Theophylline therapy for Cheyne-Stokes respiration during sleep in a 41-year-old man with refractory arterial hypertension.

We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a significant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modification. These observations suggest a potent hypotensive action of oral theophylline via Cheyne-Stokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime.

[A case report of posttraumatic deep vein thrombosis of the lower limbs in a patient with factor V Leiden mutation and the congenital absence of the inferior vena cava]. / Opis przypadku pourazowej zakrzepicy zyl glebokich konczyn dolnych u chorego obciazonego mutacja czynnika V typu Leiden oraz wrodzonym brakiem zyly glównej dolnej.

The congenital absence of the inferior vena cava (AIVC) is a rare vessels' malformation which may predispose to the development of thrombosis. Although AIVC is very rare, its occurrence should be considered in young patients, under 40 years old, with deep vein thrombosis (DVT). We are describing a case of a young male with bilateral deep vein thrombosis, in whom we defined three risk factors for DVT--trauma, factor V Leiden and the absence of the inferior vena cava. It is worth to consider the occurrence of malformation of the inferior vena cava in the young patients with deep vein thrombosis even when the other obvious risk factors are present (trauma, factor V Leiden mutation). The clinical state and the diagnostic process are discussed.