Sick sinus syndrome encompasses a variety of EKG manifestations consisting of atrial bradyarrhythmias and tachyarrhythmias, alternating bradyarrhythmias and tachyarrhythmias as in tachycardia-bradycardia syndrome. Supraventricular tachyarrhythmias that can occur include atrial flutter, atrial fibrillation, atrial tachycardia and paroxysmal supraventricular tachycardia, although there is no direct causal relation between paroxysmal supraventricular tachycardia and sinus node disease. Atrioventricular node re-entry is a common cause of paroxysmal supraventricular tachycardia episodes. We present the case of a 70 year old female, hospitalized for atypical chest pain and dizziness when walking. The EKG on admission showed sinus bradyarrhythmia, anterior fascicular block, atrial and ventricular extrasystoles. During the hospitalization the patient presented an episode of palpitations, narrow complex tachycardia being registered on the EKG, with no response to the Valsalva maneuver or intravenous beta blocker. The tachyarrhythmia ceased spontaneously after one hour. 24 hour Holter EKG was performed and confirmed sinus node dysfunction. The electrophysiological study identified paroxysmal supraventricular tachycardia due to atrioventricular nodal reentrant tachycardia, which was successfully treated by ablating the slow intranodal pathway. Therefore, in a case of sick sinus syndrome when the patient's symptoms cannot be attributed to the bradycardia, but to the tachyarrythmic episodes, it is often most efficient to treat the patient's paroxysmal supraventricular tachycardia by radiofrequency ablation, rather than using cardiac pacing.
Pericarditis is the most common pericardial disease found in clinical practice, with an incidence of acute pericarditis reported in 27.7 cases per 100,000 subjects per year. Hemodialysis in end stage renal disease (ESRD) is associated with frequent cardiovascular modifications, mostly because of the highly fluctuating levels of potassium, magnesium, ionized calcium, sodium and volume status. The risk of arrhythmias is increased and chronic atrial fibrillation (AF) can be found among approximately 14% of patients. The renal disease combined with arrhythmias increases the risk of systemic thromboembolism but also of bleeding events. Here we present the case of a male patient, with ESRD, recently diagnosed with intradialytic paroxysmal AF for which oral anticoagulation therapy is initiated, but it's early complicated with hemorrhagic pleural-pericarditis.
Introduction. Even though the soft tissue liposarcoma is a frequent tumor, the primary bone liposarcoma is very rare, being localized especially in the long bones. Material and method. We present the case of a 14 years old female child, hospitalized in the „Sf. Maria“ Emergency Clinic Hospital for Children Iasi accusing pain, functional impairment and tumefaction in the right arm, symptoms which suddenly occurred about 24 hours prior to presentation, following a falling trauma on the right arm. The bone x-ray emphasized a tumor in the proximal part of the humerus bone, associated with a pathological fracture. Results. A biopsy form the tumor was performed and the pathology report (histology and immunohistochemistry) documented a malignant liposarcomatous proliferation. Conclusion. The final pathology diagnosis, correlated with the clinical findings, which excluded the possibility of a bone metastasis, was that of a primary bone liposarcoma. Case particularity: very rare tumor, witch presented with a pathological bone fracture. In establishing the diagnosis of a bone liposarcoma it is very important to exclude a bone metastasis from a liposarcoma with a primary localization other than the bone, as well as other primary bone tumors. The prognosis seems to be better than in the osteosarcoma but liposarcoma presents a higher rate of local recurrence and systemic dissemination.
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