Rationale:Venlafaxine is an antidepressant and anxiolytic agent that functions by inhibiting central serotonin and norepinephrine reuptake, and it is a relatively recently introduced drug. In particular, overdose of venlafaxine has been reported to cause severe cardiac toxicity including ventricular tachycardia, prolongation of QT interval, and seizure or severe muscular injury. However, reports describing venlafaxine-induced rhabdomyolysis with neuropathy remain scarce. Accordingly, we report such a case involving a 49-year-old woman with bilateral sciatic neuropathy combined with rhabdomyolysis following venlafaxine overdose.Patient concerns:The patient complained of severe pain and tenderness in both thighs, weakness in both ankle flexor and extensor muscles, and a tingling sensation in the toes of both feet.Diagnoses:Bilateral sciatic neuropathy combined with rhabdomyolysis following venlafaxine overdose.Intervention:Needle electromyography revealed fibrillation potentials and positive sharp waves, with absent recruitment in all the major muscles innervating the sciatic nerve bilaterally. Pelvic magnetic resonance imaging was performed after electromyography and revealed multifocal enhancement of signal intensity, suggesting muscle necrosis in the gluteus and thigh muscles, and swelling of both sciatic nerves on short tau inversion recovery (STIR) imaging sequences.Outcomes:Two months later, the patient's ankle dorsiflexion strength, measured with manual muscle test, was grade 0/0, and ankle plantar flexion was grade 0/0. The patient reported little sensation at the lateral and posterior aspects of her lower leg, and dorsum and sole of the foot. A follow-up electromyography study revealed improvement in the long head of the right biceps femoris; polyphasic motor unit action potentials with diminished recruitment were observed, but otherwise unchanged.Lessons:When encountering patients who have overdosed on venlafaxine, it is very important to detect and treat severe complications such as cardiac toxicity, seizure, and rhabdomyolysis, among others. However, if rhabdomyolysis has already materialized, it should not be forgotten that the secondary damage caused by it. Physicians should rapidly detect and be minimized to mitigate future complications.

ObjectiveTo determine the age-related changes in cardiac rehabilitation (CR) outcomes, which includes hemodynamic and metabolic factors, in patients with myocardial infarction (MI).MethodsCR was administered for 8 weeks to 32 men (mean age, 54.0±8.8 years) who underwent percutaneous coronary intervention for acute MI between July 2012 and January 2016. The exercise tolerance tests were performed before and after the CR. The results were stratified based on a cut-off age of 55 years.ResultsIn the whole patient group, the hemodynamic variables such as the resting heart rate (HRrest), systolic blood pressure (SBPrest), submaximal HR (HRsubmax), SBP (SBPsubmax), and rate pressure product (RPPsubmax) significantly decreased and the maximal HR (HRmax) and RPP (RPPmax) significantly increased. All metabolic variables displayed significant improvement, to include maximal oxygen consumption (VO2max) and ventilation (VEmax), anaerobic threshold (AT), and the maximal oxygen pulse (O2pulsemax). However, upon stratification by age, those who were younger than 55 years of age exhibited significant changes only in the HRrest and RPPsubmax and those aged 55 years old or greater displayed significant changes in all hemodynamic variables except diastolic BP. Both groups displayed significant increases in the VO2max, VEmax, and AT; the older group also exhibited a significant increase in O2pulsemax. The magnitude of the changes in the hemodynamic and metabolic variables before and after CR, based on age, did not differ between the groups; although, it tended to be greater among the older participants of this study's sample.ConclusionBecause the older participants tended to show greater hemodynamic and metabolic changes due to CR, a more aggressive CR program must be administered to elderly patients with MI.

The purpose of this retrospective study was to investigate the effect of revised cardiac rehabilitation Clinical Pathways (CPs) on the Cardiac Rehabilitation (CR) participation rate of patients with Myocardial Infarction (MI) undergoing Percutaneous Coronary Intervention (PCI). Methods: We reviewed the electronic medical record of patients who were referred for CR after MI from July 2015 to December 2016. In April 2016, the patient groups were divided into 9-month periods: pre-and post-CP revision. We reduced the mean number of hospital visits for CR and the wait times before starting CR and the first Cardio Pulmonary Exercise (CPX) test. We added a home-based CR program and reinforced the CR liaison nurse's role. The changes in the CR wait time, mean number of hospital visits post-discharge, and participation rates at 1 and 3 months were investigated. Results: Ninety-two patients were recruited from July 2015 to March 2016. Twenty-four (26.1%) participated in CR at 1 month, and 11 (12.0%) were maintained up to 3 months. From April 2016 to December 2016, 107 patients were recruited. Sixty-five (60.7%) participated at 1 month, and 38 (35.5%) were maintained up to 3 months. The mean number of hospital visits was 3.5±0.8 versus 1.9±0.9 in the previous and revised CP groups. The average number of days to the first CPX test after MI was 43.4±17.6 versus 26.3±10.6. Conclusion: Following CP revision, the CR participation rate significantly improved among patients with PCI post-MI. CP revision in terms of inter-physician communication and additional nursing interventions should be considered.

Intraosseous pneumatocyst is a benign, gas-filled, cystic lesion, and is commonly encountered in iliac bone or sacrum. Other locations of this lesion following trauma are rare, and only a handful of isolated cases have been reported. The pathogenesis and etiologies of this uncommon entity are various and it can present a diagnostic challenge. Only four previous cases have described the natural course of intravertebral pneumatocysts. Here, the authors report a rare case of traumatic pneumatocyst, which resolved rapidly without further complication. Possible pathogenic mechanisms are discussed and reviews of literatures are included.