Ipsilateral Aymand’s and Richter’s hernia, complicated by necrosing fascitis

This study presents the case of a patient with necrobiosis or necrosing fascitis of the inguinal region, secondary to a complicated Amyand’s hernia with a concomitant ipsilateral Richter’s hernia. The patient was treated with open trans-abdominal surgery and hernia repair through the pre-peritoneal approach, plus anti-microbians, and thrice-daily wound cleansing and dressings to the inguinal region. Evolution was satisfactory. There are no reports in the literature of a case such as this.     

Determinants of left ventricular systolic function recovery after an acute coronary syndrome.

INTRODUCTION: Ischemic heart disease is a major cause of heart failure in western societies. However, the factors that may influence left ventricular function (LVF) recovery after an acute coronary syndrome (ACS) are still unclear. OBJECTIVE: To identify variables that may influence LVF evolution one year after ACS. METHODS: 104 patients hospitalized with ACS between 7/1/2001 and 12/31/2002 and with systolic dysfunction--defined as an echocardiographic ejection fraction (EF) < or = 45%--were randomly allocated to a planned coronary follow-up program (FUP) or a general cardiology clinic (GC); patients from both groups were also randomly referred to a structured cardiac rehabilitation program (CRP). EF was re-assessed at one year. We compared differences between patients who recovered left ventricular function (EF > 45%; group 1) and those who did not (group 2). RESULTS: One year after discharge, 44.2% of the patients had recovered function. There were no significant differences between the groups in gender (77.7 vs. 76.5% male), age (56 vs. 59 years), hypertension, diabetes, dyslipidemia, smoking habits or family history. A previous history of cardiovascular events was more frequent in group 2 (11.1% vs. 35.3%, p = 0.03). Cardiac catheterization was performed before discharge in 88.8% and 88.2% in groups 1 and 2 respectively (p = NS); no differences were found in coronary anatomy between the two groups. Angioplasty was performed in 54.2% in group 1 and 50% in group 2 (p = NS). There were no differences in the use of angiotensin-converting enzyme inhibitors (83.3% vs. 87.5%), beta-blockers (87.5% vs. 87.5%), nitrates (37.5% vs. 33.3%), aspirin (95.8% vs. 95.8%), statins (79.1% vs. 75%) or diuretics (20.8% vs. 45.8%). There was no significant difference in LVF recovery between patients randomized to FUP or GC (38.5% vs. 54.5%). 87.5% of patients who completed the CRP had normal EF at one year compared to 32.7% of patients not referred to the program (p = 0.009). Although EF improved in both groups, this improvement was greater in patients who completed a CRP (EF 8% vs. 5%, p = 0.003). CONCLUSION: A previous cardiovascular event and completion of a CRP were the only variables that influenced LVF recovery. Thus, enrollment in a CRP, in addition to standard therapy, could be an important therapeutic measure in patients with systolic dysfunction after ACS; our data suggest that these programs should be more widely used.     

Electrophysiologic evaluation of Emery-Dreifuss muscular dystrophy. A single fiber and quantitative EMG study

A 16-year-old boy, the only affected member of the family, noticed early onset contracture of the elbows, and developed slowly progressive humeroperoneal weakness and atrophy, and bilateral equinus. The severe restriction of the forward flexion of the neck and thoracolumbar spine, resembled a rigid spine syndrome. An electrocardiogram showed atrioventricular conduction abnormalities. Muscle biopsy was consistent with mild myopathy. The overall conventional findings of a detailed electromyographic study in the limbs and erector trunci muscles, as well as the results of conduction velocity, automatic analysis of the voluntary pattern and single fiber electromyography studies were consistent with myopathy, although some atypical findings were found. The controversy about neurogenic and myopathic features in Emery-Dreifuss disease is discussed. The unspecific value of the flexion limitation of the spine, and the uncertain nosological position of the rigid spine syndrome are also commented.     

Selective hypersensitivity to boiled razor shell.

Many types of seafood require cooking before ingestion and it has been demonstrated that this cooking process may affect the antigenicity and allergenicity of the food. We describe a case of anaphylaxis caused by selective sensitization to razor shell, a mollusc. In vivo and in vitro studies confirmed sensitization to boiled razor shell. Analysis of the nature of the allergen yielded results that were consistent with the findings of other authors and suggested that allergens involved in seafood allergy are commonly high molecular weight proteins that, in most cases, are heat stable.     

Über die Entstehung und die Bedeutung der Bogenförmigen ST-Strecke,Sowie der Sog. Zwischenzacke und Ihren Zusammenhang mit der S-Achse

Zusammenfassung Die bogenförmige ST-Strecke kommt häufig, in etwa 12%der Fälle, und die Zwischenzacke selten, in 5der Fälle eines nichtausgewählten Krankenmaterials, vor. Sowohl die Entstehungsursache der bogenförmigen ST-Strecke als der Kischschen Zwischenzacke liegt in der stärkeren oder schwächeren Rechts- oder Linksdeviation der S-Achse. Die Richtung und der Grad der S-Achsendeviation wird es also bestimmen, in wie vielen und welcher Einthovenschen Ableitung die bogenförmige ST-Strecke bzw. die Zwischenzacke notwendigerweise auftreten muß. Bei S-Achsenstellungen zwischen –90°und –30°wird die ST-Strecke in Ableitung I, bei S-Achsenstellungen zwischen –30°und +30°in der I. und II., zwischen +30°und +90°in der I., II., III., zwischen +90°und +150°in der II., III. und bei den Achsenstellungen zwischen +150°und –150°in der III. Einthovenschen Ableitung bogenförmig sein. Die klinische Bedeutung der bogenförmigen ST-Strecke ist gleich mit der klinischen Bedeutung der S-Achsendeviation. Bei dem Vergleich des Herzbefundes der Kranken mit der elektrischen S-Achsenstellung können folgende Feststellungen gemacht werden: Geringergradige Linksdeviation der S-Achse, d. h. bogenförmiges ST _I sowie geringergradige Rechtsdeviation der S-Achse, d. h. ST_III kann praktisch bei pathologischem Herzbefund nicht verwertet werden. Stärkere Links- bzw. Rechtsdeviation der S-Achse, d. h. ST_I und_II bzw. ST_II und_III können im allgemeinen ebenfalls nicht verwertet werden, es ist jedoch wahrscheinlich, daß sie schon einen Übergang zu den pathologischen Befunden bilden. Während jene starken S-Achsendeviationen, wo schon in allen drei Ableitungen bogenförmiges ST besteht, meistens für das Zeichen der myokardialen Läsion betrachtet werden sollen, und zwar in erster Linie dann, wenn die positive S-Zacke in oder neben dem absteigenden Schenkel der R-Zacke gut wahrnehmbar ist.