Marina Somin

Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation.

Abstract: Acute renal embolus is rarely reported in the medical literature; thus, accurate data regarding presentation, laboratory tests, diagnostic techniques, and treatment are lacking. To better define this condition, we examined the medical records of all patients admitted to Kaplan Medical Center and Sheba Medical Center in central Israel from 1984 to 2002 who had a diagnosis of renal infarction and atrial fibrillation. We noted demographic, clinical, and laboratory parameters; method of diagnosis; treatment received; and patient outcome. We identified 44 cases of renal embolus: 23 females and 21 males, with an average age of 69.5 ± 12.6 years. Thirty (68%) patients had abdominal pain, and 6 (14%) had a previous embolic event. Nine patients were being treated with warfarin on admission, 6 (66%) of whom had an international normalized ratio (INR) <1.8. Hematuria was present in 21/39 (54%), and 41 (93%) patients had a serum lactate dehydrogenase (LDH) level >400 U/dL. The mean LDH was 1100 ± 985 U/dL. Diagnostic techniques included renal isotope scan, which was abnormal in 36/37 cases (97%); contrast-enhanced computed tomography (CT) scan, which was diagnostic in 12/15 cases (80%); and ultrasound, which was positive in only 3/27 cases (11%). Angiography was positive in 10/10 cases (100%). Twenty-three (61%) of 38 patients had normal renal function on follow-up. The 30-day mortality was 11.4%. Renal embolus was diagnosed mainly in patients aged more than 60 years, some of whom had a previous embolic event. Most of those receiving anticoagulant therapy had a subtherapeutic INR. Abdominal pain was common, as well as hematuria and an elevated LDH. These patients are at risk of subsequent embolic events to other organs. The most sensitive diagnostic technique in this population is a renal isotope scan, but contrast-enhanced CT scan requires further assessment.

Fatal heart block following treatment with botulinum toxin for achalasia

CCS diagnosis category 139) versusregional enteritis and ulcerative colitis (IBD, single-level CCS diagnosis category 144) based on age, sex, income, location, and region, while using the same query for all hospital stays as controls. These two diagnoses were chosen because of the known lower socioeconomic status and later onset of ulcer patients (epidemiology ofHelicobacter pylori ) and anticipated inverse trends for IBD. All hospital stays (discharges) were used as controls to ascertain that socioeconomic differences between the two diseases are not just due to lower socioeconomics of the first, but also to the higher than average socioeconomic status of patients with IBD. Abbreviated results are shown in Table 1 (while the reader is invited to run detailed queries on HCUPnet). As anticipated, IBD is characterized by earlier onset/need for hospitalization, and does affect a higher socioeconomic group. Regional differences (Northeast vs South) may also be a function of socioeconomic differences. Sex distribution in both diagnosis was very similar (not shown)—about 43% male and 57% female, and closely approximated all hospital stays.

Case Report: Three Cases of Chronic Mesenteric Ischemia Presenting as Abdominal Pain and Helicobacter pylori-negative Gastric Ulcer

Mesenteric ischemia is well described as a cause of chronic abdominal pain (1). The classic complaint is of postprandial abdominal pain. The pain steadily increases in severity before reaching a plateau and resolves during the next 1 to 2 hr. The pain appears in the epigastrium and may radiate through to the back. The severity of the pain is greater after large meals or meals with a high fat content (2). These complaints are, of course, not specific and raise the possibility of peptic ulcer disease. Chronic Helicobacter pylori infection is the major cause of peptic ulcer disease, and use of nonsteroidal antiinflammatory drugs (NSAIDs) accounts for the majority of the remainder (3). Non-NSAID, non-H. pylori gastric ulcers are constituting a greater proportion of diagnosed ulcers as the prevalence of H. pylori decreases (3). We report here three cases of chronic mesenteric ischemia where an H. pylori-negative gastric ulcer unassociated with the use of NSAIDs was detected in the initial evaluation. the patients’ complaints ultimately responded to revascularization therapy, with resolution of their non-NSAID, nonH. pylori gastric ulcers.

Perimyocarditis following streptococcal group A infection: From clinical cases to bioinformatics analysis

BACKGROUND Streptococcal infection is known to be associated with non-suppurative complications, including rheumatic fever. A less well recognized complication is perimyocarditis. METHODS We report 4 cases of myocarditis in young males associated with acute streptoccal infection. Following this clinical observation we employed bioinformatic techniques to identify common epitopes between Streptococcus group A and human muscle proteins. We used Blast to search all the proteome (1697 proteins) of the Streptococcus pyogenes M1 GAS against the human proteome of 34,180 proteins. RESULTS 4 patients with streptococcal A related myocarditis were treated and made a complete recovery. One cardiac protein, ATP2A2 (NP_733765.1)), a cardiac Ca2+ ATPase, shared an epitope with Streptococcus group A and a high probability of being presented on a MHC Class II molecule. CONCLUSION Streptococcal myocarditis may be a commoner entity than previously appreciated. Bioinformatic techniques have identified a suspected common epitope between the streptococcal proteins and a cardiac Ca2+ ATPase.