Myocardial infarction in an adult resulting from coronary ancurysms previously documented in childhood after an acute episode of Kawasaki's disease

Coronary aneurysms resulting from a previous episode of Kawasaki'sdisease are considered an important cause of myocardial infarctionin children. A case of a 19-year-old man presenting with anacute myocardial infarction associated with coronary aneurysmsis described. These coronary lesions were previously evaluatedangiographically and echocardiographically at the age of 13years, 5 months after the acute episode of a Kawasaki's disease.     

PREDICTIVE VALUE OF FRC AND RESPIRATORY COMPLIANCE ON PULMONARY GAS EXCHANGE INDUCED BY HIGH FREQUENCY JET VENTILATION IN HUMANS

To determine if functional residual capacity (FRC), complianceof the respiratory system (C), or underlying pulmonary diseaseare predictive for the efficacy of high frequency jet ventilation(HFJV) on pulmonary gas exchange, we investigated six adultpatients within 4 h of abdominal surgery and six patients withsevere adult respiratory distress syndrome. Gas exchange duringintermittent positive pressure ventilation (IPPV) was comparedwith that during HFJV at frequencies of 100 b.p.m. (HFJV₁₀₀)and 200 b.p.m. (HFJV₂₀₀), resulting in a minute ventilationof about 400 ml kg^–1 with both ventilatory frequencies,and in both groups of patients. Baseline FRC and C were measuredduring IPPV with the multiple-breath nitrogen washout methodand from expiratory pressure-volume curves, respectively. Changesin the alveolar-arterial oxygen difference (PA_O2–Pa_O2):FlO2 ratio induced by HFJV correlated negatively with C (HFJV₁₀₀:r = –0.78, P <0.005; HFJV200: r = –0.84, P <0.005); that is, greater oxygenation was obtained in patientswith a better compliance. Similarly, changes in arterial partialpressure of carbon dioxide (Pa_co2) induced by HFJV correlatednegatively with C (HFJV₁₀₀: r = –0.77, P < 0.001; HFJV₂₀₀:r = —0.61, P < 0.05). In contrast, there was no significantcorrelation between FRC measured during IPPV and changes in(PA_O2–Pa_O2): Fl_O2 ratio or Pa_co2 induced by HFJV, as thesechanges were influenced more by the patient's pulmonary diseasethan by baseline FRC. These results should be interpreted inthe context of different underlying pathophysiological mechanismsreducing FRC in both groups of patients.     

Adrenal carcinoma with intravenous extension into the tricuspid valvular plane in a patient with patent foramen ovale

We report on an adrenal carcinoma growing via the inferior venacava into the right atrium and prolapsing into the right ventricle.A patent foramen ovale determined the pathophysiological andclinical appearance. Instead of an expected caval congestionthe main features were paroxysmal dyspnoea and cyanosis. The patient was investigated using echocardiography, magneticresonance tomography and angiography.