RESUMEN
Introduction: Persistent Left Superior Vena Cava (PLSVC) is a rare congenital vascular anomaly that may occur alone or in combination with complex congenital heart anomalies and dangerous arrhythmias. We report the first case in the literature of combined PLSVC, Ebstein's Anomaly (Type A) and complete atrioventricular block in an adult female, being successfully managed with permanent pacemaker implantation in Sierra Leone. Case summary: We present an interesting case of a 29-year-old female, referred to the cardiology clinic on account of breathlessness, dizziness, and recurrent syncope. Physical examination revealed a pulse rate of 39 bpm, jugular venous pulse with occasional cannon waves, and grade 3/6 pansystolic murmur in the tricuspid valve area. An electrocardiogram confirmed complete atrioventricular block with junctional escape rhythm, while Transthoracic Echocardiogram (TTE) confirmed Ebstein's Anomaly (Type A) and moderate tricuspid regurgitation. PLSVC was discovered as an incidental intraprocedural finding. Deploying a pacemaker lead through this venous anomaly from the left side was futile. Nevertheless, we used a right sided approach that resulted in a successful permanent pacemaker implantation with optimal and stable parameters. Conclusion: This rare case report highlights the practical challenges often encountered in the practice of cardiology during pacemaker and other cardiac device implantation. Cardiologists and critical care physicians should be acquainted with the venous anomaly of PLSVC, its variants, and procedure-associated risks, for better clinical decision making.
RESUMEN
METHODS: In a retrospective study, 83 patients with diabetic neuropathic foot ulceration were classified into two groups: those with a higher rate of ulceration defined as >/=3.5 ulcers per foot per 10 years (group H) and those with a lower rate of <3.5 ulcers per foot per 10 years (group L). RESULTS: Higher risk was associated with neuroarthropathy, higher mean HbA(1c), men who lived alone, alcohol misuse by men, poor compliance with footwear, footcare and with non-foot aspects of diabetic self-care, higher non-attendance rates and, in patients with type 1 diabetes, delay in reporting new foot problems. CONCLUSIONS: Reduction in ulcer recurrence rates will require improved orthotic provision in patients with neuroarthropathy and new methods to achieve behavioural change in other higher risk patients.
Asunto(s)
Neuropatías Diabéticas/epidemiología , Úlcera del Pie/epidemiología , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/psicología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Zapatos , Negativa del Paciente al TratamientoRESUMEN
In a review of the chest X-rays and medical records of 597 cases of culture- or biopsy-proven pulmonary tuberculosis (PTB; age range 1.5-72 years), seen over a period of 6 years (1991-97), 26 patients had radiographic patterns unusual for PTB. These patterns were mass-like densities simulating neoplasms, chronic lower lobe airspace opacities without adenopathy, mediastinal adenopathy without parenchymal airspace opacities and bronchopleural fistula without other radiographic abnormalities. The most common of these unusual radiographic patterns was mass-like densities, most of which were initially and mistakenly diagnosed as neoplasms. These masses, seen in 11 adult patients, form the basis of this report. Two children aged 1.5 and 2 years also had tuberculous mass densities initially diagnosed as neurogenic tumour and round pneumonia, respectively. They have been excluded from the present series, and form the subject of another report. The masses were lower lobe predominant and were not usually associated with fibro-productive satellite lesions or with calcification or cavitation. In view of the recent resurgence of PTB and the importance of chest X-rays in its diagnosis and management, this rare radiographic pattern needs to be emphasized.