Hyperthyroidism caused by amiodarone. Apropos of 4 clinical cases

The authors report four new cases of hyperthyroidism associated with prolonged treatment with amiodarone. Massive doses of beta-blockers were required to deal with the severely disordered rhythm in one of the patients. Amiodarone, which is an effective treatment for angina, is not free from risk, even at the doses which are currently accepted. Hyperthyroidism, which may occur even in patients who have had no past history of any thyroid troupble at all, remains a most unusual complication.     

Treatment of amiodarone-induced hyperthyroidism by carbimazole with maintenance of amiodarone

The authors report the case of a patient treated with amiodarone for syncopal ventricular tachycardia complicating idiopathic dilated cardiomyopathy in whom symptomatic hyperthyroidism led to a discussion of the different therapeutic options available in this type of case. Neomercazole treatment was prescribed with success enabling maintenance of the antiarrhythmic drug. The reputation of inefficacy of carbimazole should be reconsidered ; high dose therapy should probably be tried in patients with hyperthyroidism when withdrawal of the antiarrhythmic drug does not seem to be possible.     

Sialadenitis caused by carbimazole

The aim of our study was to compare the impact of chemotherapy alone with that of chemotherapy plus immunotherapy on the quality of life (QL) of patients affected by advanced-stage malignancies (eight head and neck squamous-cell carcinomas, two melanomas). Ten patients receiving chemotherapy and immunotherapy sequentially were evaluated. The impact on QL was assessed by both objective and subjective scales. Evaluation was performed before the first cycle of therapy, at the end of chemotherapy, and after immunotherapy. The analysis of our data showed that the association of chemotherapy and immunotherapy did not significantly worsen the QL of patients as compared to chemotherapy alone.     

Profound neutropenia caused by oxacillin

An instance of profound neutropenia secondary to oxacillin which resolved rapidly on withdrawal of the drug was reported. It was accompanied by eosinophilia. Although the bone marrow findings were indicative of destruction of granulocytes in the periphery, antibody could not be demonstrated.     

Spondylodiscitis caused by Tropheryma whippelii

We describe the first case of spondylodiscitis caused by Tropheryma whippelii in which this so far unculturable organism was shown to be present at the site of infection in a patient without significant gastrointestinal symptoms. The methods used included broad-range PCR amplification with universal primers complementary to constant sequences of the gene coding for 16S rRNA, direct sequencing of the amplified fragment, and comparison of the sequence determined with those deposited in sequence databases. In addition to demonstrating the presence of this organism in the affected vertebral body, we found in our patient that the specific PCR is more sensitive than histology for detecting Whipple's bacilli in bowel biopsy specimens. Because histology of small bowel biopsies from the duodenum were-in contrast to PCR from the same site-not diagnostic for Whipple's disease in our patient, we recommend PCR whenever Whipple's disease has to be excluded.     

Caustic ulcers caused by cement

Seven similar cases with deep ulceration probably due to wet cement are presented. Within 12 hours after making a concrete floor in a kneeling position, curved ulcers developed on both sides of both patellae. The exposure time varied from 2 to 6 h. One patient got wet concrete into her boots and, consequently, ulcers developed on her feet. The high alkalinity of calcium hydroxide in wet cement was the only apparent causative agent in every case.     

Endobronchial mass caused by tuberculosis

A 2-year-old girl who presented with cough, had been started on prednisone and bronchodilators 10 days prior to admission because of presumed hyperactive, small airway obstruction. Fluoroscopy revealed hyperinflation of the right lung and mediastinal shift to the left on expiration. Bronchoscopy disclosed an endobronchial mass. At that time the tuberculin test was negative. Since such lesions are rare in young children, thoracotomy was performed. An enlarged mediastinal lymph node was removed and the histopathological findings were suggestive of tuberculosis. The tuberculin test 1 month following prednisone therapy was positive, suggesting that previously the skin reaction to tuberculin had been altered by the prednisone. Tuberculosis should be considered in the differential diagnosis of an endobronchial mass even in an otherwise apparently healthy child.     

Anasarca caused by rheumatic carditis

According to the old testament Adam was convinced by eve to put a "Bite Mark" on the apple. Interest in Forensic Odontology was heightened in the latter part of 19th Century. The first formal instructional programme was given at the Armed Forces Institute of Pathology, U.S. Since then the number of cases reported has played a significant role in expanding the role of Forensic Odontology. The earliest reported case was of Lollia Paulina in the year 49 A. D. One of the early reported case is also found in India in the year 1193. In the last few decades, the basic pattern of Forensic Odontology has changed quite a lot. Advances in dental material and laboratory techniques, with improvements in scientific and photographic technology, have made the proof of presentation much to forensic science.     

Phaeohyphomycosis caused by Phaeoacremonium inflatipes

Phaeoacremonium inflatipes, one of three species previously classified as strains of Phialophora parasitica, was identified as the causal agent of a subcutaneous infection of the left foot of an 83-year-old woman from South Carolina. The patient had a granulomatous growth over the anteromedial aspect of her left foot. It was surgically excised, which led to complete healing without complications. Tissue sections of the excised mass stained with hematoxylin and eosin and Gomori's methenamine silver strains showed many septate hyphal elements of various lengths, some exhibiting brownish pigment in the cell walls of the hyphae. Portions of the tissue, when cultured, yielded many colonies which were initially glabrous, off white becoming velvety, greyish brown on aging. Microscopically, their hyphae were septate, branched, and phaeoid and bore lateral and terminal, erect, septate conidiophores. The conidiogenous cells (phialides) were terminal or lateral, mostly monophialidic, subcylindrical to spinelike in shape, and constricted at their bases and bore funnel-shaped, inconspicuous collarettes at their tips. The conidia were subhyaline, oblong, and ellipsoid to allantoid.     

Endophthalmitis caused by Enterobacter cloacae

Cataract extraction with placement of intraocular lenses is the most common intraocular procedure done today, with endophthalmitis as its most devastating complication. To our knowledge, this is only the third reported case of postoperative endophthalmitis caused by the gram-negative bacillus, Enterobacter cloacae. The course of infection, the treatment, and the laboratory identification of this organism are presented. It is important to add this proven case of gram-negative endophthalmitis to our growing knowledge of causes of this disease because, despite aggressive treatment with vitrectomy and intravitreal antibiotics, the infection was so virulent that it led to eventual phthisis bulbi.