The American journal of the medical sciences
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Review Case Reports
Successful treatment of unusual life-threatening complications of idiopathic edema.
Idiopathic edema (IE) is a disease that occurs predominantly in women. It is characterized by increasing weight gain of >1.4 kg from morning to night, increasing edema, increasing truncal and abdominal girth with bloating when assuming an upright position and nocturia that is unrelated to menses. There is an increase in morbidity but not mortality. ⋯ The first patient was successfully treated with salt restriction, timely use of furosemide and limitation of water intake; the other was successfully treated by use of support hose. Treatment of these patients required a fundamental understanding of the intricate pathophysiological consequences of a leaky capillary membrane, an understanding of Starling forces and detailing the effectiveness of a low salt diet, use of diuretics and limited water intake in one and why support hose would be beneficial in the other patient. Both patients experienced significant physical and emotional benefits that substantially improved quality of life.
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In clinical practice, the d-dimer levels rule out venous thromboembolism and diagnose disseminated intravascular coagulation. d-dimers increase in both physiological and pathological conditions. Liver cirrhosis, especially in the final stages, is characterized by complex coagulation and fibrinolysis factor disorders. ⋯ The cut-off d-dimer level used for the prognosis of thrombotic events is not standardized in advanced liver cirrhosis. Thus, it is necessary to update the clinical guidelines regarding the usefulness of d-dimer testing in advanced liver cirrhosis and the cut-off d-dimer levels, which should vary based on the detection method.
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Despite tacrolimus (TAC) or mycophenolate mofetil (MMF) for alternate approaches, a proportion of patients still required further exploration of other therapeutic options due to uncontrolled autoimmune hepatitis(AIH). The role of cyclophosphamide (CYC) for AIH has been explored in isolated case reports and small series. We present a review of CYC therapy in AIH patients. ⋯ We cautiously recommend that CYC could be a conditioning alternative to starting second-line therapy after unsuccessful intensification of first-line treatment. Pharmacogenetic methods may play a role in guiding cyclophosphamide therapy. Given our small sample size, results should be considered preliminary.
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Coronary embolism (CE) is an infrequent etiology of myocardial infarction secondary to embolization of occlusive thrombi within the coronary arteries, typically arising in patients with pre-existing atrial fibrillation. Clinical presentation is similar to atherosclerotic myocardial infarction, however the condition is likely underrecognized. ⋯ We aim to lower the threshold for clinical suspicion in the appropriate setting and promote assessment of predisposing embolic conditions once a tentative diagnosis of CE is established. In addition, we intend to highlight the need for focused refinement of the existing diagnostic criteria and further optimization of management guidelines for CE.
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According to reports, coronavirus disease 2019 (COVID-19) is associated with various complications, including hematological abnormalities. Lymphopenia and thrombocytopenia have been recognized as common hematological abnormalities. Moreover, some reports have shown cases of neutropenia occurring during or after infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). ⋯ This will allow for effective therapeutic intervention and appropriate disease management in challenging conditions. In this study, our aim was to conduct a comprehensive review of the current literature on neutropenia during or after SARS-CoV2 infection. Furthermore, we assessed whether there have been any documented cases of immune-mediated neutropenia following COVID-19 and if the appropriate laboratory investigations have been carried out in these patients.