Chest
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Case Reports
Extensive aortic dissection from combined-type cystic medial necrosis in a young man without predisposing factors.
A 33-year-old man with no predisposing factors had a DeBakey type 1 aortic dissection requiring surgical intervention. Microscopic examination showed combined-type cystic medial necrosis. This is the first report of extensive aortic dissection associated with combined-type cystic medial necrosis in a person younger than 40 years with no predisposing factors.
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Laryngospasm developed in a 33-year-old woman following attempted endotracheal intubation. Following establishment of the airway, the patient developed pulmonary edema which was successfully treated by conventional means. The sequence of events suggests that laryngospasm precipitated the development of the pulmonary edema in this patient.
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A direct relationship between the extent of atherosclerotic lesions and smoking habits and age was found in a study of 1,412 aortas collected at autopsy from male patients from 1965 to 1970. The extent of the lesions was recorded using grading systems for formation of plaques, ulceration, and calcification. These findings increased with the number of cigarettes smoked and were greater in ex-cigarette smokers and pipe or cigar smokers than in nonsmokers. ⋯ Aneurysms were found eight times more frequently among those smoking one to two packs of cigarettes per day than in nonsmokers. Black subjects showed about one-half the number of aneurysms and fewer extensive atherosclerotic lesions than white subjects. At ages over 65 years, abdominal aortic aneurysms were found in 11 percent of all men and in 16 percent of the heavy smokers.
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Cardiac disease associated with congestive heart failure was found to be the most common cause (22 of 76) of pericardial effusion in patients referred for echocardiography. Parameters of left heart function were markedly abnormal in these patients with congestive heart failure and pericardial effusion, but were not significantly different from a group of patients with congestive heart failure without pericardial effusion. Clinical findings consistent with cardiac decompensation also failed to discern between these two groups. ⋯ Patients with pericardial effusion related to congestive heart failure (P < .01), heart disease without congestive heart failure (P < 0.001) and those patients post recent myocardial infarction (P < 0.05) had significantly larger right ventricular internal dimensions in diastole than normal subjects. Patients with pericardial effusions related to recent open heart surgery, idiopathic pericarditis or of miscellaneous causes had normal right ventricular internal dimensions. It is likely that right ventricular dilation indicates abnormal volume/pressure relationships of the right heart and that this abnormality, through alterations in venous and lymphatic drainage, underlies the accumulation of pericardial effusion in these patients with heart disease with or without congestive heart failure.
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A 68-year-old patient developed increasingly frequent episodes of ventricular and supraventricular arrhythmias over the past five years. During the last 12 months, he was admitted to the hospital on several occasions with complex arrhythmias including multifocal PVCs, bigeminy, trigeminy, ventricular tachycardia, and atrial flutter and fibrillation. Large and frequent doses of quinidine, procainamide, disopyramide, propranolol, and digoxin failed to suppress his arrhythmias. ⋯ A new antiarrhythmic drug, lorcainide, was given intravenously and it suppressed all PVCs, including bigeminy and ventricular tachycardia. All his arrhythmias have been completely suppressed by oral regimens of lorcainide, 100 mg four times daily, for the past four months. This is the first case of oral treatment of ventricular arrhythmias with lorcainide in this country.