A rare presentation of the Klinefelter's syndrome

A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter's syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and siblings. His laboratory tests showed high levels of FSH and normal levels of LH and testosterone. With regards to all these findings, we suspected that there might be an occult Klinefelter's syndrome. So, we made his karyotype that showed a 47XXY pattern. Because there are only a few number of cases that have occult Klinefelter's syndrome in the basis of chronic renal failure, we decided to report this case

A rare presentation of the Klinefelter's syndrome

A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter's syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and siblings. His laboratory tests showed high levels of FSH and normal levels of LH and testosterone. With regards to all these findings, we suspected that there might be an occult Klinefelter's syndrome. So, we made his karyotype that showed a 47XXY pattern. Because there are only a few number of cases that have occult Klinefelter's syndrome in the basis of chronic renal failure, we decided to report this case

The Effect of Aortic Valve Replacement on Left Ventricular Function in Patients with Aortic Valvular Disease

Despite improved surgical techniques and survival in patients following aortic valve replacement for aortic stenosis and aortic insufficiency, the proper timing for surgery remains controversial. The incomplete reversibility of left ventricular dysfunction remains a concern, and postoperative improvement of left ventricular function is not consistently demonstrated. We studied 11 patients with aortic stenosis and nine patients with aortic insufficiency using angiographic and radioisotope assessment of left ventricular function preoperatively. Postoperative left ventricular function was assessed over nine to 13 months by radioisotope multiple-gated acquisition (MUGA) scan. All patients with impaired left ventricular function preoperatively showed slow but significant recovery toward a normal left ventricular ejection fraction by nine to 13 months postoperatively. Patients with aortic stenosis or aortic insufficiency and depressed left ventricular function can clearly obtain substantial, albeit delayed, improvement after valve replacement

Patterns of Complex Comorbidity in Older Patients with Heart Failure

Background Heart failure (HF) carries a high burden of comorbidity with approximately one half of patients with HF having at least one additional comorbid condition present. Rates of comorbidity in patients with HF have steadily increased over the past 2 decades. Objective To examine patterns of comorbidity among older patients with HF in the Cardiovascular Research Network PRESERVE cohort. Methods PRESERVE Cohort Data are from the CVRN PRESERVE cohort which is a multicenter cohort of 37,054 patients [mean age = 74 years (SD = 12.4 yrs); 46% female] with HF diagnosed between 2005 and 2008 currently being conducted at 4 CVRN sites: KPNC, KPCO, KPNW, and FCHP. The primary data source for the PRESERVE cohort was the HMO Research Network Virtual Data Warehouse. Identification of Coexisting Diseases Coexisiting illnesses at the time of HF diagnosis were based on diagnoses and procedures mapped to relevant International Classification of Diseases, Ninth Edition (ICD-9) codes. For the purposes of characterizing clusters of comorbidities, we focused on coexisting conditions with a prevalence rate of ≥3%. Statistical Analysis We used the Agglomerative Clustering technique to characterize patterns of comorbidity. Over multiple iterations, each condition is clustered with the condition with which it has the highest squared correlation. This process is repeated to determine whether assigning a condition to a different cluster increases the amount of explained variance [ranging from 1.0 (all variance explained) to 0.0 (no variance explained)]. The conditions in each cluster are as correlated as possible among themselves and as uncorrelated as possible with conditions in other clusters. Results Burden of Comorbidity There was a high degree of comorbidity and multi-morbidity among patients with HF. (Table 1) Hypertension and arrhythmias were the comorbidities of HF that occurred most often in the absence of other chronic conditions (4.8% and 4.7%, respectively). The average number of comorbid conditions varied from 3.5 to 5.2. Patients with HF and unstable angina or other thromboembolic disorders had the highest multi-morbidity (mean = 5.2 conditions), whereas those with HF and hypertension had the lowest (mean = 3.5). Clustering of Comorbiditites A five-cluster structure was derived. Cluster 1: Dyslipidemia, Hypertension, Diabetes Mellitus, Visual Impairment Cluster 2: Acute Myocardial Infarction, Unstable Angina, Thromboembolic Disorder, Dementia Cluster 3: Aortic Valvular Disease, Cancer, Hearing Impairment, Arrthythmia Cluster 4: Peripheral Arterial Disease, Stroke Cluster 5: Lung Disease, Liver Disease, Depression Discussion and Conclusions Cluster analysis is an innovative approach to examining the co-occurrence of diseases and allows for identification of broad patterns of multi-morbidity beyond the pairings of diseases or disease counts. Patients with HF have a high rate of multi-morbidity, with an average of 4 co-occurring conditions. Intuitive and unintuitive patterns of clustering were identified. Randomized clinical trials in HF will need to include more diverse patient populations in order to adapt to the increasingly complex patient population. A cluster analysis approach to characterizing patterns of comorbidity may help indentify important patient subgroups

An analytical study of one hundred cases of rheumatic heart disease in children

In this Thesis are given the results of an investigation into the social and medical histories of one hundred cases of rheumatic heart disease.In the first section of the Thesis are given the clinical findings upon which the diagnosis of heart disease has been based. In the next section follows the incidence rates of acute arthritis, chorea, growing pains, tonsillitis and scarlet fever, discovered in the histories of these patients. The results of tonsillectomy in the prevention of rheumatism are given. In other sections the subjects of enquiry are the social circumstances of the patients, and the relationship between the environment of the patients and the incidence of rheumatism among them.Two series of control cases have been used in these investigations, the first control series was a group of 600 children drawn from the same localities and schools as the rheumatic heart cases, and the second control series a group of 500 boys from a public school in the City.The examination of all these cases was carried out in the schools and school clinics in Hull, and in compiling their case- histories, use was made of Medical Âecords from the Maternity and Child Welfare Department and the School Medical Department of Hull. These records gave a very full account of the past illnesses of the children and added greatly to the reliability of the histories recorded.In the final section of the thesis are discussed and summarised the results from this enquiry