1/222. Chronic creatine kinase elevation not associated with HMG-CoA reductase inhibitor treatment.OBJECTIVE: To report a case of chronically elevated creatine kinase (CK) concentration that is possibly associated with renal insufficiency and prostatic carcinoma. The goal is to raise awareness among clinicians who monitor CK concentrations in patients receiving hydroxymethylglutaryl-coenzyme a (HMG-CoA) reductase inhibitors. CASE SUMMARY: Because of an elevated CK concentration, a 64-year-old African-American man with a history of chronic heart disease and renal insufficiency was assessed for possible myositis relating to his treatment with HMG-CoA reductase inhibitors. However, an association between the elevated enzyme concentration and drug treatment could not be clearly established. The patient was subsequently diagnosed with prostatic cancer and underwent a radical retropubic prostatectomy. The CK enzyme concentration declined following the surgery despite continuation of the drug therapy. DISCUSSION: CK is relatively nonspecific because of its wide distribution in human tissues. Although several findings of elevated CK concentrations, particularly the CK-BB isoenzyme, in patients with carcinoma or chronic renal insufficiency have been documented, these may not be common knowledge among clinicians. This case report provides an example of an unusually high CK enzyme concentration that may be linked to prostatic carcinoma and renal insufficiency. CONCLUSIONS: It is important to be aware of different causes for CK enzyme concentration elevation, especially when it is used as a monitoring parameter during HMG-CoA reductase inhibitor treatment. In a case of persistent elevated CK enzyme concentration without evidence of myositis, renal insufficiency may be a contributing factor and malignancy must be ruled out.- - - - - - - - - - ranking = 1keywords = i (Clic here for more details about this article) |
2/222. Recognizing the faces of hypothyroidism.physicians may not recognize hypothyroidism if they rely on the stereotypical picture of the disorder. The age of the patient, stage of the disease, and other illnesses or conditions such as pregnancy can change the clinical presentation. The signs and symptoms of hypothyroidism are remarkably diverse. Instead of a single picture, physicians need a mental gallery.- - - - - - - - - - ranking = 0.25465838509317keywords = i (Clic here for more details about this article) |
3/222. Acute cholestatic hepatitis associated with pravastatin.A 57-yr-old man presented with clinical and laboratory signs of acute cholestatic hepatitis. Symptoms had appeared 7 wk after he was started on pravastatin 20 mg/day for hypercholesterolemia. A full evaluation including ultrasound, computed tomography, endoscopic cholangiography, and liver biopsy confirmed the diagnosis of intrahepatic nonobstructive jaundice. The liver function abnormalities normalized 7 wk after cessation of therapy. pravastatin should be considered as a potential cause of cholestatic hepatitis with favorable clinical outcome after drug withdrawal.- - - - - - - - - - ranking = 0.39130434782609keywords = i (Clic here for more details about this article) |
4/222. Manifestations of hypercholesterolaemia, hypoglycaemia, erythrocytosis and hypercalcaemia in patients with hepatocellular carcinoma: report of two cases.BACKGROUND: Hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis, are well-known paraneoplastic manifestations in patients with hepatocellular carcinoma (HCC). Hepatocellular carcinoma patients manifesting with two or three paraneoplastic manifestations have been previously reported. However, HCC patients presenting with four paraneoplastic syndromes have not been previously reported. methods AND RESULTS: This manuscript describes two HCC patients who manifested with hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis during their clinical course. Erythrocytosis appeared early when HCC was diagnosed and declined to within normal range after optimal therapy for HCC. Hypercholesterolaemia manifested initially after the diagnosis in case 1, declined to within normal range after lobectomy and was re-elevated after tumour recurred. With disease progression, hypercalcaemia and hypoglycaemia occurred 1-3 months after diagnosis and the both patients subsequently died several days later. CONCLUSIONS: Similar features found in both patients were large tumour burden, high serum alpha-fetoprotein level and rapid downhill clinical course even with optimal therapy. The clinical significance of these paraneoplastic manifestations is discussed.- - - - - - - - - - ranking = 0.7888198757764keywords = i (Clic here for more details about this article) |
5/222. Ocular ischemic syndrome: two case reports of bilateral involvement.The ocular ischemic syndrome is characterised by ocular symptoms and signs secondary to severe carotid artery obstruction. In this paper, two cases of bilateral ocular involvement are presented. The first case was caused by severe bilateral carotid stenosis and the second by bilateral occlusion of the carotid artery.- - - - - - - - - - ranking = 0.20496894409938keywords = i (Clic here for more details about this article) |
6/222. Relapsing acute pancreatitis induced by re-exposure to the cholesterol lowering agent bezafibrate.We report a 75-yr-old patient, who presented three times with acute pancreatitis, accompanied by high temperature, shock, and multiorgan involvement and associated each time with exposure to the cholesterol lowering agent bezafibrate. Extensive workup excluded other possible causes for recurrent pancreatitis in this patient, further supporting bezafibrate as the cause of the patient's acute illness. Based on the short time elapsing between rechallenge and development of manifestations and the specific features of the attacks, we proposed hypersensitivity to bezafibrate as the underlying mechanism. The present report includes, for the first time, bezafibrate among definite causes of acute pancreatitis.- - - - - - - - - - ranking = 0.42857142857143keywords = i (Clic here for more details about this article) |
7/222. Subclinical course of cholesteryl ester storage disease in an adult with hypercholesterolemia, accelerated atherosclerosis, and liver cancer.Few cases of asymptomatic cholesteryl ester storage disease (CESD) due to low enzymatic activity of human lysosomal acid lipase/cholesteryl ester hydrolase (hLAL) have been reported thus far in adults Here, we describe a 51-year-old man with a long clinical history of mixed hyperlipoproteinemia and severe premature atherosclerosis, but with no signs of hepatomegaly, liver dysfunction, or splenomegaly. The disease was discovered by chance in a biopsy performed because of suspected liver cancer (proven to be a cholangiocarcinoma). Residual hLAL activity in peripheral leukocytes was determined to be 6% of control values. dna sequence and restriction fragment length polymorphism analysis demonstrated that the patient was a compound heterozygote for the prevalent CESD exon 8 splice site mutation (G934A) and the deletion of a C (nucleotide 673, 674, or 675) in exon 6 of the hLAL gene, resulting in premature termination of protein translation at residue 195. The patient died of liver failure as a consequence of extensive tumor infiltration at age 52. Lipid analysis revealed moderate cholesteryl ester storage in the liver and in the suprarenal cortex, and massive accumulation in the testicular histiocytes and leydig cells, resulting in a pronounced secondary atrophy of the seminiferous tubules. Our case study demonstrates that hepatomegaly is an inconstant feature, even in CESD patients compound heterozygous for a Wolman mutation which results in complete loss of hLAL enzymic activity. It also highlights the need to be aware of this condition as it may be underdiagnosed.- - - - - - - - - - ranking = 76194.540129716keywords = lipoprotein, hyperlipoproteinemia, lipase, i (Clic here for more details about this article) |
8/222. Usefulness of coronary MR angiography prior to angioplasty.The range of indications for percutaneous transluminal coronary angioplasty (PTCA) has increased greatly since the procedure was initially introduced. The success rate depends on the anatomy and length of the occlusion and on the state of the distal vessel. We present a case where the use of magnetic resonance angiography (MRA) allowed to evaluate the length of a subtotal occlusion prior to PTCA, and thus could have had an impact on therapeutic decisions. Coronary MR angiography is one of the many applications of breathhold MRI, where breathholding and segmented k-space acquisition are combined to provide anatomical images of coronary vessels. Coronary MR angiography allows reproducible visualization of coronary vessels. Even under adverse circumstances (poor cardiac triggering) the images are sometimes of sufficient quality to help make a diagnosis. This capability may increase the as yet limited clinical use of MR technology in the practice of cardiology.- - - - - - - - - - ranking = 0.4472049689441keywords = i (Clic here for more details about this article) |
9/222. Atherosclerotic narrowing of the left main coronary artery. A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing.Histologic sections of the left main (LM) and the other three major coronary arteries were studied in 152 patients. The lumen of the LM in 35 patients was greater than 75% narrowed; in thirty, 50-75%; and in 87, less than 50% narrowed. The patients with greater than 75% narrowing were younger. angina pectoris and hyperlipoproteinemia, specifically type II, were more common (P less than 0.02) and acute transmural and healed subendocardial myocardial infarcts were less frequent (P less than 0.05) in the patients with greater 75% LM narrowing than in those with less than 50% narrowing. Of the three other major coronary arteries, the average number narrowed in the patients with greater than 75% LM narrowing was 2.9; in those with 50-75% LM narrowing 2.7, and in those with less than 50% LM narrowing, 2.4. Of the 35 patients with greater than 75% LM narrowing, 33 had greater than 75% luminal narrowing of each of the other three major coronary arteries. Narrowing of the LM, therefore, indicates severe narrowing of usually all major coronary arteries.- - - - - - - - - - ranking = 75798.19044098keywords = lipoprotein, hyperlipoproteinemia, i (Clic here for more details about this article) |
10/222. simvastatin-induced rhabdomyolysis in a patient with chronic renal failure.simvastatin belongs to a class of lipid-lowering drugs which completely inhibit 3-hydroxy-3-methylglutaryl co-enzyme A (HMG CoA) reductase. The commonest adverse effects of therapy with simvastatin HMG CoA reductase inhibitors are gastro-intestinal disturbance, myositis and myopathy. rhabdomyolysis leading to renal failure has been reported, but it appears to be very rare, except in patients also receiving cyclosporin, nicotinic acid or gemfibrozil. Here we report the case of an elderly lady who was known to have chronic renal failure, but who developed rhabdomyolysis following simvastatin therapy. Her symptoms of muscle pain, fatigue, myoglobulinuria, oliguria and pulmonary oedema appeared 48 h after the first dose of simvastatin. simvastatin was immediately stopped, and the patient was dialysed for 1 week. Her renal function improved and came back. We suggest that extreme care should be exercised in prescribing this drug, particularly for the elderly with renal impairment.- - - - - - - - - - ranking = 0.63975155279503keywords = i (Clic here for more details about this article) |
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