Kazuhito Hirata

Electrocardiographic abnormalities in patients with acute aortic dissection

In conclusion, acute electrocardiographic changes were not uncommon in patients with acute aortic dissection. It was suggested that acute electrocardiographic changes in aortic dissection resulted from at least 1 of the following 3 mechanisms: (1) involvement of the ostium of the coronary artery; (2) shock state, especially tamponade; and (3) preexisting coronary artery disease. We believe that physicians should be aware of the possibility of acute aortic dissection not only in patients with chest pain with a normal electrocardiogram, but also in those with electrocardiographic changes.

Beat-to-beat variation of the ST segment in a patient with right bundle branch block, persistent ST segment elevation, and ventricular fibrillation: a case report.

The authors describe a patient with ventricular fibrillation associated with right bundle branch block-like QRS morphology and persisting ST segment elevation in the precordial leads, in whom the morphology of the ST segment changed from the coved type to the saddle-back type or vice versa on a beat-to-beat basis. Such an observation has never been reported in the previous literature.

Pneumatosis Intestinalis Caused by an Ingested Denture

A 60-year-old woman, bedridden in a nursing home because of multisystem atrophy, developed aspiration pneumonia. Coarse crackles were observed in the lung fields, her abdomen was slightly distended, and the bowel sounds were diminished. An abdominal X-ray showed a possible foreign body (arrow head) and pneumatosis intestinalis (arrows) in the ascending colon (Picture A). Computed tomography confirmed the presence of a foreign body and marked accumulation of air in the subserosal layer, consistent with pneumatosis (Picture B). Because of her general condition, she was conservatively managed. Several days later, her pneumatosis spontaneously improved, but the foreign body had moved down to the cecum. Endoscopy revealed that the foreign body was covered with food debris and was stuck in the appendix (Picture C). The foreign body turned out to be a denture (Picture D) which was successfully retrieved. Pneumatosis intestinalis associated with an ingested foreign body is rare. In this particular patient, the pneumatosis appeared to have been caused by traumatic mucosal damage because of an ingested denture (1). Medical problems associated with an ingested denture may increase and become relevant in the era of an aging society.