Fibrinolysis treatment for loculated parapneumonic pleural effusion secondary to right lower lobe pneumonia.

The administration of fibrinolytic agents in the pleural cavity is an alternative treatment for the management of loculated empyemas in patients who are poor candidates for surgery and/or do not respond to more standard treatments (e.g., chest tube placement, pleurodesis).

A rare case of uterine leiomyosarcoma metastasis to the duodenum.

Uterine leiomyosarcoma (ULMS) is an uncommon malignant tumor that accounts for less than one-third of uterine sarcomas and approximately 1% of uterine malignancies. Cases of local and distant ULMS metastasis have been widely reported, especially to the lungs. There have been very few cases, however, of ULMS metastasis to the upper gastrointestinal (GI) tract published in the peer-reviewed literature.

Delayed-onset heparin-induced thrombocytopenia type-2 during fondiparinux (Arixtra) therapy.

Heparin is the most commonly used anticoagulant drug for prevention and treatment of thromboembolic diseases. Heparin-induced thrombocytopenia (HIT) is a well-known and potentially fatal side-effect of heparin therapy. HIT type 1 (HIT-1) is transient and relatively common; it usually develops within 1-7 days of initial heparin exposure.

The impact of systemic sclerosis on arterial wall stiffness parameters and endothelial function.

Systemic sclerosis (SSc) is characterized by thickening and fibrosis of skin and internal organs that is associated with vascular damage. SSc may lead to arterial dysfunction and premature aging of the arteries. However, its relationship with parameters of arterial wall dysfunction has not been fully explored.

An atypical course of myasthenia gravis.

Myasthenia gravis (MG) is a chronic neuromuscular disease which leads to varying degrees of weakness in the skeletal muscles. Some of the symptoms of the disorder include weakness of the eye muscles, difficulty in swallowing and slurred speech. When only the muscles of the eyes are affected, the illness is termed ocular myasthenia, which is often characterized by abrupt onset of diplopia and ptosis of the eyelid.

Wegener's granulomatosis presenting as fever of unknown origin in an African-American male.

Wegener's Granulomatosis (WG) is a rare, Multisystem disease of the medium and small sized arteries and veins. It most commonly involves the upper respiratory tract, lungs, and kidneys and often presents as chronic fatigue, upper respiratory infection, sinusitis, and otitis media. Symptoms can include fever, weight loss and fatigue, though these are not usually the primary presenting complaints.

Methemoglobinemia and transesophageal echo.

Methemoglobin (MHb) is the oxidized form of Hemoglobin (Hb) containing iron in its ferric (Fe3+) rather than ferrous (Fe2+) state. Under physiologic conditions, diaphorase II accounts for only a small percentage of the red blood cell reducing capacity but can be pharmacologically activated by exogenous cofactors. Methemoglobinemia is an abnormal elevation of MHb levels resulting in impaired oxygen delivery to tissues as well as a left shift of the oxygen-Hb dissociation curve.

Systemic assessment of arterial wall structure and function in metabolic syndrome.

Metabolic syndrome (MetS) is thought to increase cardiovascular risk. The aim of this study was to investigate whether the MetS and its components are associated with parameters of arterial stiffness, flow mediated dilatation (FMD) of the brachial artery, carotid intima-media thickness (IMT) and the presence of carotid plaques (CP) in middle-aged subjects. One-hundred eighty-six asymptomatic volunteers (40-65 years-old, 86 males and 100 females) without clinically overt cardiovascular disease were examined.

Non-invasive assessment of arterial stiffness indices by applanation tonometry and pulse wave analysis in patients with rheumatoid arthritis treated with TNF-alpha blocker remicade (infliximab).

Rheumatoid arthritis (RA) is accompanied by long lasting inflammation, which may lead to arterial dysfunction and premature aging of the arteries. The purpose of this clinical work was to determine the modification of carotid-radial pulse wave velocity (PWV) and aortic augmentation index (AIx) in young-aged RA patients and the influence of treatment with anti-TNF-alpha (infliximab) on these measures. We examined 68 RA patients (mean age 40.

Herpetic and candidal infections of the esophagus in an elderly male.

We present the unique case of an eighty-nine-year-old male without any immunodeficiency state or taking immunosuppressive medication and who did not have conditions affecting clearance of the esophageal lumen who was diagnosed with simultaneous herpetic esophagitis and candidal duodenitis.

Platelet aggregation inhibition in patients receiving statins either fully or partially metabolized by CYP3A4.

Clopidogrel therapy is the standard for prevention of cardiovascular thrombotic events. Clopidogrel is converted to an active thiol by the cytochrome P450 CYP 3A4 and 2C19 enzymes. Recent studies suggest that statins metabolized by CYP3A4 attenuate the anti-aggregatory effect of clopidogrel.

Splenic non-Hodgkin's lymphoma presenting as recurrent kidney stones -- an "incidentaloma"?

Splenic lymphoma, or primary malignant lymphoma of the spleen (PMLS), is an uncommon condition whose true nature is difficult to define due to the variable ways it has been classified. Out of all non-Hodgkin's lymphomas it comprises less than 2% of cases. Some experts suggest that PMLS only involves the spleen and splenic hilum, while others consider PMLS to be an entity that develops within the spleen and later has the potential for invading adjacent organs and metastasizing.

Takotsubo cardiomyopathy: case report and review of the literature.

Takotsubo cardiomyopathy, also known as stress induced cardiomyopathy and transient left ventricular apical ballooning syndrome, is a rare syndrome that is characterized by a transient decrease in ejection fraction. This is accompanied by hypokinesis of the left ventricle and ballooning of the apex, with hypercontractile base and non-obstructive coronary artery disease. Takotsubo was first described in Japan in the early 1990's.

Coronary artery disease risk factors in patients with diastolic dysfunction.

Diastolic dysfunction (DD) is a common entity associated with advanced age and hypertension, often present in patients with ischemic heart disease. The correlation of DD and coronary artery disease (CAD) in asymptomatic young patients is not known. We sought to determine the prevalence of CAD risk factors in asymptomatic patients with DD.

Cervical cancer screening among elderly urban women in a primary care setting.

Cervical cancer remains an important cause of morbidity and mortality in older women. The cancer screening by means of Papanicolaou (Pap) smear testing has been shown to improve early detection. One quarter of new cases of invasive cervical cancer occur in women age 65 and older, yet only 52% of this population has had cervical cytology within the past 3 years, and approximately 25% of elderly women have never been screened.

Prolonged requirement for ventilatory support in a patient with Eskalith overdose.

Lithium (Eskalith) is commonly used in the treatment of depressive and bipolar affective disorders, in a population at relatively high risk for overdose. Lithium may help correct a chemical imbalance in the brain; however, it has a comparatively narrow therapeutic index. Thus, lithium intoxication is a frequent complication of chronic lithium therapy.

Unique case of thrombotic thrombocytopenic purpura and diabetes insipidus.

Thrombotic thrombocytopenic purpura (TTP) is a rare and often fatal disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, mental status changes, and renal dysfunction. Central diabetes insipidus (CDI) is a rare disease due to anatomic lesions of the hypothalamicpituitary system associated with various underlying diseases, or trauma. We present an unusual case of TTP and CDI in a 47 year-old African American female who was admitted to our hospital with crampy abdominal pain and nausea.

Troponin I as a marker of doxorubicin induced cardiotoxicity.

Doxorubicin is a chemotherapeutic agent successfully used in the treatment of a wide range of cancers. However, with cumulative doses, doxorubicin also is known to have cardiotoxic effects, including cardiomyopathy and heart failure. Identification and quantification of myocardial cell damage has been a point of Controversy.

Etiology of cerebrovascular accidents in octogenarians.

Stroke is the third leading cause of death in the United States, after coronary heart disease and cancer. Many survivors are left with mental and physical impairment and require assistance with activities of daily living. Twenty-eight percent of patients with stroke are under 65 years of age.

Correlation between cardiac enzyme elevation and the duration of cardiopulmonary resuscitation.

Cardiovascular disease is the leading cause of death in the United States. Acute myocardial infarction (MI) is defined as necrosis of myocardial cells. Several studies have shown that cardiac markers are elevated after successful cardiopulmonary resuscitation (CPR) due to physical as well as electrical trauma.

Nephropathy in critically Ill patients without preexisting renal disease.

Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Isovue (lopamidol) is a low-osmolality nonionic monomeric tri-iodinated water soluble agent widely used as a contrast medium in radiographic procedures for intravascular, intrathecal, and body cavity administration. The purpose of this study was to evaluate the effect of lopamidol on renal function in patients without any preexisting renal condition who were undergoing radiographic imaging with the iodine contrast.

Prevalence of hypertension in Lithuanian mariners.

Several international studies from Spain, the Netherlands, Poland, Croatia, and Finland indicate contradicting findings regarding cardiovascular dysfunction among seamen, deep sea fishermen, and harbor workers. The purpose of the present survey was to evaluate the prevalence of hypertension in a selected group of Lithuanian seamen. The survey was conducted during a one year period and involved sailors from commercial, passenger, and fishing boats.

Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing.

Chronic atrial fibrillation (AF) is a common arrhythmia with significant morbidity and mortality. AF has been the subject of considerable attention and intensive clinical research in recent years. Current opinion on the management of AF favors the restoration and maintenance of normal ventricular rhythm.

High-frequency ultrasonographic imaging of the endothelium-dependent flow-mediated dilatation (FMD) in a brachial artery: normative ranges in a group of low CV risk subjects of different ages.

High-frequency ultrasonographic imaging of flow-mediated dilatation (FMD) in a brachial artery, as non-invasive technique, was used for the clinical evaluation of endothelial function (EF) in 115 subjects (ages 44.19+/-12.23 (26 to 83) free of coronary heart disease or its equivalents.