Ayala Browne (lowwool62)

Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction. Concealed Mahaim fiber is not very rare; however, concealed nodoventricular fiber is a very rare kind of retrograde accessory pathway in supraventricular tachycardia with atrioventricular (AV) dissociation. Only a few cases about successful ablation of the nodoventricular accessory pathway have been reported. We describe the case of a 32-year-old woman who underwent an electrophysiology study and radiofrequency (RF) ablation of a rare narrow QRS tachycardia with AV dissociation. A 32-year-old woman with a history of paroxysmal palpitation was admitted to our hospital for RF ablation. Electrocardiography revealed a narrow QRS complex tachycardia with the same morphology in sinus rhythm. Echocardiography showed no structural heart disease. A right-sided concealed AV accessory pathway and a right-sided concealed nodoventricular accessory pathway were involved in the orthodromic atrioventricular reciprocating tachycardia. His bundle-ventricular interval during tachycardia was the same as that in sinus rhythm. The tachycardia could be initiated and entrained by ventricular pacing. Premature right ventricular stimulus introduced during the His-bundle refractory period when tachycardia occurred was able to advance the next atrial potential. The earliest atrial activation was mapped near the proximal slow AV nodal pathway. RF ablation of both accessary pathways was successfully performed under the guidance of a three-dimensional mapping system by recording the earliest retrograde atrial potential, and tachycardia could no longer be induced. Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential. Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential. Gallbladder adenoma is a relatively rare benign tumor with a potential for malignant transformation if found to be greater than 1 cm in size. Herein, we report a case of a 51-year-old female with large 3 cm × 3 cm mass of gallbladder adenoma that was misdiagnosed as adenocarcinoma due to its clinical presentation. Computed tomography and magnetic resonance imaging scans showed an irregularly shaped cauliflower-like lump in the gallbladder measuring 38 mm × 32 mm corresponding to a malignant tumor and several gallbladder stones with low diffusion-weighted imaging and equisignal of T1-weighted imaging and T2-weighted imaging; moreover, the CA 19-9 levels were very high (184.1 U/mL). Pathology reports after tumor resection showed adenoma with moderate epithelial atypia and moderate atypia in the focal area with fine pedicle and no clear infiltration. Computed tomography and magnetic resonance imaging scans need to be carefully scrutinized in certain rare cases of adenomas with abnormal imaging features. Computed tomography and magnetic resonance imaging scans need to be carefully scrutinized in certain rare cases of adenomas with abnormal imaging features. Esophageal cancer is a common malignant tumor of the digestive system. At present, surgery is the most important treatment strategy. After esophagectomy and gastric esophagoplasty, the patients are prone to regurgitation. However, these patients currently do not receive much attention, especially from anesthesiologists. A 55-year-old woman was scheduled for right lower lung lobectomy. The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior. Although the patient had fasted for > 17 h, unexpected aspiration still occurred during induction of general anesthesia. see more Throughout the operation, oxygen saturation was 98%-100%, but the airway pressure was high (35 cmH O at double lung ventilation). T