Ronny Cohen - Academia.edu (original) (raw)

Papers by Ronny Cohen

Case Report Takotsubo Cardiomyopathy in the Setting of Tension Pneumothorax

which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocar-diographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting.Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/

World Journal of Cardiovascular Diseases, 2012

Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion wit... more Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: ...

Idiopathic Thrombocytopenic Purpura (ITP) is defined as a hematologic disorder, characterized by ... more Idiopathic Thrombocytopenic Purpura (ITP) is defined as a hematologic disorder, characterized by isolated thrombocytopenia without a clinically apparent cause. The major causes of accelerated platelet consumption include immune thrombocytopenia, decreased bone marrow production and increased splenic sequestration. The clinical presentation may be acute with severe bleeding, or insidious with slow development with mild or no symptoms. The initial laboratory tests useful at the first visit to predict future diagnosis were erythrocyte count, leukocyte count, anti-glycoprotein (GP) IIb/ IIIa antibodies, reticulated platelets, plasma thrombopoietin level. Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding. It should be limited in duration unless demonstrated that symptomatic thrombocytopenia persists. Patients with mild, asymptomatic thrombocytopenia, discovered incidentally on a routine blood count, should not be treated. We present a case report on ITP and summarize the key points in the diagnosis and management of ITP.

Behavioral Sciences & the Law, 1983

Issues regarding the question of what constitutes malpractice by psychologists, psychiatrists, an... more Issues regarding the question of what constitutes malpractice by psychologists, psychiatrists, and other mental health professionals, are reviewed. The legal concepts of negligence, professional liability, and causation are explained and related subjects including the duty of mental health professionals and what constitutes a breach of that duty are discussed and illustrated. Guidelines for avoiding legal jeopardy are also presented. A record amount of malpractice litigation against physicians during the last decade has sensitized practitioners in all health-related professions to the need for an adequate understanding of the legal framework in which they function. Practitioners in the field of behavioral science, including psychologists, psychiatrists, social workers, psychiatric nurses, occupational therapists and others have taken cognizance of a foreboding constellation of societal factors that may make them more vulnerable than ever before to the receipt of a summons and complaint alleging malpractice (Cohen, 1979; Cohen and Mariano, 1982; Stone, 1977; Green and Cox, 1978; Bernstein, 1978.) Thorough knowledge of a professional specialty is a necessary but no longer sufficient condition for the successful practice of that specialty; a knowledge of the law is essential. NEGLIGENCE, MALPRACTICE, AND PROFESSIONAL LIABILITY Stated generally, all adults have a legal duty to conduct'themselves in a fashion that at least measures up to the way that any ordinary and reasonable person would behave under the same or similar circumstances. If a person's unintentional behavior falls short of this "ordinary and reasonable person" standard, the behavior is described as "negligent." Negligence is formally ~~ ~

Abdominal Imaging, 2000

Background: We investigated the constituting collateral vessels in cavernous transformation of th... more Background: We investigated the constituting collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC) by using contrast-enhanced spiral computed tomographic (CT) examination. Methods: Fifty-four histopathologically proven HCC patients with tumor thrombosis-induced CTPV were retrospectively included and assigned to cirrhosis negative (n ϭ 31) and positive (n ϭ 23) groups. Another 15 cirrhotic patients with portal hypertension but no HCC and CTPV were used for comparison. Standardized dualphase contrast-enhanced spiral CT was performed for all patients. CT appearances of the collateral vessels of CTPV were observed, and their visualization rates were analyzed. Results: Biliary (cystic and paracholedochal veins) and gastric (left and right gastric veins) branches of the portal vein were the most frequently visualized collateral vessels of CTPV. There was a marked difference in CT visualization rates for biliary branches between patients with and without CTPV (83-94% vs. 0). No difference existed in visualization rates for gastric branches across the three groups (77-87% for left gastric, 58-61% for right gastric vein). Conclusions: Biliary and gastric branches of the portal vein are the major collateral vessels of CTPV. The intergroup differences in CT visualization rates may provide clues to the roles that they might play in the hemodynamic adaptation process of CTPV.

World Journal of Cardiovascular Diseases, 2012

Echocardiography can be used as an easy, inexpensive, devoid of complications and, for the most p... more Echocardiography can be used as an easy, inexpensive, devoid of complications and, for the most part, universally available tool for the risk stratification of patient with acute pulmonary embolism. Because of its low sensibility, an echocardiogram is best indicated in a patient in whom hypotension and or shock are suspected to be due to pulmonary embolism. Pertinent findings in the echocardiogram can justify the use of fibrinolytic therapy. Most common echocardiographic findings in acute pulmonary embolism are: dilatation of the right ventricle, right ventricular dysfunction in some cases with preservation of the motility of the apex, dilatation of the inferior vena cava with lack of collapse during inspiration flattening of the interventricular septum suggesting right ventricular pressure overload and pulmonary hypertension based on the jet of tricuspid regurgitation if available.

Post-ablation Dyspnea a Case Report to Highlight the Differential Diagnoses

Cureus

Cardiology research, 2012

Myxomas are the most common primary cardiac tumors, most frequently found in the left atrium. We ... more Myxomas are the most common primary cardiac tumors, most frequently found in the left atrium. We present a case of an atrial myxoma. An in-depth review of atrial myxoma is presented, examining the important clinical symptoms and diagnostic indicators. The treatment of atrial myxoma is then discussed, with an emphasis on current therapies. An extensive literature review has been performed to present a comprehensive review of the causes, pathophysiology of atrial myxoma.

Case Reports in Nephrology, 2016

Potassium-binding resins are widely used in the treatment of hyperkalemia, mostly in the acute se... more Potassium-binding resins are widely used in the treatment of hyperkalemia, mostly in the acute setting. Gastrointestinal adverse events, although reported, are not frequently seen due to its short course of use. This report describes a case involving an end-stage renal disease patient on hemodialysis who developed a colonic mass after being on sodium polystyrene sulfonate chronically for persistent hyperkalemia. Gastrointestinal symptoms developed late during the treatment rather than early as reported previously in the literature. This mass was mistaken for a carcinomatous lesion, which initiated an extensive work-up as well as hospitalization that nearly resulted in a subtotal colectomy.

Case reports in cardiology, 2015

We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patie... more We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus...

Case Reports in Critical Care, 2015

Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usua... more Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting.Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL), troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10–15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient’s condition improved with a subsequent echocardiogram showing a LVEF of 60%.Conclusion. The patient was...

Portal vein thrombosis

Case reports in vascular medicine, 2015

Portal vein thrombosis (PVT) is the blockage or narrowing of the portal vein by a thrombus. It is... more Portal vein thrombosis (PVT) is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

World Journal of Cardiovascular Diseases, 2012

Hyperkalemia is defined as serum potassium level of more than 5 mmol/L. Prompt identification of ... more Hyperkalemia is defined as serum potassium level of more than 5 mmol/L. Prompt identification of hyperkalemia and appropriate management are critical, since severe hyperkalemia can lead to lethal cardiac dysrhythmias. There is a wide range of electrocardiogram (EKG) changes associated with hyperkalemia. The sequence of EKG changes has been previously described with limited information to correlate the level of potassium to a particular change in the EKG. This study aims to describe a correlation between the level of potassium and EKG changes in the presence or absence of certain diagnoses, to determine which EKG finding in the context of level of hyperkalemia, should be considered life-threatening and prompt emergency intervention. If a relationship between serum levels of potassium and EKG changes is significant, clinicians may be able to better monitor and treat hyperkalemic patients. This paper reviews the literature on hyperkalemia, potassium homeostasis and EKG changes attributed to elevated potassium.

Acute ST segment elevation myocardial infarction from myocardial bridging of left anterior descending coronary artery

Portal Vein Thrombosis

Case Reports in Vascular Medicine, 2015

Improvement in Pulmonary Hypertension and Closure of a Patent Foramen Ovale with Treatment of Hyperthyroidism in a Patient with Graves’ Disease

Journal of Autoimmune Diseases and Rheumatology, 2014

Cardiology Research, 2012

The incidental diagnosis in adult age is very unusual and the presence of clinical symptoms is re... more The incidental diagnosis in adult age is very unusual and the presence of clinical symptoms is related to its location, which is most commonly intrapericardial. The presence of intramyocardial teratoma lesions is even rarer and has been reported in few publications. The recommendations for the diagnosis and management of a cardiac teratoma depends upon the imaging studies and the pathological report after surgical excision. The prognosis of surgically treated patient is very good and a complete surgical excision is preferred in order to avoid complications.

Journal of Clinical Medicine Research, 2013

Background: Alcohol withdrawal is a relatively common problem among chronic alcohol users, and it... more Background: Alcohol withdrawal is a relatively common problem among chronic alcohol users, and its severity will determine the setting in which it will be more appropriate to take care of the patients. Those with mild symptoms will be managed in an outpatient setting, as opposed to those with advanced moderate or severe symptoms who will require inpatient management. Among those patients who will require hospitalization, some of them will do well in a regular floor, but some of them will have to be managed in an intensive care unit. We tried to determine whether some variables could be predictive of an increased risk of being managed in an intensive care unit as opposed to being managed in a regular medical floor. Methods: A retrospective non-randomized review trial design was implemented and a total of 110 medical charts of patients admitted to our institution with severe alcohol withdrawal during the calendar year of 2009 were reviewed. Different demographic and clinical parameters were analyzed, and their significance established in regard to the clinical settings (ICU vs. medical floor) in which the patients were managed. Results: The patients managed in the ICU were found to be younger than their counterparts who were managed in the medical floor, and they were more likely to be white and unemployed. On the other hand, being diabetic, using over-the-counter drugs or prescribed medications appeared to be protective factors, resulting in management of alcohol withdrawal on the medical floors. Conclusion: A likely explanation to our findings could be that patients exhibiting better health protective behaviors have a better chance to stay away from the ICU. However no tools could be developed to stratify the patients' risks and more behavioral and observational cohort studies will be needed for that purpose.

Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavia... more Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavian artery. It is a rare anatomical anomaly that can be associated with a double aortic arc, a left aortic arch, and anomalous origin of the right subclavian artery or a right aortic arch with anomalous left subclavian artery. We present a case of KD presenting initially as syncope, as well as a review of the literature of this rare syndrome, including diagnosis, imaging techniques, and current surgical treatments.

Case Report Takotsubo Cardiomyopathy in the Setting of Tension Pneumothorax

which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocar-diographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting.Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/

World Journal of Cardiovascular Diseases, 2012

Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion wit... more Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: ...

Idiopathic Thrombocytopenic Purpura (ITP) is defined as a hematologic disorder, characterized by ... more Idiopathic Thrombocytopenic Purpura (ITP) is defined as a hematologic disorder, characterized by isolated thrombocytopenia without a clinically apparent cause. The major causes of accelerated platelet consumption include immune thrombocytopenia, decreased bone marrow production and increased splenic sequestration. The clinical presentation may be acute with severe bleeding, or insidious with slow development with mild or no symptoms. The initial laboratory tests useful at the first visit to predict future diagnosis were erythrocyte count, leukocyte count, anti-glycoprotein (GP) IIb/ IIIa antibodies, reticulated platelets, plasma thrombopoietin level. Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding. It should be limited in duration unless demonstrated that symptomatic thrombocytopenia persists. Patients with mild, asymptomatic thrombocytopenia, discovered incidentally on a routine blood count, should not be treated. We present a case report on ITP and summarize the key points in the diagnosis and management of ITP.

Behavioral Sciences & the Law, 1983

Issues regarding the question of what constitutes malpractice by psychologists, psychiatrists, an... more Issues regarding the question of what constitutes malpractice by psychologists, psychiatrists, and other mental health professionals, are reviewed. The legal concepts of negligence, professional liability, and causation are explained and related subjects including the duty of mental health professionals and what constitutes a breach of that duty are discussed and illustrated. Guidelines for avoiding legal jeopardy are also presented. A record amount of malpractice litigation against physicians during the last decade has sensitized practitioners in all health-related professions to the need for an adequate understanding of the legal framework in which they function. Practitioners in the field of behavioral science, including psychologists, psychiatrists, social workers, psychiatric nurses, occupational therapists and others have taken cognizance of a foreboding constellation of societal factors that may make them more vulnerable than ever before to the receipt of a summons and complaint alleging malpractice (Cohen, 1979; Cohen and Mariano, 1982; Stone, 1977; Green and Cox, 1978; Bernstein, 1978.) Thorough knowledge of a professional specialty is a necessary but no longer sufficient condition for the successful practice of that specialty; a knowledge of the law is essential. NEGLIGENCE, MALPRACTICE, AND PROFESSIONAL LIABILITY Stated generally, all adults have a legal duty to conduct'themselves in a fashion that at least measures up to the way that any ordinary and reasonable person would behave under the same or similar circumstances. If a person's unintentional behavior falls short of this "ordinary and reasonable person" standard, the behavior is described as "negligent." Negligence is formally ~~ ~

Abdominal Imaging, 2000

Background: We investigated the constituting collateral vessels in cavernous transformation of th... more Background: We investigated the constituting collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC) by using contrast-enhanced spiral computed tomographic (CT) examination. Methods: Fifty-four histopathologically proven HCC patients with tumor thrombosis-induced CTPV were retrospectively included and assigned to cirrhosis negative (n ϭ 31) and positive (n ϭ 23) groups. Another 15 cirrhotic patients with portal hypertension but no HCC and CTPV were used for comparison. Standardized dualphase contrast-enhanced spiral CT was performed for all patients. CT appearances of the collateral vessels of CTPV were observed, and their visualization rates were analyzed. Results: Biliary (cystic and paracholedochal veins) and gastric (left and right gastric veins) branches of the portal vein were the most frequently visualized collateral vessels of CTPV. There was a marked difference in CT visualization rates for biliary branches between patients with and without CTPV (83-94% vs. 0). No difference existed in visualization rates for gastric branches across the three groups (77-87% for left gastric, 58-61% for right gastric vein). Conclusions: Biliary and gastric branches of the portal vein are the major collateral vessels of CTPV. The intergroup differences in CT visualization rates may provide clues to the roles that they might play in the hemodynamic adaptation process of CTPV.

World Journal of Cardiovascular Diseases, 2012

Echocardiography can be used as an easy, inexpensive, devoid of complications and, for the most p... more Echocardiography can be used as an easy, inexpensive, devoid of complications and, for the most part, universally available tool for the risk stratification of patient with acute pulmonary embolism. Because of its low sensibility, an echocardiogram is best indicated in a patient in whom hypotension and or shock are suspected to be due to pulmonary embolism. Pertinent findings in the echocardiogram can justify the use of fibrinolytic therapy. Most common echocardiographic findings in acute pulmonary embolism are: dilatation of the right ventricle, right ventricular dysfunction in some cases with preservation of the motility of the apex, dilatation of the inferior vena cava with lack of collapse during inspiration flattening of the interventricular septum suggesting right ventricular pressure overload and pulmonary hypertension based on the jet of tricuspid regurgitation if available.

Post-ablation Dyspnea a Case Report to Highlight the Differential Diagnoses

Cureus

Cardiology research, 2012

Myxomas are the most common primary cardiac tumors, most frequently found in the left atrium. We ... more Myxomas are the most common primary cardiac tumors, most frequently found in the left atrium. We present a case of an atrial myxoma. An in-depth review of atrial myxoma is presented, examining the important clinical symptoms and diagnostic indicators. The treatment of atrial myxoma is then discussed, with an emphasis on current therapies. An extensive literature review has been performed to present a comprehensive review of the causes, pathophysiology of atrial myxoma.

Case Reports in Nephrology, 2016

Potassium-binding resins are widely used in the treatment of hyperkalemia, mostly in the acute se... more Potassium-binding resins are widely used in the treatment of hyperkalemia, mostly in the acute setting. Gastrointestinal adverse events, although reported, are not frequently seen due to its short course of use. This report describes a case involving an end-stage renal disease patient on hemodialysis who developed a colonic mass after being on sodium polystyrene sulfonate chronically for persistent hyperkalemia. Gastrointestinal symptoms developed late during the treatment rather than early as reported previously in the literature. This mass was mistaken for a carcinomatous lesion, which initiated an extensive work-up as well as hospitalization that nearly resulted in a subtotal colectomy.

Case reports in cardiology, 2015

We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patie... more We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus...

Case Reports in Critical Care, 2015

Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usua... more Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting.Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL), troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10–15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient’s condition improved with a subsequent echocardiogram showing a LVEF of 60%.Conclusion. The patient was...

Portal vein thrombosis

Case reports in vascular medicine, 2015

Portal vein thrombosis (PVT) is the blockage or narrowing of the portal vein by a thrombus. It is... more Portal vein thrombosis (PVT) is the blockage or narrowing of the portal vein by a thrombus. It is relatively rare and has been linked with the presence of an underlying liver disease or prothrombotic disorders. We present a case of a young male who presented with vague abdominal symptoms for approximately one week. Imaging revealed the presence of multiple nonocclusive thrombi involving the right portal vein, the splenic vein, and the left renal vein, as well as complete occlusion of the left portal vein and the superior mesenteric vein. We discuss pathogenesis, clinical presentation, and management of both acute and chronic thrombosis. The presence of PVT should be considered as a clue for prothrombotic disorders, liver disease, and other local and general factors that must be carefully investigated. It is hoped that this case report will help increase awareness of the complexity associated with portal vein thrombosis among the medical community.

World Journal of Cardiovascular Diseases, 2012

Hyperkalemia is defined as serum potassium level of more than 5 mmol/L. Prompt identification of ... more Hyperkalemia is defined as serum potassium level of more than 5 mmol/L. Prompt identification of hyperkalemia and appropriate management are critical, since severe hyperkalemia can lead to lethal cardiac dysrhythmias. There is a wide range of electrocardiogram (EKG) changes associated with hyperkalemia. The sequence of EKG changes has been previously described with limited information to correlate the level of potassium to a particular change in the EKG. This study aims to describe a correlation between the level of potassium and EKG changes in the presence or absence of certain diagnoses, to determine which EKG finding in the context of level of hyperkalemia, should be considered life-threatening and prompt emergency intervention. If a relationship between serum levels of potassium and EKG changes is significant, clinicians may be able to better monitor and treat hyperkalemic patients. This paper reviews the literature on hyperkalemia, potassium homeostasis and EKG changes attributed to elevated potassium.

Acute ST segment elevation myocardial infarction from myocardial bridging of left anterior descending coronary artery

Portal Vein Thrombosis

Case Reports in Vascular Medicine, 2015

Improvement in Pulmonary Hypertension and Closure of a Patent Foramen Ovale with Treatment of Hyperthyroidism in a Patient with Graves’ Disease

Journal of Autoimmune Diseases and Rheumatology, 2014

Cardiology Research, 2012

The incidental diagnosis in adult age is very unusual and the presence of clinical symptoms is re... more The incidental diagnosis in adult age is very unusual and the presence of clinical symptoms is related to its location, which is most commonly intrapericardial. The presence of intramyocardial teratoma lesions is even rarer and has been reported in few publications. The recommendations for the diagnosis and management of a cardiac teratoma depends upon the imaging studies and the pathological report after surgical excision. The prognosis of surgically treated patient is very good and a complete surgical excision is preferred in order to avoid complications.

Journal of Clinical Medicine Research, 2013

Background: Alcohol withdrawal is a relatively common problem among chronic alcohol users, and it... more Background: Alcohol withdrawal is a relatively common problem among chronic alcohol users, and its severity will determine the setting in which it will be more appropriate to take care of the patients. Those with mild symptoms will be managed in an outpatient setting, as opposed to those with advanced moderate or severe symptoms who will require inpatient management. Among those patients who will require hospitalization, some of them will do well in a regular floor, but some of them will have to be managed in an intensive care unit. We tried to determine whether some variables could be predictive of an increased risk of being managed in an intensive care unit as opposed to being managed in a regular medical floor. Methods: A retrospective non-randomized review trial design was implemented and a total of 110 medical charts of patients admitted to our institution with severe alcohol withdrawal during the calendar year of 2009 were reviewed. Different demographic and clinical parameters were analyzed, and their significance established in regard to the clinical settings (ICU vs. medical floor) in which the patients were managed. Results: The patients managed in the ICU were found to be younger than their counterparts who were managed in the medical floor, and they were more likely to be white and unemployed. On the other hand, being diabetic, using over-the-counter drugs or prescribed medications appeared to be protective factors, resulting in management of alcohol withdrawal on the medical floors. Conclusion: A likely explanation to our findings could be that patients exhibiting better health protective behaviors have a better chance to stay away from the ICU. However no tools could be developed to stratify the patients' risks and more behavioral and observational cohort studies will be needed for that purpose.

Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavia... more Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavian artery. It is a rare anatomical anomaly that can be associated with a double aortic arc, a left aortic arch, and anomalous origin of the right subclavian artery or a right aortic arch with anomalous left subclavian artery. We present a case of KD presenting initially as syncope, as well as a review of the literature of this rare syndrome, including diagnosis, imaging techniques, and current surgical treatments.