Reversible second degree atrioventricular block after a severe sickle cell crisis.

Despite the high prevalence of sickle cell disease and trait in the black population and its serious potential for microinfarction, there are only a few reports on acute myocardial damage during vasoocclusive crisis. We report a unique case of transient second degree atrioventricular (A-V) block of Mobitz I and II type during a severe sickle cell crisis. Localized high ventricular septum hypoperfusion demonstrated by a 99mTc-MIBI radionuclide study and reversible echocardiographic wall motion abnormalities in the same area were strong indicators for a local ischemic event in the A-V node and His bundle area, explaining the observed transient conduction abnormalities.

Recurrent infections in children observed throughout electronic medical record.

This paper shows the usefulness of routinely collected structured clinical findings in an computerized patient record. Medical observations are collected as detailed clinical findings, without any interpretation, according to a time structure, visit by visit. In the present example, the role of the microbial colonization is studied in relationship with infected organs and other processes which could facilitate the infection.

Organizing the clinical data in the medical record.

We have developed a method of collecting and arranging clinical data that makes the medical record more useful in patient care and research. The design is based on two principles: that detailed clinical findings should be recorded independently of any diagnostic interpretation, and that time should be integrated as a dimension of the medical record. Analysis of the principal components of the medical record as we have organized it allows identification of clinical entities on the basis of synchronous or sequential features and facilitates precise tracking of symptoms, evaluation of therapeutic effects, comparison of treatments, identification of patients at risk of recurrence, transmission of observations from physician to physician, and analysis and reinterpretation of the observations recorded.

Junctional ectopic tachycardia with a benign course in a premature infant.

The case of a premature baby with junctional ectopic tachycardia is described. The arrhythmia had an unusually benign course, contrary to what has been reported in the literature. Sinus rhythm was restored after 3 days of treatment with quinidine, and there has been no recurrence.