ABSTRACT
Diagnosis and treatment of myocarditis can be challenging, including determining indications for heart transplantation. We present a 6-year medical history of a 54 years old patient with severe morphologically verified viral-negative lymphocytic myocarditis and systemic manifestations (onset of hemorrhagic vasculitis) combined with moderate coronary atherosclerosis, which regressed according to repeated coronary angiography. For 5 years, the patient received immunosuppressive therapy with methylprednisolone and azathioprine with a significant improvement. Repeated relapses of atrial fibrillation required correction of basic therapy and plasmapheresis. The disease was complicated by thyrotoxicosis and multi-organ dysfunction; the autopsy showed persistent myocarditis activity. The myocarditis is a chronic condition and requires a review of the treatment strategy at each stage.
Subject(s)
Myocarditis , Virus Diseases , Humans , Middle Aged , Myocarditis/diagnosis , Myocarditis/etiology , Myocarditis/therapy , Myocardium , Immunosuppressive Agents/therapeutic use , Biopsy , AzathioprineABSTRACT
AIM: To study diagnostic value of intestinoscopy with biopsy of the mucosa from different portions of the small intestine in patients with chronic diarrhea and malabsorption. MATERIAL AND METHODS: The examination of 116 patients with chronic diarrhea and malabsorption (endoscopic and histological study of biopsy specimens from different portions of the small intestine) detected gluten enteropathy (n = 51), Wipple's disease (n = 8), general variable hypogammaglobulinemia (n = 11), lymphangioectasy (n = 9), lymphangiomatosis (n = 1), lymphoma (n = 2), amyloidosis (n = 3), eosinophilic gastroenteritis (n = 1), duodenoejunitis without atrophy (n = 7). 23 patients had normal mucosa of the small intestine. RESULTS: Pathological changes in the jejunum and duodenum were identical in glutenic enteropathy (GE), Wipple's disease (WD), variable hypogammaglobulinemia (VH) and amyloidosis. CONCLUSION: For diagnosis of GE, WD, VH and amyloidosis it is sufficient to take biopsy from distal duodenum. Spot biopsy from sites of lymphostasis or nodular lymphoid hyperplasia is most informative for identification of lymphangioectasy, lymphangiomatosis and small intestinal lymphoma. Pathological changes in the ileum in GE, WD, VH and amyloidosis indicate severe total lesion of the small intestine.
Subject(s)
Intestinal Diseases/diagnosis , Intestine, Small/pathology , Adolescent , Adult , Biopsy , Endoscopy, Gastrointestinal/methods , Female , Humans , Intestinal Diseases/pathology , Male , Middle AgedABSTRACT
From 1987 to 1998, examination and treatment were conducted of 12 patients with infectious endocarditis of the tricuspid valve (TIE). 11 of them were operated. TIE was clinically characterized by lesser circulation thromboembolism and marked right ventricular failure. TIE was successfully diagnosed by echo-CG (diagnostic sensitivity 83.3%). Serious disturbances of cellular immunity demanded immunocorrection. Indications for surgical treatment are listed.
Subject(s)
Endocarditis, Bacterial , Staphylococcal Infections , Tricuspid Valve/microbiology , Adolescent , Adult , Echocardiography , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Female , Humans , Male , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiologyABSTRACT
AIM: To ascertain the role of intestinoscopy in diagnosis of small intestinal diseases. MATERIALS AND METHODS: Intestinoscopy with multiple topographic biopsies was made with SIF-10 device (Olympus) in 92 patients. RESULTS: Of 60 patients with absorption disorders, the diagnosis of gluten enteropathy (GEP), Whipple's disease (WD), general variable hypogammaglobulinemia (GVHG) and small intestinal diverticulum was established in 38, 3, 5 and 1 patients, respectively. 13 patients with mild malabsorption were free of the pathology. GEP, amyloidosis, intestinal lymphangiectasia were found in 5, 3 and 4 of 15 patients with exudative enteropathy. The rest had lymphoma, lymphangiomatosis, Crohn's disease. 11 patients with focal affections had Crohn's disease, polyps, GVHG or had only motor defects. Repeated intestinal hemorrhages in a few patients were due to adenocarcinoma, aberrant pancreas, intestinal or gastric erosions. CONCLUSION: Patients with malabsorption and exudative enteropathy had similar abnormalities in the small intestine and duodenum. Endoscopic biopsy from the distal duodenum is enough for diagnosis of GEP, Whipple's disease and GVHG. Intestinoscopy as well as x-ray imaging are effective in detection of focal lesions of the small intestine and sources of intestinal bleeding.