Mitral valve paravalvular leaks: Comprehensive review of literature.

Background: Mitral paravalvular leaks (mPVL) are a recognized complication for patients with mitral valve prostheses. Although clinically insignificant for many patients, it may pose life-threatening haemolysis and regurgitation-induced heart failure, and so clinicians should have a high index of suspicion in the presence of new symptoms.

Aims: This review discusses the pathogenesis, clinical features, diagnosis, imaging and treatment of mPVLs.

Combined hormonal contraceptives and the risk of venous and arterial thromboembolism and cardiovascular death: misuse of automated databases.

Background: In December 2011, the US Food and Drug Administration (FDA) convened a public Advisory Committee meeting to review evidence from a study commissioned by the agency. An analysis of findings derived from four databases was published on the FDA website, and presented at the meeting. Among users of combined hormonal contraceptives containing ethinylestradiol (EE) plus drospirenone (DRSP) the risks of venous (VTE) and arterial thromboembolism (ATE) were higher than among users of older reference contraceptives containing other progestogens.

Catastrophic antiphospholipid syndrome: proposed guidelines for diagnosis and treatment.

The term "catastrophic" antiphospholipid syndrome (APS) was introduced to define an accelerated form of APS resulting in multi-organ failure. Although patients with the catastrophic form represent less than 1% of all patients with APS, they are usually in a life-threatening medical situation that requires high clinical awareness. In this article, we propose guidelines for the diagnosis and treatment of patients with catastrophic APS, based on the cumulated published experience of 130 cases with this syndrome.

Recurrent alveolar hemorrhage and pulmonary capillaritis in the "primary" antiphospholipid syndrome.

Pulmonary involvement in the primary antiphospholipid syndrome (PAPS) has generally been on the basis of thromboembolism. We describe a patient with hemorrhagic alveolitis, a life-threatening complication that must also be considered. The patient was a 63-year-old Caucasian man who had a past history of recurrent deep vein thromboses as well as an arterial occlusion of the left popliteal artery and who developed hemorrhagic alveolitis and capillaritis at age 57 years, which was treated with long-term cyclophosphamide, steroids, and anticoagulation.

Molecular mechanisms, emerging etiological insights and models to test potential therapeutic interventions in Alzheimer's disease.

Alzheimer's disease (AD) is a common cause of dementia, resulting from accumulated beta-amyloid protein deposits in the brain. As the population ages the incidence of AD is also on the rise. The incidence is very high in the developed countries where life expectancy is high, but it is also rising rapidly in the developing countries.

Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines.

The term 'catastrophic' antiphospholipid syndrome (APS) is used to define an accelerated form of APS resulting in multiorgan failure. Although catastrophic APS patients represent less than 1% of all patients with APS, they are usually in a life-threatening medical situation that requires high clinical awareness. The careful and open discussion of several proposals by all participants in the presymposium workshop on APS consensus, held in Taormina on occasion of the 10th International Congress on aPL and chaired by Munther A Khamashta and Yehuda Shoenfeld (29 September 2002), has allowed the acceptation of a preliminary set of classification criteria.

Unusual manifestations of the antiphospholipid syndrome.

The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years.

Antiphospholipid antibodies and infections.

Many infections have been found to be associated with antiphospholipid antibodies (aPL), although a pathogenic role for these antibodies has not usually been obvious except in a few isolated cases. Two types of aPL have been referred to as "autoimmune" and "infectious" types. This distinction, however, has subsequently been found not to be absolute.

Tracheoesophageal speech in a developing world community.

Objectives: To determine the tracheoesophageal speech results in a Third World medical practice; to examine the impact of socioeconomic status, literacy, and proximity to specialist services on tracheoesophageal speech; to assess whether these factors should affect patient selection for fistula speech; and to determine guidelines for voice prosthesis selection.

Design: Retrospective analysis.

Setting: Groote Schuur Hospital, Cape Town, South Africa, which serves a Third World community.

Laser ablation of granulation tissue at the tracheoesophageal puncture site.

Background: Tracheoesophageal fistula speech may be complicated by granulation tissue around the puncture site. Treatment includes antibiotics, antifungals, chemical or electrocautery, and surgical excision of the granulation tissue. Chemical cautery generally requires repeated treatment sessions.

Catastrophic antiphospholipid syndrome.

In its classic presentation, the antiphospholipid syndrome manifests a combination of venous or arterial thrombosis and fetal loss, accompanied by elevations of antibodies directed toward negatively charged phospholipids, as measured by anticardiolipin antibody assays and/or positive lupus anticoagulant tests. The manifestations often include a moderate thrombocytopenia and, less commonly, hemolysis. In contrast, a less frequently encountered subset of the antiphospholipid syndrome, termed the "catastrophic" antiphospholipid syndrome, affects mainly small vessels predominantly supplying organs.

The catastrophic antiphospholipid syndrome, 1998. A review of the clinical features, possible pathogenesis and treatment.

A review of 50 patients who manifest features of the catastrophic antiphospholipid syndrome (CAPS) is presented. The clinical features comprise mainly organ involvement as opposed to large-vessel venous or arterial occlusions as is seen in patients with 'simple' antiphospholipid syndrome (APS), which makes the pathogenesis of this unusually rare complication perhaps somewhat different from that of patients with the APS. The mortality of the condition is 50%, most patients dying as a result of a combination of cardiac and respiratory failure.

Catastrophic antiphospholipid syndrome. Clinical and laboratory features of 50 patients.

We analyzed the clinical and laboratory characteristics of 50 patients with catastrophic antiphospholipid syndrome (APS) (5 from our clinics and 45 from a MEDLINE computer-assisted review of the literature from 1992 through 1996). Thirty-three (66%) patients were female and 17 (34%) were male. Twenty-eight (56%) patients had primary APS, 15 (30%) had defined systemic lupus erythematosus (SLE), 6 (12%) had "lupus-like" syndrome, and 1 (2%) had rheumatoid arthritis.

Antiphospholipid antibodies: guidelines for determination.

Although significant progress has been made during the last decade in our knowledge of the antiphospholipid antibodies (aPL), there are two major questions in clinical practice that require further guidelines: Indications for aPL determination and laboratory tests to choose. This article reviews the main clinical indications to search for aPL (systemic lupus erythematosus, selected autoimmune conditions, spontaneous venous and arterial thrombosis, recurrent fetal losses, and autoimmune thrombocytopenia, among others) as well as the routine tests to detect aPL (serological tests for syphilis, lupus anticoagulant tests, solid phase techniques to detect anticardiolipin and other aPL and antibodies to aPL cofactors). Finally, a complete work-up is suggested for those patients with clinical manifestations of the aPL syndrome but without detection of aPL in the routine tests ("seronegative" aPL syndrome).

The catastrophic antiphospholipid syndrome 1996: acute multi-organ failure associated with antiphospholipid antibodies: a review of 31 patients.

Thirty one patients with antiphospholipid antibodies who developed multi-organ failure ("Catastrophic Antiphospholipid Syndrome") are reviewed. Thirteen suffered from a 'Primary' antiphospholipid syndrome, 13 from defined SLE, 4 from 'lupus-like' disease and one from rheumatoid arthritis. In more than one third precipitating factors were evident (e.

Review: antiphospholipid antibodies and the lung.

Pleuropulmonary complications of systemic lupus erythematosus (SLE) occur in 50-70% of patients and include pleuritis, pleural effusions, acute lupus pneumonitis, diffuse interstitial lung disease, atelectasis, diaphragmatic dysfunction and bronchiolitis obliterans. Additionally, a syndrome of acute reversible hypoxemia has recently been documented. This seems to occur in patients hospitalized for exacerbations of SLE and may be due to pulmonary leukoaggregation.

Early appearance of dispersed low density lipoprotein receptors on the fibroblast surface during recycling.

We have examined the distributions of recycling low density lipoprotein receptors (LDL-Rs) as they emerge onto and cluster on the surfaces of cultured cells. Surface LDL-Rs were labeled with colloidal gold-LDL conjugates (AuLDL) and cells viewed as whole-mounts in the transmission electron microscope. The steady-state distribution of LDL-Rs on the cell surface, labeled with AuLDL at 4 degrees C, comprised ring-shaped clusters of receptors with dispersed receptors scattered amongst them.