A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery and obtuse marginalis, although the right coronary artery was normal. Laboratory findings, including a complete blood count, erythrocyte sedimentation rate, and C reactive protein, were normal. Chest X-ray revealed no abnormal findings, and there was no valvular abnormality on preoperative echocardiography. The patient had no co-morbid disorders, but his left ventricular ejection fraction was reduced (40–45%).\nThe intraoperative course was uneventful. There were no findings of pericarditis. On physical examination, there was no respiratory distress, blood pressure was 130/80 mm Hg, heart rate was 80 beats per minute, respiratory rate was 23 per minute, the neck veins were not distended, and there was no ankle edema. Cardiovascular system examination showed regular first and second heart sounds with no gallop or murmur. The electrocardiogram (ECG) demonstrated a Q wave in the precordial leads. For temporary coronary artery occlusion, 4/0 Viline sutures and a Bulldog Clamp were used, and warm blood was employed to de air the graft. Temporary coronary artery occlusion was not prolonged, and the electrocardiogram and hemodynamic variables and objective data showed no signs of ischemia or contractile dysfunction. The operation was uneventful. No intra-coronary shunt was utilized.\nThe patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output. At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. There were no findings as regards pericarditis, and the patient’s postoperative erythrocyte sedimentation rate, C-reactive protein, and cardiac enzymes were normal. A high dose of adrenalin and dobutamine was administered, and an intra-aortic balloon pump was used.\nIntraoperative transesophageal echocardiography demonstrated a depression in the left ventricular function due to an akinetic lateral left ventricular wall in the region of the obtuse marginalis. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, a coronary angiogram demonstrated patent grafts and correct anastomotic sites ( & ). On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally, after hospital discharge on the thirtieth postoperative day, an echocardiogram showed a normal left ventricular function without regional wall motion abnormalities.
The patient was a previously healthy 23-year-old Caucasian male who complained of the sudden onset of linear rash on his trunk evolving for 2 days. The patient denied other symptoms, such as pruritus, arthralgia, mucosal abnormalities, and fever. When asked about consumption of shiitake, he confirmed that he had eaten those mushrooms 4 days before he sought medical assistance and stated that he thought the shiitakes had been well cooked. The patient denied the intake of other medications or changes of personal hygiene products.\nAt physical examination, the patient presented with small, grouped papules forming a linear design, spreading on the trunk and extending to the proximal part of the upper limbs (Fig. , , ). No alterations on the face, scalp, or mucosa were observed. Dexamethasone ointment was applied for 5 days in the area of the lesions, and complete remission was observed after 7 days.