[Association of celiac disease and cerebral venous thrombosis: report of two cases]. / Association maladie cœliaque et thrombose veineuse cérébrale. Revue de deux observations.

UNLABELLED: Thrombosis events may occur in celiac disease. Thrombophilic risk factors have been reported. INTRODUCTION: To report two cases of cerebral venous thrombosis in celiac disease patients and to determine associated thrombophilic factors. Case 1: a 63-year-old woman was admitted for cerebral venous thrombosis. Her past history included celiac disease which was untreated for the last 10 years. Biological data showed moderate hyperhomocysteinemia and positive reaction for antiphospholipid antibodies. Case 2: a 19-year-old girl was hospitalized for seizures and impaired consciousness. MRA demonstrated longitudinal sinus thrombosis with parietal infarction. Biological findings showed: protein S deficiency and positive reaction for antiendomysium and antigliadin antibodies. Gastroesophageal endoscopy with biopsy showed villous atrophy. Both patients improved under anticoagulant treatment. CONCLUSION: The sites of associated venous thrombosis are generally unusual in celiac disease, yet the cerebral localization is only exceptionally reported. It is essential to search for risk factors. Gluten-free diet remains the mainstay treatment for patients with celiac disease.

Cardiovascular risk and lupus disease.

AIM: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The aim of this study was to evaluate subclinical atherosclerosis and to determine the prevalence of risk factors for CVD in SLE patients. METHODS: One hundred fifty-three patients (149 women and 4 men), aged (37±11.6) years with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology (ACR), underwent physical examination, carotid and leg arteries B-mode ultrasound with a measure of ankle-brachial pressure index (ABPI); 94 patients had myocardial tomoscintigraphy. The laboratory check-up was: total cholesterol (TC), HDLc, LDLc, homocystein, glycemia, vascular cell adhesion molecules (VCAM-I). All patients had a normal renal function at the time of the study. RESULTS: The mean age is 37 years. Cardiovascular events were noticed in 15 patients (6 angina, 2 myocardial infarction and 7 strokes). Cardiovascular risk factors (CVRF) were: dyslipidemia (62.8%), moderate homocysteinemia (55%), BMI>25 (39%) and hypertension (35%) which is associated with a stroke (P<0.0006). The cumulative prednisone dose per patient was 45.5g. V.C.A.M-I level was high in 86.2 % of cases.95% of our patients had at least two CVRF. Myocardial perfusion stress scanning showed abnormalities in 21 patients (22.3%). Perfusion defects were linked with a stroke (P<0.01) and coronary events (P<0.02). Carotid atheroma was present in 32 patients (20.9%). Carotid plaques were associated with age (P<0.01), total cholesterol (TC)(P<0.05), and steroid dose (P<0.01). Intima-media-thickness was correlated with age (P<0.0003), TC (P<0.0007), LDLc (P<0.002), and homocysteine (P<0.03). 70% patients had a mediacalcinosis in femoral and popliteal arteries. The ABPI was correlated with V.C.A.M-I (P<0.0005). CONCLUSION: In Algeria, as elsewhere, young women with SLE have subclinical atherosclerosis which must be detected and they are at high risk of a vascular event.

[Hypoplasia of the hepatic segment of the inferior vena cava]. / Hypoplasie de la veine cave inférieure rétrohépatique.

Congenital anomalies of the inferior vena cava are not uncommon. In the past, the diagnosis was made by angiography and retrograde right heart studies which were being commonly performed for the assessment of congenital malformation of the heart. The advent of ultrasound and three-dimensional imaging such as computed tomography and magnetic resonance made it easier to obtain the diagnosis. We report here a case of inferior vena cava hypoplasia in a 19-year-old male, who presented with progressive ascitis and edema.

[Assessment of myocardial perfusion in systemic lupus erythematosus]. / Evaluation de la perfusion myocardique au cours du lupus érythémateux systémique.

INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Necropsy studies found a high incidence of myocardial and coronary injuries while clinical manifestations were observed in less than 10%. The purpose of this study was to evaluate myocardial perfusion in SLE patients. PATIENTS AND METHODS: The study was carried out in 153 patients with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology. Ninety-four (61.4%) underwent 99mTc-tétrofosmine SPECT analysis at rest and after stress. RESULTS: The average disease duration was 11 years. Ninety-four patients (93 women and one man) with a mean age 37 years were assessed. Twelve had a past history of vascular event: six stroke, four angina pectoris and two myocardial infarctions. Cardiovascular risk factor included: high blood pressure (35.2%), dyslipidemia (62.3%), moderate hyperhomocysteinemia (55%), BMI greater than 25 (40%).The cumulative prednisone dose per patient was 45.5g. Myocardial perfusion stress scanning showed abnormal perfusion in 21 patients (22.3%). Among these, eight underwent coronary angiography which was normal in seven cases. One patient had a right coronary stenosis. Perfusion abnormalities were correlated with stroke (p<0.01) and coronary events (p<0.02). CONCLUSION: Myocardial perfusion scintigraphy can be a useful noninvasive method to identify subclinical myocardial involvement in systemic lupus erythematosus and patients at risk of later events.