Atrial Flutter with 1:1 Conduction in Undiagnosed Wolff-Parkinson-White Syndrome

Background

Atrial flutter with 1:1 atrioventricular conduction via an accessory pathway is an uncommon presentation of Wolff-Parkinson-White syndrome not previously reported in the emergency medicine literature. Wolff-Parkinson-White syndrome, a form of ventricular preexcitation sometimes initially seen and diagnosed in the emergency department (ED), can present with varied tachydysrhythmias for which certain treatments are contraindicated. For instance, atrial fibrillation with preexcited conduction needs specific consideration of medication choice to avoid potential degeneration into ventricular fibrillation.

Case Report

We describe an adult female presenting with a very rapid, regular wide complex tachycardia successfully cardioverted in the ED followed by a normal electrocardiogram (ECG). Electrophysiology study confirmed atrial flutter with 1:1 conduction and revealed an accessory pathway consistent with Wolff-Parkinson-White syndrome, despite lack of ECG findings of preexcitation during sinus rhythm.Why should an emergency physician be aware of this? Ventricular tachycardia must be the first consideration in patients with regular wide complex tachycardia. However, clinicians should consider atrial flutter with 1:1 conduction related to an accessory pathway when treating patients with the triad of very rapid rate (>250 beats/min), wide QRS complex, and regular rhythm, especially when considering pharmacologic treatment. Emergency physicians also should be aware of electrocardiographically concealed accessory pathways, and that lack of delta waves does not rule out preexcitation syndromes such as Wolff-Parkinson-White syndrome.     

7例重症甲型H1N1流感患儿的护理

我院儿童重症监护病房（PICU）于2009年10月15日后相继收治7例重症甲型H1N1流感病例,对7例患儿加强了呼吸道管理、心理护理、安全护理、传染病防护、神经系统监护五方面工作,为护理重症甲型H1N1流感留下了宝贵的护理经验。     

1例甲型H1N1流感合并肺部感染的护理

甲型H1N1流感是一种新的甲型流感病毒引起的急性呼吸道传染病, 通常表现为流感样症状,包括发热、咳嗽、咽痛、咳痰、流涕、鼻塞、头痛、全身酸痛、乏力.     

Atrial Flutter with 1:1 Atrioventricular Conduction Caused by Propafenone

We describe a case of 1:1 atrial flutter in a patient with coronary disease taking propafenone. In atrial flutter, the atrial rate is usually about 300 beciis/min with 2:1 AV conduction and a ventricular rate of 150 beats/min. Class IA antiarrhythmic drugs, especially quinidine and disopyramide, may cause 1:1 AV response because they reduce atrial rate and are vagolytic. However, propafenone is a Class IC agent and has no anticholinergic properties, and the occurrence of 1:1 AV conduction at a rate of about 250 beats/min is an important side, effect that, although uncommon, should be recognized.     

MLL1 and DOT1L cooperate with meningioma-1 to induce acute myeloid leukemia

Meningioma-1 (MN1) overexpression is frequently observed in patients with acute myeloid leukemia (AML) and is predictive of poor prognosis. In murine models, forced expression of MN1 in hematopoietic progenitors induces an aggressive myeloid leukemia that is strictly dependent on a defined gene expression program in the cell of origin, which includes the homeobox genes Hoxa9 and Meis1 as key components. Here, we have shown that this program is controlled by two histone methyltransferases, MLL1 and DOT1L, as deletion of either Mll1 or Dot1l in MN1-expressing cells abrogated the cell of origin–derived gene expression program, including the expression of Hoxa cluster genes. In murine models, genetic inactivation of either Mll1 or Dot1l impaired MN1-mediated leukemogenesis. We determined that HOXA9 and MEIS1 are coexpressed with MN1 in a subset of clinical MN1^hi leukemia, and human MN1^hi/HOXA9^hi leukemias were sensitive to pharmacologic inhibition of DOT1L. Together, these data point to DOT1L as a potential therapeutic target in MN1^hi AML. In addition, our findings suggest that epigenetic modulation of the interplay between an oncogenic lesion and its cooperating developmental program has therapeutic potential in AML.     

妊娠合并暴发性1型糖尿病的护理

【】暴发性1型糖尿病是特发性1型糖尿病其中的一种亚型,由日本学者Imagawa等于2000年首次提出,国内少见。国内妊娠合并暴发性1型糖尿病的护理报道更少。现总结1例妊娠合并暴发性1型糖尿病患者的护理体会,护理要点包括：严密观察患者病情变化并配合抢救,及时监测血糖及各系统功能变化,准确记录24h出入量,正确补充胰岛素,纠正水电解质、酸碱平衡,待病情稳定时进行引产,产时严密观察产程进展及血糖变化,采取措施防止产程延长,产后加强产褥期护理,防止产后出血,加强饮食、基础护理,予以积极的糖尿病宣教和心理疏导,防止产后抑郁,最后患者痊愈出院。     

1例重症小儿甲型H1N1流感合并心肌炎的护理

甲型H1N1流感是由变异后的新型甲型H1N1流感病毒所引起的急性呼吸道传染病.通过飞沫、气溶胶、直接接触或间接接触传播[1].临床主要表现为流感样症状,少数病例病情重,进展迅速,可出现病毒性肺炎、心肌炎,合并呼吸衰竭、多脏器功能损伤,严重者可以导致死亡.我院2009年12月6收治1例重症甲型H1N1流感合并心肌炎患儿,现将护理体会总结如下.     

1例重症小儿甲型H1N1流感合并心肌炎的护理

甲型H1N1流感是南变异后的新型甲型H1N1流感病毒所引起的急性呼吸道传染病。通过飞沫、气溶胶、直接接触或问接接触传播。临床主要表现为流感样症状,少数病例病情重,进展迅速,可出现病毒性肺炎、心肌炎,合并呼吸衰竭、多脏器功能损伤,严重者可以导致死亡。我院2009年12月6收治1例重症甲型H1N1流感合并心肌炎患儿,现将护理体会总结如下。     

Indirect mesentericoportography with prostaglandin E1

Indirect mesentericoportography was performed in 36 patients after administration of prostaglandin E1 and immediately before contrast medium injection. The results were compared with the findings in a control group of 20 patients receiving tolazoline as vasodilator. On comparing prostaglandin E1 with tolazoline no significant improvement in contrast enhancement of the superior mesenteric vein was obtained. On the other hand, prostaglandin E1 seemed to produce less side effects than tolazoline.     

Living with disability: part 1

This is the first of three articles which consider the holistic care required by children with a disability and their families. Although the articles mainly address care of children with disabilities in the acute hospital setting, the concepts and knowledge can be transferred to care in other settings. The articles aim to provide a summary of the main subject areas while prompting readers to revisit their own opinions and experiences. This article provides an overview of: commonly used terminolgy; receiving the news that your child has a disability; impact on family members; and relevant social policy. The second and third articles cover: the therapeutic use of self; the value of communication; meeting complex needs on a paediatric ward and multi-diciplinary working.     

α1-Antitrypsin with unusual behaviour

The unusual behaviour of an α₁-antitrypsin, probably genetically determined, found in the serum of a Filipino in San Francisco is described. On starch gel electrophoresis the α₁-antitrypsin did not show any pattern or a very weak Pi MM type pattern. However, the protein level estimated by the immunodiffusion method and the trypsin inhibitory capacity was normal.