No abstract available.
Echocardiography ; Heart Defects, Congenital/*diagnosis/pathology ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

Pre-excitation-syndrome has not been reported as a phenotypic feature of facio-scapulo-humeral muscular dystrophy (FSH-MD). In a 39-year-old male with FSH-MD due to a reduced tandem repeat size in the D4Z4-locus on chromosome 4q35, cardiac involvement, manifesting as an incomplete right bundle-branch-block, tall T-waves in V 3-5, ST-elevation in V 2-4, and mild thickening of the left ventricular myocardium, was first recognised 10 years earlier. Follow-up at age 39 years revealed mild myocardial thickening, two intra-ventricular aberrant bands, and, surprisingly, intermittent pre-excitation on a routine electrocardiography. Cardiac involvement in FSH-MD may manifest as hypertrophic cardiomyopathy or various arrhythmias, of which one may be pre-excitation-syndrome.
Adult ; Arrhythmias, Cardiac ; Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Electrocardiography ; Follow-Up Studies ; Heart ; Humans ; Male ; Muscular Dystrophies* ; Myocardium ; Pre-Excitation Syndromes ; Tandem Repeat Sequences

A 23-year-old male with Duchenne muscular dystrophy (DMD) experienced self-limiting palpitations at age 19 years for the first time. Palpitations recurred not earlier than at age 23 years, and were attributed to narrow complex tachycardia, which could be terminated with adenosine. Since electrocardiography showed a delta-wave, Wolff-Parkinson-White (WPW) syndrome was diagnosed, ajmaline prescribed and radio-frequency catheter ablation of three accessory pathways carried out one week later. One day after ablation, however, a relapse of the supraventricular tachycardia occurred and was terminated with ajmaline. Re-entry tachycardia occurred a second time six days after ablation, and as before, it was stopped only with ajmaline. Despite administration of verapamil to prevent tachycardia, it occurred a third time four months after ablation. This case shows that cardiac involvement in DMD may manifest also as WPW-syndrome. In these patients, repeated radio-frequency catheter ablation of accessory pathways may be necessary to completely block the re-entry mechanism.
Adenosine ; Ajmaline ; Arrhythmias, Cardiac ; Catheter Ablation ; Catheters ; Electrocardiography ; Humans ; Male ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne ; Recurrence ; Tachycardia ; Tachycardia, Supraventricular ; Verapamil

A 23-year-old male with Duchenne muscular dystrophy (DMD) experienced self-limiting palpitations at age 19 years for the first time. Palpitations recurred not earlier than at age 23 years, and were attributed to narrow complex tachycardia, which could be terminated with adenosine. Since electrocardiography showed a delta-wave, Wolff-Parkinson-White (WPW) syndrome was diagnosed, ajmaline prescribed and radio-frequency catheter ablation of three accessory pathways carried out one week later. One day after ablation, however, a relapse of the supraventricular tachycardia occurred and was terminated with ajmaline. Re-entry tachycardia occurred a second time six days after ablation, and as before, it was stopped only with ajmaline. Despite administration of verapamil to prevent tachycardia, it occurred a third time four months after ablation. This case shows that cardiac involvement in DMD may manifest also as WPW-syndrome. In these patients, repeated radio-frequency catheter ablation of accessory pathways may be necessary to completely block the re-entry mechanism.
Adenosine ; Ajmaline ; Arrhythmias, Cardiac ; Catheter Ablation ; Catheters ; Electrocardiography ; Humans ; Male ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne ; Recurrence ; Tachycardia ; Tachycardia, Supraventricular ; Verapamil

Fatal air embolism to the cerebrum during an endoscopic retrograde cholangiopancreatography (ERCP) has not been reported in a patient with a biliodigestive anastomosis and multiresistant extended-spectrum beta-lactamase Escherichia coli (ESBL) bacteremia. A 59-year-old woman with a history of laparoscopic cholecystectomy and iatrogenic injury of the right choledochal duct, choledochojejunostomy (biliodigestive anastomosis), recurrent cholangitis, revision of the biliodigestive anastomosis, recurrent liver abscesses, and recurrent stenting of stenotic bile ducts, was admitted because of fever and tenderness of the right upper quadrant. On ERCP, a previously deployed covered Wallstent was replaced. Blood cultures grew ESBL. After stent removal 8 days later, the patient did not wake up and developed arterial hypotension and respiratory insufficiency, requiring mechanical ventilation. Computed tomography scans showed extensive air embolism to the liver, heart, and cerebrum. She died 1 day later. Although the exact pathogenesis of the fatal cerebral air embolism remains speculative, the nonphysiological anatomy and chronic infection with ESBL may have been contributory factors.
Bacteremia ; beta-Lactamases ; Bile Ducts ; Brain Edema ; Cerebrum ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy, Laparoscopic ; Choledochostomy ; Embolism, Air* ; Endoscopy ; Escherichia coli ; Female ; Fever ; Foramen Ovale, Patent* ; Heart ; Humans ; Hypotension ; Intracranial Pressure ; Liver ; Liver Abscess ; Middle Aged ; Respiration, Artificial ; Respiratory Insufficiency ; Stents