DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKH
in Case Study
Lancisi’s Sign
Lancisi’s Sign
A 60-year-old man with nonischemic cardiomyopathy presented with progressive dyspnea and weight gain of approximately 9 kg that had developed over a period of 2 to 3 weeks. On examination, a grade 2/6 holosystolic murmur that augmented with inspiration was noted at the left lower sternal border. Examination of the neck revealed a palpable, monomorphic venous pulsation, known as Lancisi’s sign (see video). Transthoracic echocardiography revealed malcoaptation of the tricuspid-valve leaflets as a result of annular dilatation, with resultant severe regurgitation. Lancisi’s sign is a physical finding of severe tricuspid regurgitation. Normally, three peaks and two troughs characterize the venous waveform (the lower strip is a generic representation of normal findings, for comparison). The first peak, called the a wave, results from atrial contraction during late diastole. Next, during early systole, isovolumetric ventricular contraction triggers closure of the tricuspid valve, producing the c wave. In mid-systole, given a competent tricuspid valve, a combination of atrial relaxation and descent of the atrial floor during ventricular contraction results in the x descent. The third peak, the v wave, occurs as a result of atrial filling during late systole. Finally, passive ventricular filling in early diastole produces the y descent. In the context of tricuspid regurgitation, retrograde blood flow into the right atrium during ventricular systole results in loss of the x descent (the upper strip shows the right atrial pressure tracing from this patient), creating a fused cv wave that appears as a large pulsation within the internal jugular vein that is often palpable. This wave is typically followed by an augmented y descent, which is the consequence of an increased pressure gradient between the right atrium and right ventricle. In this patient, diuretic agents were used to normalize the volume status, and the symptoms abated.
DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKH
in Case Study
Spontaneous Retropharyngeal Hematoma
DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKH
in Case Study
Taenia saginata Infestation
Taenia saginata Infestation
A 38-year-old man presented with worsening abdominal pain, vomiting, anorexia, generalized weakness, and weight loss that had begun 3 days earlier. He had a history of eating raw beef. During the previous 2 years, he had been seen by several different doctors and had been given clinical treatment for stomachache, abdominal pain, and chronic anemia. Physical examination was largely unremarkable. Microscopic examination of stool showed an embryonated egg containing an oncosphere (Panel A). The patient was treated with praziquantel, administered orally at a dose of 60 mg per kilogram of body weight; approximately 40 minutes later, he received mannitol as a catharsis drug, administered orally at a dose of 300 ml in 20% aqueous solution. Two and one half hours after the administration of mannitol, the patient discharged a tapeworm that measured 6.2 m excluding the scolex (Panel B, arrow). A gravid proglottid was identified, with at least 23 lateral uterine branches on each side (Panel C) and a distinct genital pore containing a vaginal sphincter (Panel D, arrow). The patient received a diagnosis of Taenia saginata (beef tapeworm) infection. Humans become infected with T. saginata by ingesting cysticerci during consumption of raw or inadequately cooked beef. The tapeworm attaches to the small intestine and can grow to be several meters in length. Humans are the only definitive hosts. At a follow-up visit 3 months later, the patient was asymptomatic, with recovery of appetite and weight.
Medicalpedia
Medicalpedia
in General
Photo following a surgical drainage of a brain abscess.  
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