EBV : not your Everyday Benign Virus.

BACKGROUND: Epstein-Barr virus infection is common, with seroprevalence of 90% in adults. Clinical presentation of primary EBV infection can be variable and atypical. It is often subclinical or can result in infectious mononucleosis. Clinical course is mostly benign, but in rare cases serious short- and long-term complications may occur. CASE PRESENTATION: We present a case of a 19-year-old woman who was admitted to the hospital with general malaise, fever, dyspnea, icterus, vomiting and diarrhea, with acute left upper quadrant pain. She was diagnosed with acute EBV-infection with hepatitis, splenomegaly and spontaneous splenic rupture. CONCLUSIONS: Spontaneous splenic rupture is an uncommon, but potentially fatal complication of infectious mononucleosis. In a patient with suspicion of EBV infection and abdominal pain, we should always be aware of the possibility of spontaneous splenic rupture and emphasis should be put on appropriate counseling.

Second primary malignancies in patients with a gastrointestinal neuroendocrine tumour: a case report and review of the literature.

A second primary malignancy (SPM) is frequently reported in patients with a gastrointestinal neuroendocrine tumour (NET). The majority of SPM are located in the gastrointestinal tract, but malignancies at other sites are described as well. This phenomenon might just be coincidental due to high incidence rates of asymptomatic NET lesions in patients who are operated or who undergo autopsy for another primary malignancy. However, other theories have been developed since the observed incidences rates seem to be double as high as expected. Some authors suggest a common genetic predisposition, while others report tumourigenic properties of various neuroendocrine peptides, including secretin, gastrin and cholecystokinin. This review is illustrated by a case report of a patient in whom the radiological diagnosis of a diffuse liver metastasized adenocarcinoma of the rectum changed dramatically after positron emission tomography and explorative laparoscopy to a curable adenocarcinoma of the rectum with a simultaneous well-differentiated neuroendocrine carcinoma.

Is ambulatory 24-h dual-probe pH monitoring useful in suspected ENT manifestations of GERD?

BACKGROUND AND AIMS: The present study is aimed at assessing the relationship between ear, nose and throat manifestations and proximal reflux in gastro-oesophageal reflux disease by using 24-h dual-probe pH monitoring. PATIENTS AND METHODS: Fifty-eight patients were included: (;) 28 patients with suspected ear, nose and throat manifestations of gastrooesophageal reflux disease: (ii) 18 patients with typical symptoms of gastro-oesophageal reflux disease without extraoesophageal manifestations of gastro-oesophageal reflux disease; (iii) 12 healthy volunteers. Ambulatory 24-h dual-probe pH monitoring was performed in all patients. Oesophagogastroscopy was performed in all patients of groups I and II. Ear, nose and throat examination was performed in all patients with ear, nose and throat complaints. RESULTS: At the upper oesophageal sphincter, results of pH monitoring were significantly different between groups I and III (0.009 < P < 0.02) and between groups I and II (0.008 < P < 0.03). When comparing data at the lower oesophageal sphincter, we found a significant difference between groups II and III (0.002 < P < 0.009) and between groups I and III (0.001 < P < 0.002). Endoscopic examination of the oesophagus did not show any significant difference between groups I and II. Laryngoscopy was abnormal in 86% of the patients with ear, nose and throat symptoms. CONCLUSIONS: Ambulatory 24-h dual-probe pH monitoring is useful in the assessment of patients with suspected ear, nose and throat manifestations of gastro-oesophageal reflux disease, especially in the case of abnormal laryngoscopy.

Prevention of OKT3 nephrotoxicity after kidney transplantation.

In our experience the use of OKT3 as prophylaxis in renal transplantation has been associated with an increased incidence of both delayed graft function and thromboses of graft vessels. OKT3 nephrotoxicity might have been favored by restriction of perioperative fluid infusion to prevent pulmonary edema and by the use of very high dose (30 mg/kg) of methylprednisolone (mPDS) before the first OKT3 injection to reduce the release of cytokines. This led us to modify our perioperative management in three ways: (1) hydration status was optimalized; (2) the calcium-channel blocker diltiazem, considered beneficial for recovery of graft function, was administered on the day of transplantation; and (3) the dose of mPDS given before the first OKT3 injection was fixed at 8 mg/kg. Comparison of two consecutive series of patients (group 1, control patients, N = 172; group 2, managed as described above, N = 173) showed that: (1) the incidence of delayed graft function fell from 52% in group 1 to 22% in group 2 (P < 0.0001): (2) the incidence of pulmonary edema was not significantly increased in group 2 (3.5% vs. 1.7% in group 1, P = 0.5); and (3) the frequency of intragraft thrombosis fell from 7.6% in group 1 to 1.2% in group 2 (P = 0.0034). Multivariate analysis showed that the volemia/diltiazem program and avoidance of high mPDS dose were the most important factors responsible for the reduced occurrence of delayed graft function and graft vessels thrombosis, respectively. We conclude that a combined strategy of appropriate dosage of steroids before the first OKT3 injection, administration of a calcium-channel blocker and optimalization of volemia is safe and efficiently prevents against OKT3 nephrotoxic effects.

[Comparative effect of atenolol and verapamil in exertion angina. A single-blind crossed study with computerized exercise test]. / Activité comparée de l'aténolol et du vérapamil dans l'angor d'effort. Etude en simple aveugle croisée par épreuve d'effort informatisée.

The anti-ischemic activity of Verapamil (360 mg/24 h) is compared with a cardioselective betablocker, Atenolol (100 mg/24 h), in a single blind study with computerized stress tests. Although acting through different mechanisms, and are evaluated indirectly by measurements with equal cardiac work and frequency, the improvement of the performance, the decrease of the sub-denivellation at the end of the stress and the frequency of interruption because of pain, seem approximately similar for both medications.

[Critical study of the prognostic value of echocardiography in chronic aortic insufficiency]. / Etude critique de la valeur pronostique de l'échocardiogramme dans l'insuffisance aortique chronique.

The aim of this study was to assess whether, as previously reported series have suggested, aortic valve replacement is too late when echocardiography shows a left ventricular end systolic diameter (LVS) greater than or equal to 55 mm, a left ventricular fractional shortening (FS) less than or equal to 25%, and a ratio of left ventricular radius to wall thickness (R/H) greater than or equal to 4. Sixty-seven patients with pure chronic aortic regurgitation were operated in the period between 1979 and June 1981. All had at least one good quality preoperative M mode recording. Using the above mentioned parameters, the patients were divided into two groups: Group I (n = 41) "good surgical candidates" with LVS less than or equal to 55 mm, FS greater than 25%, and/or R/H less than 4; and Group II (n = 26) "high risk candidates" with LVS greater than 55 mm, FS less than or equal to 25% and/or R/H greater than or equal to 4. The clinical improvement was spectacular in both groups after surgery (mean follow-up 28 +/- 8 months). There were no operative deaths but 5 patients out of each group died secondarily. An echocardiogram was recorded in the immediate post-operative period in 55 cases; there was a significant reduction in LV diameters in both groups but the values in Group II remained higher. A control echocardiogram was recorded 17,5 +/- 8,9 months later 46 cases. The LV diameters had returned to normal in Group I but remained at the upper limit of normal in Group II. We conclude that patients with echocardiographic indices of " high risk " usually have a favourable postoperative course. However, although the echocardiographic parameters to improve, they do not return completely to normal.