Introduction Hypothyroidism increases the risk of cardiovascular complications in patients scheduled for coronary artery bypass grafting. Atrial fibrillation is one of its cardiac complications. Case Report Our 45-yea...Introduction Hypothyroidism increases the risk of cardiovascular complications in patients scheduled for coronary artery bypass grafting. Atrial fibrillation is one of its cardiac complications. Case Report Our 45-year-old male patient was admitted to the Emergency Medicine Clinic of our hospital with chest pain that started in the left arm and extended to the chin 2 days ago. It was noted that the patient had hypothyroidism, but did not have any medication for the disease. On physical examination, dry and pale skin, sparse coarse hair, non-pitting edema were diagnosed with acute coronary artery disease. No signs of ischemia were observed on the ECG at the time of admission, but bradycardic sinus rhythm was recorded. The patient was started to be followed up with the diagnosis of NON-ST myocardial infarction. Nitroglycerin 0.25 - 2 mcgr/h and morphine 2 mg were administered intravenously to the patient whose anginal complaints continued after admission. Anginal complaint continued was operated in 1:1 mode by attaching an intraaortic balloon pump (Maquet Sensation 7Fr 40 cc, Datascope CS300 console) via the left femoral artery. Surgery procedure: The patient was performed with median sternotomi (aortic, two-stage cannulation). While the patient was cooled to 32 degrees and given blood cardioplegia (St. Thomas II) and applied topical cold. After distal anastomoses were performed with saphenous vein graft. Total cross-clamp time was 60 min. Epinephrine was given for bradycardia sinus rhythm. No cardiovascular complications were encountered while being followed in the intensive care unit. The patient was discharged on the 6th postoperative day. Conlucion: Our case, who was taken to emergency CABG operation with myxedema, was discharged without any cardiovascular, respiratory or metabolic complications both in the perioperative and postoperative periods. In this case, the major stress caused by cardiovascular surgery was successfully overcome by both the cardiovascular surgery team and the anesthesiology team.展开更多
The patient is a 37-year-old male with a right anterior tibial mass for more than one year and a left anterior tibial mass for more than one month.There was a history of hyperthyroidism.Histopathology of the lesions s...The patient is a 37-year-old male with a right anterior tibial mass for more than one year and a left anterior tibial mass for more than one month.There was a history of hyperthyroidism.Histopathology of the lesions showed epidermal hyperkeratosis of the skin tissue,thickening of the spinous layer,extensive collagen fibrillation in the superficial dermis and reticular layer,and numerous linear and granular mucoprotein deposits in the lower and middle dermis.Blastocystis hominis was routinely detected in the stool.Diagnosis:1.Pretibial myxedema 2.intestinal parasitosis(Blastocystis hominis infection).展开更多
Pretibial myxedema(PTM), an uncommon manifestation of Graves' disease(GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with P...Pretibial myxedema(PTM), an uncommon manifestation of Graves' disease(GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide(40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient's PTM achieved complete remission in both legs afteran approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective,and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.展开更多
Central neurogenic hyperventilation (CNH) is a rare condition and defined as a syndrome comprising normal or elevated arterial oxygen tension, decreased arterial carbon dioxide tension, respiratory alkalosis with hype...Central neurogenic hyperventilation (CNH) is a rare condition and defined as a syndrome comprising normal or elevated arterial oxygen tension, decreased arterial carbon dioxide tension, respiratory alkalosis with hyperventilation even during sleep, and the absence of a peripheral respiratory stimulus. The diagnosis of CNH requires the exclusion of pulmonary, cardiac, metabolic-immunological disorders and some medicines that can result in hyperventilation. We detailed the case of CNH in the 4th day after vascular surgery probably secondary to acute metabolic acidosis with hyperlactatemia, due to severe hypothyroidism in the context of critically ill patient.展开更多
文摘Introduction Hypothyroidism increases the risk of cardiovascular complications in patients scheduled for coronary artery bypass grafting. Atrial fibrillation is one of its cardiac complications. Case Report Our 45-year-old male patient was admitted to the Emergency Medicine Clinic of our hospital with chest pain that started in the left arm and extended to the chin 2 days ago. It was noted that the patient had hypothyroidism, but did not have any medication for the disease. On physical examination, dry and pale skin, sparse coarse hair, non-pitting edema were diagnosed with acute coronary artery disease. No signs of ischemia were observed on the ECG at the time of admission, but bradycardic sinus rhythm was recorded. The patient was started to be followed up with the diagnosis of NON-ST myocardial infarction. Nitroglycerin 0.25 - 2 mcgr/h and morphine 2 mg were administered intravenously to the patient whose anginal complaints continued after admission. Anginal complaint continued was operated in 1:1 mode by attaching an intraaortic balloon pump (Maquet Sensation 7Fr 40 cc, Datascope CS300 console) via the left femoral artery. Surgery procedure: The patient was performed with median sternotomi (aortic, two-stage cannulation). While the patient was cooled to 32 degrees and given blood cardioplegia (St. Thomas II) and applied topical cold. After distal anastomoses were performed with saphenous vein graft. Total cross-clamp time was 60 min. Epinephrine was given for bradycardia sinus rhythm. No cardiovascular complications were encountered while being followed in the intensive care unit. The patient was discharged on the 6th postoperative day. Conlucion: Our case, who was taken to emergency CABG operation with myxedema, was discharged without any cardiovascular, respiratory or metabolic complications both in the perioperative and postoperative periods. In this case, the major stress caused by cardiovascular surgery was successfully overcome by both the cardiovascular surgery team and the anesthesiology team.
文摘The patient is a 37-year-old male with a right anterior tibial mass for more than one year and a left anterior tibial mass for more than one month.There was a history of hyperthyroidism.Histopathology of the lesions showed epidermal hyperkeratosis of the skin tissue,thickening of the spinous layer,extensive collagen fibrillation in the superficial dermis and reticular layer,and numerous linear and granular mucoprotein deposits in the lower and middle dermis.Blastocystis hominis was routinely detected in the stool.Diagnosis:1.Pretibial myxedema 2.intestinal parasitosis(Blastocystis hominis infection).
文摘Pretibial myxedema(PTM), an uncommon manifestation of Graves' disease(GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide(40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient's PTM achieved complete remission in both legs afteran approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective,and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.
文摘Central neurogenic hyperventilation (CNH) is a rare condition and defined as a syndrome comprising normal or elevated arterial oxygen tension, decreased arterial carbon dioxide tension, respiratory alkalosis with hyperventilation even during sleep, and the absence of a peripheral respiratory stimulus. The diagnosis of CNH requires the exclusion of pulmonary, cardiac, metabolic-immunological disorders and some medicines that can result in hyperventilation. We detailed the case of CNH in the 4th day after vascular surgery probably secondary to acute metabolic acidosis with hyperlactatemia, due to severe hypothyroidism in the context of critically ill patient.
