Homayoun Khanlou

Long-term Remission of Refractory Stiff-Man Syndrome After Treatment With Intravenous Immunoglobulin

The stiff-man syndrome is a rare neuromuscular disorder characterized by progressive rigidity, stiffness, and intermittent spasm of axial and extremity muscles. Its etiology is unknown. Different therapeutic regimens have been used with variable success. We present a case of refractory stiff-man syndrome, in which the symptoms were successfully controlled by the administration of intravenous immunoglobulin (IVIg). This case gives evidence that IVIg can be a safe and an efficient treatment of refractory stiff-man syndrome. The exact indication for and the cost-effectiveness of IVIg in the treatment of this rare entity remain to be determined.

Fatal alveolar hemorrhage and Abciximab (ReoProTM) therapy for acute myocardial infarction

We describe two cases of diffuse alveolar hemorrhage and development of ARDS in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting in whom Abciximab (ReoPro) was used in combination with other agents interfering with the hemostatic mechanism. The development of pulmonary infiltrates, associated with a fall in hemoglobin after the administration of Abciximab, should strongly suggest the possibility of diffuse alveolar hemorrhage. Physicians should be aware of the possible association between the use of Abciximab and the development of alveolar hemorrhage.

Resolution of adult respiratory distress syndrome after recovery from fulminant hepatic failure.

Adult respiratory distress syndrome (ARDS) complicating the course of fulminant hepatic failure is nearly always fatal without orthotopic liver transplantation. We report the case of a 50-year-old woman with fulminant hepatic failure and ARDS that resolved after her recovery from the acute liver failure without liver transplantation. The pathogenesis is discussed, particularly with regard to liver-lung interactions.

Schwannoma of posterior mediastinum: A case report and concise review****

In the vast majority of cases, schwannoma (neurilemmoma) of the posterior mediastinum arises from 1 of the intercostal nerves and most often is manifested by an asymptomatic solitary mass on a radiograph. This case report emphasizes the importance of new imaging studies in the diagnosis of this classic tumor of the mediastinum, with special regard to the differential diagnosis of such a tumor.

Relationship between Mitral valve regurgitant flow and peripartum change in systemic vascular resistance

Mitral regurgitation is usually tolerated well in pregnancy, mainly because of left ventricular unloading due to the physiologic decrease in systemic vascular resistance (SVR). We report the case of a patient with mitral regurgitation who had pulmonary edema soon after delivery, which likely was due to a sudden increase in SVR. The sudden changes in SVR should be added to the differential diagnosis when pulmonary edema occurs after delivery in patients with mitral regurgitation.

Massive Subfascial Hematoma After Alteplase Therapy for Acute Myocardial Infarction

The authors report a case of a patient who received alteplase for acute myocardial infarction and developed spontaneous subfascial hematoma without any evidence of direct trauma. Subfascial hematoma remains a rare and self-limited complication of thrombolytic therapy. The development of cutaneous ecchymosis associated with a sudden fall in hemoglobin after the administration of alteplase should strongly suggest the possibility of diffuse subfascial hematoma. Physicians should be aware of the possible association between the use of alteplase and the development of subfascial hemorrhage.