Yeouda Edoute

Clinical manifestations of sarcoid liver disease

Sarcoidosis is a systemic granulomatous disease of unknown etiology that involves many organs and has different clinical manifestation. We reviewed the clinical manifestations of sarcoid liver disease. Liver involvement in sarcoidosis can be serious and life‐threatening, independent of its lung and other organ involvement.

Diagnosis and Treatment of Urinary Tract Complication in Crohn’s Disease: An Experience over 15 Years

BACKGROUD: Urinary tract complications in Crohn’s disease are common but treatable, and often present diagnostic and therapeutic dilemmas.

Long-term prognosis of acute pulmonary oedema — an ominous outcome

Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long‐term outcomes. There is a relative paucity of studies describing prognosis of consecutive unsolicited patients diagnosed with APOE and hospitalized in internal medicine departments.

Case Report: Severe cholestatic jaundice induced by Epstein‐Barr virus infection in the elderly

Infectious mononucleosis due to Epstein‐Barr virus (EBV) is almost always a self‐limited disease, most commonly seen in young adults. Hepatitis is a well‐recognized complication of EBV infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. We report a 60‐year‐old man with severe cholestatic jaundice whose history, liver histology and laboratory findings suggested EBV infection. He also developed significant jaundice related to his hepatitis, but not to autoimmune haemolysis, a situation that led to diagnostic delay. Costly diagnostic laboratory tests and invasive procedures were performed to rule out a malignant extrahepatic biliary obstruction. Physicians need to be aware of this complication and EBV infection should be included in the differential diagnosis of cholestatic jaundice in the elderly.

A fatal case of Behcet's disease associated with multiple cardiovascular lesions

Behçets disease is recognised as a chronic multisystem disorder with vasculitis as its underlying pathological process. Cardiac involvement is rare and often associated with poor prognosis. A large right atrial thrombus, pulmonary aneurysms and aortic pseudoaneurysm that developed 17 years after surgery for bilateral renal artery stenosis is presented in a 26-year-old Behçets disease patient. He was admitted to the hospital with fever of unknown origin associated with chest pain, dyspnea, cough, haemoptysis and pulmonary opacity in chest X-ray. Initial pulmonary CT demonstrated small subpleural infiltrates bilaterally, one of which was round and suspected as being metastatic. Examination of open lung biopsy demonstrated haemorrhagic infarct surrounded by some occluded pulmonary arteries. Subsequent CT showed pulmonary aneurysms compatible with Behçets disease. Echocardiography demonstrated a large pedunculated mass in the right atrium. Injection of urographin showed a right atrial mass and a large right pulmonary artery aneurysm. The atrial mass was completely excised during open heart surgery and was identified as being an organising thrombus. Eight weeks later while taking prednisone, he was readmitted because of an infected mid sternal wound. CT showed slight separation of the stemum, retrosternal fluid, pulmonary arteries aneurysm and ascending aorta aneurysm. The next day, the patient died from massive bleeding from his ruptured ascending aortic pseudoaneurysm. Bizarre presentation of arterial and venous thromboses or arterial aneurysm formation, particularly in young patients, should suggest Behçets disease.

Prospective evaluation of pulmonary edema.

Objectives: To describe the clinical profile and hospital outcome of successive unselected patients with pulmonary edema hospitalized in an internal medicine department. Design: Prospective, consecutive, unsolicited patients diagnosed with pulmonary edema. Setting: An internal medicine department in a 900 tertiary care center. Patients: A total of 150 consecutive unselected patients (90 males, 60 females; median age, 75 yrs). Results: Ischemic heart disease, hypertension, various valvular lesions and diabetes mellitus were present in 85%, 70%, 53%, and 52% of patients, respectively. Acute myocardial infarction at admission was observed in 15% of patients. The most common precipitating factors associated with the development of pulmonary edema included: high blood pressure (29%), rapid atrial fibrillation (29%,) unstable angina pectoris (25%), infection (18%), and acute myocardial infarction (15%). Twenty‐two patients (15%) were mechanically ventilated. Eighteen patients (12%) died while in the hospital, and the cause of death was cardiac pump failure in 82%. The median hospital stay was 10 days. Predictors for increase rate of in‐hospital mortality included: diabetes (p < .05), orthopnea (p < .05), echocardiographic finding of moderate‐to‐severely depressed global left ventricular systolic function (p < .001), acute myocardial infarction during hospital stay (p < .001), hypotension/shock (p < .05), and the need for mechanical ventilation (p < .001). Conclusions: Most patients with pulmonary edema in the internal medicine department are elderly, having ischemic heart disease, hypertension, diabetes, and a previous history of pulmonary edema. The overall mortality is high (in‐hospital, 12%) and the predictors associated with high in‐hospital mortality are related to left ventricular myocardial function. The long median hospital stay (10 days) and the need for many cardiovascular drugs, impose a considerable cost in the management and health care of these patients.

Testosterone and cyproterone acetate modulate peripheral but not central benzodiazepine receptors in rats

Sixteen days of testosterone acetate (TA) treatment in male rats induced an increase in the densities of peripheral benzodiazepine receptors (PBR) in the adrenal and Cowpers glands and a decrease in PBR density in the testis. TA did not alter PBR density in the heart, cerebral cortex, or pituitary, or central benzodiazepine receptor (CBR) density in the cerebral cortex or hypothalamus. The antiandrogenic agent cyproterone acetate induced a decrease in PBR density in the testis, adrenal, and pituitary, but did not affect PBR density in Cowpers glands, heart, or cerebral cortex, or CBR density in the cerebral cortex or hypothalamus. In all of the above organs, affinity values did not change following the treatment with both agents. The receptoral changes may be relevant to the physiological and neurobehavioral effects of the chronic exogenous androgenic and antiandrogenic treatment.

Beat-to-beat electrocardiographic morphology variation in healed myocardial infarction☆

Using high-fidelity electrocardiographic (ECG) amplifiers, we measured subtle beat-to-beat ECG morphologic variations at different phases of the ECG complex. The electrocardiograms were recorded from 49 men with a documented Q-wave myocardial infarction and from 30 age-matched normal men. Forty consecutive beats were averaged to achieve an average ECG signal from which variance could be calculated. The relative variance, defined as the ratio between the integrated variance of the examined window and the integrated variance of the ECG signal that was close to full cycle length, was calculated at QRS onset and at offset in 2 frequency bands (4 to 40 and 60 to 120 Hz). Patients with healed infarction had a relative variance of 2.1 +/- 0.5 (mean +/- standard deviation [SD]) at QRS offset (a window of 40 ms), which was significantly lower than that of the healthy volunteers: 2.5 +/- 0.33 (mean +/- SD; p less than 0.02) at the low-frequency band. At the high-frequency band, patients with healed infarction had a significantly higher relative variance than the control subjects at QRS onset: 1.95 +/- 0.58 vs 1.55 +/- 0.35 (mean +/- SD; p less than 0.005). A model based on the numerous minor conduction abnormalities that exist in the chronically ischemic myocardium is presented to explain the changes in variance at the onset and offset of the QRS. The variance changes described can eventually serve as quantitative indexes of myocardial injury and electrical stability in patients with ischemic heart disease.

Ro 5-4864 and PK 11195, but Not Diazepam, Depress Cardiac Function in an Isolated Working Rat Heart Model

The present study was designed to investigate the effects of diazepam, a benzodiazepine (BZ) with high affinity to central BZ receptors and moderate affinity to mitochondrial BZ receptors, and of Ro 5-4864 and PK 11195, ligands specific for mitochondrial BZ receptors, on cardiac function in the isolated working rat heart model. Five concentrations of these drugs (10(-9)-10(-5) mol/l) were used, and the chronotropic (heart rate) and inotropic [maximum elastance of the left ventricle at end systole (Emax), maximal first derivative of left ventricular (LV) pressure (dP/dtmax), LV pressure at dP/dtmax (pressure at dP/dtmax), aortic flow, stroke work, and total pressure-volume area] cardiac parameters were measured. Diazepam, Ro 5-4864, and PK 11195 showed no significant chronotropic activity up to 10(-5) mol/l. Diazepam did not alter the inotropic properties of the heart. Ro 5-4864 at 10(-5) mol/l significantly decreased the indices of contractility, namely, Emax, dP/dtmax, and pressure at dP/dtmax. Aortic flow, stroke work, and total pressure-volume area were significantly depressed at the same concentration. The negative inotropism of PK 11195 appeared to be identical, by most indices, to that of Ro 5-4864, both qualitatively (same pattern) and quantitatively (similar maximal variations); however, for some indices a depressant effect was also found at 10(-7) mol/l. These results show that at high concentrations Ro 5-4864 and PK 11195, but not diazepam, have a depressant effect on mechanical function.

Acute Transient Chylous Ascites Associated with Acute Biliary Pancreatitis

We report a case of acute chylous ascites secondary to acute biliary pancreatitis, the first such case reported in the literature. Surprisingly, chylous ascites was detected during elective cholecystectomy. The pathogenesis and management of this problem is discussed.