ABSTRACT
INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy due to ADAMTS13 deficiency (a von Willebrand factor's metalloprotease) with multiple organs' involvement, one of which may be the heart. CASE REPORT: We report a 29-year-old woman who presented a TTP during her last trimester of pregnancy, under the features of a HELLP syndrome. After caesarean section, cardiac involvement was revealed by chest pain, ECG changes, antero-septal hypokinesia and troponin rise. Cardiac MRI found no large-vessel ischemic heart disease and confirmed hypokinesia. CONCLUSION: When TTP is diagnosed, cardiac involvement must be systematically investigated by ECG and troponin assay because of the risk of a cardiac arrest.
Subject(s)
Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Hematologic/diagnosis , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Adult , Female , HELLP Syndrome/diagnosis , HELLP Syndrome/etiology , Heart Diseases/diagnosis , Heart Diseases/etiology , Humans , Magnetic Resonance Imaging , PregnancySubject(s)
Cardiomyopathies/etiology , Suicide, Attempted , Electrocardiography , Humans , Male , Middle Aged , Tachycardia/etiologySubject(s)
Diabetes Mellitus, Type 1/drug therapy , Insulin Infusion Systems , Insulin/administration & dosage , Adult , Female , Humans , MaleABSTRACT
Eighteen insulin-dependent diabetic patients received insulin in a continuous subcutaneous infusion delivered by a portable pump. Short-term glycemic control was evaluated on the average glycemia (serum glucose was assayed seven times per 24 hours for three to five days), on the MAGE coefficient which gives an estimate of glycemic lability, and, in eight patients, on serum C-peptide concentrations. Results were compared to those recorded with two daily subcutaneous injections of a combination of regular and intermediate insulin. The average glycemia and the MAGE coefficient were 1.32 + 0.05 milligram (m + SEM) and 1 + 0.05 milligram respectively under continuous infusion, compared to 2.05 + 0.12 and 1.76 + 0.12 milligram respectively under insulin injections. Insulin requirements were significantly lower under continuous infusion (0.99 + 0.08 U/kg versus 1.35 + 0.11 U/kg). In three patients with brittle diabetes the use of the pump ensured rapid metabolic control. The advantages and drawbacks of portable insulin pumps are discussed in the light of this experience.
