Cor triatriatum dexter in an adult diagnosed by transesophageal echocardiography: a case report

Cor triatriatum dexter is a rare congenital heart malformation in which a persistent right sinus venosus valve divides the right atrium into two chambers. Before echocardiography, this anomaly has been rarely diagnosed before surgery or death. This is a case of cor triatriatum dexter in an adult with lifelong exertional cyanosis and dyspnea. A definitive diagnosis of cor triatriatum dexter with associated heart defects was best made by transesophageal echocardiography at 47 years of age. Subsequent surgical intervention confirmed all of the echocardiographic findings and successful correction of the defects was performed.     

Cor triatriatum in a 70-year-old woman: role of transesophageal echocardiography and dynamic three-dimensional echocardiography in diagnostic assessment

In this report we describe a 70-year-old woman with unrecognized nonobstructive cor triatriatum (CT). She had concomitant mitral regurgitation and coronary artery disease. Diagnosis of CT and its hemodynamic assessment were accomplished by transesophageal echocardiography. Dynamic three-dimensional echocardiography demonstrated multiple fenestrations in the left atrial membrane. Intraoperative findings confirmed the diagnostic accuracy of three-dimensional echocardiography. To our knowledge, this is the first case of CT that has anatomic correlation with three-dimensional echocardiography.     

An unusual case of cor triatriatum

Cor triatriatum (CT) is a rare congenital cardiac anomaly. A case is presented of subdivided left atrium, corrected surgically, which can be considered a type of CT not previously reported.     

Cheilo-candidosis in an adult

A rare case of candidal infection of the lips is presented. Predisposing factors appeared to be intra-oral candidal carriage, actinic lip damage and Sj?gren's syndrome. Systemic antifungal therapy with fluconazole resolved the initial infection and a subsequent recurrence.     

Scurvy in an adult

The case is reported of a 29-year-old previously healthy female patient who developed the typical clinical picture of scurvy eight months after changing to a diet exclusively containing cooked cereals. Serum levels of B12, folic acid, and calcium were lowered and the alkaline phosphatase was slightly raised due to the dietary lack of vitamins A, D, B12 and folic acid. No clinical signs of these deficiencies could be observed. Addition of vitamin C to this diet resulted in complete cure in a matter of days. Signs and symptoms of scurvy are discussed in the light of the recent literature. This rare disease is particularly worth considering if one of the following situations is encountered: hemorrhages in the skin, muscles, joints or mucous membranes without apparent cause; therapy-resistant ulcers of mucous membranes in elderly patients; Sicca syndrome and/or wounds exhibiting poor healing.     

Cor pulmonale: pathophysiology and management

Pulmonary disease may set in motion a chain of events that ultimately leads to hypertrophy--or even failure--of the heart's right ventricle. The most common cause is chronic obstructive disease, which deprives the lungs of oxygen and produces pulmonary hypertension. But other disorders that raise pulmonary artery pressure also may be responsible. The thin right ventricle, which must work harder to overcome this increased resistance, ends up resembling the thick left ventricle. Comprehensive treatment of the primary lung condition at home usually enables the patient with chronic cor pulmonale to be more active and prevents frequent hospitalizations. Controlled-dose supplemental oxygen therapy is particularly effective, according to recent studies. Bronchospasm or bronchial infection super-imposed on the chronic lung condition may prove too much for the already strained right ventricle. Right ventricular failure calls for hospitalization and vigorous treatment, which may include mechanical ventilation, phlebotomy, antibiotics, steroids, digitalis, diuretics, and correction of electrolyte disturbances.     

Annular pancreas in an adult

Annular pancreas is a rare congenital anomaly which can remain symptom free for a long time and be manifested mainly in adults. 1130 endoscopic retrograde pancreatographies were performed in the author's laboratory during 3.5 years, and annular pancreas was seen in 2 cases. Duodenal obstruction with consecutive ulcers was the clinical manifestation in a young woman requiring duodeno-jejunostomy. Annular pancreas was an accidental finding in an other old woman presenting obstructive jaundice caused by several big stones in the main bile duct. A short review of the literature is given concerning the diagnostic possibilities, eventual complications and treatment modalities of this rare anomaly. It is emphasised that the diagnosis became possible due to the modern radiologic and endoscopic methods.     

Enterovirus meningitis in an adult

Claudication distance and maximum walking distance are both measures of disability. Estimates of the distances which a patient with intermittent claudication can walk are commonly used by vascular surgeons as surrogate measures of handicap. We studied how accurately distance was estimated by 70 patients with intermittent claudication, and by 100 British vascular surgeons. Patients and vascular surgeons estimated actual distances of 30 m and 34 m, respectively. Estimates were 46 m median (range 2.7-402 m) for claudicants, and 46 m median (range 15.2-186 m) for vascular surgeons, median over estimates of 52% and 34% respectively. Claudicants' errors can easily be eliminated by accurate and appropriate measurement of claudication and maximum walking distances but interpretation of the data by surgeons is dependent on their own ability to estimate distance. Flawed perceptions by patients and their surgeons of the disability of reduced walking distance illustrates the need for reliable measures of handicap on which to base therapeutic decisions in patients with intermittent claudication.     

Meningoradiculitis revealing an occult medulloblastoma-PNET in an adult

Neoplastic meningitis as the presentation of occult primitive neuroectodermal tumor (PNET) is occasionally described in children. We report the case of an 64 year old-man who presented a meningo-radiculopathy with progressive injury of the cauda equina and then the ocular motor nerves, revealing an occult medulloblastoma-PNET.     

Cor pulmonale due to obstructive sleep apnoea

A 47 year old man with a long history of chronic loud snoring and daytime sleepiness presented with hypercapnic respiratory failure and right ventricular failure. The diagnosis of obstructive sleep apnoea (OSA) leading to the 'obesity-hypoventilation syndrome', was supported by the findings of an overnight cardio-respiratory monitoring during sleep. His symptoms and arterial blood gases improved following treatment with nocturnal nasal continuous positive airway pressure (CPAP).     

Idiopathic pulmonary haemosiderosis in an adult

We report a very, rare case of idiopathic pulmonary haemosiderosis (IPH) occurring in a 68 yr old patient. Following alveolar haemorrhage onset, the diagnosis was obtained by a process of elimination, after clinical, endoscopic, cytohistological and laboratory investigations. The immunoglobulin G directed against myeloperoxidase antigen (C-ANCA), which was detected, can be regarded as indicative of an occult vasculitis to be followed up. Current therapy and perspectives for idiopathic pulmonary haemosiderosis patients are discussed herein.     

Gastric duplication cyst in an adult

Gastric duplication cysts are rare in adults and usually asymptomatic. In most cases they are discovered incidentally by abdominal ultrasound, CT, or upper gastrointestinal x-rays. Most of the duplications (82%) are cystic and do not communicate with the stomach. Approximately half of the cases are associated with other congenital anomalies. We report a 59-year-old woman operated on for a pancreatic mass that proved to be a gastric duplication cyst. The cyst was resected and the postoperative course was uneventful.     

Spontaneous thymic hemorrhage in an adult

Acute hemorrhage in a normal thymus in neonates and infants has been reported in the literature. These patients were known to have an antecedent cause or defects in coagulation. The case of an adult who developed acute hemorrhage in a normal thymus and who was known not to have any defects in coagulation, hypertension, or other underlying cause is reported.