Impressive story and inspiring for a lot of people I think. This case
report again shows that mindfulness-based cognitive therapy is a really
effective way of treatment for this particular, persisting disorder and
should surely be investigated further!
I read with interest the case reported by Diaz and Valdez (1)
regarding a patient who was successfully resuscitated from ventricular
fibrillation cardiac arrest while running in a marathon race. The patient
had a posterior diagnosis of anomalous right coronary artery arising from
the aorta above the left sinus of Valsalva that subsequently runs between
the aorta and the pulmonary artery, discovered by a 64-slice multidet...
I read with interest the case reported by Diaz and Valdez (1)
regarding a patient who was successfully resuscitated from ventricular
fibrillation cardiac arrest while running in a marathon race. The patient
had a posterior diagnosis of anomalous right coronary artery arising from
the aorta above the left sinus of Valsalva that subsequently runs between
the aorta and the pulmonary artery, discovered by a 64-slice multidetector
coronary computerized tomography. However, the title of this article is
not in accordance with current standards defined by the American College
of Cardiology, the American Heart Journal, and the Heart Rhythm Society
(2). In this document, it was postulated that "sudden cardiac death should
not be used to describe events that are not fatal", restricting the use of
this term only to the events directly resulting in death, in order to
avoid misinterpretations. Thus, I do believe that the best title for this
interesting report would be: 'Cardiac arrest associated with an anomalous
right coronary artery'.
References:
1) Diaz RA, Vald?s J. Aborted sudden cardiac death associated with an
anomalous right coronary artery. BMJ Case Rep 2015; doi:10.1136/bcr-2015-
210850.
2) Buxton AE, Calkins H, Callans DJ, et al. ACC/AHA/HRS 2006 key data
elements and definitions for electrophysiological studies and procedures:
a report of the American College of Cardiology/American Heart Association
Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to
Develop Data Standards on Electrophysiology). Circulation
2006;114(23):2534-70.
I too have dimples in both shoulders. I have never met or heard of
anyone else having them, not even a family member. Until 2 years ago when
my youngest grandson was born. He has them on both shoulders as well.
This report is the first I've seen on this and hope to learn more.
Thankyou
I thank Dr. Veloso for his comments regarding our case report [1].
Directly from the consensus statement he cites [2], his opinion is
valuable, but feel that aborted sudden death conveys a better picture due
to successful resuscitation with CPR and defibrillation, a description
already used by other authors [3].
Rienzi A Diaz, MD, FACC, EACVI,
Professor of Cardiology
I thank Dr. Veloso for his comments regarding our case report [1].
Directly from the consensus statement he cites [2], his opinion is
valuable, but feel that aborted sudden death conveys a better picture due
to successful resuscitation with CPR and defibrillation, a description
already used by other authors [3].
Rienzi A Diaz, MD, FACC, EACVI,
Professor of Cardiology
References: 1) Diaz RA, Valdes J. Aborted sudden cardiac death
associated with an anomalous right coronary artery. BMJ Case Rep 2015;
doi: 10.1136/bcr-2015- 210850. 2) Buxton AE, Calkins H, Callans DJ, et al.
ACC/AHA/HRS 2006 key data elements and definitions for
electrophysiological studies and procedures: a report of the American
College of Cardiology/American Heart Association Task Force on Clinical
Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on
Electrophysiology). Circulation 2006; 114(23):2534-70. 3) Kaushik S,
Subramanian SR, Rafii S, Castillo R. Aborted sudden cardiac death (SCD) in
a patient with hypertrophic cardiomyopathy (HCM) with low-risk factors for
SCD. BMJ Case Reports 2013; doi: 10.1136/bcr-2012-006459
I read with interest the case report of "Spinal epidural abscess
treated with antibiotics alone" by Pathak et al. This patient had
presented with paraparesis and incontinence of bladder and bowel, which by
itself is an indication for emergency surgery. Such a case should not be
managed medically. It is a surprise that the patient had recovered. But
this should not mislead the clinician into managing all the acute spinal...
I read with interest the case report of "Spinal epidural abscess
treated with antibiotics alone" by Pathak et al. This patient had
presented with paraparesis and incontinence of bladder and bowel, which by
itself is an indication for emergency surgery. Such a case should not be
managed medically. It is a surprise that the patient had recovered. But
this should not mislead the clinician into managing all the acute spinal
epidural abscesses medically; on the other hand,the acute spinal epidural
abscess is a neurosurgical emergency and should be managed surgically as
soon as the diagnosis is made.
I would like to raise two specific questions with regard to the RBBB
seen in this patient. Firstly, how are the authors certain that this
patient did not have a pre-existing benign RBBB with a superimposed
NSTEMI? Did they have an older ECG for comparison? Secondly, in addition
to the presence of RBBB, this ECG also shows an S1Q3T3 pattern suggestive
of RV volume overload, although the tachycardia seen in PE is absent. D...
I would like to raise two specific questions with regard to the RBBB
seen in this patient. Firstly, how are the authors certain that this
patient did not have a pre-existing benign RBBB with a superimposed
NSTEMI? Did they have an older ECG for comparison? Secondly, in addition
to the presence of RBBB, this ECG also shows an S1Q3T3 pattern suggestive
of RV volume overload, although the tachycardia seen in PE is absent. Did
echocardiography show any evidence of RV dysfunction?
This article is extremely relevant in light of the recent increase in
use of chlorhexidine to achieve GBS negative vaginal cultures at the end
of pregnancy.
"Gynahex" from a company called "Concept" is selling an aqueous
vaginal gel with 1% chlorhexidine. It is inserted vaginally twice a day
for 8-10 days to result in a negative GBS culture. Then the woman
continues to apply the gel vaginally once a day until l...
This article is extremely relevant in light of the recent increase in
use of chlorhexidine to achieve GBS negative vaginal cultures at the end
of pregnancy.
"Gynahex" from a company called "Concept" is selling an aqueous
vaginal gel with 1% chlorhexidine. It is inserted vaginally twice a day
for 8-10 days to result in a negative GBS culture. Then the woman
continues to apply the gel vaginally once a day until labor begins.
http://www.concept-rx.co.il/ gynahex.html
It appears that if this protocol became more commonly adopted, a case
of anaphylaxis may occur. I would love to hear the thoughts of others.
cohain@013.net
I have 2 points to make here, and i also agree whether this patient
had ischemia in the first place.
1)In case of ischemia it is known that the Echo shows regional wall
motion abnormalities in 1 to 2 minutes, and much earlier than the ECG
changes, but in this case, patient had no regional wall motion
abnormalities and normal LV function.
2) This patient might be having a NSTEMI with a preexisting RBBB...
I have 2 points to make here, and i also agree whether this patient
had ischemia in the first place.
1)In case of ischemia it is known that the Echo shows regional wall
motion abnormalities in 1 to 2 minutes, and much earlier than the ECG
changes, but in this case, patient had no regional wall motion
abnormalities and normal LV function.
2) This patient might be having a NSTEMI with a preexisting RBBB.
Dear Editor,
This case demonstrates the importance of accurate history taking combined
with imaging. However, the authors have discredited the importance of
history in the case report. Studies have proven the importance of symptom
clusters in predicting testicular torsion. The triad of a) previous
trauma, b) pain attacks, and c) nausea and vomiting along with absence of
urinary complaints has high sensitivity and positiv...
Dear Editor,
This case demonstrates the importance of accurate history taking combined
with imaging. However, the authors have discredited the importance of
history in the case report. Studies have proven the importance of symptom
clusters in predicting testicular torsion. The triad of a) previous
trauma, b) pain attacks, and c) nausea and vomiting along with absence of
urinary complaints has high sensitivity and positive predictive value(1).
A recent attempt at validating a scoring system for diagnosing testicular
torsion has also included the following predictors: testicular swelling,
hard testicle, absent cremasteric reflex, nausea/vomiting and high riding
testis; undescoring the importance of good history and physical
examination (2).
References:
1. Ciftci AO, Senocak ME, Tanyel FC, Buyukpamukcu N. Clinical predictors
for differential diagnosis of acute scrotum. Eur J Pediatr Surg
2004;14(5):333-8.
2. Barbosa JA, Tiseo B, Barayan GA, Rosman BM, Torricelli F, Passerotti
CC, et al. Development and Initial Validation of a Scoring System to
Diagnose Testicular Torsion in Children. J Urol 2012.
Very interesting case with complex and expert care. Wondered why
repeated courses off co-amoxiclav were given when it is associated with
cholestatic jaundice which while usually self-limiting can be fatal. Do
you have IgG4 levels on patient and did patient have eosinophilia at any
time?
Impressive story and inspiring for a lot of people I think. This case report again shows that mindfulness-based cognitive therapy is a really effective way of treatment for this particular, persisting disorder and should surely be investigated further!
Conflict of Interest:
None declared
I read with interest the case reported by Diaz and Valdez (1) regarding a patient who was successfully resuscitated from ventricular fibrillation cardiac arrest while running in a marathon race. The patient had a posterior diagnosis of anomalous right coronary artery arising from the aorta above the left sinus of Valsalva that subsequently runs between the aorta and the pulmonary artery, discovered by a 64-slice multidet...
I too have dimples in both shoulders. I have never met or heard of anyone else having them, not even a family member. Until 2 years ago when my youngest grandson was born. He has them on both shoulders as well. This report is the first I've seen on this and hope to learn more. Thankyou
Conflict of Interest:
None declared
I thank Dr. Veloso for his comments regarding our case report [1]. Directly from the consensus statement he cites [2], his opinion is valuable, but feel that aborted sudden death conveys a better picture due to successful resuscitation with CPR and defibrillation, a description already used by other authors [3].
Rienzi A Diaz, MD, FACC, EACVI, Professor of Cardiology
References: 1) Diaz RA, Valdes J. A...
I read with interest the case report of "Spinal epidural abscess treated with antibiotics alone" by Pathak et al. This patient had presented with paraparesis and incontinence of bladder and bowel, which by itself is an indication for emergency surgery. Such a case should not be managed medically. It is a surprise that the patient had recovered. But this should not mislead the clinician into managing all the acute spinal...
I would like to raise two specific questions with regard to the RBBB seen in this patient. Firstly, how are the authors certain that this patient did not have a pre-existing benign RBBB with a superimposed NSTEMI? Did they have an older ECG for comparison? Secondly, in addition to the presence of RBBB, this ECG also shows an S1Q3T3 pattern suggestive of RV volume overload, although the tachycardia seen in PE is absent. D...
This article is extremely relevant in light of the recent increase in use of chlorhexidine to achieve GBS negative vaginal cultures at the end of pregnancy.
"Gynahex" from a company called "Concept" is selling an aqueous vaginal gel with 1% chlorhexidine. It is inserted vaginally twice a day for 8-10 days to result in a negative GBS culture. Then the woman continues to apply the gel vaginally once a day until l...
I have 2 points to make here, and i also agree whether this patient had ischemia in the first place.
1)In case of ischemia it is known that the Echo shows regional wall motion abnormalities in 1 to 2 minutes, and much earlier than the ECG changes, but in this case, patient had no regional wall motion abnormalities and normal LV function.
2) This patient might be having a NSTEMI with a preexisting RBBB...
Dear Editor, This case demonstrates the importance of accurate history taking combined with imaging. However, the authors have discredited the importance of history in the case report. Studies have proven the importance of symptom clusters in predicting testicular torsion. The triad of a) previous trauma, b) pain attacks, and c) nausea and vomiting along with absence of urinary complaints has high sensitivity and positiv...
Very interesting case with complex and expert care. Wondered why repeated courses off co-amoxiclav were given when it is associated with cholestatic jaundice which while usually self-limiting can be fatal. Do you have IgG4 levels on patient and did patient have eosinophilia at any time?
Conflict of Interest:
None declared
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