Aortic dissection in a patient receiving chemotherapy for Hodgkin's disease--a case report

Cancer chemotherapy is associated with a wide range of vascular toxicities, which may be related to endothelial cell damage by these agents. The authors describe a patient with Hodgkin's disease who developed an atypical aortic dissection while receiving MOPP/ABV chemotherapy (nitrogen mustard, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine). They would place aortic dissection on the list of potential vascular complications associated with antineoplastic agents.     

Cowden's disease--a report on the first case in Korea and literature review

Cowden's disease, or multiple hamartoma syndrome, is an uncommon condition with characteristic mucocutaneous lesions associated with abnormalities of the breast, thyroid, and gastrointestinal tract. We describe a 32-year-old man with oral mucosal papillomatosis and plantar hyperkeratosis as a definite case of Cowden's disease according to the criteria proposed by Salem and Steck. The patient also had a thyroid mass and numerous gastrointestinal polyps endoscopically. Histologically the polyps were hamartomatous or hyperplastic polyps. The oral papillary lesions were fibroepithelial polyps and the thyroid mass was a follicular adenoma. We review the literature on this entity and summarize the pertinent findings. To the best of our knowledge, this is the first documented case of Cowden's disease in a Korean.     

A case report of jejunal carcinoma in a patient with tuberous sclerosis]

It remains uncertain if law enforcement officers experience an elevated cardiovascular disease morbidity and, if so, whether their profession contributes to this incidence. Consequently, the self-reported incidence of cardiovascular disease (CVD) (coronary heart disease, myocardial infarction, stroke, coronary artery bypass graft surgery, angioplasty) and CVD risk factors (age, diabetes, elevated body mass index (> or = 27.8 kg.m-2), hypercholesterolemia, hypertension, tobacco use) in 232 male retirees, > or = 55 years of age, from the Iowa Department of Public Safety were compared with 817 male Iowans of similar age. CVD incidence was higher in the law enforcement officers than the general population (31.5% vs 18.4%, P < 0.001). Using multiple logistic regression, factors found to be associated with CVD included the law enforcement profession (odds ratio [OR] = 2.34; 95% confidence interval [95% CI] = 1.5-3.6), hypercholesterolemia (OR = 2.37; 95% CI = 1.7-3.3); diabetes (OR = 2.22; 95% CI = 1.4-3.6), hypertension (OR = 1.79; 95% CI = 1.3-2.5), tobacco use (OR = 1.67; 95% CI = 1.07-2.6), and age (OR = 1.06; 95% CI = 1.03-1.08). These results suggest that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.     

Periodontal management of gingival overgrowth in the heart transplant patient: a case report

Heart transplant patients take several medications that could affect their periodontal health. Gingival overgrowth associated with cyclosporin (immunosuppressant agent) and nifedipine (calcium channel blocker) is well documented. Candidal infections often develop because of immune suppression. This report describes the clinical and histopathological changes in the gingival tissues of a heart transplant patient and their management. The gingival tissues exhibited pronounced enlargement. The gingivae were lobulated, and the surface of the lobulations was pebbly and granular. Biopsies showed lobules of fibrous connective tissue covered by stratified squamous epithelium. The outer surfaces were dotted with numerous smaller papillations. Candidal hyphae were present in the superficial layers of the epithelium. The extensive papillary lesions appear to be related to candidiasis and constitute a condition which is best designated as papillary stomatitis. Hyperplastic gingival tissues were excised, and the patient was placed on periodic maintenance. One-year postoperative follow-up showed minor gingival growth.     

A case report of coronary artery bypass grafting in a patient with ankylosing spondylitis

We reported a case of ankylosing spondylitis who successfully underwent coronary artery bypass grafting (CABG) for unstable angina pectoris. A 67-year-old man was admitted with symptom of anginal pain. Selective coronary angiography revealed coronary artery stenoses; 90% in seg 6, 90% in seg 11, proximal 75%, distal 90% in seg 3, 99% in 4 PD and 99% with delay in 4 AV. The left internal thoracic artery was anastomosed to seg 7 and saphenous vein (SVG) to PL-2, PL-1 sequentially, and another SVG to 4 PD. His postoperative course was uneventful. Cardiac lesions accompanied by ankylosing spondylitis are rare in Japan. Perioperative problems of these lesions therefore, are discussed.     

Reed-Sternberg cells in sputum from a patient with Hodgkin''s disease. A case report

A patient with stage IV Hodgkin's disease developed severe dyspnea and was found to have pulmonary infiltrates one year following his initial diagnosis of nodular sclerosing Hodgkin's disease, stage IIB. Two separate cell block sputum cytology samples demonstrated Reed-Sternberg cells. The patient died of respiratory failure. At autopsy the main findings were extensive confluent nodules of Hodgkin's disease nearly replacing the pulmonary parenchyma of both lungs. Cytology of sputum or bronchial washings may reveal diagnostic Reed-Sternberg cells and establish the diagnosis of pulmonary Hodgkin's disease without a lung biopsy.     

Diffuse panbronchiolitis in an elderly patient. A case report]

The purpose of this study was to examine the association between recurrent sleep, panic, and suicidal behavior in panic disorder. We compared the recurrent sleep panickers (N = 33) with other panickers (N = 34). The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that recurrent sleep panickers also had a higher percentage of insomnia and comorbid major depression than the others. A multivariate analysis demonstrated an association between recurrent sleep panic and suicidal tendencies in patients with panic disorder. Although recurrent sleep panic alone is not an independent risk factor for suicidal behavior, it may modify the severity of illness in patients with panic disorder.     

Carious lesions in the heroin addicted patient. A case report

Heroin abuse is destroying the health of many individuals in our society. Much of the information that has appeared in the literature has concerned itself with the general health of addicts; the oral health status of these individuals has not been studied to the same extent. This report will present and discuss the management of a case involving the effects of long-term heroin abuse on the dentition.     

A case report of incomplete endocardial cushion defect with mitral stenosis in an elderly patient

The following paper describes a mitral valve replacement (SJM 27 mm), the patch closure (EPTFE) of an ostium primum atrial septal defect and tricuspid annuloplasty (De Vega's method) in a 64-year-old female patient with an incomplete endocardial cushion defect and mitral stenosis. Surgery revealed thickened, mitral valve leaflets and the presence of a cleft, findings similar to those observed in case of rheumatic degeneration. Investigation of patient hemodynamics confirmed a diagnosis of Lutembacher syndrome and a lower with left ventricle volume. After surgery, the volume of left ventricle increased and the patients clinical course was uneventful.     

Orthotopic heart transplantation: a case report

In July 1994, we performed orthotopic heart transplantation for a patient with hypertrophic myocardiopathy, who had had open heart surgery enlarging the right ventricular outlet. The patient had an excellent postoperative result. He received triple-drug immunosuppressive therapy. Large dose of methyl-prednisolone was used successfully for his acute rejection reaction. At present, the patient is living well with good cardiac, hepatic and renal function. We described donor heart harvest, myocardial protection, operative procedure, immune monitoring, anti-rejection and anti-infectious therapy. We introduced the process of protecting donor heart on the way to hospital by retrograde perfusion with medium hypothermic oxygenated-blood combined with St. Thomas cardioplegia. Besides endomyocardial biopsy, other noninvasive examinations such as noninvasive cardiac output monitoring could be helpful to monitor acute rejection reaction.     

Osseointegrated implants in a patient with osteoporosis: a case report

OBJECTIVE: To evaluate the performance of in situ piezolectric extracorporeal shock-wave lithotripsy (ESWL) in the middle part of the ureter. MATERIAL AND METHODS: 36 consecutive patients presenting with stones of the middle part of the ureter were treated by in situ piezoelectric ESWL (EDAP LT 02). The maximal dimensions of the stones ranged from 5 to 14 mm (m = 7.8). Moderate or severe ureterohydronephrosis was present in 19 cases (53%) and a double J stent had been previously implanted in 6 cases (17%). The ESWL sessions were performed in the ventral supine position without any anaesthesia or systematic premedication, but an IM injection of 100 mg of pethidine was administered during poorly tolerated treatments. RESULTS: The stone was located easily in 23 cases (64%) and with greater difficulty in 13 cases (36%), as an intraoperative intravenous injection of contrast agent was performed in 6 cases (17%). The number of sessions per patient ranged from 1 to 2 (m = 1.16). The complete sucess rate was 75%, with a 64% success rate after a single ESWL session. The performances were statistically independent of stone dimensions and the degree of obstruction of the urinary tract. The complication rate was 5.5%, but no ancillary endoscopic or percutaneous treatment was required. CONCLUSION: In situ piezoelectric ESWL allows effective management of most stones of the middle part of the ureter. However, the treatment of stones with a maximal diameter < 5 mm, especially poorly radiopaque stones, can raise problems of localization. Very large or impacted stones, especially when complicated by urinary tract infection, should be preferably treated by first-line ureteroscopy.     

Rhinolith in a patient with cleft palate: a case report

Dental anomalies are well documented in patients with cleft palate, although reports of intranasal teeth in these patients are extremely rare. This paper discusses the case of a rhinolith associated with tooth-like structures in a patient with a treated cleft palate.     

Idiopathic hemochromatosis: case report of a patient presenting with neurologic symptoms

Idiopathic hemochromatosis is an iron-storage disease more common in men than in women. It is characterized clinically by diabetes mellitus, cirrhosis of the liver, pigmentation of the skin and cardiac failure. The diagnosis may be overlooked when the presenting symptoms do not follow the pattern. A case is reported which was diagnosed after an onset that featured neurologic symptoms.     

Abnormal rapid-sequence imaging in a patient with subdural empyema: case report

Static brain images in a patient with subdural empyema showed findings similar to those of a subdural hematoma. The rapid-sequence study, however, showed increased peripheral activity on the affected side. Since this finding suggested an inflammatory process, further neuroradiologic evaluation and immediate surgical treatment were undertaken. The significance of the rapid-sequence study in subdural empyema has not been reported previously.     

Coronary arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia--a case report

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu) disease is characterized by cutaneous, mucosal, and visceral vascular anomalies. Two patients were previously described with coronary artery aneurysms (ectasia) associated with this disease. This report describes a patient with Osler-Weber-Rendu disease in whom multiple coronary arteriovenous malformations were identified during coronary angiography. The patient presented with anginal chest pain resulting from severe anemia. Upper gastrointestinal endoscopy revealed multiple angiodysplastic lesions throughout the esophagus and stomach.     

Gingival lesions in a patient with dermochondrocorneal dystrophy (Fran?ois syndrome). A case report

This report is concerned with gingival manifestations associated with a case of dermochondrocorneal dystrophy (DCCD) or Fran?ois syndrome occurring in a 42-year-old woman. Our Department treated this patient for 15 years. Oral examination of this case revealed a diffuse enlargement and severe inflammation of the attached gingiva. Systemic findings were similar to those reported in the literature for patients with DCCD. Firm papules 3 mm wide, localized on the face and on the dorsal surface of the hands, were associated with corneal involvement and progressive and severe articular disorder. Because they recurred after surgical ablation, the gingival lesions became an important problem in the management of the patient. After 10 years of unsuccessful treatment limited to scaling, oral hygiene control and mouth rinses with 0.2% chlorexidine solution, the patient was submitted to extraction of the remaining teeth, remodelling osteoplasty and cutaneous graft. An acrylic full denture was inserted. In a follow-up of 7 years, good results for the oral health of the patient were seen.     

Management of the hypertensive patient: a case report

Hypertension is a potentially life-threatening condition that can lead to heart failure, stroke, and kidney disease. Most patients with hypertension can be treated and controlled if they are diagnosed in a timely manner. This case report exemplifies how the dentist can play a key role in the detection of hypertension by simply taking vital signs on all patients. It is incumbent upon us as health-care professionals to understand the causes of hypertension, the therapeutic drugs used and associated side effects, and the potential for drug interactions. The dentist's ability to recognize and appropriately manage hypertension will greatly enhance the health and safety of our patients.     

POEMS syndrome in a patient with diabetic ketoacidosis: case report and review

This article summarise the main data in the literature on the role of bacteriological contamination of the dialysate fluid in inflammatory reactions in hemodialysis. Pyrogenic substances of small molecular weight from Gram-negative bacteria grown in dialysate can pass across intact dialyzer membrane to stimulate cytokine production by peripheral blood mononuclear cells. Cellulosic hemodialysis membranes are more permeable to endotoxins than synthetic membranes. Polysulfone membranes and polyamide membranes are able to adsorb bacterial toxins on the dialysate side. The diffusive transfer of bacterial products across dialysis membrane from dialysate fluid was demonstrated. Transmembrane passage of cytokine-inducing bacterial products across reprocessed dialyzers is greater than across new dialyzers. Bacteriological contamination of the dialysate fluid is a problem which must be considered with much more care by nephrologists, especially as LAL test is unable to detect all the bacterial products which can contaminate the dialysate fluid.