Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature

Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 55 year-old man presented at the emergency department with acute abdominal pain, vomiting and fever. Preoperative radiological examination followed by laparotomy revealed multiple giant jejunal diverticula causing intestinal obstruction. We also review the literature for this uncommon disease

Catheter Ablation of Right Ventricular Outflow Tract Ventricular Tachycardia

Α 57-year-old female with repetitive monomorphic ventricular tachycardia was referred for an electrophysiological study. ECG during sinus rhythm was normal. ECG during tachycardia revealed a left bundle branch block (LBBB) pattern with inferior axis suggestive of an outflow tract tachycardia (Fig. 1). Structural heart disease was excluded. Transthoracic echocardiography and coronary angiography were unremarkable. The tachycardia was easily induced by atrial pacing (Fig. 2). This was suggestive of cyclic adenosine monophosphate (c-AMP) triggered activity as the pathophysiological basis of the arrhythmia. Activation mapping revealed the earliest activity at the posteroseptal region of the right ventricular outflow tract. A systolic pre-potential was recorded in this area, which is rarely seen in these type of arrhythmias (Fig. 3)... (excerpt

Delayed Intraventricular Hemorrhage following a Ventriculoperitoneal Shunt Placement: Exploring the Surgical Anatomy of a Rare Complication

Ventriculoperitoneal shunt (VPS) placement is one of the commoner neurosurgical procedures worldwide. The purpose of this article is to report a case of delayed intraventricular hemorrhage (IVH) following a VPS and to review the literature regarding anatomic factors that could potentially explain this rare complication. A 78-year-old man with normal pressure hydrocephalus, who underwent an uneventful right VPS placement, suffered from a catastrophic isolated IVH five days later. The reported cases of delayed intracerebral hemorrhage (ICH) following VPS are rare and those with IVH are even rarer. Potential factors of surgical anatomy that could cause delayed ICH/IVH following a VPS procedure include erosion of vasculature by catheter cannulation, multiple attempts at perforation, puncture of the choroid plexus, improper placement of the tubing within the brain parenchyma, VPS system revision, venous infarction, vascular malformations, head trauma, and brain tumors. Other causes include generalized convulsion, VPS system malfunction, increased intracranial or blood pressure, sudden intracranial hypotension, and bleeding disorders. According to the current literature, our case is the first reported delayed isolated IVH after a VPS placement so far. Neurosurgeons should be aware of the delayed ICH/IVH as a rare, potentially fatal complication of VPS, as well as of its risk factors

Catheter Ablation of Ventricular Extrasystoles Originating from the Left Coronary Cusp

We describe the case of a 55-year-old man with frequent premature ventricular extrasystoles displaying inferior axis and positive QRS concordance in precordial leads. The arrhythmia was successfully ablated from the left coronary cusp. The electrocardiographic and electrophysiological characteristics of this arrhythmia are discussed

Cardiology News /Recent Literature Review / First Quarter 2014

Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014HRS Meeting: San Francisco, 7-10/5/2014EuroPCR: Paris, 20-23/5/2014CardioStim: Nice, 18-21/6/2014ESC Congress: Barcelona, 30/8-3/9/14TCT: Washington, 12-17/9/14HCS Annual Meeting: Athens, 23-25/10/2014AHA: Chicago, 15-19/11/14Cutting Inappropriate ICD Shocks: Long Arrhythmia-Detection Time Strategy Confirmed            Programming implantable cardioverter defibrillators (ICDs) to delay the time they take to treat ventricular arrhythmias cuts mortality by 23% and inappropriate shocks by more than one-half in a meta-analysis encompassing ~4900 patients. The included studies were prospective and multicenter and covered both primary and secondary prevention and patients with either ischemic or nonischemic cardiomyopathy. The risk of syncope did not rise significantly with longer detection times, despite traditional concerns that lots of patients would not tolerate prolonged arrhythmia exposure before their ICD is allowed to deliver therapy, either shocks or antitachycardia pacing (ATP). Instead, the extra time frequently gave devices a better chance to exclude non–life-threatening arrhythmias like atrial fibrillation and to let otherwise self-terminating ventricular arrhythmias play out on their own. Current nominal settings used by some ICD manufacturers are likely to be too aggressive, with arrhythmia detection times that in some cases may be as short as 1-3 s. These results highlight the importance of setting longer default ICD detection times. The analysis included 4896 patients from the MADIT-RIT, ADVANCE 3, and PROVIDE randomized trials and the RELEVANT nonrandomized study. Overall, 264 patients received appropriate shocks and 253 experienced inappropriate shocks at follow-up (12 - 17 months). The relative risk (RR) of death from any cause was 0.77 (p=0.02) in the prolonged-detection-time groups compared with controls; the risks of inappropriate shocks and appropriate and inappropriate ATP also fell significantly. Why there were fewer deaths with longer detection times is unclear but it may derive from less exposure to potential hazards of shocks and ATP; inappropriate shocks may up mortality, and ATP poses a small risk of inducing ventricular fibrillation; or it may be due to some other factor, e.g. avoidance of treatment for multiple ICD therapies (e.g., prescription of antiarrhythmic drugs) (Scott PA et al, Heart Rhythm 2014; DOI:10.1016/j.hrthm.2014.02.009. Epub 2014 Feb 12)... (excerpt

Cardiology News / Recent Literature Review / Second Quarter 2014

ESC Congress: Barcelona, 30/8-3/9/14TCT: Washington, 12-17/9/14HCS Annual Meeting: Athens, 23-25/10/2014AHA: Chicago, 15-19/11/1420th Annual Boston AF Symposium: Orlando, 8-10/1/15HCS Working Groups Seminar: Ioannina, 2/2015ACC: San Diego, 14-16/3/15HRS: Boston, 13-16/5/15EuroPCR: Paris, 19-22/5/15Europace: Milan, 21-24/6/15ESC: London, 29/8-2/9/15Short QT Syndrome is Highly Lethal     A total of 62 out of 73 short QT syndrome (SQTS) patients (84% male; mean age, 26 ± 15 years; corrected QT interval, 329 ± 22 ms) were followed for 60 ± 41 months. Cardiac arrest (CA) was the most frequent presenting symptom (40% of probands). There was an age dependency in the susceptibility to arrhythmias, with a peak in the occurrence of CA in the first year of life (4%) and a second peak (1.3%) between 20 and 40 years of age; the probability of a first occurrence of CA by 40 years of age was 41%. Despite the male predominance, female patients had a similar risk profile. Familial disease was present in 44% of kindreds, but the yield of genetic screening was low (14%). A history of CA was the only predictor of recurrences at follow-up (p< 0.0000001). Arrhythmias occurred mainly at rest. The authors concluded that SQTS is highly lethal with CA often as the first manifestation of the disease with a peak incidence in the first year of life; survivors of CA have a high CA recurrence rate; implantation of a defibrillator is strongly recommended (Mazzanti A et al, J Am Coll Cardiol 2014;63:1300-1308).Inferior Vena Cava (IVC) Filters in Patients With Acute Symptomatic Venous Thromboembolism (VTE) and a Significant Bleeding Risk Lower Pulmonary Embolism Mortality but Increase Risk of Recurrence    In a prospective cohort study of patients with acute VTE identified from the RIETE (Computerized Registry of Patients With Venous Thromboembolism), the investigators assessed the association between IVC filter insertion due to significant bleeding risk and the 30-day outcomes [all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates]. Of 40,142 patients who had acute symptomatic VTE, 371 received an IVC filter. A total of 344 patients treated with a filter were matched with 344 patients treated without a filter. There was a non-significant trend toward lower risk of all-cause death for filter insertion (6.6% vs 10.2%; p = 0.12). The risk adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs 4.9%; p = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than for no insertion (6.1% vs 0.6%; p < 0.001). The authors concluded that in patients presenting with VTE and a significant bleeding risk, IVC filter insertion compared with anticoagulant therapy was associated with a lower risk of PE-related death and a higher risk of recurrent VTE (Muriel et al, J Am Coll Cardiol 2014;63:1675–1683). ... (excerpt

Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis

Colovesical fistula is a common complication of diverticulitis. Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported. The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms. They also briefly review the literature

Modern mapping and ablation of idiopathic outflow tract ventricular arrhythmias

Outflow tract (OT) premature ventricular complexes (PVCs) are being recognized as a common and often troubling, clinical electrocardiographic finding. The OT areas consist of the Right Ventricular Outflow Tract (RVOT), the Left Ventricular Outflow Tract (LVOT), the Aortomitral Continuity (AMC), the aortic cusps and the Left Ventricular (LV) summit. By definition, all OT PVCs will exhibit an inferior QRS axis, defined as positive net forces in leads II, III and aVF. Activation mapping using the contemporary 3D mapping systems followed by pace mapping is the cornerstone strategy of every ablation procedure in these patients. In this mini review we discuss in brief all the modern mapping and ablation modalities for successful elimination of OT PVCs, along with the potential advantages and disadvantages of each ablation technique