenesis for the cardiomegaly.

  11. Genetics Home Reference: Cantú syndrome

    Science.gov (United States)

    ... defect such as an enlarged heart (cardiomegaly) or patent ductus arteriosus (PDA). The ductus arteriosus is a connection between ... named? Additional Information & Resources MedlinePlus (3 links) Encyclopedia: Patent Ductus Arteriosus Health Topic: Bone Diseases Health Topic: Congenital Heart ...

  12. Hjerteinfarkter og fatal hjerteinsufficiens hos en fem måneder gammel dreng med abnorm afgang af venstre koronararterie

    DEFF Research Database (Denmark)

    Fenger-Grøn, Jesper; Aunsholt, Lise; Hansborg, Niels

    2008-01-01

    A five month old boy was admitted with symptoms of asthmatic bronchitis. Careful anamnesis revealed failure to thrive latest month, cough since age of three weeks and a few episodes of severe crying. He had cardiomegaly and an electrocardiogram showed Q waves and ST segment elevation in several...

  13. Vertebral heart scores in eight dog breeds.

    Science.gov (United States)

    Jepsen-Grant, K; Pollard, R E; Johnson, L R

    2013-01-01

    The vertebral heart score (VHS) measurement is commonly used to provide a more objective measurement of cardiomegaly in canines. However, several studies have shown significant breed variations from the value previously established by Buchanan and Bücheler (9.7 ± 0.5). This study describes VHS measurements in Pug, Pomeranian, Yorkshire Terrier, Dachshund, Bulldog, Shih Tzu, Lhasa Apso, and Boston Terrier dog breeds. Dogs with two or three view thoracic radiographs, no subjective radiographic evidence of cardiomegaly, and no physical examination findings of heart murmurs or gallop rhythms were included in the study. The Pug, Pomeranian, Bulldog, and Boston Terrier groups were found to have a VHS significantly greater than 9.7 ± 0.5 (P Bulldog (P = 0.028) and Boston Terrier (P = 0.0004) groups. Thoracic depth to width ratio did not have a significant effect on VHS.

  14. [Doctor's degree thesis of Tomasz Adolf Wołkowiński "Carditidis rheumaticae historia"].

    Science.gov (United States)

    Stembrowicz, W

    2001-01-01

    In 1817 on the University of Vilnius Faculty of Medicine, T. A. Wołkowiński, a student of the eminent clinician Józef Frank, defended his doctor's degree thesis about a direct relation between rheumatic disease and cardiomegaly. It was probably the first paper in Poland describing with details the rheumatic heart disease. Unfortunately we don't know much about T. A. Wołkowiński's life.

  15. Idiopathic giant right atrial aneurysm

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    Santosh C Uppu

    2013-01-01

    Full Text Available A 2-year-old boy with an incidental finding of massive cardiomegaly on a chest X-ray was diagnosed with a giant right atrial aneurysm upon further investigation with echocardiography. The patient underwent successful surgical reduction of the right atrium and closure of the patent foramen ovale to prevent thromboembolic complications and to lower the risk of atrial arrhythmias. The resected atrium had paper-thin walls and pathological features of interstitial fibrosis with endocardial thickening.

  16. A study on findings from simple chest radiographs without any clinical symptoms

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    Kim, Ham Gyum [Ansan College, Ansan (Korea, Republic of)

    2007-06-15

    In this study, the analysis on findings from simple chest radiography (CXR) test with total 1,669 subjects without any special clinical symptom came to the following conclusions: In terms of the general characteristics of subjects hereof, male and female group accounted for 55.2% and 44.8% respectively out of all 1,669 people. Pulmonary disease cases amounted to 249 persons (14.9%) out of all subjects. In the analysis on prevalence rate by age distribution, it was noted that the older age led to the more number of diseases, which was demonstrated by age 34 or younger (6.1%), age 35 {approx} 39 (9.7%), age 40 {approx} 49 (13.3%), and age 50 or older (30.8%). In regard of pulmonary disease alone, the region of onset was represented primarily by right upper lobe, which was followed by both upper lobe and left upper lobe, respectively. In terms of disease types, it was found that most cases were represented by pulmonary nodule (55.0%), which was followed by cardiomegaly (24.5%), CP angle blunting (4.8%), scoliosis (4.6%) tortuous aorta (2.8%), bronchial luminal dilatation(2.4%), and pleural thickening (2.0%). However, dextrocardia, cystic dilation of bronchus, cavitary lesion, and lung collapse accounted for relatively low rate (0.4% respectively). In terms of disease types by sex, it was found that male group accounted for higher percentage of having cardiomegaly, tortuous aorta and scoliosis than the former. In terms of disease types by age distribution, it was noted that age 34 or younger group accounted for higher percentage of scoliosis than any other age groups, while age 40 {approx} 49 group, age 35 {approx} 39 group, and age 50 or older group represented the case of CP angle blunting, pulmonary nodule, and cardiomegaly/tortuous aorta, respectively.

  17. Persistent candidemia in major burn patients: radiologic findings of the thorax

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    Lee, Eil Seong; Lee, Kwan Seop; Kang, Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-04-01

    To describe radiologic findings of burn-associated persistent candidemia of the thorax. This study included 42 patients with major burns in whom blood culture had shown the presence for more than 24 hours of persistent candidemia. The duration of positive culture for candidiasis ranged from two to 67 days(mean, 15 days). Radiographic(n=42) and thin-section CT findings(n=13) were retrospectively analyzed. The onset, pattern, size, distribution and persistence of parenchymal abnormalities as well as the presence or absence of pleural effusions, mediastinal lymphadenopathy and cardiomegaly were assessed. On chest radiographs, positive findings were noticed in 61.9%(26/42) and on thin-section CT, in 76.9%(10/13). The most frequent radiographic finding was pulmonary nodule(s), observed in 14 patients(33.3%); in 13, these were bilateral. Bronchovascular bundle thickening(n=6, 14.3%), consolidation(n=4, 9.5%), cardiomegaly(n=6, 14.3%) and pleural effusion(n=4, 9.5%) were also observed. Those lesions appeared eight to 129 days(mean, 33 days) after the burn. Radiographic abnormalities persisted for seven to 115(mean, 35) days, regardless of the treatment. Thin-section CT showed parenchymal abnormalities in 10/13 patients(76.9%) and subpleural nodules of less than 1cm in diameter and without halo in all patients. Cardiomegaly, pleural effusion and mediastinal adenopathy were observed on CT in 5(38.5%), 4(30.8%) and 2(15.4%) of the 13 patients, respectively. In a high proportion of patients with burn-associated candidemia, chest radiograph and thin-section CT findings were positive. The most frequent radiographic parenchymal abnormality was multiple bilateral nodules.

  18. Pulmonary edema: radiographic differential diagnosis

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    Yoo, Dong Soo; Choi, Young Hi; Kim, Seung Cheol; An, Ji Hyun; Lee, Jee Young; Park, Hee Hong [Dankook Univ. College of Medicine, Chonan (Korea, Republic of)

    1997-04-01

    To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema. Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups : group 1 (cardiogenic edema : n = 35), group 2 (renal pulmonary edema : n = 16) and group 3 (permeability edema : n = 26). We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution. In cardiogenic pulmonary edema (n=35), cardiomegaly (n=29), peribronchial cuffing (n=29), inverted pulmonary blood flow distribution (n=21) and basal distribution of edema (n=20) were common. In renal pulmonary edema (n=16), cardiomegaly (n=15), balanced blood flow distribution (n=12), and central (n=9) or basal distribution of edema (n=7) were common. Permeability edema (n=26) showed different findings. Air bronchogram (n=25), normal blood flow distribution (n=14) and peripheral distribution of edema (n=21) were frequent findings, while cardiomegaly (n=7), peribronchial cuffing (n=7) and septal line (n=5) were observed in only a few cases. On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema.

  19. Hepatic failure in a rapidly involuting congenital hemangioma of the liver: failure of embolotherapy

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    Zenzen, Wendy; Alomari, Ahmad I. [Children' s Hospital Boston, Division of Vascular and Interventional Radiology, Department of Radiology, Boston, MA (United States); Perez-Atayde, Antonio R. [Children' s Hospital Boston and Harvard Medical School, Department of Pathology, Boston, MA (United States); Elisofon, Scott A. [Children' s Hospital Boston and Harvard Medical School, Division of Gastroenterology, Boston, MA (United States); Bae Kim, Heung [Children' s Hospital Boston and Harvard Medical School, Department of Surgery, Boston, MA (United States)

    2009-10-15

    We report the clinical course, imaging findings, and management of a rare case of rapidly involuting congenital hemangioma of the liver in a newborn girl. The baby presented with severe progressive hepatic dysfunction and cardiomegaly. Multimodality imaging demonstrated a large hypervascular solitary hepatic mass with marked transhepatic shunting, consistent with rapidly involuting congenital hemangioma. Because medical therapy failed, transarterial and transvenous embolization was performed with the main intention to improve the hepatic perfusion and function. Unfortunately, despite improvement in the cardiac overload, liver function continued to deteriorate. The baby eventually underwent successful liver transplantation. (orig.)

  20. Cardiac Involvement in Ankylosing Spondylitis

    Science.gov (United States)

    Ozkan, Yasemin

    2016-01-01

    Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  1. Clinical evaluation on cardiac enlargement in patients with esophageal cancer treated by radiotherapy with or without chemotherapy

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    Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine

    2002-09-01

    Recent literature on chemoradiotherapy for esophageal cancer report the comparable survival results as surgery, and suggest the importance of management for the late adverse effect of chemoradiotherapy. The aim of this study is to investigate the incidence and risk factors of cardiomegaly after chemoradiotherapy using low dose continuous infusion of 5FU/CDDP+5FU for esophageal cancer. Fifty-one patients with stage I-IVA esophageal cancer who were treated by radiotherapy with more than 50 Gy with or without chemotherapy and followed up for more than 6 months were analyzed. Sixteen patients were treated by radiation alone and 35 patients were treated by chemoradiotherapy. A change of CTR (cardio-thoracic ratio) was defined as the difference between CTR in the pre-treatment X-ray film and CTR in the post-treatment X-ray film with maximum cardiac silhouette. A change of CTR by more than 10% was defined as ''significant cardiomegaly''. In this study cardiac area-dose'', which is the sum of the products of cardiac area within every radiation field and its target dose, was calculated in each patient as a radiation parameter. Significant cardiomegaly was noted in 1 patient (6%) in the radiation alone group, in 8 patients (23%) in the chemoradiotherapy group and in 9 patients (18%) in the total population. In cases with more than 0.4 m{sup 2}{center_dot}Gy in cardiac area-dose, CTR elevation was significantly higher than in cases with less than 0.4m{sup 2}{center_dot}Gy. More than moderate pleural effusion was noted in 5 patients (10%). Chronic pericardial effusion and subsequent cardiac tamponade was considered to be one of the contributing factors for pleural effusion, because increases of pleural effusion coincided with CTR elevations in 3 cases. In addition, the fact that no case had right-sided unilateral pleural effusion suggested the direct effect of radiation to the pleura. Significant cardiomegaly was seen in 18% of 51 patients with

  2. Masa metástasica intracardíaca en ventrículo derecho en un paciente con antecedente de hepatocarcinoma

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    Limber Mora Tumminelli

    2006-05-01

    Full Text Available Se presenta un paciente hipertenso con antecedente de hepatocarcinoma resecado quirúrgicamente y con quimioterapia asociada. Cinco años después se presenta con disnea de medianos esfuerzos, cardiomegalia en la radiografía de tórax y un soplo cardíaco pandiastólico GII/IV.We describe the case of a patient with essential hypertension and the antecedent of hepatocarcinoma treated with the combination of surgery and chemotherapy. Five years later he presents dyspnea, cardiomegaly in the chest radiography and a pandiastolic II/IV cardiac murmur.

  3. Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review

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    Cowles, Robert A. [Morgan Stanley Children' s Hospital of New York-Presbyterian, Division of Pediatric Surgery,Columbia University College of Physicians and Surgeons, New York, NY (United States); Berdon, Walter E. [Morgan Stanley Children' s Hospital of New York-Presbyterian, Department of Pediatric Radiology, Columbia University College of Physicians and Surgeons, New York, NY (United States)

    2007-09-15

    The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787-801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes. (orig.)

  4. Effect of the Plasmid-DNA Vaccination on Macroscopic and Microscopic Damage Caused by the Experimental Chronic Trypanosoma cruzi Infection in the Canine Model

    Science.gov (United States)

    Rodríguez-Morales, Olivia; Carrillo-Sánchez, Silvia C.; García-Mendoza, Humberto; Aranda-Fraustro, Alberto; Ballinas-Verdugo, Martha A.; Alejandre-Aguilar, Ricardo; Rosales-Encina, José Luis; Arce-Fonseca, Minerva

    2013-01-01

    The dog is considered the main domestic reservoir for Trypanosoma cruzi infection and a suitable experimental animal model to study the pathological changes during the course of Chagas disease (CD). Vaccine development is one of CD prevention methods to protect people at risk. Two plasmids containing genes encoding a trans-sialidase protein (TcSP) and an amastigote-specific glycoprotein (TcSSP4) were used as DNA vaccines in a canine model. Splenomegaly was not found in either of the recombinant plasmid-immunized groups; however, cardiomegaly was absent in animals immunized only with the plasmid containing the TcSSP4 gene. The inflammation of subendocardial and myocardial tissues was prevented only with the immunization with TcSSP4 gene. In conclusion, the vaccination with these genes has a partial protective effect on the enlargement of splenic and cardiac tissues during the chronic CD and on microscopic hearth damage, since both plasmids prevented splenomegaly but only one avoided cardiomegaly, and the lesions in heart tissue of dog immunized with plasmid containing the TcSSP4 gene covered only subepicardial tissue. PMID:24163822

  5. Incidental cardiac findings on computed tomography imaging of the thorax

    Directory of Open Access Journals (Sweden)

    El-Gendi Hossam

    2010-12-01

    Full Text Available Abstract Background Investigation of pulmonary pathology with computed tomography also allows visualisation of the heart and major vessels. We sought to explore whether clinically relevant cardiac pathology could be identified on computed tomography pulmonary angiograms (CTPA requested for the exclusion of pulmonary embolism (PE. 100 consecutive CT contrast-enhanced pulmonary angiograms carried out for exclusion of PE at a single centre were assessed retrospectively by two cardiologists. Findings Evidence of PE was reported in 5% of scans. Incidental cardiac findings included: aortic wall calcification (54%, coronary calcification (46%, cardiomegaly (41%, atrial dilatation (18%, mitral annulus calcification (15%, right ventricular dilatation (11%, aortic dilatation (8% and right ventricular thrombus (1%. Apart from 3 (3% reports describing cardiomegaly, no other cardiac findings were described in radiologists' reports. Other reported pulmonary abnormalities included: lung nodules (14%, lobar collapse/consolidation (8%, pleural effusion (2%, lobar collapse/consolidation (8%, emphysema (6% and pleural calcification (4%. Conclusions CTPAs requested for the exclusion of PE have a high yield of cardiac abnormalities. Although these abnormalities may not have implications for acute clinical management, they may, nevertheless, be important in long-term care.

  6. Effect of the Plasmid-DNA Vaccination on Macroscopic and Microscopic Damage Caused by the Experimental Chronic Trypanosoma cruzi Infection in the Canine Model

    Directory of Open Access Journals (Sweden)

    Olivia Rodríguez-Morales

    2013-01-01

    Full Text Available The dog is considered the main domestic reservoir for Trypanosoma cruzi infection and a suitable experimental animal model to study the pathological changes during the course of Chagas disease (CD. Vaccine development is one of CD prevention methods to protect people at risk. Two plasmids containing genes encoding a trans-sialidase protein (TcSP and an amastigote-specific glycoprotein (TcSSP4 were used as DNA vaccines in a canine model. Splenomegaly was not found in either of the recombinant plasmid-immunized groups; however, cardiomegaly was absent in animals immunized only with the plasmid containing the TcSSP4 gene. The inflammation of subendocardial and myocardial tissues was prevented only with the immunization with TcSSP4 gene. In conclusion, the vaccination with these genes has a partial protective effect on the enlargement of splenic and cardiac tissues during the chronic CD and on microscopic hearth damage, since both plasmids prevented splenomegaly but only one avoided cardiomegaly, and the lesions in heart tissue of dog immunized with plasmid containing the TcSSP4 gene covered only subepicardial tissue.

  7. Fournier gangrene and unexpected death.

    Science.gov (United States)

    Bury, Danielle; Byard, Roger W

    2012-11-01

    Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70-year-old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case.

  8. Frontal Cardiac area in patent ductus arteriosus patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Choo, Dong Woon [Seoul Natinal University College of Medicine, Seoul (Korea, Republic of)

    1972-03-15

    Cardiac mensuration by radiographic frontal cardiac area method was carried out on 21 patent ductus arteriosus patients, 15 females and 6 males. Formula used in this study is as follows. Frontal cardiac area = {pi}/4 X long diameter X broad diameter. Increase of frontal cardiac area in patent ductus arteriosus patients seems to be evident but the degree of the cardiomegaly is variable. Comparing to normal data by Choo and Kim, frontal cardiac area in patent ductus arteriosus patients in this series is increased in 15.9% to 98.1%. After surgical ligation of the ductus arteriosus, significant decrease of the frontal cardiac area is observed and the average is 12.5%.

  9. Three-dimensional modeling of a patent ductus arteriosus in a cat.

    Science.gov (United States)

    Saunders, A B; Birch, S A

    2015-12-01

    A left-to-right shunting patent ductus arteriosus was diagnosed in a 13-week-old, 2.5 kg, male, domestic Shorthair cat with a continuous murmur. Echocardiographic abnormalities were identified, including: cardiomegaly, wide and presumably short ductal ampulla, and a large right branch pulmonary artery. When these findings were combined with the small patient size, additional imaging was considered prior to surgical ligation, and computed tomography angiography was preferred over standard angiography to provide multi-dimensional appreciation of the anatomy prior to surgery. The dataset from a computed tomography angiographic study performed prior to surgical ligation was used to create a three-dimensional model of the heart and great vessels. The rendered images accurately depicted the cardiac anatomy in situ, which can be utilized for surgical procedural planning and to enhance visuospatial understanding of the anatomy at all levels of training.

  10. Radiographic findings in pulmonary hypertension from unresolved embolism

    Energy Technology Data Exchange (ETDEWEB)

    Woodruff, W.W. III; Hoeck, B.E.; Chitwood, W.R. Jr.; Lyerly, H.K.; Sabiston, D.C. Jr.; Chen, J.T.T.

    1985-04-01

    Pulmonary artery hypertension with chronic pulmonary embolism is an uncommon entity that is potentially treatable with pulmonary embolectomy. Although the classic radiographic features have been described, several recent investigators report a significant percentage of these patients with normal chest radiographs. In a series of 22 patients, no normal radiographs were seen. Findings included cardiomegaly (86.4%) with right-sided enlargement (68.4%), right descending pulmonary artery enlargement (54.5%), azygos vein enlargement (27.3%), mosaic oligemia (68.2%), chronic volume loss (27.3%), atelectasis and/or effusion (22.7%), and pleural thickening (13.6%). Good correlation with specific areas of diminished vascularity was seen on chest radiographs compared with pulmonary angiograms.

  11. Forensic postmortem computed tomography

    DEFF Research Database (Denmark)

    Jakobsen, Lykke Schrøder; Lundemose, Sissel; Banner, Jytte

    2016-01-01

    PURPOSE: The purpose of this study was to investigate the utility of postmortem computed tomography (PMCT) images in estimating organ sizes and to examine the use of the cardiothoracic ratio (CTR). METHODS: We included 45 individuals (19 females), who underwent a medico-legal autopsy. Using...... the computer software program Mimics(®), we determined in situ heart and liver volumes derived from linear measurements (width, height and depth) on a whole body PMCT-scan, and compared the volumes with ex vivo volumes derived by CT-scan of the eviscerated heart and liver. The ex vivo volumes were also...... differences. CONCLUSIONS: Noninvasive in situ PMCT methods for organ measuring, as performed in this study, are not useful tools in forensic pathology. The best method to estimate organ volume is a CT-scan of the eviscerated organ. PMCT-determined CTR seems to be useless for ascertaining cardiomegaly...

  12. Treatment of twin-twin transfusion syndrome by fetoscopic laser photocoagulation

    Institute of Scientific and Technical Information of China (English)

    劉子建; 梁德楊; 馮德源; 梁子昂

    2004-01-01

    @@ Twin-twin transfusion syndrome (TTTS) is a serious obstetric complication, occurring in about 15% of monochorionic (MC) twin pregnancies. If untreated, the prognosis is poor, with an overall perinatal mortality of 80%.1 It is now clear that TTTS is the result of an unbalanced unidirectional blood flow through placental arteriovenous anastomoses (also termed deep anastomoses) between the two fetal circulations.2 The donor twin progressively becomes anemic, and develops growth restriction, oliguria, and oligohydramnios/anhydramnios; whereas the recipient becomes plethoric and polyuric, and develops congestive heart failure, cardiomegaly, polyhydramnios and fetal hydrops. Preterm labor is common because of gross polyhydramnios, and further deteriorations will lead to intrauterine death of both twins.

  13. Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome

    Directory of Open Access Journals (Sweden)

    García-Díaz Lutgardo

    2012-07-01

    Full Text Available Abstract Background Giant placental chorioangiomas have been associated with a number of severe fetal complications and high perinatal mortality. Case presentation We report a case of giant chorioangioma with fetal hydrops, additionally complicated by severe anemia, mild cardiomegaly with hyperdinamic heart circulation and maternal mirror syndrome. Intrauterine blood transfusion and amniodrainage was performed at 29 weeks. Worsening of the fetal and maternal condition prompted us to proceed with delivery at 29 + 5 weeks. The newborn died 3 hours later due to pulmonary hypoplasia and hemodynamic failure. Maternal course was favourable, mirror syndrome resolved in the second day and the patient was discharged four days following delivery. Conclusions In the case described here, fetal condition got worse despite of the anemia correction and amniodrainage. Our outcome raises the issue whether additional intrauterine clinical intervention, as intersticial laser, should have been performed to stop further deterioration of the fetal condition when progressive severe hydrops develops.

  14. Unilateral right pulmonary artery agenesis and congenital cystic adenomatoid malformation of the right lung with Ortner′s syndrome

    Directory of Open Access Journals (Sweden)

    Jane Jackie David

    2016-01-01

    Full Text Available We report a 2.5-year-old girl who presented with hoarseness of voice since 3 months of age and failure to thrive. Chest X-ray showed cardiomegaly with a deviation of the trachea and mediastinum to the right side. Two-dimensional echocardiography showed decreased flow across the right pulmonary artery, a small atrial septal defect (ASD with a right-to-left shunt, and a dilated right atrium and right ventricle with severe tricuspid regurgitation suggestive of severe pulmonary hypertension. A silent large patent ductus arteriosus was also seen. Multiple detector computerized tomography aortogram confirmed the findings of absent right pulmonary artery and hypoplastic right lung with small cystic lesions suggestive of congenital cystic adenomatoid malformation in the right lower lobe. Hoarseness of voice was due to the left vocal cord palsy probably secondary to severe pulmonary hypertension (Ortner′s syndrome.

  15. Unilateral right pulmonary artery agenesis and congenital cystic adenomatoid malformation of the right lung with Ortner's syndrome.

    Science.gov (United States)

    David, Jane Jackie; Mohanlal, Smilu; Sankhe, Punam; Ghildiyal, Radha

    2016-01-01

    We report a 2.5-year-old girl who presented with hoarseness of voice since 3 months of age and failure to thrive. Chest X-ray showed cardiomegaly with a deviation of the trachea and mediastinum to the right side. Two-dimensional echocardiography showed decreased flow across the right pulmonary artery, a small atrial septal defect (ASD) with a right-to-left shunt, and a dilated right atrium and right ventricle with severe tricuspid regurgitation suggestive of severe pulmonary hypertension. A silent large patent ductus arteriosus was also seen. Multiple detector computerized tomography aortogram confirmed the findings of absent right pulmonary artery and hypoplastic right lung with small cystic lesions suggestive of congenital cystic adenomatoid malformation in the right lower lobe. Hoarseness of voice was due to the left vocal cord palsy probably secondary to severe pulmonary hypertension (Ortner's syndrome).

  16. Characterization of T cell clones from chagasic patients: predominance of CD8 surface phenotype in clones from patients with pathology

    Directory of Open Access Journals (Sweden)

    Washington R. Cuna

    1995-08-01

    Full Text Available Human Chagas' disease, caused by the protozoan Trypanosoma cruzi, is associated with pathological processes whose mechanisms are not known. To address this question, T cell lines were developed from chronic chagasic patients peripheral blood mononuclear cells (PBMC and cloned. These T cell clones (TCC were analyzed phenotypically with monoclonal antibodies by the use of a fluorescence microscope. The surface phenotype of the TCC from the asymptomatic patient were predominantly CD4 positive (86%. On the contrary, the surface phenotype CD8 was predominant in the TCC from the patients suffering from cardiomegaly with right bundle branch block (83%, bradycardia with megacolon (75 % and bradycardia (75%. Future studies will be developed in order to identify the antigens eliciting these T cell subpopulations.

  17. October 2016 imaging case of the month

    Directory of Open Access Journals (Sweden)

    Gotway MB

    2016-10-01

    Full Text Available No abstract available. Article truncated after first page. Clinical History: A 35-year-old woman presented with a several month history of slowly worsening shortness of breath and dry cough. Laboratory data, include white blood cell count and serum chemistries were within normal limits. Oxygen saturation on room air was 99%. Frontal and lateral chest radiographs (Figure 1 were performed. Which of the following statements regarding the chest radiograph is most accurate? 1. Frontal and lateral chest radiography appears normal; 2. Frontal and lateral chest radiography shows abnormally diminished lung volumes; 3. Frontal and lateral chest radiography shows bilateral peribronchial and mediastinal lymph node enlargement; 4. Frontal and lateral chest radiography shows cardiomegaly; 5. Frontal and lateral chest radiography shows upper lobe bilateral linear and reticular abnormalities. ...

  18. February 2015 imaging case of the month

    Directory of Open Access Journals (Sweden)

    Gotway MB

    2015-02-01

    Full Text Available No abstract available. Article truncated after first page. Clinical History: A 37-year-old man, a former smoker (quit 10 years ago presented to his physician as an outpatient with complaints of intermittent chest pain, malaise, and intermittent fever. Stress ECG and upper endoscopy were negative. His previous medical history was otherwise unremarkable. Various physicians told the patient his symptoms were due to “stress”; presumptive antibiotic treatment had no effect. Frontal chest radiography (Figure 1 was performed. Which of the following statements regarding the chest radiograph is most accurate? 1. The chest radiograph shows a circumscribed pulmonary mass; 2. The chest radiograph shows asymmetric pulmonary vascularity; 3. The chest radiograph shows bilateral linear and reticular opacities and diminished lung volumes suggesting fibrotic lung disease; 4. The chest radiograph shows cardiomegaly and small pleural effusions; 5. The chest radiograph shows numerous small nodules ...

  19. Lethal Cardiomyopathy in Mice Lacking Transferrin Receptor in the Heart

    Directory of Open Access Journals (Sweden)

    Wenjing Xu

    2015-10-01

    Full Text Available Both iron overload and iron deficiency have been associated with cardiomyopathy and heart failure, but cardiac iron utilization is incompletely understood. We hypothesized that the transferrin receptor (Tfr1 might play a role in cardiac iron uptake and used gene targeting to examine the role of Tfr1 in vivo. Surprisingly, we found that decreased iron, due to inactivation of Tfr1, was associated with severe cardiac consequences. Mice lacking Tfr1 in the heart died in the second week of life and had cardiomegaly, poor cardiac function, failure of mitochondrial respiration, and ineffective mitophagy. The phenotype could only be rescued by aggressive iron therapy, but it was ameliorated by administration of nicotinamide riboside, an NAD precursor. Our findings underscore the importance of both Tfr1 and iron in the heart, and may inform therapy for patients with heart failure.

  20. Two unusual cases of haemoglobin Bart's hydrops fetalis due to uniparental disomy or non-paternity.

    Science.gov (United States)

    Kou, K O; Lee, Helena; Lau, Betty; Wong, W S; Kan, Anita; Tang, Mary; Lau, Elizabeth T; Poon, C F; Leung, K Y

    2014-01-01

    The authors present 2 unusual cases of haemoglobin (Hb) Bart's hydrops fetalis and highlight the problem of a screening system for α-thalassaemia which focuses on maternal and paternal mean corpuscular volume (MCV) alone. Normal paternal MCV may not preclude fetal Hb Bart's disease because of the rare occurrence of maternal uniparental disomy or non-paternity. During a mid-trimester anomaly scan, with fetal cardiomegaly or hydrops in a woman with low MCV but normal paternal MCV, obstetricians should remain alert for fetal Hb Bart's disease. This is very important and relevant for national screening systems in South-East Asia, where a routine mid-trimester scan may not be available. A routine mid-trimester anomaly scan should therefore be implemented and in high prevalence areas, sonographers should be sensitive to the cardio-thoracic ratio even if screening shows that pregnancy is unlikely to be at risk.

  1. A rare case of peripartum cardiomyopathy posted for caesarean section

    Directory of Open Access Journals (Sweden)

    Nalini Kotekar

    2007-01-01

    Full Text Available Post Partum Cardiomyopathy (PPCM is a relatively rare form of heart failure associated with pregnancy. It was recognized first in the 19th century by Ritchie and is defined as the onset of acute heart failure in the last trimester or early post partum period in the absence of infections, metabolic, toxic, ischaemic or valvular causes of myocardial dysfunction. Prognosis depends on the degree of cardiomegaly at presentation and in the following 6 months. Initial high risk period carries a mortality of 25 to 50%. Keeping in mind the reduced contractility and ejection fraction with ventricular dilatation proceeding to cardiac failure, the anesthesiologist managing a case of PPCM faces the challenge of avoiding myocardial depression, hypovolemia and increased SVR, all of which may be hazardous

  2. Cardiac tamponade as a presenting manifestation of severe hypothyroidism.

    Science.gov (United States)

    Butala, Ashvin; Chaudhari, Shilpa; Sacerdote, Alan

    2013-02-05

    We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.

  3. Prenatal MR findings in a case of aneurysm of the vein of Galen

    Energy Technology Data Exchange (ETDEWEB)

    Kurihara, Nobuyoshi; Ikeda, Kazushige; Mori, Kazuhiro; Hokuto, Isamu [Dept. of Paediatrics, Keio University School of Medicine, Tokyo (Japan); Tokieda, Keisuke [Dept. of Paediatrics, Keio University School of Medicine, Tokyo (Japan); Div. of Neonatology, Department of Paediatrics, Keio University School of Medicine, Tokyo (Japan); Nishimura, Osamu; Ishimoto, Hitoshi [Dept. of Obstetrics and Gynaecology, Keio University School of Medicine, Tokyo (Japan); Yuasa, Yuji [Dept. of Diagnostic Radiology, Keio University School of Medicine, Tokyo (Japan)

    2001-03-01

    We describe a case of aneurysm of the vein of Galen (AVG), which was diagnosed by intrauterine US, MRI and MRA. The baby girl was born at 35 weeks' gestation. She had severe clinical symptoms at birth and died at 29 h of age from intractable congestive heart failure. Intrauterine US detected an intracranial aneurysm and cardiomegaly due to excessive arteriovenous shunting. Intrauterine MRI (SSFSE) confirmed the diagnosis of AVG, and intrauterine MRA (2D-TOF) successfully demonstrated the anatomical structure of the AVG. MRA may be a useful additional sequence to evaluate AVG, and 2D-TOF is thought to be an appropriate technique for scanning fetal AVG. (orig.)

  4. Cardiac Fibroma in a Neonate Presenting With Dyspnea and Tachycardia: A Very Rare Case Tachycardia

    Directory of Open Access Journals (Sweden)

    Anvari Shahriar

    2016-01-01

    Full Text Available Introduction: Cardiac tumors can be divided to primary and secondary and to benign and malignant tumors. One of the benign tumors of the heart is cardiac fibroma. More than 80% of this tumor occurs in children; however its occurrence in neonates is very rare. Fewer than 100 cases have been reported. Case Presentation: Our patient is a 10 day’s girl neonate with severe dyspnea, mild cyanosis, tachycardia (heart rate = 170- 180/min and obstruction of right ventricle (RV outlet with very large tumor. Conclusion: Cardiac tumors in neonate population must be considered in the diagnosis of arrhythmias, cardiac insufficiency, valvular disease, cardiomegaly or presence of murmurs. Early diagnosis before birth should be appropriate and accurate imaging devices must be used in detecting these tumors.

  5. Clinical and laboratory diagnosis of congenital Zika virus syndrome and diaphragmatic unilateral palsy: case report

    Directory of Open Access Journals (Sweden)

    Alex Sandro Rolland Souza

    Full Text Available Abstract Introduction: several birth defects associated to congenital Zika virus infection have been reported, although the clinical features have not been fully characterized. Description: this is the first case report on unilateral diaphragmatic paralysis diagnosed on a neonate with congenital Zika confirmed by the examination of the amniotic fluid through polymerase chain reaction (ZIKV RT-PCR and the examination of cerebrospinal fluid by serological test (IgM ZIKV-ELISA after birth. The main manifestations detected by intrauterine ultrasound were: microcephaly, ventriculomegaly, intracranial calcifications, enlarged cisterna magna, increased amniotic fluid index and fetal akinesia syndrome. The newborn had acute respiratory failure in the first hours of life, requiring mechanical ventila-tion. The X- ray of the chest showed unilateral diaphragmatic paralysis and cardiomegaly. Discussion: diaphragmatic palsy in congenital Zika has not been previously reported, the etiopathogenic mechanisms of this event in congenital Zika virus needs to be elucidated.

  6. SPECTRUM OF ACUTE GLOMERULO NEPHRITIS IN CHILDREN AT GOVERNMENT GENERAL HOSPITAL, ANANTAPURAMU

    Directory of Open Access Journals (Sweden)

    Ravi Kumar

    2015-04-01

    Full Text Available AIM: Aim of the study is to study the spectrum of AGN in children and to assess the age, sex and seasonal incidence and prognostic factors. Acute glomerulonephritis is one of the most common condition seen in children. The study group included 50 children. In most of the children presenting complaints s of are puffiness of face, haematuria and oliguria. METHODS AND MATERIALS: Fifty children who were admitted in the government hospital during the period of September 2013 to January 2015 were included in the stud y. RESULTS: The maximum admissions were seen from the months of September to December. Common age group was between 3 and 8 years. Rare age group was below 2 years. Hypertension was noticed in 32 out of 50 children. Albuminuria and hematuria were commonest urinary abnormalities. CONCLUSION: acute glomerulonephritis is less common below 2 years. Hypertension was of varying degree. Cardiomegaly by x - ray was an added feature.

  7. Lethal Cardiomyopathy in Mice Lacking Transferrin Receptor in the Heart.

    Science.gov (United States)

    Xu, Wenjing; Barrientos, Tomasa; Mao, Lan; Rockman, Howard A; Sauve, Anthony A; Andrews, Nancy C

    2015-10-20

    Both iron overload and iron deficiency have been associated with cardiomyopathy and heart failure, but cardiac iron utilization is incompletely understood. We hypothesized that the transferrin receptor (Tfr1) might play a role in cardiac iron uptake and used gene targeting to examine the role of Tfr1 in vivo. Surprisingly, we found that decreased iron, due to inactivation of Tfr1, was associated with severe cardiac consequences. Mice lacking Tfr1 in the heart died in the second week of life and had cardiomegaly, poor cardiac function, failure of mitochondrial respiration, and ineffective mitophagy. The phenotype could only be rescued by aggressive iron therapy, but it was ameliorated by administration of nicotinamide riboside, an NAD precursor. Our findings underscore the importance of both Tfr1 and iron in the heart, and may inform therapy for patients with heart failure.

  8. Radiological and clinical features of the single ventricle

    Energy Technology Data Exchange (ETDEWEB)

    Maisch, B.; Kulke, H.; Marcin, S.; Deeg, P.; Braun, H.; Kochsiek, K.

    1983-03-01

    The case a twenty year old patient is reported, whose chest X-ray demonstrated cardiomegaly with a prominent pulmonary segment. The echocardiographical examination indicated a single ventricle with septal rudiments; heart catherization confirmed the diagnosis of a single ventricle of the right ventricular type with a well-sized left ventricular outlet chamber and the banding of the pulmonary artery. In addition the case of a 17 year old patient is reported, whose chest X-ray demonstrated dextrocardia. Clinical manifestations (cyanosis, elevated hemoglobin, clubbing, 3rd heart sound) as well as one- and two-dimensional echocardiography with echocontrast media confirmed the diagnosis of corrected transposition of the great arteries, pulmonary stenosis and incompetence, single ventricle and dextrocardia, a diagnosis made already 12 years ago by heart catherization.

  9. Shone's complex with dextrocardia and situs inversus totalis: a case report.

    Science.gov (United States)

    Ekici, Berkay; Erkan, Aycan Fahri; Sökmen, Yeliz; Tüfekçioğlu, Omaç

    2012-10-01

    Parachute mitral valve complex is an unusual congenital anomaly that has been described by Shone et al. It is characterized by a parachute deformity of the mitral valve associated with additional forms of left heart anomalies, such as aortic valvular stenosis and coarctation of the aorta. A 21-year-old female who was referred to our department because of progressive dyspnea on effort and at rest and minimal cyanosis is presented in this case report. On cardiac auscultation, the patient had a grade III/VI pansystolic murmur best heard at the lower left sternal border. The chest X-ray demonstrated dextrocardia and mild cardiomegaly. Echocardiographic evaluation revealed Shone's complex, including parachute mitral valve anomaly.

  10. Morganella morganii causing solitary liver abscess complicated by pyopericardium and left pleural effusion in a nondiabetic patient.

    Science.gov (United States)

    Tsai, Wen-Cheng; Chang, Liang-Kai

    2002-09-01

    Morganella morganii is a rare cause of solitary liver abscess in Taiwan. The complication of pyopericardium and pleural effusion in nondiabetic patient with solitary liver abscess are also rare. We present a case of a 48-year-old nondiabetic woman who experienced with epigastric discomfort 1 month prior to admission. Chills and fever developed 2 weeks before admission. Physical examination on admission revealed engorgement of the jugular vein over the right neck, precordial friction rubs, and tenderness over the right upper quadrant of abdomen. Chest film showed mild cardiomegaly and left pleural effusion. Computed tomography of the abdomen showed liver abscess, left hepatic lobe, pyopericardium, and left pleural effusion. M. morganii was isolated from 2 sets of blood cultures, one set of hepatic pus culture, and one set of pericardial pus culture. After pigtail drainage of liver abscess, pyopericardium for 12 days, and ceftriaxone intravenous administration for 19 days, the patient was discharged in stable condition.

  11. An interesting case of cor pulmonale

    Directory of Open Access Journals (Sweden)

    Bagrecha Manish V, Kunkulol Rahul R

    2013-01-01

    Full Text Available A 14 yrs old boy presented with a history of breathlessness since 1 yr which had increased from 2 days, cough with expectoration and pedal edema since 7 days. In the past patient had history of kyphoscoliosissince birth and had a history of repeated URTI. On examination he had tachycardia, tachypnea, raised JVP, kyphoscoliosis, bilateral pitting edema. Respiratory auscultation revealed bilateral fine crepitations and wheezes. On investigation haemoglobin: 14.6, T.L.C: 20,000,chest X-ray: kyphoscoliosis with cardiomegaly. Clinical diagnosis of corpulmonale due to kyphoscoliosis was achieved and was confirmed with 2D echo. ECG showed RVH. The patient was treated with oxygen, diuretics, antibiotics, bronchodilators. Patient improved and was discharged on bronchodilators and was asymptomatic on follow up.

  12. Ultrasound for critical care physicians: connecting disparate symptoms

    Directory of Open Access Journals (Sweden)

    Gotway MB

    2013-09-01

    Full Text Available No abstract available. Article truncated after the first page. An 18-year-old woman was recently diagnosed with non-ACTH-Mediated Cushing syndrome, now with a complaint of mild shortness of breath. Her cardiac exam showed normal sinus rhythm at 84 beats per minute and blood pressure of 130/80 mmHg. Her mitral first heart sound was slightly accentuated, but the pulmonic sound was normal. Grade-I diastolic murmur was heard over the mitral area. Opening snap was absent. Lungs were clear and chest radiograph showed slight cardiomegaly. She had multiple freckles on his face and trunk and along the vermillion border of the lips. An ultrasound of the heart was performed (Figure 1. Which of the following is the likely diagnosis? 1.Brugada syndrome 2.Carney syndrome 3.Gotway syndrome 4.Jervell and Lange-Nielsen syndrome 5.Peutz-Jeghers syndrome …

  13. Hb Lansing (HBA2: c.264C > G) and a new β promoter transversion [-52 (G > T)]: an attempt to define the phenotype of two mutations found in the Omani population.

    Science.gov (United States)

    Hassan, Suha M; Harteveld, Cornelis L; Bakker, Engbert; Giordano, Piero C

    2015-01-01

    We report two examples showing how problematic it can be to define the phenotype of new or rare globin genes mutations. We describe two mutations observed for the first time in the Omani population: the first was found in the consanguineous parents of a deceased newborn with hepatomegaly, cardiomegaly and severe hemolytic anemia, putatively homozygous for the rare Hb Lansing (HBA2: c.264C > G) variant. The second is a novel β-globin gene promoter mutation [-52 (G > T)] observed in four independent patients. Two with borderline/elevated Hb A2, α-thalassemia (α-thal) and hypochromic red cell indices, and two heterozygotes for Hb S (HBB: c.20A > T), α-thal and with Hb A/Hb S ratios possibly indicating a very mild β(+)-thalassemia (β(+)-thal) mutation.

  14. MRI Verification of a Case of Huge Infantile Rhabdomyoma

    Science.gov (United States)

    Ramadani, Naser; Kreshnike, Kreshnike Dedushi; Muçaj, Sefedin; Kabashi, Serbeze; Hoxhaj, Astrit; Jerliu, Naim; Bejiçi, Ramush

    2016-01-01

    Introduction: Cardiac rhabdomyoma is type of benign myocardial tumor that is the most common fetal cardiac tumor. Cardiac rhabdomyomas are usually detected before birth or during the first year of life. They account for over 60% of all primary cardiac tumors. Case report: A 6 month old child with coughing and obstruction in breathing, was hospitalized in the Pediatric Clinic in UCCK, Pristine. The difficulty of breathing was heard and the pathological noise of the heart was noticed from the pediatrician. In the echo of the heart at the posterior and apico-lateral part of the left ventricle a tumoral mass was presented with the dimensions of 56 × 54 mm that forwarded the contractions of the left ventricle, the mass involved also the left ventricle wall and was not vascularized. The right ventricle was deformed and with the shifting of the SIV on the right the contractility was preserved. Aorta, the left arch and AP were normal with laminar circulation. The pericard was presented free. Radiography of thoracic organs was made; it resulted on cardiomegaly and significant bronchovascular drawing. It was completed with an MRI and it resulted on: Cardiomegaly due to large tumoral mass lesion (60×34 mm) involving lateral wall of left ventricle. It was isointense to the muscle on T1W images, markedly hyperintense on T2W images. There were a few septa or bant like hypointensities within lesion. On postcontrast study it showed avid enhancement. The left ventricle volume was decreased. Mild pericardial effusion was also noted. Surgical intervention was performed and it resulted on the histopathological aspect as a huge infantile rhadbomyoma. Conclusion: In most cases no treatment is required and these lesions regress spontaneously. Patients with left ventricular outflow tract obstruction or refractory arrhythmias respond well to surgical excision. Rhabdomyomas are frequently diagnosed by means of fetal echocardiography during the prenatal period. PMID:27147810

  15. CT of the chest in the evaluation of idiopathic pulmonary arterial hypertension in children

    Energy Technology Data Exchange (ETDEWEB)

    Chaudry, Gulraiz [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto (Canada); Children' s Hospital Boston, Department of Radiology, Boston, MA (United States); MacDonald, Cathy; Gundogan, Munire; Manson, David [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto (Canada); Adatia, Ian [UCSF Children' s Hospital, Department of Pediatric Cardiology, San Francisco, CA (United States)

    2007-04-15

    Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease in children. By definition it is a diagnosis of exclusion, and CT of the chest is primarily performed to exclude other causes. Previous studies have defined CT features suggestive of the diagnosis of IPAH, but these have all been limited to the adult population. Contrast-enhanced chest CT and high-resolution CT findings in IPAH were evaluated in an attempt to define features consistently seen in children with this condition. The chest CT scans performed at initial presentation were reviewed in 17 children with echocardiographic or angiographic evidence of IPAH. There were nine boys and eight girls, ranging in age from 1 month to 17 years. The extrapulmonary findings included cardiomegaly with right-sided cardiac enlargement, which was seen in 13 children. The central pulmonary arteries were enlarged in 15 children, with peripheral enlargement in two. In six children this resulted in bronchial compression. In addition, mediastinal and hilar lymphadenopathy was noted in three children. Prominent intrapulmonary features included a peripheral vasculopathy, with enlarged tortuous vessels, seen in eight children. Ill-defined ground-glass centrilobular opacities were also noted in eight children, representing the most common parenchymal abnormality. Other findings included septal lines in five, diffuse ground-glass opacification in four and focal hyperlucent zones in three. Mosaic attenuation was seen in one child. A variety of imaging findings are identified in IPAH. Features particularly consistent with the diagnosis include peripheral vasculopathy and centrilobular opacities in the setting of cardiomegaly and central pulmonary arterial enlargement. (orig.)

  16. HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY IN AN 8-MONTH OLD FEMALE INFANT SUSPECTED INFANTILE ONSET POMPE DISEASE

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    Made Dwi Purnami

    2015-05-01

    Full Text Available Hypertrophic cardiomyopathy (HCM is an autosomal dominant cardiac disorder marked with muscular hypertrophy of the left ventricle, associated obstruction of left ventricular outflow. About 0.2% of all cases worldwide. The majority of patients are asymptomatic, and some present with severe activity- limiting symptoms. The diagnosis of HCM before the age of 2 years is rare and usually discovered by chance, during the investigation of a murmur. Progressive disease characterized by prominent cardiomegaly, cadiomyopathy, hepatomegaly, musle weakness or hypotonia, respiratory distress, feeding difficulties and failure to thrive as presenting sign and symptoms are often referred to infantile Pompe disease. A deficiency of of the enzyme acid alpha glucosidase disease, result in lysosomal accumulation of glycogen in heart and skeletal muscle. Cardiorespiratory failure is the cause of significant morbidity and mortality in the first year of life. We reported a rare case, 8 month-old female with frequent respiratory distress since 2 months before admission. Physical examination showed dyspnea with chest wall retraction, no cyanosis, with grade III systolic murmur at midclavicular line sinistra, ICS IV- V and floopy infant. Chest films showed   pneumonia and cardiomegaly. The echocardiogram demonstrated bi-ventricular and interventricular hypertrophy with left ventricular obstruction. Laboratory finding there was increased levels of glutamic oxaloacetic acid transferase, alanin aminotransferase, and lactate dehydrogenase. Patient was diagnosed with hypertrophic obstructive cardiomyopathy of suspected infantile onset pompe disease. Despite medical treatment with propanolol dan diuretics, there was no significant improvement and she was died after 26th days of treatment in intermediate ward. [MEDICINA 2014;45:108-14]    

  17. Evolução da cardiopatia experimentalmente induzida em coelhos infectados com Trypanosoma cruzi

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    Florêncio Figueiredo

    1985-09-01

    Full Text Available Coelhos jovens de ambos os sexos (1-2 meses de idade, outbred, inoculados com tripomastigotas da cepa Colômbia de Trypanosoma cruzi desenvolveram lesões cardíacas, macro e microscópicas, além de características parasitológicas e imunológicas, muito semelhantes às observadas na doença de Chagas humana, tanto na fase aguda como na fase crônica. Na fase aguda a síndrome cardíaca caracteriza-se macroscopicamente por discreta cardiomegalia, com dilatação de câmaras direitas, e miscroscopicamente por miocardite focal pouco acentuada; na fase crônica, por cardiomegalia moderada ou acentuada, com hipertrofia e dilatação de câmaras e adelgaçamento da ponta (aneurisma apical, predominantemente do ventrículo esquerdo, e por miocardite focal, cóm áreas de necrose miocitolítica e degeneração de miocélulas, associadas a infiltrado inflamatório, principalmente composto de linfócitos, e fibrose intersticial. Devido à reprodução de aspectos da doença cardíaca chagásica humana em tempo relativamente curto, à simplicidade, à disponibilidade para múltiplos pesquisadores e ao baixo custo, o modelo representado pelo coelho constitui uma alternativa para estudos dos mecanismos, patologia e tratamento da cardiopatia chagásica.Male and female out bred young rabbits (1-2 months of age inoculated with trypomastigote forms of the Colombia strain of T. cruzi have been shown to develop cardiac pathologic changes, besides parasitologícal and immunological features, very similar to those observed in both acute and chronic phases of Chagas' disease in man. In the acute phase the cardiac syndrome is characterized grossly by slight cardiomegaly, with dilatation of the right chambers and microscopically by discretefocal myocarditis: in the chronic phase, by moderate ormarked cardiomegaly, with hypertrophy and dilatation of all chambers, and thinning of the ventricularapex (apical aneurysm, particularly of the left ventricle, andstriking

  18. Pulmonary manifestation of leptospirosis

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    Im, Jung Gi; Yeon, Kyung Mo; Han, Man Chung; Kim, Chu Wan; Lee, Jung Sang; Kim, Suhng Gwon; Han, Yong Chol; Chang, Woo Hyun; Chi, Je Geun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Authors analysed and present chest X-ray findings of serologically proven leptospirosis from Seoul National University Hospital, either admitted or referred for serological verification, during recent 2 years. Radiological findings were correlated with the lung specimen findings of experimentally induced leptospirosis in guinea pig. The results are as follows: 1. 24 cases (56%) showed positive X-ray findings. 2. Predominant radiological patterns of involved lung were tiny dot, small nodule, rosette density in 11 cases, massive confluent consolidation in 4 cases, and diffuse ill-defined velly increased density in 9 cases. 3. Distribution of pulmonary lesions were bilateral (100%), non-lobar, non-segmental (95%), and there were conspicuous tendency of peripheral lung predominance. 4. Extrapulmonary manifestation, such as pleural effusion or cardiomegaly was rate. 5. Pulmonary lesions resolved completely usually 5 to 10 days after their appearance. 6. From the gross and microscopic findings of serially sacrificed guinea pig's lung and a case of autopsy, authors concluded that fine dot-like density in chest X-ray was due to paleolithic hemorrhage in intraalveolar space at initial stage, growing up to ressette density or confluent consolidation as the pathetic extends to surrounding lung forming purpura and coalescent hemorrhage.

  19. Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico

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    María del Carmen Sánchez-Guillén

    2006-11-01

    Full Text Available In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA. Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF asymptomatic individuals without evidence of abnormalities (n = 34 cases; those with gastrointestinal alterations (12 patients including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients - mild electrocardiographic changes of ventricular repolarization, sinus bradychardia; moderate (6 patients - left bundle branch block, right bundle branch block associated with left anterior fascicular block; severe (8 patients - signs of cardiomegaly, dilated cardiomyopathy; and the associated form (3 cases that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.

  20. Carlos Chagas Discoveries as a Drop Back to Scientific Construction of Chronic Chagas Heart Disease

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    Bestetti, Reinaldo B., E-mail: rbestetti44@gmail.com; Restini, Carolina Baraldi A.; Couto, Lucélio B. [Universidade de Ribeirão Preto, Ribeirão Preto, São Paulo, SP (Brazil)

    2016-07-15

    The scientific construction of chronic Chagas heart disease (CCHD) started in 1910 when Carlos Chagas highlighted the presence of cardiac arrhythmia during physical examination of patients with chronic Chagas disease, and described a case of heart failure associated with myocardial inflammation and nests of parasites at autopsy. He described sudden cardiac death associated with arrhythmias in 1911, and its association with complete AV block detected by Jacquet's polygraph as Chagas reported in 1912. Chagas showed the presence of myocardial fibrosis underlying the clinical picture of CCHD in 1916, he presented a full characterization of the clinical aspects of CCHD in 1922. In 1928, Chagas detected fibrosis of the conductive system, and pointed out the presence of marked cardiomegaly at the chest X-Ray associated with minimal symptomatology. The use of serological reaction to diagnose CCHD was put into clinical practice in 1936, after Chagas' death, which along with the 12-lead ECG, revealed the epidemiological importance of CCHD in 1945. In 1953, the long period between initial infection and appearance of CCHD was established, whereas the annual incidence of CCHD from patients with the indeterminate form of the disease was established in 1956. The use of heart catheterization in 1965, exercise stress testing in 1973, Holter monitoring in 1975, Electrophysiologic testing in 1973, echocardiography in 1975, endomyocardial biopsy in 1981, and Magnetic Resonance Imaging in 1995, added to the fundamental clinical aspects of CCHD as described by Carlos Chagas.

  1. Carlos Chagas Discoveries as a Drop Back to Scientific Construction of Chronic Chagas Heart Disease

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    Reinaldo B. Bestetti

    2016-01-01

    Full Text Available Abstract The scientific construction of chronic Chagas heart disease (CCHD started in 1910 when Carlos Chagas highlighted the presence of cardiac arrhythmia during physical examination of patients with chronic Chagas disease, and described a case of heart failure associated with myocardial inflammation and nests of parasites at autopsy. He described sudden cardiac death associated with arrhythmias in 1911, and its association with complete AV block detected by Jacquet's polygraph as Chagas reported in 1912. Chagas showed the presence of myocardial fibrosis underlying the clinical picture of CCHD in 1916, he presented a full characterization of the clinical aspects of CCHD in 1922. In 1928, Chagas detected fibrosis of the conductive system, and pointed out the presence of marked cardiomegaly at the chest X-Ray associated with minimal symptomatology. The use of serological reaction to diagnose CCHD was put into clinical practice in 1936, after Chagas' death, which along with the 12-lead ECG, revealed the epidemiological importance of CCHD in 1945. In 1953, the long period between initial infection and appearance of CCHD was established, whereas the annual incidence of CCHD from patients with the indeterminate form of the disease was established in 1956. The use of heart catheterization in 1965, exercise stress testing in 1973, Holter monitoring in 1975, Electrophysiologic testing in 1973, echocardiography in 1975, endomyocardial biopsy in 1981, and Magnetic Resonance Imaging in 1995, added to the fundamental clinical aspects of CCHD as described by Carlos Chagas.

  2. Chagas Disease in Dogs from Endemic Areas of Costa Rica

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    Montenegro Victor M

    2002-01-01

    Full Text Available Dogs with the presumptive diagnosis of Chagas disease are commonly sent to our School of Veterinary Medicine by independent veterinarians. This prompted us to evaluate the prevalence of canine trypanosomiasis in some villages of the Central Valley of Costa Rica. A total of 54 dogs (21 males and 33 females from five rural villages, with ages between 3 months and 10 years old, were bled and submitted to three serological tests: indirect immunofluorescence, indirect hemagglutination and ELISA. Among all animals, 15 (27.7% revealed antibodies (6 pure bred and 9 mongrels and in 3 of them the parasite was also demonstrated by xenodiagnosis. All positive animals except 1, and 9 negative animals (control group were examined by X-rays and electrocardiography, revealing different degrees of cardiomegaly and ECG alteration, consistent with Chagas disease pathology in one dog (SA-11 of the infected ones. Examination of 50 inhabitants living in the houses where dogs and Triatoma dimidiata were found, yielded negative serological reactions. This was assumed to support the hypothesis that dogs are commonly infected by the oral route, a more effective means of infection compared with the vector transmission mechanism that occurs in humans.

  3. Trypanosoma cruzi high infectivity in vitro is related to cardiac lesions during long-term infection in Beagledogs

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    Paulo MM Guedes

    2007-03-01

    Full Text Available Trypanosoma cruzi is a hemoflagelate parasite associated with heart dysfunctions causing serious problems in Central and South America. Beagle dogs develop the symptoms of Chagas disease in humans, and could be an important experimental model for better understanding the immunopathogenic mechanisms involved in the chagasic infection. In the present study we investigated the relation among biological factors inherent to the parasite (trypomastigote polymorphism and in vitro infectivity and immunoglobulin production, inflammation, and fibrosis in the heart of Beagle dogs infected with either T. cruzi Y or Berenice-78 strains. In vitro infectivity of Vero cells as well as the extension of cardiac lesions in infected Beagle was higher for Y strain when compared to Berenice-78 strain. These data suggested that in vitro infectivity assays may correlate with pathogenicity in vivo. In fact, animals infected with Y strain, which shows prevalence of slender forms and high infectivity in vitro, presented cardiomegaly, inflammation, and fibrosis in heart area. Concerning the immunoglobulin production, no statistically significant difference was observed for IgA, IgM or IgG levels among T. cruzi infected animals. However, IgA together IgM levels have shown to be a good marker for the acute phase of Chagas disease.

  4. Mucopolysaccharidoses and anaesthetic risks.

    Science.gov (United States)

    Sjøgren, P; Pedersen, T; Steinmetz, H

    1987-04-01

    The purpose of this review is to asses the current knowledge of mucopolysaccharidosis (MPS), with reference to the serious complications which may arise in connection with anaesthesia and operation. MPS consists of a heterogeneous group of hereditary diseases which are characterized by an abnormal accumulation of mucopolysaccharides, especially in cartilaginous and bone tissue. Because of their progressive and disabling nature, frequent surgical intervention is common, and is associated with a high degree of per- and postoperative risk. The clinical manifestations of MPS are frequently dwarfism, scaphocephaly, grotesque facial features with snub nose, hypertelorism, macroglossia and dental anomalies. The chest is deformed by pectus carinatum or excavatum, club-formed ribs and kyphosis with gibbus. Furthermore, cardiomegaly, abdomen pendens, hepatosplenomegaly, umbilical hernia, corneal clouding, conductive deafness and subnormal intelligence are common findings. Prior to operation, patients should be thoroughly evaluated through clinical examination and laboratory investigations. In particular, lung function should be optimized by lung physiotherapy and treatment of airway infections. When inducing general anaesthesia, spontaneous respiration is recommended until the patient has been intubated, as airway anomalies, bleeding and salivation may make intubation extremely difficult. Local or regional anaesthesia is often preferable, though age and mental status are relative contraindications. When used in combination with careful sedation, many problems may be overcome. Postoperatively, it is important to treat stagnation of secretions and airway infections with lung physiotherapy positive end-expiratory pressure, and antibiotics. In connection with anesthesia, it is vital to monitor the patient carefully before, during and after anaesthesia.

  5. Is aorto-arteritis a manifestation of primary antiphospholipid antibody syndrome?

    Science.gov (United States)

    Dhaon, P; Das, S K; Saran, R K; Parihar, A

    2011-12-01

    A 23 year old female presented with dyspnea on exertion and absent pulses in the left upper limb. She had prior history of two first trimester abortions and pre-eclampsia with premature delivery. A Doppler examination had revealed left subclavian and axillary artery thrombosis for which she had been given warfarin six months previously. She was admitted and investigated. Patient had low positive aCL IgG antibody, positive antibeta2gp1 antibody, negative lupus anticoagulant and negative ANA. Patient had cardiomegaly and her echocardiography showed severe aortic regurgitation, moderate mitral regurgitation and moderate pulmonary artery hypertension with poor ejection fraction with normal aortic root. A diagnosis of primary antiphospholipid antibody syndrome with valvular involvement with dilated cardiomyopathy was entertained. A CT angiogram of the aorta revealed narrowing and irregularity of the aorta and its multiple branches suggestive of type III Takayasu's arteritis. Temporal relationship suggests development of aorto-arteritis secondary to APS but simultaneous presence of both these disorders in this patient cannot be ruled out.

  6. Antiphospholipid syndrome: A case study

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    Davies, T. [Royal Adelaide Hospital, Adelaide, SA (Australia). Department of Nuclear Medicine

    1998-03-01

    Full text: A forty-two-year-old male presented to the Royal Adelaide Hospital with symptoms of increasing shortness of breath, swelling in both ankles, petechial rash and blood in his sputum. Initial investigations showed cardiomegaly, right ventricular hypertrophy, patchy lung infiltrates, a platelet count of 1500 and a clotting time of 60 seconds. A V/Q scan indicated a high probability of pulmonary embolism. Further investigations showed that the patient was positive for lupus anticoagulant and cardiolipin antibodies. A diagnosis of primary antiphospholipid syndrome was made. The patient``s high risk of strokes and hemorrhaging prompted investigation by a {sup 99}mTc-HMPAO brain scan. Further V/Q scans were performed to follow up the initial finding of multiple pulmonary embolism and a R-L shunt study was performed to investigate a left subclavian murmur. The patient was admitted for four weeks and began treatment which included cyclaphosphamide, corticosteroids and plasmaphoresis and was discharged when stable. Over the next six months he was re admitted three times for relapse of antiphospholipid syndrome. On his fourth admission he collapsed and died five hours after admission. Cause of death was due to cardiac arrhythmia secondary to severe right ventricular hypertrophy and dilation. The effects of antiphospholipid syndrome was believed to be responsible for this outcome.

  7. Ebstein’s Anomaly – A Rare Cause of Shortness of Breath in Pregnancy

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    Mark Belham

    2012-01-01

    Full Text Available In October 2009, a 28-year-old woman, G1P0A0, presented at 24 weeks gestation, with a two week history of progressive shortness of breath. Prior to this admission, she had attended for routine antenatal care. She did not have any significant past medical history. On examination, she was not cyanosed. Her blood pressure was 80/40 mmHg, pulse was 100-120, irregularly, irregular and respiratory rate was 35 per minute. Her jugular venous pressure was raised to the ear lobes and she had mild peripheral oedema. Her chest was clear to auscultation. She had audible third and fourth heart sounds along with a 3/6 pansystolic murmur maximally heard in the third and fourth left intercostal spaces parasternally.Her chest x-ray revealed severe cardiomegaly. Electrocardiogram showed atrial fibrillation incomplete right bundle branch block with right ventricular strain pattern. A CT pulmonary angiogram showed no evidence of pulmonary embolism. Her transthoracic echocardiogram revealed normal left ventricle, dilated right ventricle with preserved contractility and severe tricuspid incompetence with a severely dilated right atrium.The findings were suggestive of a congenital Ebstein’s anomaly. She was admitted under the joint care of cardiology and obstetric medicine. She was treated with intravenous diuretics, digoxin and therapeutically anticoagulated with subcutaneous Low-Molecular Weight (LMW heparin. An obstetric ultrasound showed normal foetal anatomy and normal foetal growth.

  8. Persistent release of IL-1s from skin is associated with systemic cardio-vascular disease, emaciation and systemic amyloidosis: the potential of anti-IL-1 therapy for systemic inflammatory diseases.

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    Keiichi Yamanaka

    Full Text Available The skin is an immune organ that contains innate and acquired immune systems and thus is able to respond to exogenous stimuli producing large amount of proinflammatory cytokines including IL-1 and IL-1 family members. The role of the epidermal IL-1 is not limited to initiation of local inflammatory responses, but also to induction of systemic inflammation. However, association of persistent release of IL-1 family members from severe skin inflammatory diseases such as psoriasis, epidermolysis bullosa, atopic dermatitis, blistering diseases and desmoglein-1 deficiency syndrome with diseases in systemic organs have not been so far assessed. Here, we showed the occurrence of severe systemic cardiovascular diseases and metabolic abnormalities including aberrant vascular wall remodeling with aortic stenosis, cardiomegaly, impaired limb and tail circulation, fatty tissue loss and systemic amyloid deposition in multiple organs with liver and kidney dysfunction in mouse models with severe dermatitis caused by persistent release of IL-1s from the skin. These morbid conditions were ameliorated by simultaneous administration of anti-IL-1α and IL-1β antibodies. These findings may explain the morbid association of arteriosclerosis, heart involvement, amyloidosis and cachexia in severe systemic skin diseases and systemic autoinflammatory diseases, and support the value of anti-IL-1 therapy for systemic inflammatory diseases.

  9. Radiographic evaluation of cardiac silhouette in healthy Maine Coon cats

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    Caio Sabino de Oliveira

    2014-09-01

    Full Text Available Determining the size of the heart is important for evaluating cardiac patients, because the increase of the cardiac silhouette in the chest radiography can be indicative of heart disease. The vertebral heart size (VHS method is useful because it allows objective assessment of the limits of cardiac silhouette, and can help assess cardiomegaly and document changes in heart size in response to treatment or disease progression. The aim of this study was to compare VHS values of Maine Coon cats (MCC with values cited in the literature (7.5 ± 0.3 vertebrae obtained in non Maine Coon cats (NMCC. Sixty three MCC underwent the physical examination, electrocardiography, echocardiography, laboratory tests (blood count, biochemistry, including liver and kidney function, and total T4, as well as measurement of blood pressure. Faced with normal results, the cats were positioned in right lateral decubitus (right laterallateral projection, to perform chest radiography. The radiographic examinations were performed using the Fuji computed radiography system. The values of VHS found in the animals of this study were 7.61 ± 0.34 vertebrae with a minimum of 6.9 and of maximum 8.5 vertebrae. Statistical analysis performed by Student’s t test identified a significant difference between the values obtained in this study with those in the literature (p = 0.03 for non Maine Coon cats. The highest values of VHS obtained in MCC may be associated with the size of this giant breed.

  10. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection.

    Science.gov (United States)

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun; Lee, Jae-Ik; Jeon, Yang Bin

    2015-11-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.

  11. Bronchial compression in an infant with isolated secundum atrial septal defect associated with severe pulmonary arterial hypertension

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    Sung-Hee Park

    2012-08-01

    Full Text Available Symptomatic pulmonary arterial hypertension (PAH in patients with isolated atrial septal defect (ASD is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg. The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg, and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.

  12. Intestinal DMT1 is critical for iron absorption in the mouse but is not required for the absorption of copper or manganese

    Science.gov (United States)

    Shawki, Ali; Anthony, Sarah R.; Nose, Yasuhiro; Engevik, Melinda A.; Niespodzany, Eric J.; Barrientos, Tomasa; Öhrvik, Helena; Worrell, Roger T.; Thiele, Dennis J.

    2015-01-01

    Divalent metal-ion transporter-1 (DMT1) is a widely expressed iron-preferring membrane-transport protein that serves a critical role in erythroid iron utilization. We have investigated its role in intestinal metal absorption by studying a mouse model lacking intestinal DMT1 (i.e., DMT1int/int). DMT1int/int mice exhibited a profound hypochromic-microcytic anemia, splenomegaly, and cardiomegaly. That the anemia was due to iron deficiency was demonstrated by the following observations in DMT1int/int mice: 1) blood iron and tissue nonheme-iron stores were depleted; 2) mRNA expression of liver hepcidin (Hamp1) was depressed; and 3) intraperitoneal iron injection corrected the anemia, and reversed the changes in blood iron, nonheme-iron stores, and hepcidin expression levels. We observed decreased total iron content in multiple tissues from DMT1int/int mice compared with DMT1+/+ mice but no meaningful change in copper, manganese, or zinc. DMT1int/int mice absorbed 64Cu and 54Mn from an intragastric dose to the same extent as did DMT1+/+ mice but the absorption of 59Fe was virtually abolished in DMT1int/int mice. This study reveals a critical function for DMT1 in intestinal nonheme-iron absorption for normal growth and development. Further, this work demonstrates that intestinal DMT1 is not required for the intestinal transport of copper, manganese, or zinc. PMID:26294671

  13. Left-sided cardiac chamber evaluation using single-phase mid-diastolic coronary computed tomography angiography: derivation of normal values and comparison with conventional end-diastolic and end-systolic phases

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Jonathan R. [Technion-Israel Institute of Technology, Haifa (Israel); Abadi, Sobhi [Rambam Health Care Campus, Medical Imaging Department, Haifa (Israel); Solomonica, Amir [Rambam Health Care Campus, Cardiology Department, Haifa (Israel); Mutlak, Diab; Aronson, Doron; Agmon, Yoram; Lessick, Jonathan [Rambam Health Care Campus, Cardiology Department, Haifa (Israel); Technion-Israel Institute of Technology, Haifa (Israel)

    2016-10-15

    With increasing use of prospective scanning techniques for cardiac computed tomography (CT), meaningful evaluation of chamber volumes is no longer possible due to lack of normal values. We aimed to define normal values for mid-diastolic (MD) chamber volumes and to determine their significance in comparison to maximum volumes. Normal ranges at MD for left ventricular (LV) volume and mass and left atrial (LA) volume were determined from 101 normal controls. Thereafter, 109 consecutive CT scans, as well as 21 post-myocardial infarction patients, were analysed to determine the relationship between MD and maximum volumes. MD volumes correlated closely with maximal volumes (r = 0.99) for both LV and LA, and could estimate maximum volumes accurately. LV mass, measured at ED or MD, were very similar (r = 0.99). Abnormal MD volumes had excellent sensitivity and specificity to detect chamber enlargement based on maximal volumes (LV 86 %, 100 %, respectively; LA 100 %, 92 %, respectively). A single MD phase can identify patients with cardiomegaly or LV hypertrophy with a high degree of accuracy and MD volumes can give an accurate estimate of maximum LV and LA volumes. circle Traditionally, helical cardiac CT provided clinically important information from chamber volume analysis. (orig.)

  14. Radiological evaluation of sinus valsalva rupture

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    Lee, Yul; Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-03-15

    We obtained the following results by reviewing the radiographic findings of 15 cases of Sinus valsalva rupture who were diagnosed surgically at Seoul National University Hospital since 1979. 1. Among distribution was from 15 years to 40 years with the mean age of 24 years. Among the 15 cases, 9 cases were male and 7 were female. 2. Ruptured sinus is right coronary sinus projecting to right ventricle in all 15 cases. Combined diseases are ventricular septal defect in 12 cases, Aortic Valvular heart disease in 4 cases, and narrowing of right ventricular outflow tract in 2 cases, and aneurysmal dilatation of right pulmonary artery in 1 cases. 3. Chest X-ray findings were that of left to right shunt, i.e, cardiomegaly, increased pulmonary vascularity but were normal in 3 cases. 4. Aortography showed sequential leakage of dye from right coronary sinus to right ventricle and finally to pulmonary artery in 9 cases, and in 9 cases of them the leakage is directly to right ventricular outflow tract without filling of sinus portion of the ventricle., i.e., type I. 5. The leakage was well shown in left ventricular diastolic phase and not shown in systolic phase. 6. Ventricular septal defects were not detected definitely in spite of taking left ventriculography. 7. Cine angiography is essential for detecting accurate site, degree and direction of sinus valsalva rupture and other associated cardiac abnormality.

  15. Clinical forms of Trypanosoma cruzi infected individuals in the chronic phase of Chagas disease in Puebla, Mexico.

    Science.gov (United States)

    Sánchez-Guillén, María Del Carmen; López-Colombo, Aurelio; Ordóñez-Toquero, Guillermo; Gomez-Albino, Isidoro; Ramos-Jimenez, Judith; Torres-Rasgado, Enrique; Salgado-Rosas, Hilda; Romero-Díaz, Mónica; Pulido-Pérez, Patricia; Pérez-Fuentes, Ricardo

    2006-11-01

    In Mexico, despite the relatively high seroprevalence of Trypanosoma cruzi infection in humans in some areas, reported morbidity of Chagas disease is not clear. We determined clinical stage in 71 individuals seropositive to T. cruzi in the state of Puebla, Mexico, an area endemic for Chagas disease with a reported seroprevalence of 7.7%. Diagnosis of Chagas disease was made by two standardized serological tests (ELISA, IHA). Individuals were stratified according to clinical studies. All patients were submitted to EKG, barium swallow, and barium enema. Groups were identified as indeterminate form (IF) asymptomatic individuals without evidence of abnormalities (n = 34 cases); those with gastrointestinal alterations (12 patients) including symptoms of abnormal relaxation of the lower esophageal sphincter and absent peristalsis in the esophageal body, grade I megaesophagus, and/or megacolon; patients with clinical manifestations and documented changes of chronic Chagas heart disease who were subdivided as follows: mild (8 patients)--mild electrocardiographic changes of ventricular repolarization, sinus bradychardia); moderate (6 patients)--left bundle branch block, right bundle branch block associated with left anterior fascicular block); severe (8 patients)--signs of cardiomegaly, dilated cardiomyopathy); and the associated form (3 cases) that included presence of both cardiomyopathy and megaesophagus. These data highlight the importance of accurate evaluation of the prevalence and clinical course of Chagas disease in endemic and non-endemic areas of Mexico.

  16. Identification of patients at low risk of dying after acute myocardial infarction, by simple clinical and submaximal exercise test criteria.

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    Campbell, S; A'Hern, R; Quigley, P; Vincent, R; Jewitt, D; Chamberlain, D

    1988-09-01

    A consecutive series of 559 hospital survivors of acute myocardial infarction aged less than 66 years were studied; 93 were designated prospectively as low-risk because they were suitable for early submaximal exercise testing and had none of the following clinical or exercise test 'risk factors': (1) angina for at least one month prior to infarction; (2) symptomatic ventricular arrhythmias, or (3) recurrent ischaemic pain, both after the first 24 h of infarction; (4) cardiac failure; (5) cardiomegaly; and (6) an abnormal exercise test (angina, ST-depression or poor blood pressure response). Altogether 301 patients were exercised; their mortality over a median follow-up of 2.4 years was 10.2%, versus 24.6% in the 258 patients not exercised (P = 0.0005). Absence of clinical 'risk factors' alone, in the exercised patients, identified 156 with a mortality of 5.4% versus 15.6% in the 145 with at least one clinical 'risk factor' (P = 0.004). The fully defined low-risk group comprised 93 of the former patients who had neither clinical nor exercise test 'risk factors'. None of these patients died compared with 19 of those with at least one 'risk factor' (mortality = 14.7%; P = 0.002). Their respective rates of non-fatal reinfarction were similar and never exceeded 5% per annum. Therefore, simple clinical and exercise test criteria can positively identify low-risk patients after infarction in whom secondary prevention may be inappropriate.

  17. Rapidly vanishing lung pseudotumor in a patient with acute bilateral bronchopneumonia

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    Lazović Biljana

    2013-01-01

    Full Text Available Introduction. Rapidly vanishing lung pseudotumor (phantom tumor refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. Case report. A 47-yearold woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2°C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patient’s symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. Conclusion. The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.

  18. Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

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    Kazuhito Yajima

    2012-01-01

    Full Text Available We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

  19. Carlos Chagas Discoveries as a Drop Back to Scientific Construction of Chronic Chagas Heart Disease

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    Bestetti, Reinaldo B.; Restini, Carolina Baraldi A.; Couto, Lucélio B.

    2016-01-01

    The scientific construction of chronic Chagas heart disease (CCHD) started in 1910 when Carlos Chagas highlighted the presence of cardiac arrhythmia during physical examination of patients with chronic Chagas disease, and described a case of heart failure associated with myocardial inflammation and nests of parasites at autopsy. He described sudden cardiac death associated with arrhythmias in 1911, and its association with complete AV block detected by Jacquet's polygraph as Chagas reported in 1912. Chagas showed the presence of myocardial fibrosis underlying the clinical picture of CCHD in 1916, he presented a full characterization of the clinical aspects of CCHD in 1922. In 1928, Chagas detected fibrosis of the conductive system, and pointed out the presence of marked cardiomegaly at the chest X-Ray associated with minimal symptomatology. The use of serological reaction to diagnose CCHD was put into clinical practice in 1936, after Chagas' death, which along with the 12-lead ECG, revealed the epidemiological importance of CCHD in 1945. In 1953, the long period between initial infection and appearance of CCHD was established, whereas the annual incidence of CCHD from patients with the indeterminate form of the disease was established in 1956. The use of heart catheterization in 1965, exercise stress testing in 1973, Holter monitoring in 1975, Electrophysiologic testing in 1973, echocardiography in 1975, endomyocardial biopsy in 1981, and Magnetic Resonance Imaging in 1995, added to the fundamental clinical aspects of CCHD as described by Carlos Chagas. PMID:27223644

  20. Two different avipoxviruses associated with pox disease in Magellanic penguins (Spheniscus magellanicus) along the Brazilian coast.

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    Niemeyer, Claudia; Favero, Cíntia M; Kolesnikovas, Cristiane K M; Bhering, Renata C C; Brandão, Paulo; Catão-Dias, José Luiz

    2013-12-01

    A novel avipoxvirus caused diphtheritic lesions in the oesophagus of five and in the bronchioli of four Magellanic penguins (Spheniscus magellanicus) and also cutaneous lesions in eight Magellanic penguins housed in outdoor enclosures in a Rehabilitation Centre at Florianópolis, Santa Catarina State, Brazil. At the same time, another avipoxvirus strain caused cutaneous lesions in three Magellanic penguins at a geographically distinct Rehabilitation Centre localized at Vila Velha, Espírito Santo State, Brazil. Diagnosis was based on clinical signs, histopathology and use of the polymerase chain reaction (PCR). Clinical signs in the penguins included cutaneous papules and nodules around eyelids and beaks, depression and restriction in weight gain. The most common gross lesions were severely congested and haemorrhagic lungs, splenomegaly and cardiomegaly. Histological examination revealed Bollinger inclusion bodies in cutaneous lesions, mild to severe bronchopneumonia, moderate periportal lymphocytic hepatitis, splenic lymphopenia and lymphocytolysis. Other frequent findings included necrotizing splenitis, enteritis, oesophagitis, dermatitis and airsacculitis. Cytoplasmic inclusion bodies were seen within oesophageal epithelial cells in five birds and in epithelial cells of the bronchioli in four penguins. DNA from all samples was amplified from skin tissue by PCR using P4b-targeting primers already described in the literature for avipoxvirus. The sequences showed two different virus strains belonging to the genus Avipoxvirus of the Chordopoxvirinae subfamily, one being divergent from the penguinpox and avipoxviruses already described in Magellanic penguins in Patagonia, but segregating within a clade of canarypox-like viruses implicated in diphtheritic and respiratory disease.

  1. Restrictive cardiomyopathy. Report of seven cases

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    Fonseca Sánchez Luis Alfonso

    2014-07-01

    Full Text Available Restrictive cardiomyopathy is a disease characterized by ventricular diastolic failure with elevation of end-dyastolic pressure and preserved systolic function. Materials and methods: retrospective study of patients with a diagnosis of restrictive cardiomyopathy. We carry out an analysis of demographic data, clinical presentation, and studies of patients diagnosed in the last 15 years at Instituto Nacional de Pediatría. Results: all included patients had clinical data of heart failure manifested mainly by medium-sized efforts dyspnea on schoolchildren and dyspnea by feeding in infants, as well as polypnea and diaphoresis. The most important signs were hepatomegaly, ascites, and gallop rhythm. Cardiomegaly by right atrial dilatation was the most frequent radiological data. The most frequent electrocardiographic data were dilatation of both atria, ST-segment depression and negative T waves. Echocardiogram showed in all cases binaural dilation and restrictive pattern. Conclusions: our patients were similar to those described in the specialized literature. Echocardiogram is still the best study for the diagnosis and the use of functional measurements as Doppler imaging can help to reveal early diastolic failure. In our country the heart transplant is just feasible; mortality remains 100%. Keywords: Restrictive cardiomyopathy, Heart failure, Cardiomyopathy.

  2. Origen anómalo de la arteria coronaria izquierda originándose de la arteria pulmonar. Reporte de caso y revisión de literatura

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    José Jiménez Vega

    2007-01-01

    Full Text Available Se presenta el caso de un lactante de 2 meses de edad que consultó por tos y dificultad respiratoria; al ser admitido en el servicio de urgencias, el abordaje inicial fue de una infección respiratoria baja (bronquiolitis pero la evolución tórpida y la presencia de cardiomegalia hizo sospechar una cardiopatía, diagnosticándose origen anómalo de la arteria coronaria izquierda que nace de la arteria pulmonar, la cual fue tratada quirúrgicamente con resultado favorable.2 month old male who was brought to the emergency department with a history of non productive cold, was noticed with difficulty breathing. He was admitted with the possible diagnosis of bronquioloitis. The poor evolution of the patient, and the presence of cardiomegaly, made the physicians look for a cardiopathy, and a diagnosis of anomalous left coronary artery from the pulmonary artery was made. He was stabilized and then was taken to the operating room and had his anomalous coronary artery reimplanted to his aorta

  3. A Fetus with Hb Bart's Disease Due to Maternal Uniparental Disomy for Chromosome 16.

    Science.gov (United States)

    Au, Patrick K C; Kan, Anita S Y; Tang, Mary H Y; Leung, Kwok Y; Chan, Kelvin Y K; Tang, Tommy W F; Lau, Elizabeth T

    2016-01-01

    We here report an unusual case of Hb Bart's (γ4) disease. Thalassemia screening of a couple showed that the wife was an α(0)-thalassemia (α(0)-thal) carrier and her husband's mean corpuscular volume (MCV) was normal. Chorionic villus sampling (CVS) was performed at 13 weeks' gestation for positive Down syndrome screening and chromosomal study of the cultured CVS showed a normal karyotype. Ultrasound examination at 22 weeks' gestation showed fetal cardiomegaly and raised middle cerebral artery peak systolic velocity. Cordocentesis confirmed fetal anemia and showed Hb Bart's disease. Multiplex gap-polymerase chain reaction (gap-PCR) for α-thal deletions on DNA extracted from the CVS showed the presence of a homozygous α(0)-thal - -(SEA) (Southeast Asian) deletion. The husband was found to be a carrier of the α(+)-thal -α(3.7) (rightward) deletion. Non paternity was excluded by fluorescent PCR using short tandem repeat (STR) markers on chromosomes 13, 18 and 21. A de novo terminal deletion of chromosome 16 was excluded by array comparative genomic hybridization (aCGH). Detection of uniparental disomy (UPD), using STR markers on chromosome 16 showed maternal uniparental isodisomy from 16pter to 16p13.2, and uniparental heterodisomy from 16p13.13 to 16qter.

  4. Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease

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    Alves, Ursula David; Lopes, Agnaldo Jose; Maioli, Maria Christina Paixao; Soares, Andrea Ribeiro; Melo, Pedro Lopes de; Mogami, Roberto, E-mail: agnaldolopes.uerj@gmail.com [Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ (Brazil)

    2016-07-15

    Objective: To describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of haemoglobinopathy. Materials and Methods: A prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of haemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen. Results: The changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of haemoglobinopathy (HbSS group versus not HbSS group) was 72.7%. Conclusion: In adult patients with sickle cell disease, the main tomography findings reflect fibrotic changes. In addition, computed tomography can be helpful in differentiating among haemoglobinopathies. (author)

  5. Pericardial Effusion due to Primary Malignant Pericardial Mesothelioma: A Common Finding but an Uncommon Cause

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    Valery Istomin

    2016-01-01

    Full Text Available This case report describes a 37-year-old female who was admitted to our Emergency Department because of shortness of breath. On physical examination, she had dyspnea and tachycardia and blood pressure was 80/50 mmHg with a pulsus paradoxus of 22 mmHg. Neck veins were distended, heart sounds were distant, and dullness was found on both lung bases. Her chest X-ray revealed bilateral pleural effusion and cardiomegaly. On both computed tomography and echocardiography the heart was of normal size and a large pericardial effusion was noted. The echocardiogram showed signs of impending tamponade, so the patient underwent an emergent pericardiocentesis. No infectious etiology was found and she was assumed to have viral pericarditis and was treated accordingly. However, when the pericardial effusion recurred and empirical therapy for tuberculosis failed, a pericardial window was performed. A typical staining pattern for mesothelioma was found on her pericardial biopsy specimen. Since no other mesodermal tissue was affected, a diagnosis of primary malignant pericardial mesothelioma was made. Chemotherapy was not effective and she passed away a year after the diagnosis was made. This case highlights the difficulties in diagnosing this uncommon disease in patients that present with the common finding of pericardial effusion.

  6. Acute Purulent Tuberculosis Pericarditis with Cardiac Tamponade: a Case Report.

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    F. Z. Benaich

    2015-12-01

    Full Text Available Tuberculosis is a disease caused by Mycobacterium tuberculosis. Pulmonary localization is the most frequent. However, pericardial including extra- pulmonary disease, can cause fatal complications. A 37 years old man , without pathological history , who consults for emergency mid-thoracic pain associated with dyspnea, preceded by 10 days before a febrile syndrome with night sweats. Clinical examination showed patient in poor general condition, dyspneic and tachycardia. Cardiovascular examination showed spontaneous jugular veins and painful hepatomegaly, auscultation showed muted heart sounds without pericardial friction and breathless. Chest radiography showed cardiomegaly with symmetric edge straightness, electrocardiogram showed sinus tachycardia at 125bpm, microvoltage and electric alternating QRS complexes. A diffuse ST elevation ascending .Diagnosis of tamponade is suspected, transthoracic echocardiography showed abundance circumferential pericardial effusion measuring 40mm, with prolonged collapse of the right atrium and right ventricle , paradoxical septum , and significant changes in the flow inspiration. Pericardiocentesis ultrasound-guided has allowed a gradual evacuation of 2 liters of a cloudy yellow pericardial fluid, slightly viscous. Direct examination revealed the presence of 14 400 white cells, 99 % are neutrophils with gram-negative bacilli. Research bacillus by PCR and culture in the middle of LOWENSTEIN, later returned negative. Biologically, it is an important infectious syndrome. Taking into account the epidemiological profile of the country, diagnosis tuberculous primary infection tamponade was certain. quadruple anti- tuberculous treatment associated to corticosteroid therapy is instituted, The outcome was good, the patient was asymptomatic, with complete remission, echocardiography control finds no signs suggesting chronic constrictive pericarditis.

  7. Medical image of the week: malignant pericardial effusion and cardiac tamponade

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    Yun S

    2014-06-01

    Full Text Available No abstract available. Article truncated after 150 words. A 53 year old woman with history of metastatic breast cancer presented to the emergency department (ED with worsening shortness of breath for 2 weeks. She was initially diagnosed with grade III breast intraductal carcinoma was estrogen receptor, progesterone receptor, and HER2 negative 5 years earlier. A lumpectomy was performed followed by 4 cycles of chemotherapy with cyclophosphamide and taxol as well as radiation therapy. However, follow-up CT and MRI and subsequent biopsy demonstrated metastatic disease in the left adrenal gland, right ovary, and mediastinal lymph nodes, for which additional chemotherapy was started a month prior to presentation. In the ED, the patient was tachycardic and tachypneic. Vital signs showed BP 112/94 mmHg, HR 118 /min, RR 28 /min, temperature 97.5 °F, and SpO2 97 % with room air. EKG showed sinus tachycardia, low QRS voltage with electric alternans (Figure 1, and chest x-ray demonstrated cardiomegaly with a water bottle ...

  8. Assessment of congenital heart disease (CHD): Is there a role for fetal magnetic resonance imaging (MRI)?

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    Manganaro, L. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Savelli, S. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy)], E-mail: sarasavelli@hotmail.it; Di Maurizio, M.; Perrone, A.; Francioso, A.; La Barbera, L.; Totaro, P.; Fierro, F.; Tomei, A.; Coratella, F. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Giancotti, A. [Department of Gynaecological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Ballesio, L. [Department of Radiological Sciences, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy); Ventriglia, F. [Department of Pediatric Cardiology, UMBERTO I Hospital, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome (Italy)

    2009-10-15

    Purpose: To review our experience with fetal magnetic resonance imaging (MRI) to evaluate congenital heart disease (CHD). Methods: We performed fetal MRI in 32 fetuses with an echocardiographically assessed CHD. Both direct and indirect signs of CHD were investigated. Direct signs considered were: morpho-volumetric abnormalities of the heart; malrotations; ventricular and atrial septal defects; anomalies of the origin, size and course of the great arteries. Indirect signs considered were: difficulty to recognize a 'normal' anatomical structures in the reference projections; increase of the vascular size before a stenosis; hypertrophy of the papillary muscles; cardiomegaly and pericardial effusion. All MRI findings were compared with postnatal or autoptic findings. Results: MRI allowed the CHD to be visualised by direct signs in 17 fetuses, indirect signs in 5 and both direct and indirect signs in 9 fetuses, excluding the prenatal echocardiographic suspect of hypoplastic left heart syndrome in 1 fetus. Postnatal echocardiograms or autoptic findings confirmed a normal heart in 1 fetus and CHD in 31 fetuses including a single cardiac anomaly or syndrome in 19 fetuses, 2 associated cardiac abnormalities in 11 and 3 cardiac anomalies in 1 fetus. However, in 2 fetuses MRI detected a ventricular septal defect successively disclosed by gold standard. Conclusions: MRI is a promising method for further assessment of the cardiovascular pathologies diagnosed by echocardiography, and may be a valuable tool in assessing associated extracardiac anomalies.

  9. Fatal Angiostrongylus dujardini infection in callitrichid monkeys and suricates in an Italian zoological garden.

    Science.gov (United States)

    Eleni, Claudia; Di Cesare, Angela; Cavicchio, Paolo; Tonnicchia, Maria Cristina; Meoli, Roberta; di Regalbono, Antonio Frangipane; Paoletti, Barbara; Pietrobelli, Mario; De Liberato, Claudio

    2016-08-01

    This paper reports four fatal cases of metastrongylid nematode Angiostrongylus dujardini infection observed in a Saguinus oedipus and a Callimico goeldii monkey and in two suricates (Suricata suricatta). All animals were kept in captivity in a zoo of central Italy. The two monkeys died with no premonitory signs, while the two-month-old suricates showed malaise, anorexia and tachypnea for a few days prior to death. Cardiomegaly and/or granulomatous pneumonia were the major anatomo-pathological findings. Inflammatory lesions were observed in the liver, heart and kidney of the suricates at histology. A. dujardini diagnosis was confirmed through both morphological identification of adult worms recovered at necropsy and molecular characterization of larvae in tissue samples. Callitrichidae and suricates are active predators and maintain their hunting behaviour in captivity and it is then likely that they were exposed to infection by preying on parasitized gastropods, intermediate hosts of A. dujardini, entering zoo enclosures from the surrounding environment. This is the first report of A. dujardini in Italy and in S. suricatta.

  10. Retrospective, Single Center Study of Clinical, Paraclinical and Natural Course of Infantile-Onset Pompe Disease

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    Noormohammad Noori

    2015-01-01

    Full Text Available Background: Infantile-onset Pompe disease is a rare genetic and lethal disorder which is caused by the lack of acid alpha-glucosidase activity (GAA. The aim of our study was to identify the demographic and clinical characteristics, and natural history of these patients. Materials and Methods: In this retrospective study, clinical file of 15 patients diagnosed with infantile-onset Pompe disease whose symptoms started before the age of 12 months were studied. Diagnosis was based on clinical history, physical examination and diagnostic parameters in chest X-ray, echocardiogram, electrocardiogram and biochemical tests after rule out the other metabolic and neuromuscular disorders. Results: Sixty percent of the patients were male and 40% were female. The mean age at the onset of symptoms was 78 days (range: 3-150 days. Most frequent clinical and paraclinical symptoms were cardiomegaly, hypotonia, hyporeflexia, macroglossia, failure to thrive, hepatomegaly, and feeding problems, respectively. The mean age at the time of death was 5.96 months (range: 4-8 months, and all patients died before one year of age. Muscle enzymes including AST, ALT, LDH, and CPK were elevated in all patients. Due to the lack of availability, enzyme replacement therapy was not possible for any patient. Conclusion: The study showed that despite the supportive measures and no specific treatment, the clinical course is not significantly different with similar studies and the overall prognosis of this form of disease is very poor and disappointing.

  11. Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroid-stimulating hormone receptor antibody after ablative therapy.

    Science.gov (United States)

    Matsumoto, Tadashi; Miyakoshi, Kei; Saisho, Yoshifumi; Ishii, Tomohiro; Ikenoue, Satoru; Kasuga, Yoshifumi; Kadohira, Ikuko; Sato, Seiji; Momotani, Naoko; Minegishi, Kazuhiro; Yoshimura, Yasunori

    2013-01-01

    High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure.

  12. Intestinal DMT1 is critical for iron absorption in the mouse but is not required for the absorption of copper or manganese.

    Science.gov (United States)

    Shawki, Ali; Anthony, Sarah R; Nose, Yasuhiro; Engevik, Melinda A; Niespodzany, Eric J; Barrientos, Tomasa; Öhrvik, Helena; Worrell, Roger T; Thiele, Dennis J; Mackenzie, Bryan

    2015-10-15

    Divalent metal-ion transporter-1 (DMT1) is a widely expressed iron-preferring membrane-transport protein that serves a critical role in erythroid iron utilization. We have investigated its role in intestinal metal absorption by studying a mouse model lacking intestinal DMT1 (i.e., DMT1(int/int)). DMT1(int/int) mice exhibited a profound hypochromic-microcytic anemia, splenomegaly, and cardiomegaly. That the anemia was due to iron deficiency was demonstrated by the following observations in DMT1(int/int) mice: 1) blood iron and tissue nonheme-iron stores were depleted; 2) mRNA expression of liver hepcidin (Hamp1) was depressed; and 3) intraperitoneal iron injection corrected the anemia, and reversed the changes in blood iron, nonheme-iron stores, and hepcidin expression levels. We observed decreased total iron content in multiple tissues from DMT1(int/int) mice compared with DMT1(+/+) mice but no meaningful change in copper, manganese, or zinc. DMT1(int/int) mice absorbed (64)Cu and (54)Mn from an intragastric dose to the same extent as did DMT1(+/+) mice but the absorption of (59)Fe was virtually abolished in DMT1(int/int) mice. This study reveals a critical function for DMT1 in intestinal nonheme-iron absorption for normal growth and development. Further, this work demonstrates that intestinal DMT1 is not required for the intestinal transport of copper, manganese, or zinc.

  13. Clinical predictors of reinfarction among men and women after a first myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial.

    Science.gov (United States)

    Kornowski, R; Goldbourt, U; Boyko, V; Behar, S

    1995-01-01

    Independent clinical factors predicting reinfarction in the 1st year following an initial myocardial infarction were identified among 900 women and 2,795 men. Women were older (65.8 vs. 59.3 years; p men (6.9 vs. 5.6%, p = 0.17). Cumulative 1-month, 1- and 5.5-year all-cause mortality following the first infarction was higher among women who sustained reinfarction (43, 52 and 74%, respectively) than among men (29, 30 and 51%, respectively, p women were (adjusted relative odds): peripheral vascular disease (3.2), postinfarction angina (2.3), diabetes mellitus (2.2), radiographic evidence of cardiomegaly (1.9), anterior location of the first infarction (2.0), congestive heart failure (1.8), prior angina (1.6) and age (10 years) increment (1.2). Predictive variables for men were: anterior infarct location (1.7), peripheral vascular disease (1.6, prior stroke (1.5), prior angina (1.4), systemic hypertension (1.3) and age (10 years) increment (1.1). Our data indicate (a) different cardiac risk factors for reinfarction among men and women after a first myocardial infarction, and (b) a prognostic advantage for men over women following reinfarction.

  14. A case of Becker muscular dystrophy with early manifestation of cardiomyopathy

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    Ki Hyun Doo

    2012-09-01

    Full Text Available An 18-year-old boy was admitted with chest discomfort, nausea, and dyspnea at rest. At the age of 3 years, he underwent muscle biopsy and dystrophin gene analysis owing to an enlarged calf muscle and elevated serum kinase level (6,378 U/L without overt weakness; based on the results, Becker muscular dystrophy (BMD was diagnosed. The dystrophin gene showed deletion of exons 45 to 49. He remained ambulant and could step upstairs without significant difficulties. A chest roentgenogram showed cardiomegaly (cardiothoracic ratio, 54%, and his electrocardiogram (ECG showed abnormal ST-T wave, biatrial enlargement, and left ventricular hypertrophy. The 2-dimensional and M-mode ECGs showed a severely dilated left ventricular cavity with diffuse hypokinesis. The systolic indices were reduced, including fractional shortening (9% and ejection fraction (19%. Despite receiving intensive medical treatment, he died from congestive heart failure 5 months after the initial cardiac symptoms. We report a case of BMD with early-onset dilated cardiomyopathy associated with deletion of exons 45 to 49. Early cardiomyopathy can occur in BMD patients with certain genotypes; therefore, careful follow-up is required even in patients with mild phenotypes of BMD.

  15. A Model of Left Ventricular Dysfunction Complicated by CAWS Arteritis in DBA/2 Mice

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    Naoto Hirata

    2012-01-01

    Full Text Available It was reported previously that a Candida albicans water-soluble fraction (CAWS, including a mannoprotein and β-glucan complex, has strong potency in inducing fatal necrotizing arteritis in DBA/2 mice. In this study, histopathological changes and cardiac function were investigated in this system. One mg/day of CAWS was given to DBA/2 mice via peritoneal injection for five days. The CAWS-treated DBA/2 mice were induced aortitis and died at an incidence of 100% within several weeks. Histological findings included stenosis in the left ventricular outflow tract (LVOT and severe inflammatory changes of the aortic valve with fibrinoid necrosis. Cardiomegaly was observed and heart weight increased 1.62 fold (<0.01. Echocardiography revealed a severe reduction in contractility and dilatation of the cavity in the left ventricle (LV: LV fractional shortening (LVFS decreased from 71% to 38% (<0.01, and the LV end-diastolic diameter (LVDd increased from 2.21 mm to 3.26 mm (<0.01. The titer of BNP mRNA increased in the CAWS-treated group. Severe inflammatory changes resulting from CAWS brought about lethal LV dysfunction by aortic valve deformation with LVOT stenosis. This system is proposed as an easy and useful experimental model of heart failure because CAWS arteritis can be induced by CAWS injection alone.

  16. Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement

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    Hanaa Ibrahim Rady

    2015-02-01

    Full Text Available OBJECTIVE: To assess children with myocarditis, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis. METHODS: This was an observational study of 63 patients admitted to PICU with non-cardiac diagnosis. Cardiac enzymes, chest-X ray, echocardiography, and electrocardiogram were performed to diagnose myocarditis among those patients. RESULTS: There were 16 cases of definite myocarditis. The age distribution was non-normal, with median of 5.5 months (3.25-21. Of the 16 patients who were diagnosed with myocarditis, 62.5% were originally diagnosed as having respiratory problems, and there were more females than males. Among the present cases, the accuracy of cardiac enzymes (cardiac troponin T [cTn] and creatine phosphokinase MB [CKMB] in the diagnosis of myocarditis was only 63.5%, while the accuracy of low fractional shortening and of chest-X ray cardiomegaly was 85.7 and 80.9%; respectively. Cardiac troponin folds 2.02 had positive predictive value of 100%, negative predictive value of 88.7%, specificity of 100%, sensitivity of 62.5%, and accuracy of 90.5%. CONCLUSIONS: Children with myocarditis present with symptoms that can be mistaken for other types of illnesses. When clinical suspicion of myocarditis exists, chest-X ray and echocardiography are sufficient as screening tests. Cardiac troponins confirm the diagnosis in screened cases, with specificity of 100%.

  17. Fractures in children with Pompe disease: a potentiallong-term complication

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    Case, Laura E. [Duke University Medical Center, Division of Physical Therapy, Department of Community and Family Medicine, Durham, NC (United States); Hanna, Rabi; DeArmey, Stephanie; Mackey, Joanne; Boney, Anne; Chen, Yuan-Tsong; Kishnani, Priya S. [Duke University Medical Center, Department of Pediatrics, Durham, NC (United States); Frush, Donald P. [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Krishnamurthy, Vidya [Duke University Medical Center, Department of Pediatrics and Department of Medicine, Durham, NC (United States); Morgan, Claire; Bouchard, Susan [Genzyme Corporation, Pharmacovigilance, Cambridge, MA (United States); Corzo, Deyanira [Genzyme Corporation, Cambridge, MA (United States); Weber, Thomas J. [Duke University Medical Center, Department of Medicine, Durham, NC (United States)

    2007-05-15

    Pompe disease (glycogen storage disease type II or acid maltase deficiency) is an autosomal recessive disorder caused by deficiency of the lysosomal enzyme acid {alpha}-glucosidase (GAA). Classic infantile-onset disease, characterized by cardiomegaly and profound weakness, leads to death in the first year of life from cardiorespiratory failure. Reversal of cardiomyopathy and improved motor function have been shown in clinical trials of rhGAA enzyme replacement therapy (ERT) with alglucosidase alfa (Myozyme), recently approved for clinical use. Increased survival potentially unmasks long-term complications of this previously lethal disease, including risk of skeletal fracture, recently identified at our institution and not previously reported in children with Pompe disease. To report the risk of fracture in children with Pompe disease with increased survival with ERT. We present four cases of fracture in patients with classic infantile Pompe disease treated with ERT at our institution, and review a study database for additional reports of fracture in this population. We review 19 fractures in 14 children with Pompe disease on ERT. Radiologists should be familiar with and vigilant for the association of fractures and increased survival on ERT in children with Pompe disease. We discuss potential mechanisms, implications for radiographic surveillance, potential intervention, and needs for further research. (orig.)

  18. The Outcome of Infantile Onset Pompe Disease in South of Iran

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    Hossein Moravej

    2016-01-01

    Full Text Available Background: Infantile Onset Pompe Disease (IOPD is a rare autosomal recessive neuromuscular disorder. It is associated with cardiomegaly, hypotonia, paresis, and death in the first year of life. Since 2006, following the use of Alglucosidase alfa as Enzyme Replacement Therapy (ERT, the patients’ survival is improved to a noticeable extent. Objectives: The purpose of this study is to examine the outcome of IOPD patients in South of Iran and the degree of responsiveness to ERT. Patients and Methods: All patients who were diagnosed with IOPD on the bases of clinical symptoms, and enzyme assay on dried blood spot, were included in the study; and were followed up regarding cardiac function, locomotor activity, and cognition. Results: Six patients with IOPD were identified. All these six patients suffered from Hypertrophic Cardiomyopathy (HCM. Four (67% of them also had generalized hypotonia. Three patients expired during the first weeks due to severe respiratory infection. One of them also got involved with Acute Cardiopulmonary Failure while receiving the fifth dose of ERT; and expired. However, the remaining two patients had a significant improvement after the maximum of 117 weeks of following up both cardiac and locomotor findings. These two patients were the same patients who showed cardiac symptoms from the beginning but did not have generalized hypotonia. Conclusions: Although ERT has a significant effect on enhancing the survival of IOPD patients, it should be associated with meticulous heart-respiratory cares during the first months of treatment and preventing infection especially nosocomial infections.

  19. Anaesthesia management of a patient with hypertrophic obstructive cardiomyopathy undergoing Morrow′s septal myectomy

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    Naresh Kumar Agarwal

    2007-01-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a rare disorder. There is paucity of literature on anaesthetic management of this disorder. Aim of this case report is to highlight the anaesthetic problems encountered during management of such patients. A thirty-five year old male was admitted with atypical chest pain for last one year. X-ray chest revealed cardiomegaly (CT ratio 0.6. Electrocardiographic findings were left axis deviation with left ventricular hypertrophy. On echocardiography, there was moderate mitral regurgitation (MR, systolic anterior motion (SAM of anterior mitral leaflet and prominent systolic narrowing of left ventricle cavity. Transoesophageal echocardiography (TOE also showed an anomalous muscle bundle stretching into LV causing obstruction. Preload was kept high. Systemic vascular resistance (SVR was maintained, avoiding use of vasodilators and inotropes. Morrow′s septal myectomy was done. Anomalous muscle bundle was excised. On postoperative TOE, there was no MR and no obstruction. Optimal anaesthetic management in such patients involves maintaining adequate preload, systemic vascular resistance and minimal outflow obstruction. Other considerations are to maintain haemodynamic stability, sinus rhythm and afterload. Transoesophageal echocardiography is an extremely useful monitoring device in such patients.

  20. "Dead in hot bathtub" phenomenon: accidental drowning or natural disease?

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    Satoh, Fumiko; Osawa, Motoki; Hasegawa, Iwao; Seto, Yoshihisa; Tsuboi, Akio

    2013-06-01

    Sudden death in a hot bathtub occurs frequently in Japan, particularly among elderly people. This retrospective report describes the epidemiologic circumstances and physical findings at autopsy. In total, 268 victims were found unconscious or dead during tub bathing. After postmortem examination, the manner of death was judged as natural cause in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Mean age (SD) was 72.1 (15.2) years with no significant difference between males and females. A seasonal difference was evident: the winter displayed the highest frequency. Drowning water inhalation, which was confirmed in 72% of victims, was absent in the others. The most common observations on postmortem examination were cardiac ischemic changes and cardiomegaly. Water inhalation signs were evident in a significantly fewer victims exhibiting these factors. In contrast, inhalational findings were observed more frequently in victims with other backgrounds such as alcohol intake, mobility disturbance, and history of epilepsy. Annual mortality in Japan from accidental drowning in persons aged older than 75 years is 33 deaths per 100,000 population. However, this number may be considerably underestimated as pathologists tend to regard lack of water inhalation as indicating a natural cause of death. Confusion in diagnosis remains consequent to the accidental and natural aspects of "dead in hot bathtub" phenomenon.

  1. Myocarditis exacerbation in a child undergoing inguinal hernioplasty after viral infection

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    Simić Dušica

    2009-01-01

    Full Text Available Introduction Immunosuppressive effects of general anesthesia and surgery could have unexpected consequences in a child with recent infection. The incidence of myocarditis in childhood is unknown. Case outline During general anesthesia for inguinal hernia repair, a seven-year-old boy suddenly developed heart failure. Clinical presentation included hypotension, pulmonary edema, drop in hemoglobin oxygen saturation, ST segment elevation and premature ventricular contractions. Homodynamic stability and adequate oxygenation were achieved with dopamine and furosemide. Preoperative history, physical examination and complete blood count were unremarkable. Moderate cardiomegaly and pulmonary edema were present on chest radiography. Diminished left ventricular contractility found on echocardiography increased troponin I and CK-MB levels suggested myocardial injury. Increased C-reactive protein with lymphocytosis suggested inflammation as its cause. Parents failed to report rubella 10 days before the operation. A clinical diagnosis of myocarditis as a complication of rubella was based on increased titer of IgM to rubella. With intravenous immunoglobulin, corticosteroids and symptomatic treatment for heart failure, his condition improved and ejection fraction reached 68 % one month after operation. Conclusion In future, we need protocols with instructions for pediatric patients undergoing elective surgery and anesthesia after viral infections.

  2. Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease*

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    Alves, Ursula David; Lopes, Agnaldo José; Maioli, Maria Christina Paixão; Soares, Andrea Ribeiro; de Melo, Pedro Lopes; Mogami, Roberto

    2016-01-01

    Objective To describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of hemoglobinopathy. Materials and Methods A prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of hemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen. Results The changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of hemoglobinopathy (HbSS group versus not HbSS group) was 72.7%. Conclusion In adult patients with sickle cell disease, the main tomography findings reflect fibrotic changes. In addition, computed tomography can be helpful in differentiating among hemoglobinopathies. PMID:27777473

  3. A case of anaemia in a neonatal warthog (Phacochoerus aethiopicus and evaluation of serum-soluble iron in warthogs : short communication

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    D.E. Kenny

    2002-07-01

    Full Text Available A 38-day-old male warthog (Phacochoerus aethiopicus with marked anaemia (haematocrit = 14 % presented to the Denver Zoological Gardens hospital with ataxia, tachypnoea, suspected stunted growth and cardiomegaly. The piglet demonstrated some features consistent with both iron deficiency anaemia and autoimmune haemolytic anaemia. Serum-soluble iron was below the level of detection (<8.96 mmol/l. Iron deficiency anaemia is a well recognised entity in domestic swine reared on concrete and denied access to soil. Fifteen captive warthogs were subsequently evaluated for serum soluble iron content (mean = 21.62±4.36 mmol/l as well as 5 neonatal warthog piglets that required hand-rearing. Only 1 of 5 neonatal warthog piglets had measurable serum soluble iron (9.50 mmol/l. These data suggest that warthogs are similar to domestic swine and are born with low iron stores. Some form of iron supplementation should be considered for captive neonatal warthog piglets, especially if they are reared on concrete.

  4. Investigation Giant Placental Chorioangioma Associated with Neonatal Sepsis-like Disease: A Case Report

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    Adauto Barbosa

    2015-06-01

    Full Text Available Giant chorioangioma is a placental tumor associated with gestational complications such as preeclampsia, polyhydramnios and hemorrhage. In addition, this tumor might lead to the incidence of non-immune fetal hydrops, heart failure, anemia, thrombocytopenia, weight loss and death among neonates. In this case report, the clinical image of a term newborn (weighing 2800 g with one-minute Apgar score of 7 was suggestive of sepsis on the second day of birth. Moreover, epistaxis, petechia, anemia, thrombocytopenia, hypothermia, cardiomegaly and hepatosplenomegaly were detected in the neonate, which required blood transfusion and antibiotic therapy. However, in case of chorioangioma in the gestational history, it was possible to detect the motive for a clinical sepsis-like disease. According to the pathophysiological explanation, this tumor functions as a "dead space", increasing the rate of blood ejection with subsequent fetal heart failure, anemia through intratumoral hemorrhage or fetal-maternal transfusion, and consumption or intratumoral sequestration resulting in disseminated intravascular coagulation. After blood transfusion, all treatment procedures, including antibiotic therapy, were suspended due to the recovery of the newborn.

  5. Coincidence of Trisomy 18 and Robertsonian (13; 14

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    A Alavi

    2012-07-01

    Full Text Available This case report presents a coincidence of trisomy 18 and balanced Robertsonian translocation (13;14. Aneuploidy was suspected based on anomalies detected in ultrasound scan and confirmed with karyotype. In a 31 years-old healthy woman with a history of one miscarriage, second trimester ultrasound scan reported IUGR (<3rd percentile with normal amniotic fluid, bilateral choroid plexus cysts, suspicious agenesis of corpus callosum and clenched hands. Amniocentesis was performed and karyotype was 46xx,der(13;14 (q10;q10,+18. Maternal karyotype was 45xx,der(13;14(q10;q10. Pregnancy was continued due to legal limitation for termination after 20 weeks gestation. Delivery was done at 36 weeks gestation. A female newborn was borned and a physical feature was hypotonia, small mouth, prominent occiput, low-set and posteriorly rotated ears, clenched hands with overlapping fingers and rocker bottom feet. Ultrasound scan and echocardiography detected agenesis of corpus callosum and VSD, ASD, PDA and cardiomegaly. These features are typical of trisomy 18. Balanced Robertsonian translocation usually has no phenotypic expression. Genetic counseling and prenatal diagnosis for future pregnancy was recommended.

  6. Chronic valvular disease: correlation between clinical, electrocardiographic, radiographic and echocardiographic aspects in dogs Doença valvar crônica: correlação entre aspectos clínicos, eletrocardiográficos, radiográficos e ecocardiográficos em cães

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    E.C. Soares

    2005-08-01

    Full Text Available Echocardiographic aspects of chronic mitral valvular disease were studied and compared to physical, radiographic and electrocardiographic aspects. Seventy dogs were used, and clinical examination, thoracic radiography, electrocardiogram and echocardiogram were performed. Correlations between regurgitation severity with cardiac failure functional class and murmur intensity were observed. The electrocardiogram showed a low sensibility in detecting cardiac chamber enlargement, caused by mitral regurgitation. All the dogs with severe mitral regurgitation showed cardiomegaly according to thoracic radiographies.Avaliaram-se os aspectos ecocardiográficos da doença valvar crônica, comparando-os com os aspectos clínicos, radiográficos e eletrocardiográficos em cães. Estudaram-se 70 animais, realizando-se exames físicos, radiografias torácicas, eletrocardiograma e ecocardiograma. Observaram-se correlações entre a gravidade da regurgitação, a classe funcional da insuficiência cardíaca e a intensidade de sopro. O eletrocardiograma mostrou baixa sensibilidade para detectar aumento de câmaras cardíacas causadas por regurgitação mitral. Todos os cães com regurgitação mitral grave apresentaram cardiomegalia nas radiografias torácicas.

  7. Acromegaly: Role of Surgery in the Therapeutic Armamentarium

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    Gerardo Guinto

    2012-01-01

    Full Text Available Acromegaly is a complex disease that requires the intervention of a multidisciplinary team. The most frequent clinical manifestations are growing of distal parts of the body and some areas of the face. Patients may also present arterial hypertension, diabetes mellitus, colonic polyps, cardiomegaly, neurological and endocrine changes secondary to the presence of a GH-secreting tumor in pituitary or extrapituitary origin, or eutopic hypothalamic GHRH hypersecretion and peripheral GHRH hypersecretion. Surgery is the first treatment used for most patients, regardless of the cause. In the great majority of cases, pituitary tumor can be removed through a transsphenoidal approach. Craniotomy is reserved for those cases with giant tumors, particularly when they grow toward the middle or posterior cranial fossa. Best surgical results are obtained when the tumor is confined into the sella turcica or if it has a regular suprasellar extension. When the disease cannot be controlled with surgery, medical treatment is indicated. Somatostatin analogues are included as the first line of medication, followed by dopamine agonist and growth hormone receptors antagonists. Radiation therapy can be also indicated in two main forms for residual tumor with medically refractory patients: radiosurgery for small tumors or fractionated stereotactic radiotherapy for larger ones.

  8. Mitral valve repair in a patient with mesocardia.

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    Morisaki, Akimasa; Hattori, Koji; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

    2014-01-01

    A 75-year-old man was referred for treatment of mitral valve prolapse secondary to tendon rupture. He had been receiving oral and inhaled corticosteroids for bronchial asthma and bronchial ectasia. Chest X-ray showed cardiomegaly with protrusion of the right atrium shadow. Computed tomography revealed dislocation and counterclockwise rotation of the heart with the apex of the heart located in the mid-thorax, indicating mesocardia. We believed that it would have been difficult to expose the mitral valve through a right-sided left atrial approach. Thus, we planned to perform mitral valve repair via a trans-septal approach. The right thoracotomy approach was not suitable because of respiratory dysfunction. After a median sternotomy, the left anterior descending coronary artery was identified just beneath the midline of the sternum. Even after decompression of the heart under cardiopulmonary bypass, we could not obtain a good view of the right side of the left atrium. By a transseptal approach with a self-retaining retractor and atrial hooks, we obtained adequate exposure of the mitral valve and performed the mitral valve repair uneventfully.

  9. Vital Importance of Delineation of Coronary Artery Anatomy in Atypical Congenital Giant Right Atrial Aneurysm

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    Malakan Rad

    2016-07-01

    Full Text Available Introduction Giant congenital right atrial aneurysm is a very rare congenital heart lesion, which may be asymptomatic or present a variety of symptoms, particularly supraventricular arrhythmias and intracardiac thrombosis formation. Case Presentation This is a report on a 3.5-month-old male infant with imperforated anus and an unusual-shaped congenital giant right atrial aneurysm with retro-ventricular extension. This unusual shape prevented appearance of cardiomegaly on the chest X-Ray. Surgical resection of the aneurysm was attempted. However, posterior descending coronary artery, which was embedded in the wall of the aneurysm, was irreversibly damaged during the operation. The patient died in the operation room. We concluded that pre-operative delineation of coronary arteries in cases with congenital giant right atrial aneurysm (CGRAA with extension to the posterior left ventricle is mandatory. Despite the current data that surgical excision of the aneurysm is the treatment of choice, our case required simple closure of the aneurysmal neck from inside the right atrium to be an easier and safer surgical approach for treatment of CGRAA with a tricky anatomy. Conclusions This case indicates that delineation of coronary artery anatomy in atypical congenital giant right atrial aneurysm is of vital importance. Closure of the aneurysmal sac, instead of aneurysmal resection, is a safer and more simple approach in atypical cases.

  10. Massive Myocardial Infarction in a Full-Term Newborn: A Case Report

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    Vlasta Fesslova

    2010-01-01

    Full Text Available A full-term female newborn with neonatal asphyxia and severe anemia (Hb 2.5 g/dL with normal heart developed a massive myocardial infarction. No examinations were performed during pregnancy for parental nomadism. The baby had immediate external cardiac massage, ventilatory assistance, and blood transfusion. Cardiomegaly was evident at chest X-ray and marked signs of ischemia-lesion at ECG. Echocardiography showed dilated, hypertrophic, and hypocontractile left ventricle (LV, mitral and tricuspid regurgitation, and moderate pericardial effusion. Rh isoimmunization and infective agents were excluded at laboratory tests. Despite the treatment with inotropes, hydrocortisone, and furosemide, the baby worsened and died at 45 hours of life. Postmortem examination showed diffuse subendocardial infarction of LV and diffuse parenchymal hemorrhages and myocardial hypertrophy, increase of eosinophilia, and polymorphonucleated cells at histology. Our patient suffered apparently from longstanding fetal anemia of unknown etiology that led to perinatal distress, severe hypoxia, and massive myocardial infarction, unresponsive to the therapy.

  11. Patau syndrome with a long survival. A case report.

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    Duarte, A C; Menezes, A I C; Devens, E S; Roth, J M; Garcias, G L; Martino-Roth, M G

    2004-06-30

    Trisomy 13 is a clinically severe entity; 85% of the patients do not survive beyond one year, and most children die before completing six months of age. We report a female child, 28 months old, white, the fourth child of a non-consanguineous couple, who presented trisomy 13. The child was born at term, from a vaginal delivery, weighing 2600 g. At birth, she was cyanotic, icteric, spastic, and cried weakly. The initial clinical examination detected polydactyly in the left hand, congenital clubfoot and convex soles, ocular hypertelorism, a low nasal bridge, numerous hemangiomas distributed throughout the body, cardiomegaly, and perimembranous inter-ventricular communication. There was no cleft lip or palate. On physical examination at 18 months old, the child weighed 6,900 g, had a cephalic perimeter of 41 cm, a thoracic perimeter of 43 cm and was 76 cm tall. At 28 months, she weighed 10,760 g and was 88.5 cm tall. Neuropsychomotor development retardation was evident from birth and, according to the psychologist and the social assistant of APAE (Handicapped Parents and Friends Association) in Canguçu, Rio Grande do Sul, there was a noticeable improvement after physiotherapy and recreational sessions.

  12. Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia

    Institute of Scientific and Technical Information of China (English)

    Xiao Yanyan; Jin Mei; Han Ling; Ding Wenhong; Zheng Jianyong; Sun Chufan; Lyu Zhenyu

    2014-01-01

    Background The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients (13 males and 10 females,aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months,16 cases) and adult type (age of onset older than 12 months,7 cases).Four patients were diagnosed with CLMCA-A (three males and one female,aged ranging from 3 months to 2 years).The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination:Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography:pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in

  13. Incidental Findings in Patients Evaluated for Pulmonary Embolism Using Computed Tomography Angiography

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    Masoud Pezeshki Rad

    2014-05-01

    Full Text Available Introduction: Pulmonary embolism (PE is a common lethal disease that its clinical symptoms may be seen in many other diseases. Computed tomography pulmonary angiography (CTPA is a valuable diagnostic modality for detection of PE. In addition, it can accurately detect the other diseases with clinical symptoms similar to PE. The aim of this study is to evaluate the frequency of PE and nonembolic disease with similar clinical symptoms including pulmonary, pleural, mediastinal, and cardiovascular diseases that have been detected by CTPA and to describe the importance of reporting these CT findings. Materials and Methods: In this cross‐sectional study, we evaluated the medical records of CTPA in 300 patients of suspected PE between March 2012 and February 2013 in Imam Reza Hospital and Ghaem Hospital in Mashhad University of Medical Sciences, Mashhad, Iran. Demographic information and the results of CTPA of these patients were re‐evaluated. One radiologist reviewed all of the CTPA and the results have been analyzed by SPSS‐16 software. Results: In this study, PE was detected in 18.7% of patients. Multiple incidental imaging findings were diagnosed as follow: pulmonary consolidation (33.2%, pleural effusion (48.7%, pulmonary nodules (10%, pulmonary masses (1.3%, pneumothorax (4.7%, mediastinal mass and lymphadenopathy (9.3%, aortic calcification (42%, coronary arteries calcification (27.3%, mitral valve calcification (2 %, cardiomegaly (30.7%, and the evidences of right ventricular dysfunction (6.7%. Conclusion: A group of disease can cause the clinical symptoms similar to that of PE. Among them, pulmonary consolidation and pleural effusion have much higher frequency than PE. In addition, CTPA can show pathologic findings in the patients that need follow‐up. It is important to detect and report these imaging findings because some of them may change the treatment and prognosis of patient who are suspected to have PE.

  14. Bronchopulmonary dysplasia: correlation of radiographic and clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Breysem, L. [Department of Radiology, University Hospitals, K. U. Leuven, Herestraat 49, B-3000 Leuven (Belgium); Smet, M.H. [Department of Radiology, University Hospitals, K. U. Leuven, Herestraat 49, B-3000 Leuven (Belgium); Lierde, S. van [Department of Pediatrics, University Hospitals of Leuven, Leuven (Belgium); Devlieger, H. [Department of Pediatrics, University Hospitals of Leuven, Leuven (Belgium); Boeck, K. de [Department of Pediatrics, University Hospitals of Leuven, Leuven (Belgium); Marchal, G. [Department of Radiology, University Hospitals, K. U. Leuven, Herestraat 49, B-3000 Leuven (Belgium)

    1997-08-01

    Background and purpose. Abnormalities of the chest wall have been described in bronchopulmonary dysplasia (BPD). Clinical, radiographic and pulmonary function variables were evaluated in 1-year-old children ventilated because of neonatal lung disease in order to quantify these thoracic changes and to evaluate the lung disease. Methods. The pulmonary status of 51 infants with neonatal lung disease requiring artificial ventilation was reevaluated clinically and radiographically at the age of 1 year. Twenty-two of these infants had developed BPD. Thoracic depth and width were measured clinically and on chest X-ray. The Toce score evaluated the presence of cardiomegaly, hyperinflation, emphysema and interstitial lung disease. Lung function was measured after sedation using previously reported methods. In BPD patients, Toce score and lung function were determined and compared at 1 month and at 1 year of age. Results. In BPD patients, chest depth was significantly smaller when measured clinically as well as on chest radiograph (P < 0.05; Mann-Whitney U-test). There was a statistically significant correlation between chest depth measured clinically and on chest X-ray. Toce score was significantly higher in BPD patients (P < 0.05). In BPD patients intersitial abnormalities and decreased lung compliance were more frequent at the age of 1 month than at the age of 1 year. At the age of 1 year, hyperinflation was more frequent and at that time increased airway resistance was still noted. Thus the type of X-ray abnormality reflects the type of lung function disturbance. Conclusion. The flatness of the chest is most likely a consequence of the long-standing lung function abnormalities. (orig.). With 3 figs., 6 tabs.

  15. Congestive heart failure in 6 African grey parrots (Psittacus e erithacus).

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    Juan-Sallés, C; Soto, S; Garner, M M; Montesinos, A; Ardiaca, M

    2011-05-01

    Six African grey parrots (Psittacus e erithacus) were diagnosed with cardiomyopathy and congestive heart failure based on gross and microscopic findings. Ages ranged from 15 days to 8 years, and 5 of 6 parrots were either neonates or juveniles at the time of diagnosis. Two neonates and 2 juveniles came from the same breeding aviary; the 2 juveniles were born to the same breeding pair. The 2 other parrots were kept as pets. Clinical signs included distention of the coelomic cavity (4 of 6), rales (3 of 6), weakness (4 of 6), bradyarrhythmia (1 of 6), growth retardation (1 of 6), crop stasis (1 of 6), and regurgitation (1 of 6). Three parrots were euthanized and 3 died. Gross findings included cardiomegaly due to biventricular, right-, or left-sided cardiomyopathy (6 of 6); coelomic effusion (6 of 6); whitish or yellow foci in the liver (6 of 6); atrophy of the liver (particularly, the left lobe; 5 of 6); reddened or grey lungs (5 of 6); subcutaneous edema (2 of 6); hydropericardium (1 of 6); and bilateral thyroid gland enlargement (1 of 6). Relevant microscopic findings included passive hepatic congestion (6 of 6) and pulmonary congestion (2 of 6), lymphocytic thyroiditis (2 of 6), and diffuse thyroid follicular hyperplasia (2 of 6). Microscopically, the heart was unremarkable (2 of 6) or had mild lymphocytic myocarditis (2 of 6), mild multifocal cytoplasmic vacuolation of cardiomyocytes (2 of 6), mild lymphocytic myocardial (Purkinje cell) ganglioneuritis (1 of 6), and mild multifocal interstitial fibrosis and nuclear hypertrophy of cardiomyocytes (1 of 6). One parrot had concurrent proventricular dilatation disease (systemic ganglioneuritis). The cause of cardiomyopathy in these parrots was not determined.

  16. A case of juvenile acromegaly that was initially diagnosed as severe congestive heart failure from acromegaly-induced dilated cardiomyopathy.

    Science.gov (United States)

    Sue, Mariko; Yoshihara, Aya; Okubo, Yoichiro; Ishikawa, Mayumi; Ando, Yasuyo; Hiroi, Naoki; Shibuya, Kazutoshi; Yoshino, Gen

    2010-01-01

    Acromegaly is characterized by chronic hypersecretion of growth hormone (GH) and is associated with increased mortality rate because of the potential complications such as cardiovascular disease, respiratory disease, or malignancy, which are probably caused by the long-term exposure of tissues to excess GH, for at least 10 years, before diagnosis and treatment. A 22-year-old man with a 2-month history of fatigue was admitted to our hospital because of chest discomfort, dyspnea, and pitting edema of the lower limbs experienced over a 1-month period. On admission, his height and body weight were 186 cm and 138.5 kg, respectively, with a BMI of 39.8 kg/m(2). He showed acromegalic features and elevated serum GH and IGF-1 levels, which were 11.5 ng/mL and 960 ng/mL, respectively. There was no GH suppression in the 75-g oral glucose tolerance test. Pituitary magnetic resonance imaging (MRI) revealed microadenoma. Chest X-ray revealed cardiomegaly, and echocardiogram showed dilated left ventricular (LV) cavity and diffuse hypokinesis with extremely decreased ejection fraction (EF). He was diagnosed as having acromegaly with congestive heart failure from diastolic cardiomyopathy. After the successful transsphenoidal resection of the pituitary adenoma, the level of GH was normalized. However, the cardiac dysfunction did not show any improvement even after the administration of β-blockers, angiotensin-converting enzyme inhibitor (ACE-I), or diuretics. The patient was re-hospitalized, and he died of cardiac failure at the age of 25 years. Patients with acromegaly have been reported to have about 30% higher mortality rate, and cardiovascular disease accounts for 60% of the deaths. We report a case of a patient with juvenile acromegaly who was diagnosed with severe cardiac failure at the time of diagnosis and failed to recover cardiac function even after the successful resection of the pituitary adenoma. Immediate diagnosis and treatment are required for better control of

  17. Improving the Recognition of Heart Murmur

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    Magd Ahmed Kotb

    2016-07-01

    Full Text Available Diagnosis of congenital cardiac defects is challenging, with some being diagnosed during pregnancy while others are diagnosed after birth or later on during childhood. Prompt diagnosis allows early intervention and best prognosis. Contemporary diagnosis relies upon the history, clinical examination, pulse oximetery, chest X-ray, electrocardiogram (ECG, echocardiography (ECHO, computed tomography (CT and cardiac catheterization. These diagnostic modalities reliable upon recording electrical activity or sound waves or upon radiation. Yet, congenital heart diseases are still liable to misdiagnosis because of level of operator expertise and other multiple factors. In an attempt to minimize effect of operator expertise this paper built a classification model for heart murmur recognition using Hidden Markov Model (HMM. This paper used Mel Frequency Cepestral coefficient (MFCC as a feature and 13 MFCC coefficients. The machine learning model built by studying 1069 different heart sounds covering normal heart sounds, ventricular septal defect (VSD, mitral regurgitation (MR, aortic stenosis (AS, aortic regurgitation (AR, patent ductus arteriosus (PDA, pulmonary regurgitation (PR, and pulmonary stenosis (PS. MFCC feature used to extract feature matrix for each type of heart sounds after separation according to amplitude threshold. The frequency of normal heart sound (range= 1Hz to 139Hz was specific without overlap with any of the studied defects (ranged= 156-556Hz. The frequency ranges for each of these defects was typical without overlap according to examined heart area (aortic, pulmonary, tricuspid and mitral area. The overall correct classification rate (CCR using this model was 96% and sensitivity 98%. This model has great potential for prompt screening and specific defect detection. Effect of cardiac contractility, cardiomegaly or cardiac electrical activity on this novel detection system needs to be verified in future works.

  18. Anaesthetic management of emergency pacemaker implantation in a case of neonatal lupus erythematosus with complete congenital heart block & severe respiratory distress

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    Usha Kiran

    2007-01-01

    Full Text Available An 8-week old 3-kilogram male baby was brought to this tertiary care hospital with respiratory distress, marked tracheal tug, poor feeding and a heart rate of 46/minute. The child had been referred from a peripheral hospital as a case of neonatal lupus with complete congenital heart block. The mother was seropositive for systemic lupus erythematosus with a history of two abortions. Evaluation on admission revealed a heart rate between 40-60/ minute, respiratory rate 40-50/ minute, inspiratory stridor, bilateral crepitations, chest retrac-tion and a marked tracheal tug that improved with prone positioning. Electrocardiography and echocardiography confirmed complete congenital heart block with cardiomegaly and mild left ventricular dysfunction. Keeping in view the impending congestive heart failure, possible early cardiomyopathy and the bad obstetric history ur-gent pacemaker implantation was planned to allow early recovery of the child. The anaesthetic risk was high due to the heart block, ventricular dysfunction, laryngomalacia, severe tracheal tug and anticipated difficult weaning from controlled ventilation. General anaesthesia was administered with endotracheal tube and con-trolled ventilation using ketamine, rocuronium and sufentanil. For patient safety invasive monitoring was pro-vided and external pacing was kept standby. Epicardial pacemaker leads were implanted onto the left ventricu-lar wall through a left anterior 6th intercostal space thoracotomy. The child was electively ventilated for two post operative days. The tracheal tug and secretions gradually subsided over 2 weeks with oxygen, antibiotics, steroids, bronchodilators and physiotherapy. At the time of discharge from hospital 2 weeks after the implant the child was feeding well, tracheal tug was minimal and the lungs were clear.

  19. Swiss cheese ventricular septal defect with myocarditis - A rare coexistence in a neonate

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    A R Saboo

    2012-01-01

    Full Text Available Myocarditis is defined as acute inflammation of the myocardium, usually following a non-specific flu-like illness, and encompasses a wide range of clinical presentations ranging from mild or subclinical disease to heart failure. We report a 12-day-old healthy full-term neonate who presented with abrupt onset of congestive cardiac failure (CCF following a viral prodrome. Examination revealed persistent sinus tachycardia, lymphocytosis, gross cardiomegaly, nonspecific electrocardiogram changes with echocardiography showing Swiss cheese ventricular septal defect (VSD. VSD alone very rarely presents as early-onset cardiac failure in the absence of other precipitating factors like anemia, sepsis, hypoglycemia etc. Myocarditis, however, can mimic VSD and can present as fulminant cardiac failure in an otherwise healthy newborn. Myocarditis is usually diagnosed based on circumstantial evidence such as a recent viral infection and the sudden onset of cardiac dysfunction while ruling out other diagnostic possibilities. Elevated troponin T level is one of the most crucial noninvasive diagnostic modalities. Several trials have concluded that levels >0.055 ng/ml are statistically significant for diagnosing myocarditis in children. In our case an abrupt onset of cardiac failure following a viral prodrome and markedly elevated cardiac troponin T without sepsis and in the presence of normal coronary anatomy clinched the diagnosis of myocarditis. An early and aggressive treatment for CCF along with regular long-term follow-up plays a key role in the management of myocarditis. Role of high-dose Intravenous immunoglobulin in myocarditis has been studied by many trials with different outcomes. This is the first case report showing coexistence of VSD with myocarditis in a neonate presenting as early-onset acute cardiac failure. The report highlights the importance of screening for myocarditis in all previously normal babies presenting primarily with cardiogenic

  20. Mathematical model of mean age, mean arsenic dietary dose and age-specific prevalence rate from endemic chronic arsenic poisoning: a human toxicology study

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    Zald' ivar, R.; Ghai, G.L.

    1980-01-01

    The aim of this investigation was to develop a mathematical model of mean age, mean arsenic dietary dose, and age-specific prevalence rate for endemic chronic arsenic poisoning. Data on mean age (years), mean arsenic dietary dose (mg/kg body weight/day), and age-specific prevalence rate per 100,000 population for endemic chronic arsenic poisoning in Antofagasta Commune, northern Chile, for the 1968 to 1971 period, were collected. Endemic chronic arsenic poisoning means here chronic arsenical dermatosis associated with marked or sever symptoms (or signs) of chronic arsenic poisoning (chronic diarrhea, hepatic cirrohsis, chronic bronchitis, bronchiectasis, recurrent broncho-pneumonia, cardiomegaly, systemic occlusive arterial disease, cerebral thrombosis, etc.). There was a strong positive correlation between age-specific pevalence rate per 100,000 population and mean arsenic dose (r = + 0.9593) and a negative correlation between prevalence rate and mean age (r = 0.8789). These findings show that the prevalence rate declines with the advancing age and increases with the increase of arsenic dose. A multiple linear regression model E(y) = alpha + beta X1 + gamma X2, where y represents the age-specific prevalence rate per 100,000 population, X1 the mean arsenic dose, and X2 the mean age, was fitted to the data. The estimates of the parameters (alpha, beta, and gamma) were obtained by minimizing the residual sum of squares sigma(y - alpha - beta X1 - gamma X2)2. The following multiple linear regression equation was obtained: Y = 202.161 + 8452.455 X1 - 2.394 X2. Of the total variability in the prevalence rate, 96.22 percent was accounted for by the multiple regression.

  1. Cardiac evaluation in pediatric patients waiting for liver transplantation

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    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  2. Natural course of subsequent pregnancy after peripartum cardiomyopathy

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    Francisco Manes Albanesi Fº

    1999-07-01

    Full Text Available OBJECTIVE: To assess the effect of subsequent pregnancy after peripartum cardiomyopathy (PPCM on maternal and fetal outcome. METHODS: Prospective study of 34 patients with the diagnosis of PPCM (mean age= 26years. At the time of first diagnosis 5 were in NYHA functional class (FC II for heart failure, one in FC III and 28 in FC IV. After clinical treatment, patients were advised to avoid new pregnancies and a follow-up was obtained. RESULTS: There were 12 (35.3% subsequent pregnancies in patients (pt aged 19 to 44 years (mean 32, divided into two groups: GI: 6 pts who had normalized their heart size and GII: 6 pts with persistent cardiomegaly. GI had initially mild clinical manifestations ( 3 were in FC II, 1 in FC II and 2 in FC IV and complete recovery of cardiac function (FC I. A new pregnancy was well-tolerated in 5 (83.3%; 1 pt presented with preeclampsia, and progressed to FC II. Presently, 5 pt are in FC I and 1 in FC II. GII pts had more severe heart failure at the onset of PPCM (1 pt in FC II and 5 in FC IV; during follow-up, 4 pt were in FC I and 2 in FC II. A new pregnancy was well tolerated in all of them, but the eldest, who had had 2 pregnancies and had a progressive worsening of clinical status, dying 8 years after the last pregnancy and 13 years after the diagnosis of PPCM. The remaining 5 pt are still alive, 3 in FC I and 2 in FC II, with worsening of FC in 1. Subsequent pregnancies occurred 3-7 years after clinical treatment of PPCM and no fetal distress was observed. CONCLUSION: Subsequent pregnancies are well-tolerated after PPCM, but not devoid of risk. No fetal distress was observed. A minimum interval of 3 years after the recovery of function seems to be safe for subsequent pregnancies.

  3. Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy.

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    Ntobeko B A Ntusi

    Full Text Available There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM, as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP (i.e., peripartum cardiac failure associated with any form of hypertension and PPCM have similar or different clinical features and outcome.We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years and PPCM (n = 30; age 31.5 ± 7.5 years. The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001. PPCM was more significantly associated with the following features than HHFP (p<0.05: twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05 to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05. There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005 during follow-up.There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.

  4. Exercise tolerance, lung function abnormalities, anemia, and cardiothoracic ratio in sickle cell patients.

    Science.gov (United States)

    van Beers, Eduard J; van der Plas, Mart N; Nur, Erfan; Bogaard, Harm-Jan; van Steenwijk, Reindert P; Biemond, Bart J; Bresser, Paul

    2014-08-01

    Many patients with sickle cell disease (SCD) have a reduced exercise capacity and abnormal lung function. Cardiopulmonary exercise testing (CPET) can identify causes of exercise limitation. Forty-four consecutive SCD patients (27 HbSS, 11 HbSC, and 6 HbS-beta thalassemia) with a median age (interquartile range) of 26 (21-41) years underwent pulmonary function tests, CPET, chest x-ray, and echocardiography to further characterize exercise limitation in SCD. Peak oxygen uptake (V'O2 -peak), expressing maximum exercise capacity, was decreased in 83% of the studied patients. V'O2 -peak correlated with hemoglobin levels (R = 0.440, P = 0.005), forced vital capacity (FVC) (R = 0.717, P anemia (n = 17), cardiovascular dysfunction (n = 2), musculoskeletal function (n = 10), pulmonary ventilatory abnormalities (n = 1), pulmonary vascular exercise limitation (n = 1), and poor effort (n = 3). In the present study we demonstrate that anemia is the most important determinant of reduced exercise tolerance observed in SCD patients without signs of pulmonary hypertension. We found a strong correlation between various parameters of lung volume and cardiothoracic ratio and we hypothesize that cardiomegaly and relative small chest size may be important causes of the impairment in pulmonary function, that is, reduced long volumes and diffusion capacity, in SCD. Taking into account anthropomorphic differences between SCD patients and controls could help to interpret lung function studies in SCD better.

  5. Radiological evaluation of pulmonary atresia: An analysis of cineangiography in 32 cases

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    Lee, Dong Ho; Yeon, Kyung Mo; Park, Jae Hyung; Han, Man Chung; Yoon, Yong Soo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1983-06-15

    Total 32 cases of pulmonary atresia were diagnosed radiographically at Seoul National University Hospital from March, 1979 to August 1982. Some characteristic radiological findings were analyzed in chest PA and cineangiographies. The results were as follows: 1. In the evaluation of chest PA, cardiomegaly was noticed in 16 cases, dextrocardia in 8 cases, elevated cardiac apex in 7 cases and right-sided aortic arch in 6 cases. The pulmonary vascularties were mildly decreased in 20 cases, markedly decreased in 9 cases and decreased with reticular pattern in 3 cases. 2. As final diagnoses after cineangiography, pulmonary atresia was associated with Tetralogy of Fallot variant in 17 cases, transposition of great vessels in 7 cases, single ventricle in 5 cases, tricuspid atresia in 2 cases and intact ventricular septum in 1 case. 3. The classification according to the pattern of pulmonary artery is main pulmonary trunk with PDA(Type Ia) in 10 cases, pulmonary arterial confluence with PDA (Type Ib) in 10 cases, no pulmonary arterial confluence with PDA (Type Ic) in 5 cases, main pulmonary trunk without PDA (Type IIa) in 0 case, pulmonary arterial confluence without PDA (Type IIb) in 5 cases, and no pulmonary arterial confluence without PDA ( Type IIc) in 2 cases. 4. Pulmonary wedge venography was done and successful in 8 cases. Among them, confluence between right and left pulmonary arteries was noticed in 5 cases. 5. Biventricular cineangiograpy and/or pulmonary wedge venography, if necessary, is essential for the accurate diagnosis of pulmonary atresia to demonstrate detailed anatomy of pulmonary artery.

  6. Emergency off-pump coronary artery surgery

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja; Zulfiqar Haider; Haider Zaman

    2004-01-01

    Background Off-pump coronary artery bypass grafting is fast-becoming a procedure of choice for elective revascularization in high-risk patients with multi-vessel coronary artery disease. However, the role of off-pump coronary artery bypass grafting for patients with acute coronary syndromes requiring emergency revascularization still requires validation. We present our experience to show the feasibility of off-pump coronary artery surgery as an emergency revascularization technique. Methods From April 2001 to September 2003, emergency (operation within 24 hours after hospitalization) coronary artery bypass grafting without cardiopulmonary bypass (CPB) was performed in 66 patients with a mean age of (66.9±5.4) years (range 49-72 years). They presented acute coronary syndromes with 38 patients on platelet glycoprotein Ⅱb/Ⅲa receptor antagonists. All patients underwent off-pump coronary artery bypass surgery via sternotomy with the intention of complete coronary revascularization.Results An average of 2.9 grafts per patient were performed and the posterior descending artery and marginal branches of the circumflex artery were grafted in 83.3% of the patients. There were 4 events of intraoperative cardiac instability, precipitated by occlusion of right coronary artery or positioning of a cardiomegaly heart, leading to immediate conversion to CPB. The mortality rate was 3% (2/66). Two patients suffered postoperative stroke while three needed hemofiltration for acute renal failure. Post surgery elective coronary angiography (n=46) showed no significant stenosis.Conclusion Emergency off-pump coronary artery surgery with complete revascularization is feasible in patients with acute coronary syndrome with low morbidity and mortality and excellent early results.

  7. Off - Pump Coronary Artery Bypass Graft Surgery: A Safe Method For Complete Revascularization

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    Mirkhani S. H

    2002-07-01

    Full Text Available In recent years off-pump coronary artery bypass surgery (OPCAB has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG, we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery."nMaterials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB."nResults: Of 150 OPCAB cases, 146 (97.3 percent were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6. Total 595 distal grafts anastomosed to LAD (140 diagonals (140, right coronary artery (145, left circumflex (164. Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein."nConclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

  8. Mitochondrial Cardioencephalomyopathy Due to a Novel SCO2 Mutation in a Brazilian Patient

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    Gurgel-Giannetti, Juliana; Oliveira, Guilherme; Filho, Geraldo Brasileiro; Martins, Poliana; Vainzof, Mariz; Hirano, Michio

    2016-01-01

    Objectives To review all patients with SCO2 mutations and to describe a Brazilian patient with cardioencephalomyopathy carrying compound heterozygous mutations in SCO2, one being the known pathogenic p.E140K mutation and the other a novel 12–base pair (bp) deletion at nucleotides 1519 through 1530 (c.1519_1530del). Design Case report and literature review. Setting University hospital Patient Infant girl presenting with an encephalomyopathy, inspiratory stridor, ventilator failure, progressive hypotonia, and weakness, leading to death. Main Outcome Measures Clinical features, neuro-imaging findings, muscle biopsy with histochemical analysis, and genetic studies. Results This infant girl was the first child of healthy, nonconsanguineous parents. She developed progressive muscular hypotonia and ventilatory failure. At the end of the first month of life, she developed cardiomegaly and signs of cardiac failure. Routine blood tests showed lactic acidosis and mild elevation of the creatine kinase level. Brain magnetic resonance imaging showed increased T2 and fluid-attenuated inversion recovery signals in the putamen bilaterally. Nerve conduction studies showed severe axonal sensorimotor neuropathy. Muscle biopsy revealed a neurogenic pattern with mitochondrial proliferation and total absence of cytochrome-c oxidase histochemical stain. Sequencing of SCO2 showed that the patient had compound heterozygote SCO2 mutations: the previously described c.1541G A (p.E140K) mutation and a novel 12-bp deletion at nucleotides 1519 through 1530 (c.1519_1530del). The patient died at age 45 days. Conclusions Our findings and the literature review indicate that it is important to consider the diagnosis of mitochondrial disease in newborns with hypotonia and cardiomyopathy. In our case, the accurate diagnosis of SCO2 mutations is particularly important for genetic counseling. PMID:23407777

  9. Chest radiographic manifestations of scrub typhus

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    KPP Abhilash

    2016-01-01

    Full Text Available Background and Rationale: Respiratory system involvement in scrub typhus is seen in 20–72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications. Materials and Methods: Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Details and radiographic findings were noted and factors associated with abnormal X-rays were analyzed. Results: The study cohort contained 398 patients. Common presenting complaints included fever (100%, generalized myalgia (83%, headache (65%, dyspnea (54%, cough (24.3%, and altered sensorium (14%. Almost half of the patients (49.4% had normal chest radiographs. Common radiological pulmonary abnormalities included pleural effusion (14.6%, acute respiratory distress syndrome (14%, airspace opacity (10.5%, reticulonodular opacities (10.3%, peribronchial thickening (5.8%, and pulmonary edema (2%. Cardiomegaly was noted in 3.5% of patients. Breathlessness, presence of an eschar, platelet counts of 2 mg/dL had the highest odds of having an abnormal chest radiograph. Patients with an abnormal chest X-ray had a higher requirement of noninvasive ventilation (odds ratio [OR]: 13.98; 95% confidence interval CI: 5.89–33.16, invasive ventilation (OR: 18.07; 95% CI: 6.42–50.88, inotropes (OR: 8.76; 95% CI: 4.35–17.62, higher involvement of other organ systems, longer duration of hospital stay (3.18 ± 3 vs. 7.27 ± 5.58 days; P< 0.001, and higher mortality (OR: 4.63; 95% CI: 1.54–13.85. Conclusion: Almost half of the patients with scrub typhus have abnormal chest radiographs. Chest radiography should be included as part of basic evaluation at presentation in patients with scrub typhus, especially in those with breathlessness, eschar, jaundice, and severe thrombocytopenia.

  10. Risk of death due to chronic chagasic cardiopathy

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    Enrique C Manzullo

    1999-09-01

    Full Text Available In this longitudinal study 5,710 people were included. The inclusion criteria were two positive serological results for Trypanosoma cruzi infection, 15 and 50 years old and no other demostrable diesease at the time of study. In the five year follow up 1,117 patients were lost. The follow up involved yearly evaluation of serology, clinical examination, X-ray of torax, and ECG, for 4,593 patients and 263 were contacted at home because they did not assist for their clinical consultant. Time average of follow up was 5.3 years. Eighty nine (1.5% of the 4,593 patients died during the follow-up period, 63 (71% by cardiac insufiency (CI and 26 (29% by severe ventricular arrithmias. Diagnosis of cardiomegaly was present in all the patients with diagnosis of CI and in 15 (5% of the patients with diagnosis of arrithmias.The ECG alterations of these pacients show 61 right bundle brunch block (RBBB, associated or not with left anterior hemiblock (LAHB, 47 pathological Q wave and 70 primary repolarization alterations; 61 had polyfocal ventricular arrithmia. The death rate was similar in the sexes and was more frequent between 40 and 50 years of age. Information on 1,380 recuperated patients shows that 15 died with no previous symptoms and without medical assistance and were interpretate as sudden death. The latest ECG in three follow-up of these pacients indicates (before death that only one had normal study and 14 presented 12 RBBB; 9 LAHB; 7 isolated ventricular arrithmia; 10 repolariz alterations; 2 patological Q wave, 10 patients of them with RBBB and repolariz alterations. In all the cases we had people between 35 and 43 years old, 9 men and 6 women. This study shows that in Chagas disease is possible to differenciate two risk groups. A low risk death group that have normal ECG and clinical evaluation during the follow up, and a high risk group associate ECG with RBBB and primary alterations of repolarization and/or inactivation zones with not anual

  11. Citomegalovirose congênita: relato de caso Congenital cytomegalovirus infection: a case report

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    Patrícia de Fátima Azevedo

    2005-12-01

    Full Text Available A citomegalovirose congênita sintomática é entidade clínica de grande importância devido a sua vasta sintomatologia fetal. No Brasil, o diagnóstico intra-útero é ainda pouco realizado, apesar do grande arsenal propedêutico. Relatamos um caso de citomegalovirose congênita grave com hepatoesplenomegalia, agenesia parcial do vérmix cerebelar, calcificações intracranianas, placentomegalia, aumento da ecogenicidade intestinal e renal, cardiomegalia, hipoplasia pulmonar, derrame pericárdico e ascite. A ressonância nuclear magnética fetal foi utilizada para confirmação dos achados ultra-sonográficos. A amniocentese foi realizada para análise do líquido amniótico por meio da PCR, sendo evidenciado resultado positivo. O óbito fetal foi constatado na 31ª semana de gestação, sendo confirmados os achados através da citopatologia e estudo anatomopatológico do natimorto. O arsenal propedêutico existente, na atualidade, para diagnóstico intra-útero da citomegalovirose congênita é de grande importância para confirmação diagnóstica e determinação do prognóstico fetal.Congenital cytomegalovirus infection is an important clinical entity, due to its sonographic symptomatology. In Brazil, in utero diagnosis is not accomplished despite the improvements in diagnostic methods. We report a congenital infection including: splenomegaly and hepatomegaly, hypoplasia of the cerebellar vermis, intracranial calcifications, hyperechoic kidneys, hyperechoic bowel, cardiomegaly, lung hypoplasia, ascites, and pericardial effusion. Fetal magnetic resonance imaging confirmed the sonographic findings. Amniocentesis was performed for cytomegalovirus PCR in amniotic fluid, which confirmed fetal infection. Fetal loss occurred in the 31st week of pregnancy. Necropsy studies confirmed the sonographic findings. The diagnostic methods have been useful to confirm congenital cytomegalovirus infection and to establish fetal outcome.

  12. Penatalaksanaan Anestesi pada Pasien dengan Sick Sinus Syndrome yang Menjalani Laparotomi Ec Perforasi Gaster

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    Radian Ahmad Halimi

    2013-04-01

    Full Text Available SA node dysfunction, or known as Sick Sinus Syndrome is the common cause of disrythmia and can be caused by intrinsic and extrinsic factors of the SA node. The diagnose performed by the occurrence of bradi- takhikardia episode and the clinical symptoms, could be syncope, palpitation, or maybe asymptomatic. Some of the literature defined that the perioperative management of sick sinus syndrome is preoperative insertion of pacemaker (transcutaneal or transvenous pacing. A 75 years old man underwent laparotomy with diffuse peritonitis caused by gastric perforation. In preoperative clinical evaluation the patients revealed full awake ( compos mentis, with history of uncontrolled hypertension. In physical exammination a severe bradicardia was found with pulse of 31x/minute, and the blood pressure was 190/100 mmHg. In this rural hospital there was no fascility to insert the pace-maker. The organ perfusion was considered to be optimal from clinical evaluation ( proved by the wakefullness, SpO2 99%, and diuresis 1cc/kgBW after optimalization . The chest X’ray showed a cardiomegali without the sign of pulmonary congestion. The laboratory test were within normal limit including the renal function test ( creatinin; 0,97 mg/dl, and ureum 82,6 mg/dl. We decided to perform general anesthesia in this procedure. Before the induction while patient still awake, fentanyl 2µg/kgBW was given intravenously. Fifteen menue after fentanyl administration induction of anesthesia performed and initiated with propofol intravenous injection slowly until patients felt asleep, than intubated after muscle relaxant intravenous reached the onset After intubation the pulse / heart rate of patients rose to 44 – 90x/minute. While the pulse was 90/ minute the heart rythm of the patients became irregular, a multifocal ventricular extra systole occured, and it was reversible when the heart rate back to 44x/ minute. We decided to maintain the heart rate between 35 – 40dmitted to

  13. Acute respiratory distress in a silversmith

    Science.gov (United States)

    Parikh, Jignesh Mukeshkumar; Dhareshwar, Shashank; Sharma, Anand; Karanth, Raghuveer; Ramkumar, V. S.; Ramaiah, Indira

    2014-01-01

    A 25-year-old young male patient presented in casualty department with severe respiratory distress on the fourth day from onset of symptoms. The patient was nonsmoker and had no antecedent medical or drug history. Prior to admission, patient had dry cough and bilateral pleuritic chest pain for the last three days. He was in severe respiratory distress with use of accessory muscles of respiration. On examination, he had heart rate of 120 beats/min, blood pressure (BP) of 150/80, respiratory rate of 48-52/min and central cyanosis present. On systemic examination, reduced intensity of breath sounds with extensive rhonchi and crepitation was found in both lung fields, with other examination being within normal limits. On pulse oximetry, oxygen saturation was 28% on room air, which increased up to 36% with the help of 4 L oxygen via nasal prongs. PaO2/FiO2 ratio was 100. Chest X-ray analysis was suggestive of non-cardiac pulmonary edema in view of bilateral fluffy opacity without cardiomegaly. In view of 2/3 positive criteria, his provisional diagnosis was Acute Respiratory Distress Syndrome (ARDS). He required mechanical ventilatory support and was gradually weaned over a period of 10 days. The patient was treated with broad spectrum antibiotics and other supportive measures. On re-evaluation of history, we found that he was a goldsmith by occupation, smelting silver and gold for the past 8-10 years. On the day of onset of symptoms, while smelting silver he was exposed to golden yellow fumes for around 15 minutes, with the quantum of exposure more than any other day earlier. From previous experience and analysis of similar silver metals, he was able to tell us that the silver was adulterated with large amount of cadmium on that day than before. Serum level of cadmium was 2.9 μg/L 6 days after initial exposure. At the time of discharge, he had residual opacities in the chest radiograph and resting oxygen saturation was 94% on room air. PMID:25006313

  14. Complications and co-morbidities in radiographs of patients in traditional bone setters’ homes in Ogwa, Edo State, Nigeria: a community-based study

    Energy Technology Data Exchange (ETDEWEB)

    Eze, Kenneth C., E-mail: ezechallenge@yahoo.co.uk [Department of Radiology, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State (Nigeria)

    2012-09-15

    Background: Musculoskeletal injuries are common in developing countries, but access to high quality orthopedic care is not. Traditional bone setters (TBS) serve to fill the gap, but the nature and quality of their treatment are largely understudied. Traditional bone setting in Idunmunkpaghan clan of Ogwa community, Edo State, Nigeria, was founded by Odion Ekhimere between about 1680 and 1705. The TBS practice in this community is studied to find out the complications and co-morbidities associated with it. Methods: A prospective community-based study of the patients admitted in the traditional bone setters’ homes was done at Ogwa over a -2-year period by studying the admission and discharge radiographs of patients treated in the community and by interviewing the TBS and patients. Result: Ninety patients with radiographs of the lesion sites were followed up from admission to discharge at the TBS homes, comprising 53 males (53.89%) and 37 females (41.11%) with a male to female ratio of 1.4:1. Sixty five patients (72.2%) had fracture or dislocation. Forty four of the 65 patients (67.7%) with fracture/dislocation had complications including mal-union 31(70.4%), secondary osteoarthritis 8 (18.2%), non-reduction of dislocation 7 (11.9%), non-union 8 (18.2%), and others 12 (27.2%). Co-morbidities were identified in 15 patients (16.7%) and included severe osteoarthritis 7 (46.7%), diabetic foot ulcer 4 (26.7%), severe hypertension with cardiomegaly 4 (26.7%), metastatic carcinoma of the prostate 3 (20.0%), septic arthritis 2 (13.3%), pulmonary tuberculosis 1 (6.7%) and others 3 (20.0%). Conclusion: The practice of traditional bone setting is well established in Idunmunkpaghan clan in Ukpogo quarter of Ogwa. Education and training of the TBS is the key to reduction of complications and co-morbidities seen in their practices as they have high patronage and the patients have high regards for them and will continue to patronize them.

  15. Dietary manipulation and social isolation alter disease progression in a murine model of coronary heart disease.

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    Yumiko Nakagawa-Toyama

    Full Text Available BACKGROUND: Mice with a deficiency in the HDL receptor SR-BI and low expression of a modified apolipoprotein E gene (SR-BI KO/ApoeR61(h/h called 'HypoE' when fed an atherogenic, 'Paigen' diet develop occlusive, atherosclerotic coronary arterial disease (CHD, myocardial infarctions (MI, and heart dysfunction and die prematurely (50% mortality ~40 days after initiation of this diet. Because few murine models share with HypoE mice these cardinal, human-like, features of CHD, HypoE mice represent a novel, small animal, diet-inducible and genetically tractable model for CHD. To better describe the properties of this model, we have explored the effects of varying the composition and timing of administration of atherogenic diets, as well as social isolation vs. group housing, on these animals. METHODOLOGY/PRINCIPAL FINDINGS: HypoE mice were maintained on a standard lab chow diet (control until two months of age. Subsequently they received one of three atherogenic diets (Paigen, Paigen without cholate, Western or control diet for varying times and were housed in groups or singly, and we determined the plasma cholesterol levels, extent of cardiomegaly and/or survival. The rate of disease progression could be reduced by lowering the severity of the atherogenic diet and accelerated by social isolation. Disease could be induced by Paigen diets either containing or free of cholate. We also established conditions under which CHD could be initiated by an atherogenic diet and then subsequently, by replacing this diet with standard lab chow, hypercholesterolemia could be reduced and progression to early death prevented. CONCLUSIONS/SIGNIFICANCE: HypoE mice provide a powerful, surgery-free, diet-'titratable' small animal model that can be used to study the onset of recovery from occlusive, atherosclerotic CHD and heart failure due to MI. HypoE mice can be used for the analysis of the effects of environment (diet, social isolation on a variety of features of

  16. Acute respiratory distress in a silversmith

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    Jignesh Mukeshkumar Parikh

    2014-01-01

    Full Text Available A 25-year-old young male patient presented in casualty department with severe respiratory distress on the fourth day from onset of symptoms. The patient was nonsmoker and had no antecedent medical or drug history. Prior to admission, patient had dry cough and bilateral pleuritic chest pain for the last three days. He was in severe respiratory distress with use of accessory muscles of respiration. On examination, he had heart rate of 120 beats/min, blood pressure (BP of 150/80, respiratory rate of 48-52/min and central cyanosis present. On systemic examination, reduced intensity of breath sounds with extensive rhonchi and crepitation was found in both lung fields, with other examination being within normal limits. On pulse oximetry, oxygen saturation was 28% on room air, which increased up to 36% with the help of 4 L oxygen via nasal prongs. PaO 2 /FiO 2 ratio was 100. Chest X-ray analysis was suggestive of non-cardiac pulmonary edema in view of bilateral fluffy opacity without cardiomegaly. In view of 2/3 positive criteria, his provisional diagnosis was Acute Respiratory Distress Syndrome (ARDS. He required mechanical ventilatory support and was gradually weaned over a period of 10 days. The patient was treated with broad spectrum antibiotics and other supportive measures. On re-evaluation of history, we found that he was a goldsmith by occupation, smelting silver and gold for the past 8-10 years. On the day of onset of symptoms, while smelting silver he was exposed to golden yellow fumes for around 15 minutes, with the quantum of exposure more than any other day earlier. From previous experience and analysis of similar silver metals, he was able to tell us that the silver was adulterated with large amount of cadmium on that day than before. Serum level of cadmium was 2.9 μg/L 6 days after initial exposure. At the time of discharge, he had residual opacities in the chest radiograph and resting oxygen saturation was 94% on room air.

  17. Intoxicação experimental por monensina em búfalos e bovinos Experimental monensin poisoning in water buffaloes (Bubalus bubalis and cattle

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    Daniela B. Rozza

    2007-04-01

    Full Text Available Sinais clínicos e lesões característicos de intoxicação por monensina foram induzidos em búfalos dosados (1 dia com 15, 10, 7,5 e 5mg/kg de monensina. Apenas os búfalos dosados com 2,5 (1 dia e 1 mg/kg (7 dias de monensina não morreram. Os sinais clínicos iniciaram cerca de 6 h após dosagem com monensina e incluíram apatia, anorexia, diarréia, sialorréia, fraqueza muscular, taquicardia, dificuldade locomotora, dispnéia, distensão da jugular, decúbito e morte. As dosagens de creatinina quinase (CK dos búfalos aumentaram acentuadamente após dosagem com monensina. As alterações macroscópicas foram ascite, hidrotórax, hidropericárdio, cardiomegalia, hepatomegalia e áreas pálidas focais no miocárdio e nos músculos esqueléticos. Degeneração e necrose de miofibras foram os principais achados histopatológicos. Por outro lado, nenhuma evidência de doença, nem mesmo alteração nos níveis de CK, foram observados nos bovinos dosados com as mesmas dosagens de monensina, confirmando observações preliminares que esses animais são mais resistentes à monensina que os búfalos.Monensin is widely used as a feed additive to improve performance of livestock; however accidental poisoning by this ionophore compound has been reported in a number of animal species. Typical clinical signs and lesions of monensin poisoning were induced in water buffaloes dosed with single dosages of 15, 10, 7.5, and 5mg/kg of the compound. Only buffaloes dosed with 2.5 mg/kg (1 day and 1mg/kg (7 days survived. Clinical signs initiated about 6 h post-dosing and included apathy, anorexia, diarrhea, drooling, muscular weakness, locomotion disorders, dyspnea, tachycardia, jugular distension and pulse, recumbency and death. The creatine kinase (CK levels were highly augmented in blood samples of buffaloes dosed with monensin. Most prominent gross changes were ascites, hydrothorax, hydropericardium, cardiomegaly, hepatomegaly, and focal pale areas in the

  18. Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery

    Institute of Scientific and Technical Information of China (English)

    ZHENG Jian-yong; ZHAO Qu-ming; HAN Ling; DING Wen-hong; JIN Mei; ZHANG Gui-zhen; XIAO Yan-yan; LUO Yi; CHENG Pei; MENG Xu

    2010-01-01

    Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart anomaly. We aimed to illustrate the clinical features and long-term prognosis of patients with ALCAPA.Methods Twenty three patients (13 males and 10 females, ages ranging from 2.5 months to 65 years) identified as ALCAPA in Beijing Anzhen Hospital from April 1984 to June 2009 were divided into two groups, based on the age of onset: group 1 (≤12 months, n=16) and group 2 (>12 months, n=7).Results Fifty six point three percent of patients in group 1 had been misdiagnosed as endocardial fibroelastosis (9/16),18.8% as dilated cardiomyopathy (3/16) and 6.3% as myocardial infarction (1/16). Patients in group 2 were usually diagnosed as coronary heart disease, myocarditis, or patent ductus arteriosus. Electrocardiography in group 1 revealed abnormal Q waves with T wave inversion in leads I, avL, V4-V6, especially in lead avL (deep and wide Q wave); but no specific manifestations in group 2. A higher percentage of patients in group 1 had cardiomegaly on chest radiograph (86.7% vs. 33.3%, P=0.031), while pulmonary artery protrusion was more common in group 2 (26.7% vs. 83.3%,P=0.046). Lower left ventricular ejection fraction (LVEF) was present in group 1 than in group 2 ((48.5±11.5)% vs.(65.0±6.1)%, P <0.001). Apical ventricular aneurysm (62.5% vs. 0%, P=0.007), enhanced echogenicity of papillary muscles (87.5% vs. 28.6%, P=0.011) and endocardial thickening (93.8% vs. 14.3%, P <0.001) were more frequent in group 1 than in group 2. The ratio of the proximal right coronary artery (RCA) diameter to the aortic root diameter exceeded 0.14 in all cases, more prominent in group 2 (0.26±0.05 vs. 0.33±0.03, P=0.009). Increased coronary artery collaterals within the interventricular septum were detected in 18 patients (78.3%) by Doppler imaging. Twenty one patients underwent cardiac surgery, including left coronary artery (LCA) ligation (1/21), LCA

  19. Toxic interaction between fumonisin B1 and moniliformin for cardiac lesions in Japanese quail.

    Science.gov (United States)

    Sharma, Deepa; Asrani, R K; Ledoux, D R; Rottinghaus, G E; Gupta, V K

    2012-09-01

    This study examined the effects of fumonisin B1 (FB1) and moniliformin (M) on the heart of Japanese quail (Coturnix coturnix japonica). Three hundred and ninety day-old Japanese quail were randomly divided into four groups: 1) FB1 alone (FX), 2) M alone (MX), 3) FB1 and M (FM), and 4) chick mash alone (CX). We used three pen replicates of 35 quail per pen in groups FX, MX, and FM and three pen replicates of 25 quail per pen in group CX. Gross and microscopic changes in the heart were studied in nine birds (three birds per replicate) from each group at weekly intervals up to 28 days postfeeding (DPF). Ultrastructural changes were studied in the heart of three birds (one bird per replicate) from each group at 21 DPF. Thinning of the heart was the only significant gross lesion in group FX. In contrast, mild-to-severe cardiomegaly was a significant finding in groups MX and FM throughout the study. Microscopically, thinning of cardiomyocytes was evident at 7 DPF in group FX. In addition to the hypertrophy of cardiomyocytes evident as early as 7 DPF, myocardial karyomegaly, nuclear hyperchromasia, and myofibril disarray exhibiting a wavy pattern were more pronounced at 28 DPF in group MX. Similar but more severe lesions were observed in the FM combination group that included myocardial hemorrhages, vacuolar changes, hypertrophy of cardiomyocytes, focal myocarditis, and loss of myofibrils cross-striations. Via transmission electron microscopy, the maximum effect of FB1 toxicity was observed on mitochondria. In addition to an increase in the number of mitochondria, the mitochondria seemed invariably swollen and pleomorphic, although the outer membrane was intact, and the membrane cristae were usually distinct. Myofibrils seemed thinner, without much disruption in their architecture. Large numbers of vacuolar bodies of irregular size, both in the sarcoplasm and in between the myofibrils, were conspicuous in group FX. In contrast to group FX, the increase in number of

  20. CLINICAL PROFILE OF ANAEMIA IN A TERTIARY CARE HOSPITAL

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    Ather Akhtar

    2016-04-01

    Full Text Available BACKGROUND Anaemia causes a reduction in the oxygen carrying capacity of the blood resulting in tissue hypoxia. Cardiac output at rest is not usually increased in most chronic anaemia until haemoglobin levels fall below 7 g/dL, but abnormal rise in output with exercise may occur with levels as high as 10 g/dL. The increase in cardiac output has been observed to correlate well with the degree of anaemia. Other compensatory mechanisms to chronic anaemia available to the body include decreased circulation time and increased tissue oxygen uptake. The latter is facilitated by a shift to the right of the oxygen haemoglobin dissociation curve. Cardiomegaly may also be as a result of the increased workload on the heart from the increased viscosity of blood in anaemia patients. Anaemia in the elderly is an extremely common problem that is associated with increased mortality and poorer health-related quality of life, regardless of the underlying cause of the low haemoglobin. A study of anaemia in elderly patients found a wide variation in prevalence, ranging from 2.9% to 61% in men and 3.3% to 41% in women. Higher rates were found in hospitalised patients than in community dwellers. It is easy to overlook anaemia in the elderly, since such symptoms as fatigue, weakness, or shortness of breath may be attributed to the ageing process itself. Our objective is to show the prevalence of anaemia even in a tertiary health care centre. METHODS One hundred patients were identified who were admitted in the Department of Medicine, Deccan College of Medical Sciences. Among the 100 patients, 38 were male and 62 were female. The study was conducted from Jan 2014 To Jan 2015. Patients having haemoglobin less than 10 g% in the medical wards were enrolled in the study. RESULTS Among the 100 patients, 38 were male and 62 were female. The average haemoglobin was 6.4 g%, the lowest being 2.8 g%. Peripheral blood smear showed hypochromic picture in 58, macrocytic picture in

  1. Imagem radiográfica da cavidade torácica de cães Golden Retriever acometidos pela distrofia muscular Radiologic images of the thoracic cavity of Golden Retriever dogs affected by muscular dystrophy

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    Flávio R. Alves

    2009-02-01

    phenotypic characteristics to Human Muscular Dystrophy and are considered a proper animal model for DMD studies. Latero-lateral and dorso-ventral thoracic radiographies were obtained from 10 Golden Retriever dogs affected by muscular dystrophy, to investigate possible radiographic alterations. Thorax radiographic examination revealed (a interstitial and alveolar pattern, (b initial phases of pneumonia and pulmonary edema, (c cardiomegaly as a principal alteration in the thoracic cavity, (d megaesophagus displacing the trachea and heart silhouette, and (e cranial protrusion of the diaphragm lining into the thorax with development of a hiatus hernia displacing the stomach to the caudal mediastinum. Postmortem examination showed pleural effusion, pulmonary emphysema, degenerative and metaplasic processes in the diaphragm and intercostal muscles. Radiographic examination was considered essential for the diagnosis of cardiac and respiratory disease in Golden Retriever dogs affected by muscular dystrophy, and to identify the primary pulmonary process and to provide the establishment of suitable therapeutic treatment, with a reserved prognosis in advanced stage of the disease.

  2. Análise dos fatores de risco para mortalidade na estimulação pediátrica endocárdica transfemoral: experiência em longo prazo Risk factors analysis in transvenous pediatric pacing through femoral access: long-term experience

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    Roberto Costa

    2005-06-01

    risk factors for mortality. METHOD: From 1981 to 2000, 99 patients ranging in ages from one day to 13 years (4.1 ± 3.6 and median = 3 years underwent permanent transfemoral pacemaker implantation due to congenital (39.4%, postsurgical (54.5%, or non-surgically acquired bradycardia (6.1%. RESULTS: By the end of 7.1 ± 5.3 years (708.3 patient-years of prospective follow-up, 18 (18.2% patients had died. The actuarial survival rates were 85%, 79.5%, and 74.2%, at 5, 10, and 15 years, respectively. Independent predictors of mortality identified by Cox proportional hazards analysis were younger age at implantation (p = 0.028, the presence of untreated cardiac anomalies or intracardiac prostheses (p = 0.0001, and radiographic evidence of cardiomegaly (p = 0.035. CONCLUSIONS: Permanent endocardial pacing via the femoral vein presented survival expectance comparable to other techniques with a low rate of pacing complications. Long-term survival was limited by lower ages and cardiac dilatation at the time of implantation as well as by the presence of untreated cardiac defects or valve prostheses.

  3. Aspectos epidemiológicos, clínicos e parasitológicos da doença de Chagas em Mato Grosso do Sul Epidemiological, clinical and parasitological aspects of Chagas' disease in Mato Grosso do Sul State

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    Maurício Antonio Pompilio

    2005-12-01

    obtained indicated that the chagasic patients are predominantly alloctones with low-grade schooling, and were exposed to triatomines. The frequency of spontaneous abortion was higher in chagasic women. Chronic chagasic cardiopathy, estimated to occur in 20.2% of the patients, showed 7.5% cardiomegaly, 6.2% aneurysm of the left ventricle, and with a predominance of dyspnea, palpitations and arterial hypertension. Xenodiagnosis was positive for 26.1% of the chagasics and the PCR was positive for 53.7%, and was significantly higher in males and alloctones. An analysis of the results shows that Chagas' disease, in the group studied, presented clinical and parasitologic characteristics demonstrating significant regional differences.

  4. Clinical features of respiratory failure and heart failure in patients with sleep disordered breathing%睡眠呼吸紊乱与呼吸衰竭及心力衰竭关系的研究

    Institute of Scientific and Technical Information of China (English)

    高莹卉; 王慧玲; 李静; 董霄松; 安培; 赵龙; 高占成; 韩芳

    2012-01-01

    Objective To assess the clinical characteristics of heart failure and respiratory failure in patients with sleep disordered breathing(SDB).Methods Symptoms,signs,laboratory tests,clinical courses,blood gases responses to voluntary hyperventilation test and non-invasive ventilation treatment were analyzed in 29 patients with SDB.All patients were diagnosed as right and left heart failure and respiratory failure from 1994 to 2009 in Peking University People's Hospital.Results Among the 29 patients recruited,13 were male and 16 female.The mean age was 62±13 yrs,and BMI was(34±4)kg/m2.Fourteen(48.3%)were diagnosed as obstructive sleep apnea syndrome at first visit.Chief complainsincludes dyspnea,edema,cough,snoring,hypersomnolence,oliguria,and altered mental status.Common signs include obesity,narrow upper airway,cyanosis,moist rales at the base of lungs,enlarged border of cardiac dullness,edema.Polycythemia was seen in 13 patients(44.80%),among the 26 patients who had underwent pulmonary function tests,14 had FEV1/FVC≥70%,the others were FEV1/FVC<70%,with 6 patients had 50% predict value≤FEV1<80% predict value and 6 patients had 30% predict value≤FEV1<50% predict value.After positive airway pressure(BiPAP and CPAP)treatment,symptoms and arterial blood gases test results improved.Chest X-ray,CT scan and UCG show pulmonary vascular congestion and edema with cardiomegaly and possible pleural effusion,pulmonary hypertension,left ventricular diastolic dysfunction.Five patients underwent 24 h blood pressure monitoring showed non-dipping pattern or morning risen pattern of BP In 11 patients who undertaken the test,voluntary hyperventilation induced significant improvement of SpO2,PaCO2 and PaO2,and most of the parameters returned from type Ⅱ respiratory failure to normal level.Conclusion The mobidity of SDB remained to be recognized.This cases report indicated that obese patients complaining of severe dyspnea and edema may have respiratory

  5. ISH AHA-2 A CASE OF CHRONIC INDOLENT PHEOCHROMOCYTOMA WHICH CAUSED MEDICALLY-CONTROLLED HYPERTENSION BUT TREATMENT-RESISTANT DIABETES MELLITUS.

    Science.gov (United States)

    Lee, Hae-Young; Park, Chan-Soon; Na, Sang-Hoon; Kim, Kyung-Jin; Lee, Chan Joo; Park, Sungha

    2016-09-01

    A 47-year-old woman was admitted via emergency department due to dyspnea NYHA Fc II-III aggravated for 2 months after upper respiratory infection. Her height and body weight were 161 cm / 67 kg. Initial vital signs were 110/70 mmHg - 112 BPM - 24/min - 36.5°C. Chest PA showed cardiomegaly and pulmonary congestion (Figure 1). B-natriuretic peptide level was markedly increased (2002 pg/mL, normal range ≤ 100 pg/mL). The echocardiographic examination showed severely dilated LV cavity (61/72 mm) and severe LV systolic dysfunction (EF 28%) with normal left ventricular wall thickness (9/11 mm) (Figure 2). She was initially treated with dobutamine and parenteral diuretics. After hemodynamic stabilization with body weight reduction of 4 kg with heart failure medication with diuretics, ACE inhibitors and beta blocker (Carvedilol 3.125 mg bid), she was discharged. At the time of discharge, her blood pressure was 90/74 mmHg and pulse rate was 107 BPM.After 2 years of follow up, her left ventricular systolic function was completely normalized (24/46/73%). Left ventricular wall thickness showed mild hypertrophy (11/12 mm) but apical segments showed akinesia. (Figure 3 ECG and chest PA, Figure 4 Echocardiography). Her blood pressure was recovered to the normal range of 132/70 mmHg and pulse rate was 72 BPM. Her heart failure medication was carvedilol (6.25 mg twice daily) and losartan (100 mg once daily)After 1 year of follow up (Year 3), her blood pressure increased to hypertensive range (150/100 mmHg) and pulse rate was 84 BPM. Nifedipine GITS 30 mg was added to the heart failure medication. Diabetes mellitus was newly developed. Despite diet control, her blood glucose levels were continuously increased (HbA1C levels 7.2%), therefore, oral hypoglycemic agents were intensified with metformin and sitagliptin. As heart failure signs disappeared and glycemic control was difficult, beta blocker was discontinued and antihypertensive regimen was changed to

  6. Agenesia isolada da artéria pulmonar direita ou esquerda: avaliação da evolução natural e a longo prazo, após intervenção corretiva Isolated unilateral pulmonary artery agenesis: evaluation of natural and long term evolution after corrective surgery

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    Edmar Atik

    2006-10-01

    hemoptysis in adults. Interventions such as pulmonary artery reconstruction and lobectomies were performed in 17% of the cases. We analyzed four of these cases, two in natural evolution and two with late term PH regression after surgical correction. METHODS: Three 22,10 and 35 month old male children and one 20 month old female child were included in the study. The 22 month old presented right-sided heart failure (RHF and cyanosis; the 10 month old presented RHF and the other two presented exertion fatigue. All had PH symptoms, right ventricular strain on the EKG and cardiomegaly. Cardiac catheterization showed systemic pressures in the contralateral pulmonary artery, with right-sided agenesis in three of the children and left-sided agenesis in one child. RESULTS: Surgical correction of pulmonary artery continuity was possible in the 22 month old and 10 month old using a 7mm diameter Goretex conduit between the pulmonary arteries up to the hypoplastic contralateral pulmonary hilum. There was early and late regression of the PH signs and the children remained stable during follow-up to the ages of 7 and 2.5 years, respectively. The pressure ratio between the left and right ventricles was 30 and 40%, in both cases. Pulmonary perfusion increased from 8 to 44% and from 8 to 23%, in the two cases. The same procedure was scheduled for the other patients. CONCLUSION: This technique has become the operation of choice for similar cases, that are rarely described in literature, even in the presence of severe PH and contralateral pulmonary artery hypoplasia.

  7. Tratamento da Doença de Chagas pelo Nifurtimox (Bayer 2502

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    Aluizio Prata

    1975-12-01

    caixas positivas de 28,6 para 3,1. Não há vantagem em se prolongar o uso do nifurtimox por mais de dois meses. As percentagens de cura são bem inferiores as obtidas na Argentina, Chile e Rio Grande do Sul. A droga produz muitas reações, sendo a mais importante a polineuropatia periférica.Seventy seven patientes with Chagas disease were treated with nifurtimox. They were divided into 4 groups. Group I consisted of 30 patients in the acute phase of the disease. Twenty two patients took an insufficient dose. Only 8 patients used the drug for 120 days in an initial daity dose of 15 mg/kilogram body weight for up to 2 weeks and later in a daily dose of 10 mg/kilo body weight. In 4 patients (50% the xenodiagnosis became negativa after treatment and in 3 the Machado Guerreiro test became negative. One patient died with acute cardiac failure on the 5th day of treatment. Six patients developed evidence of sensory peripheral neuritis while on treatment. Group II consisted of 15 outpatients in the chronic phase. They also took the drug for 120 days in a variable dosage of 5-15 mg/kilo body weight. They had at least one xenodiagnosis performedafter treatment in four patients xenodiagnosis became negative. The treatment had no effect on the electrocardiogram, degree of cardiomegaly, or appearance on barium swallow. Treatment did not prevent one patient from developing an arrhythmia and another cardiac failure. Group III also contained 15 patients in the chronic phase with positive xenodiagnosis treated with 10 mg/kilo body weight for 120 days. Twelve serial monthly xenodiagnosis were done after treatment using 80 T. infestans (10 to a box for each examination. In only 28.5% of the patients were all these xenodiagnoses negative. The frequency of parasitemia was decreased in the other patients but not eradicated. The number of xenodiagnoses positive before treatment was 43% and afterwards 24.4%. The number of positive boxes diminished from 29.6% to 7%. Group IV consisted of 17

  8. Dolor torácico y cardiopatía en la edad pediátrica

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    Rafael Gutiérrez Alvarez

    2004-01-01

    describe the findings according with the utilized diagnostic methods. Materials and methods: This is a prospective, descriptive and analytic study of 70 patients (3 to 13 years referred to the Cardiology Clinic of the Hospital Nacional de Niños, during a one year period. Every patient had a clinical history, a physical exam, a chest x-ray and ECG and an echocardiogram taken. Results: Only 62 patients completed all their evaluating tests, 3 4 (54.5% boys and 28 (45.2% girls. The mean age was 8.5 years and the median was 9 years. In 21% of the cases the chest x-ray was abnormal (6 showed bronchopneumonia, 2 air trapping, 2 pulmonary artery enlargement, 2 prominent hila and 2 cardiomegaly. The ECG was normal in 97%, the Echocardiogram was abnormal in 4 (1 showed and ASD, 1 a patent ductus arteriosus, 1 a dysplastic pulmonic valve and 1 a pericardial effusion. Stress tests and Holters were normal. Only 4.8% of the patients had heart disease. Conclusion: Consultation for chest pain in the pediatric age is frequent. History and physical examination are very important for the diagnosis and handling of these children. Chest pain though is infrequently associated with cardiac anomalies during childhood years and the patients with heart conditions and chest pain had other findings such as bradychardia, pericardial rub and murmurs.

  9. Permanent pacemaker implantation and follow-up in 23 infants and children with perioperative complete atrioventricular block%23例先天性心脏病患儿围术期永久起博器的植入及随访

    Institute of Scientific and Technical Information of China (English)

    张惠丽; 李守军; 花中东; 杨克明; 胡盛寿; 张浩; 陈柯萍; 华伟

    2014-01-01

    preoperatively and underwent PM implanted during the surgical operation. Twenty patients (3 PECD and total endocardial cushion defect (TECD), 3 ventricular septal defect (VSD), 1Tetralogy of Fallot(TOF), 6 double outlet right ventricle(DORV), 2 transposition of the great arteries(TGA), 5 CTGA) had complete AVB after CHD repair and underwent ENDO or EPI PM implantation 11 to 48 days later. Follow-up data were obtained on the records made in out-patient (symptoms and signs, ECG, x ray, echocardiography and the param-eters of the permanent cardiac pacemakers). Results EPI pacing leads were implanted via midline thoracoectomy and the pulse generator were buried in a subcutaneous pocket on the left abdomen. ENDO pacing systems were implanted via the right (3 cases) or left (4 cases) subclavian vein and the pulse generator were buried in a subcutaneous pocket in the right(3 cases) and left (4 cases)precordial area. No lead fracture and infected wound happened in these patients. Rate-responsive ventricular demand pacing (VVIR) PM were implanted in 1 and VVI in 22 patients. All patients with PM implantation had the range of pacing rate 70~160 (111 ±25.5)bpm, pacing threshold 0.5~0.75 (0.74 ±0.30)V, sensitivity threshold 2.5~2.8 (2.78 ±0.11)mV and lead resistance 271~726 (445.5 ±148.9)Ω. Twenty-one patients were followed-up for 1 month to 5.5years (91.3%21/23) and the pacing threshold were slightly high early after PM implantation and then maintained steady. One patient with TGA had a sudden death 6 months after switch operation and EPI PM implantation without the known eti-ology. One patient with TECD had battery changed 4.5 years after EPI PM implantation. The sinus rhythm recovered in 1 patient with VSD. Cardiomegaly, myocardial dysfunction and left ventricular ejection fraction (LVEF)<50% occurred in 4 patients 6 months to 2 years later after PM implantation. Conclusion The results of this study show that perioperative permanent pacing therapy for complete AVB in infants and

  10. Clinical Characteristics, Diagnosis and Treatment of Children with Anomalous Origin of Left Coronary Artery from Pulmonary Artery in Each Age Group%左冠状动脉起源于肺动脉37例患儿各年龄段的临床特点及诊治

    Institute of Scientific and Technical Information of China (English)

    张惠丽; 李守军; 胡盛寿; 沈向东; 闫军; 王旭

    2012-01-01

    ECG探查冠状动脉,必要时加行多层螺旋CT或心血管造影以明确诊断,确诊后应尽快手术治疗.%Objective To investigate the clinical features,diagnosis and treatment of children with anomalous origin of left coronary artery from pulmonary artery (ALCAPA) in each age group and improve the knowledge and decrease the nusdiagnosis of this disorder. Methods Between Apr. 1999 and Mar.2011,37 patients[21 male and 16 female,aged (5.0±4.8) years] were examined and treated for ALCAPA in Fuwai Hospital.They were divided into 3 groups:included 8 infants ( ≥1 year),10 toddlers( > 1 -3 yeare)and 19 older children( >3 years). Of 37 patients with ALCAPA,31 cases were sick with regurgitation( MR) ,2 cases with left ventricular aneurysoi.l case with Tetralogy of fallot( TOF)/atrial septal defect ( ASD), 1 case with Bevere pulmonary stenosis ( PS)/partial anomalous pulmonary venous connection (PAPVC)and 1 case with ASD at the same time. The initial and final diagnosis and surgery result were also reviewed. Follow - ups of some patients were conducted in the out - patient and by recent telephone call and the records were established. Results Infants and toddlers had disorders at an earlier age than the older children. Thirteen of 37 patients( 35. 1% ,13/37 eases) .including 5 infants(62. 5%) ,3 toddlers (30.0%) and 5 older children (26.3%) had Q and ST -T segment changes in ECG.bul there was no statistical difference among the 3 groups. Chest radiograph in all patients showed marked cardiomegaly,cardiolhoracic ratio was biggest in infants,bigger in toddlers compared with the old children. Meanwhile left ventricular end - diastolic dimension( LVED) measured by echocardiography was greatly increased in infants compared with the other 2 groups. There were more infants with LVEF < 50% than the other 2 groups and there was no statistical difference between the toddlers and the older children. Eighteen of 37 patients(48.6% , 18/37 cases) were misdiagnosed at their

  11. 婴儿型糖原累积症Ⅱ型六例临床分析%Analysis of clinical features of 6 patients with infantile type glycogen storage disease type Ⅱ

    Institute of Scientific and Technical Information of China (English)

    丁娟; 黄昱; 杨海坡; 张清友; 侯新琳; 刘雪芹; 杨艳玲; 能晖

    2015-01-01

    Objective To summarize clinical features and diagnosis of Chinese infantile patients with glycogen storage disease type Ⅱ (GSD Ⅱ).Method Six infant patients with GSD Ⅱ diagnosed from January 2012 to June 2014 in the Department of Pediatrics,Peking University First Hospital were enrolled into this study.Clinical information of the 6 patients,including clinical manifestation,blood biochemistry,chest X-ray,echocardiogram,electrocardiogram,acid alpha-glucosidase (GAA) activity and GAA gene mutation analysis by direct sequencing of polymerase chain reaction (PCR) product were reviewed.Result Of the 6 patients,five were female and one was male,five of whom were classic infantile type while the other one was atypical.The age of onset ranged from birth to 3-month-old.All patients had varying degrees of generalized muscle weakness,hypotonia and development retardation or retrogression.Other common findings were feeding difficulties in two patients,tongue weakness in two patients,respiratory distress in four patients,macroglossia in one patient,and hepatomegaly in two patients.Left ventricular hypertrophy and cardiomegaly were obvious in all the six patients.All six patients were found to have a enlarged heart in physical examination,and three patients who underwent a chest X-ray examination had an enlarged heart shadow.Four patients who had an echocardiography were found to have myocardial hypertrophy.The electrocardiogram in three patients showed short PR intervals and high voltage.The creatine kinase (CK) levels were three to seven times elevated.The mildest elevated CK was 441 IU/L,and the highest CK level was 1 238 U/L.Assay of GAA enzyme activity in whole blood showed significantly reduced activity (1.3 nmol/(spot · d) to 2 nmol/(spot · d)) in the patients tested.Gene sequencing in 4 patients showed 8 pathogenic mutations,including 6 missense mutations,one nonsense mutation and one frameshift mutation.The missense mutations were c.998C > A(p.Thr333Lys),c.1280