[Familial spam (streptococcal pharyngitis associated myocarditis): is it a new entity or a coincidence?].

BACKGROUND: Myocarditis is an inflammation of the myocardium. It is potentially life-threatening, with a wide range of clinical presentations and most often it is caused by various viral, bacterial or fungal infections. CASE PRESENTATION: A 27 year-old man, previously hospitalized due to streptococcal tonsillitis, was admitted to ED because of chest pain. He presented with pain, tightness irradiating to both shoulders and arms and associated sweating and vomiting. The ECG revealed ST elevations on Leads: V5-V6, V7-V9, II, III, AVF and ST depressions on Leads V1-V3. Laboratory results showed elevated Liver enzymes, and positive troponin-5.766 ng/mL The patient showed clinical improvement with NSAIDs and was diagnosed with myocarditis. His brother was admitted to the hospital a year earlier with a sore throat accompanied by chest pain and was diagnosed with perimyocarditis. CONCLUSIONS: The family history of myocarditis after a streptococcal infection, affecting two brothers a year apart from each other, raises the possibility that there is a genetic component responsible for an individuaLs susceptibility to develop myocarditis.

Unilateral presentation of postpartum cardiomyopathy misdiagnosed as pneumonia.

A 34-year-old woman presented to the emergency department with severe dyspnoea 10 days following a normal-course caesarean delivery. She had been experiencing shortness of breath throughout the third trimester of pregnancy accompanied by tachycardia (110 bpm); however, her evaluation did not include ECG or chest radiography to elucidate the cause. Following delivery, chest radiography was performed demonstrating predominantly unilateral findings interpreted as pneumonia. ECG revealed T-wave inversion in leads V(4)-V(6), which was unaddressed. Overnight she deteriorated and a chest CT angiography was performed demonstrating heart enlargement and pulmonary oedema. An echocardiogram established a diminished ejection fraction (EF) of 15-20%, suggesting the diagnosis of peripartum cardiomyopathy. She was treated with angiotensin-converting enzyme inhibitors, spirinolactone and furosemide, and was free of symptoms the following month with an EF of 40-45%. Though uncommon, heart failure is a potentially fatal cause of peripartum dyspnoea, often misdiagnosed, meriting further attention.

Acute Aflatoxicosis Resulting in Fulminant Hepatic Failure and Rhabdomyolysis.

BACKGROUND: Aflatoxins are known contaminants of foods. High dose exposure, particularly to Aflatoxin B1 (AFB1) may cause acute aflatoxicosis. Outbreaks have been reported in developing nations but are virtually un-documented in the developed world. CASE REPORT: A 28 year old, healthy male presented with nausea, vomiting and abdominal pain. The patient deteriorated rapidly to a state of agitation and shock. The clinical picture, encephalopathy and laboratory results indicated fulminant hepatic failure, rhabdomyolysis and multi-system organ failure. Canned food the patient consumed almost exclusively contained AFB1 at a level of 19.6 ppb. Alternate diagnoses were ruled out and a presumptive diagnosis of acute aflatoxicosis was made. After 45 days of intensive supportive therapy, the patient was discharged with no significant sequels. CONCLUSIONS: The diagnosis of aflatoxicosis was based on the clinical picture, the finding of high levels of AFB1 in foods the patient consumed, and after alternate diagnoses' were sufficiently excluded. We conclude that chronic exposure to moderately elevated levels of aflatoxin B1 may result in acute aflatoxicosis and fulminant hepatic failure.

Simulation of fiber deposition in bronchial airways.

Penetration probabilities of inhaled man-made mineral fibers to reach central human airways were computed by a stochastic lung deposition model for different flow rates and equivalent diameters. Results indicate that even thick and long fibers can penetrate into the central airways at low flow rates. Deposition efficiencies and localized deposition patterns were then computed for man-made fibers with variable lengths in a three-dimensional physiologically realistic bifurcation model of the central human airways by computational fluid dynamics (CFD) techniques for characteristic breathing patterns. The results obtained for inspiratory flow conditions indicate that deposition efficiencies were highest for parallel orientation of the fibers, increasing with rising flow rate, branching angle, and fiber length at all orientations. Furthermore, deposition patterns were highly inhomogeneous and their localized distributions showed hot spots in the vicinity of the carinal ridge and at the inner sides of the daughter airways. Comparisons with other theoretical results demonstrate that the equivalent diameter concept, if including interception, presents a reasonable approximation for the parameter ranges employed in the present study.