Multiple-shower thromboembolism in an artificial mitral valve patient

BACKGROUND: Late acute left atrial thrombosis is a rare life-threatening complication that mostly appears with predisposing primary coagulopathy, such as Protein C, Protein S, antithrombin 3 deficiency, antiphospholipid syndrome or hyperhomocysteinemia. We present grave outcome due to lack of anticoagulation in a patient with artificial mitral valve. CASE PRESENTATION: A 47-year-old male known to have an artificial valve was hospitalized in another hospital due to an acute illness. Anti-coagulation therapy was not provided during that hospitalization. He was transferred to our hospital due to lower limb weakness and diagnosed by us as having extensive emboli disease with complete occlusion of the distal aorta. Multiple infarcts were found in the abdominal organs and leg muscles. He suffered from multiple organ failure and eventually died. CONCLUSION: Neglecting the common practice of anticoagulation to a patient with a mechanical heart valve may, in rare cases, lead to immediate catastrophic event caused by shower thrombemboli with disseminated vascular occlusion from the left atrium to the abdominal aorta causing complete occlusion, spleen, kidney and muscle infarcts

Angioimmunoblastic T-cell lymphoma presenting as giant kidneys: a case report

<p>Abstract</p> <p>Introduction</p> <p>Angioimmunoblastic T-cell lymphoma is a rare form of tumor of the lymph nodes or lymphoid tissue. In this report we describe an unusual presentation of angioimmunoblastic T-cell lymphoma consisting of giant kidneys with no nephrotic syndrome.</p> <p>Case presentation</p> <p>A 46-year-old Arabic man from Gaza was hospitalized in our ward due to abdominal pain and a weight loss of 20 kg during the preceding two months. The results of the physical examination and laboratory tests raised the possibility of neoplastic disease. A computerized tomographic scan of the abdomen showed huge kidneys, and a kidney biopsy showed infiltration by lymphocytes and eosinophils. The genetic examination revealed T-cell lymphoma. Diagnosis was made by a lymph node biopsy, which shows typical findings of angioimmunoblastic T-cell lymphoma.</p> <p>Conclusions</p> <p>Angioimmunoblastic T-cell lymphoma can present with huge kidneys without nephrotic syndrome.</p

The Role of Bile Acid Excretion in Atherosclerotic Coronary Artery Disease

The impact of cholesterol and different classes of lipoproteins on the development of coronary artery disease (CAD) has been investigated in extensively during the past 50 years. The cholesterol metabolism is dependent on numerous factors, including dietary fat, fractional absorption of dietary cholesterol, tissue stores of cholesterol, endogenous cholesterol synthesis, and fecal bile excretion. Several studies showed significantly lower amounts of bile acid secretion in adult patients with CAD compared to non-CAD patients. Could it be that the inability to efficiently excrete bile acids may lead to CAD development

Diminished bile acids excretion is a risk factor for coronary artery disease: 20-year follow up and long-term outcome

Background: Patients with coronary artery disease (CAD) had significantly lower bile acid excretion (BAE) compared with non-CAD patients, leading to the hypothesis that the inability to efficiently excrete bile acids leads to coronary atherosclerosis development. We investigated the long-term role of BAE in CAD development and related mortality in 50 patients with proven CAD compared with that of 50 patients with chest pain and no CAD (controls) matched for clinical and laboratory characteristics. Methods: All subjects received a 4-day standard diet that included ~500 mg of cholesterol. Fecal bile acids from 24-h stool collections were measured by gas liquid chromatography. Results: CAD patients excreted lower amounts of total bile acids than controls ( p < 0.001), less deoxycholic acid ( p < 0.0001) and less lithocholic acid ( p < 0.01). BAE was the best significant independent laboratory factor that predicted CAD ( p < 0.05). Mortality and CAD development rates were significantly lower for the controls at the 20-year follow up. Conclusions: These results showed that CAD patients had markedly decreased BAE levels compared with non-CAD controls. BAE <415 mg/day was associated with increased CAD long-term mortality. Impaired ability to excrete cholesterol might be considered an additional independent risk factor for CAD development

Unusual Coexistence of Giant Cell Tumor and Small Bone Tuberculosis of the Hand - A Case Report

Background: The coexistence of giant cell tumor (GCT) and metacarpal bone tuberculosis (TB) of the hand has never been described before in the English written literature. We report here a first observation.&nbsp;Case presentation: We report the case of a 49-year-old male who presented with severe pain in his left hand following a blunt trauma. A plain X-ray of the metacarpal bones showed a pathological fracture of the 4th metacarpal bone (diaphysis), and computerized tomography and magnetic resonance imaging studies confirmed the diagnosis of destructive (lytic) lesions. biopsy of the metacarpal lesion revealed a GCT, and tissue cultures were positive for mycobacterium tuberculosis (TB). He was treated by a standard 4-drug protocol of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months and an additional 6 months of isoniazid and rifampicin. He then underwent excision of the metacarpal lesion, and the pathological examination showed a GCT with cultures negative for TB.&nbsp;Conclusions: The correct diagnosis of this unique combination of pathologies (GCT and metacarpal bone TB) depended on a high index of clinical suspicion, referral to mycobacterial laboratory tests, careful histologic examination of tissue samples and especially radiomorphologic findings.</p

Internal Thoracic Impedance - A Useful Method for Expedient Detection and Convenient Monitoring of Pleural Effusion

<div><p>Measurement of internal thoracic impedance (ITI) is sensitive and accurate in detecting acute pulmonary edema even at its preclinical stage. We evaluated the suitability of the highly sensitive and noninvasive RS-207 monitor for detecting pleural effusion and for demonstrating increased ITI during its resolution. This prospective controlled study was performed in a single department of internal medicine of a university-affiliated hospital between 2012-2013. One-hundred patients aged 25–96 years were included, of whom 50 had bilateral or right pleural effusion of any etiology (study group) and 50 had no pleural effusion (controls). ITI, the main component of which is lung impedance, was continuously measured by the RS-207 monitor. The predictive value of ITI monitoring was determined by 8 measurements taken every 8 hours. Pleural effusion was diagnosed according to well-accepted clinical and roentgenological criteria. During treatment, the ITI of the study group increased from 32.9±4.2 ohm to 42.8±3.8 ohm (<i>p</i><0.0001) compared to non-significant changes in the control group (59.6±6.6 ohm, <i>p</i> = 0.24). Prominent changes were observed in the respiratory rate of the study group: there was a decrease from 31.2±4.0 to 19.5±2.4 ohm (35.2%) compared to no change for the controls, and a mean increase from 83.6±5.3%-92.5±1.6% (13.2%) in O2 saturation compared to 94.2±1.7% for the controls. Determination of ITI for the detection and monitoring of treatment of patients with pleural effusion enables earlier diagnosis and more effective therapy, and can prevent hospitalization and serious complications, such as respiratory distress, and the need for mechanical ventilation.</p><p>Trial Registration</p><p>The study is registered at ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/results?term=NCT01601444" target="_blank">NCT01601444</a></p></div

Consort Flow Diagram.

<p>Consort Flow Diagram.</p