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The Tall T



TCV PTC has a relatively higher predominance in males than classical PTC, occurs at an older age and is considered an aggressive variant (5,10). Patients with TCV exhibit poorer survival than those with classical PTC (5,10). The tall-cell feature alone remains a significant prognostic factor for disease-specific mortality when the major prognostic factors for thyroid cancer are controlled for, including age and extrathyroidal extension (11). In a study of 12 cases of TCV PTC, this tumor type had an aggressive clinical course and a poorer prognosis, compared with classical PTC, in patient populations with a similar age and sex distribution, duration of follow-up and tumor size (12). The patient prognosis also remains less favorable in cases without extrathyroidal extension (13). A large multicenter study demonstrated varied prognostic risk for the three major PTC variants, establishing a risk order for PTC as follows: TCV PTC > classical PTC > follicular variant PTC (14). This previous study demonstrated clinical implications for the management of PTC based on the specific variant (14).




The Tall T



As serum K+ levels rise the qrs complex becomes wider eventually passing the upper limit of normal. At least think of hyperkalemia if you see this combination of wide qrs complexes and tall T waves.


As K+ levels rise further, the situation is becoming critical. The combination of broadening QRS complexes and tall T waves produces a sine wave pattern on the ECG readout. Cardiovascular collapse and death are imminent.


Hyperacute T waves (HATWs) have been described as tall-amplitude, primary T-wave abnormalities sometimes seen in the early phases of transmural myocardial infarction. Despite numerous human and animal studies addressing the presence and significance of HATWs, there are no widely held, reliable ECG criteria for their accurate identification. Using a specially designed computer program on a Hewlett-Packard Realm ECG analysis system, we screened 13,393 adult ECGs to identify those having T-wave amplitudes greater than accepted standards (limb leads, greater than 0.5 mV; precordial leads, greater than 1.0 mV). Patients with other known causes of primary and secondary tall T waves were excluded from the study sample. Patients with tall-amplitude T-waves who then developed clinically verifiable myocardial infarction were labeled the HATW group. The HATW group (21) represented 4.1% of the tall T wave group (513) and 0.16% of the entire sample. The remaining patients, who did not meet HATW criteria, were called the early repolarization variant (ERV) group (51). Both groups underwent comparative computer morphology analysis. Nine parameters were statistically significant in discriminating HATWs from early repolarization variants. A combination of J-point position/T-wave amplitude of more than 25%, T-wave amplitude/QRS amplitude of more than 75%, J-point position of more than 0.30 mV, and age of more than 45 years predicted HATWs from a control group with a specificity of 98.0% and a sensitivity of 61.9% and with positive and negative predictive values of 92.9% and 86.2%, respectively. We conclude that HATWs have characterizable discriminating ECG morphology as determined by computer ECG analysis compared with a control group.


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Leonard's splendid way of inventing odd turns of phrase and similes and making them sound as though there were no possible better way to describe something made him, in my opinion, one of the great wordsmiths of the past century. So when I became, for a time, part of the cast of "Justified," the FX TV series based on Leonard's work, I hoped that I would actually get to say some real Leonard dialog. More than that, I hoped his involvement with the show meant I might get to meet him. I never did. The closest I came was meeting the writers of the show, two of whom were coincidentally named (Taylor) Elmore and Leonard (Chang). What was wonderful was how well these writers captured the essence of Elmore Leonard: the clarity, the boiled-down-to-its-primary-ingredient precision, the humor to be found in the worst possible circumstances, the ability to flip a familiar phrase around to make it new and better.


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In simple terms I would believe the mechanism of ischemic tall T waves are almost similar to renal hyperkalemia. (A local , transient extracellular k + excess ) The base of the T waves are not narrow and tented as in CKD because some degree of ST elevation (that always is expected ) widens the base of T wave. Further ,the prolonged QT interval in renal hyperkalemia stretches the QT and encroach the base of the T wave to the left making it appear narrow. 041b061a72


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