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Case Report: A 59-year-old man with a 4-week history of dyspnea, coughing, and chest discomfort was referred to hospital for further evaluation. Moreover, he reported fever and fatigue. There were neither cardiovascular risk factors nor drug medication. 6 months earlier, a deep vein thrombosis of his left lower limb was diagnosed followed by an anticoagulation for 4 weeks. Physical examination revealed a dilatation of the neck veins with a present Kussmaul sign and a diastolic murmur at the left lower sternal border. The findings on the rest of his physical examination were unremarkable. Electrocardiography showed normal sinus rhythm, low voltage, and anterolateral T wave inversion. Initial laboratory results were remarkable for elevated lactate dehydrogenase level. Transthoracic echocardiography revealed a small pericardial effusion with a large intracardiac mass adjacent to the right atrium. Thoracic computed tomography confirmed the tumor mass and showed enlargement of mediastinal lymph nodes. The patient underwent transesophageal echocardiography-guided transvenous biopsy of the tumor. The immunohistology of the specimen revealed non-Hodgkin's lymphoma. The patient subsequently received a chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. His clinical response after the first cycle was remarkable with total regression of the superior vena cava syndrome. After the third cycle of therapy, both tumor and pericardial effusion had disappeared., Conclusion: A cardiac tumor is a rare cause of a superior vena cava syndrome. Tissue biopsy is warranted to guide diagnosis and therapy. Transvenous biopsy is generally safe when guided by echocardiography.

Background and Purpose: The cause of severe cardiac conduction disturbances or sinus node dysfunction is often unknown. The objective of this study was to assess the incidence of coronary artery disease (CAD) and the necessity of revascularization in patients with symptomatic bradycardia requiring permanent pacemaker implantation and to try to find a causal association between the need for a pacemaker and the presence of CAD., Patients and Methods: From January 2002 to December 2005, 507 pacemakers were implanted due to symptomatic bradycardia. In the presence of at least one atherosclerotic risk factor, patients were recommended to undergo coronary angiography. Each patient underwent exercise or dobutamine echocardiography to detect myocardial ischemia., Results: 212 of the 507 patients (42%) with permanent pacemaker implantation (141 men, mean age 70 +/- 9 years) underwent coronary angiography within 2 months before or after pacemaker implantation. Twelve patients (6%) had a normal angiogram. No significant CAD was found in 37 patients (17%), and significant narrowing of the coronary arteries in 150 (71%). Conservative treatment was recommended in 128 patients (60%), 40 patients (19%) were treated with percutaneous coronary intervention, and 44 patients (21%) underwent coronary artery bypass grafting., Conclusion: The data indicate that patients with severe conduction disturbances or sinus node dysfunction requiring permanent pacemaker implantation are more likely to have CAD with subsequent myocardial revascularization in the presence of at least one atherosclerotic risk factor. A causal association between the need for pacemaker and CAD could not be established from the results.

Background: Leptospirosis is a worldwide infectious disease affecting both animals and humans. Leptospira pomona is well known as a pathogen of a mild form of leptospirosis (maladie des jeune porchers)., Case Report: A 51-year-old male farmer was referred to our hospital with high fever, hyperbilirubinemia and acute renal failure. Further laboratory tests revealed elevated inflammatory parameters, thrombocytopenia, signs of a mild hepatitis and involvement of pancreas. About 7 days before he had experienced muscle pain accompanied by headache and fever. Suspecting leptospirosis an intravenous therapy with penicillin was started. During the subsequent course of his illness a sixfold increase increase of antibody titer against leptospira pomona was documented within 3 weeks. Urine retention parameters decreased by intravenous fluid resuscitation in the intensive care unit, so that hemodialysis was not necessary. Platelets and bilirubin returned to normal. Atrial fibrillation as a sign of cardiac manifestation of leptospirosis changed spontaneously in a regular and permanent sinusrhythm. The patient was discharged home after 3 weeks in the hospital., Conclusion: Early diagnosis is most important for the prognosis of patients with severe form of leptospirosis. Leptospira pomona is a known pathogen of anicteric leptospirosis but in some cases is able to cause a severe form of leptospirosis with renal failure, jaundice and thrombocytopenia.

Background: Distal showering of atherosclerotic debris or thrombus is a feared event during percutaneous angioplasty of degenerated vein grafts., Case Report: We report on a 66-year-old male patient with a history of coronary artery disease who was admitted into hospital with an acute coronary syndrome. He had had coronary artery bypass graft surgery in 1995. His chest pain resolved under treatment with aspirin, heparin, betablocker, and nitrate. A diagnostic angiogram demonstrated two critical stenoses of the left anterior descending graft. After a continuous infusion of tirofiban administered for 24 h prior to elective angioplasty, a JR 4SH 6 F guiding catheter (Cordis) was positioned. The lesions were crossed with a 0.014" Galeo F wire (Biotronik). A 4 mm x 16 mm stent graft (Jostent, Jomed) was deployed in the distal stenosis and a 4.5 mm x 32 mm self-expandable stent (Magic Wallstent, Boston Scientific) in the proximal stenosis. Thereafter, the patient suffered from chest pain, and the ECG showed ST elevation from V1 to V5. Angiography revealed total occlusion of the left anterior descending artery. An X-Sizer catheter (EndiCOR Medical, Inc.) was introduced and advanced through the vein graft with slow back-and-forth movements. After several aspirations, blood flow was significantly improved. A modest CK elevation (127 U/l) indicated a rather small loss of myocardial tissue., Conclusion: Percutaneous revascularization of narrowed aortocoronary saphenous vein grafts is associated with increased risk of distal embolization and "no reflow". The X-Sizer catheter system is compatible with commercially available guiding catheters, and capable of retrieving thrombotic debris after macroembolization from degenerated saphenous vein grafts including the native coronary artery.