Liver fibrosis attributed to lipid lowering medications: two cases.

We identified two cases of chronic active hepatitis with liver fibrosis induced by lipid lowering drugs of the statin and fibrate classes despite regular monitoring of transaminases. There are few reports of clinically significant hepatitis induced by these drugs and even fewer cases of fibrosis. Given the growing use of these drugs, there are implications for monitoring patients on long-term therapy for liver damage.

Aortic dissection: a rare complication of osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is an inherited connective tissue disorder, a group that includes Ehlers-Danlos syndrome, Marfan's syndrome and pseudoxanthoma elasticum. OI is a heterogeneous disease of collagen I biosynthesis characterized by variable clinical phenotypes, including skeletal and cardiovascular manifestations. A 65-year-old man with OI who had extensive prior successful cardiac valve surgeries is described. He survived for 18 years after his initial valve surgery, but died of multiorgan failure and sepsis after repair of a spontaneous type A aortic dissection. This is the fourth reported case of aortic dissection secondary to OI and illustrates the extensive cardiovascular pathology associated with OI. Aggressive management of arterial dissection risk factors, such as systemic arterial hypertension, is advocated for patients with OI.

Regurgitation of fat and marrow emboli into coronary veins during resuscitation.

Three groups of patients were examined at autopsy for the presence of fat and marrow emboli in the lungs, heart, and other organs. Group 1 was composed of patients with massive pulmonary thromboembolism and attempted cardiopulmonary resuscitation; group 2, patients with pulmonary thromboembolism and without attempted cardiopulmonary resuscitation; and group 3, patients without pulmonary thromboembolism and with attempted cardiopulmonary resuscitation. The results confirm that pulmonary fat and marrow emboli are frequent in those patients who are resuscitated. A novel observation is the finding of multiple coexistent cardiac venous emboli in those resuscitated patients who have pulmonary artery obstruction with pulmonary thromboemboli. These findings suggest that these emboli regurgitate from the right side of the heart to the coronary sinus and cardiac veins in cases of pulmonary artery hypertension.

Coronary sinus thrombosis: a potential complication of right heart catheterization.

In cardiac procedures that use access to the right atrium, the coronary sinus is at risk of accidental trauma and subsequent thrombosis as demonstrated by the two cases reported in this paper. The thromboses occurred in the setting of right heart failure and after procedures that involved catheterization or cannulation of the right atrium. A review of the literature revealed only rare instances of this complication, but, with the increasing use of the right atrium and coronary sinus for diagnostic and therapeutic purposes, injury to the coronary sinus must be considered.

Three cases of an unusual foreign body in small bowel.

The inadvertent ingestion of foreign bodies is an infrequent occurrence in adults. Three cases of an unusual form of foreign body ingestion are reported here. In each case the foreign body recovered was a plastic bag clip, found attached to the small bowel mucosa. The radiographic appearances of this foreign body are demonstrated, and the pathologic findings related to its ingestion are reviewed.

Childhood idiopathic thrombocytopenic purpura in Egypt and the neighboring Arab countries: a regional form with three different patterns of clinical expression.

Childhood idiopathic thrombocytopenic purpura in the western world is essentially an acute self-limited disorder. In contrast, the clinical expression of the disease in Arab countries, as revealed by a study of 160 patients from Egypt, Saudi Arabia, Oatar and North Sudan, is heterogenous forming a spectrum that includes three distinct clinical forms: (a) the acute self-limited form, (b) the intermediate form, and (c) the chronic adulthood-like form. The relative proportions of these forms were 40. 15 and 45%, respectively. The chronic form shows limited response to steroids, and runs a platelet count less than 100,000 microliters for more than 1 year, with a tendency for later spontaneous elevation in platelet counts during the first few years of a long follow-up. The intermediate form shows a transient steroid-induced complete remission giving place to widely fluctuating platelet counts above and below 100,000 microliters once the steroid dosage is reduced to maintenance levels. Platelet counts in excess of 100,000 microliters were achieved in this group by extending steroid maintenance therapy fo 6--9 months. In spite of a tendency to chronicity and partial resistance to steroids i the intermediate and chronic forms, the overall response to steroids was enough both to reduce the number of cases requiring splenectomy to 15%, and to prevent the development of major complications in all the children included in the study.

Lumbar epidural analgesia in labour: a 24-hour service provided by obstetricians.

Of 309 consecutive cases of epidural analgesia provided by obstetricians, 250 set up by junior obstetric staff. Midwives managed the epidural analgesia and gave the top-up doses as part of their traditional role in providing pain relief in labour. This practice was thought to be influential in producing a high sponn epidural analgesic service can safely be provided by obstetricians in a small maternity hospital.