Gastric distension and gastroparesis following pulmonary vein isolation for atrial fibrillation: a case report and review of the literature.

We present a case of marked gastric distension and gastroparesis in a patient with atrial fibrillation who underwent a pulmonary vein isolation, a procedure commonly performed in patients suffering from atrial fibrillation in order to regain sinus rhythm. Two days following the procedure, the patient presented with marked abdominal distension, and computed tomography imaging was consistent with gastroparesis and/or delayed gastric emptying. A tentative diagnosis of pylorospasm was made.

The missing link.

We present a case of a 28-year old woman who presented with bizarre wheezing breath sounds on expiration and dysphagia, with unexplained significant dilation of the esophagus mimicking achalasia finally leading to the diagnosis of a very small congenital tracheoesophageal fistula (TEF). Congenital TEF is usually detected shortly after birth and is typically accompanied by esophageal atresia. Congenital TEF without esophageal atresia (H-type fistula) can be missed in early life and diagnosis may be postponed until adulthood due to subtle symptoms.

Limitations of extensive TPMT genotyping in the management of azathioprine-induced myelosuppression in IBD patients.

Background And Aims: TPMT deficiency is associated with azathioprine (AZA)-induced myelosuppression (MS). However, in one previous study, only about ¼ of MS episodes in Crohn's Disease patients under AZA can be attributed to TPMT deficiency. Recently, new TPMT mutations have been described and our aim is to investigate their clinical relevance before and after a first MS episode on thiopurine therapy.

Factor V inhibitor after injection of human thrombin (tissucol) into a bleeding peptic ulcer.

Endoscopic injection of fibrin glue into a bleeding peptic ulcer is an effective and safe treatment modality. The present report describes a patient who developed rectal bleeding from an arteriovenous malformation after endoscopic injection of fibrin glue containing human thrombin into a gastric ulcer. Additional laboratory investigations revealed the presence of an inhibitor against coagulation factor V, which resulted in severe coagulopathy, triggering the bleeding.