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ADMISSION CHARACTERISTICS OF PATIENTS PRESENTED WITH ACUTE ABDORMINAL PAIN
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 copy. Acute metabolic encephalopathy (AME) is an acute condition of global cerebral dysfunction, in the absence of primary structural brain disease. It is an often-overlooked medical emergency that can arise during preparation for colonoscopy. Female, 70 years old, caucasian, with hypertension, treated with bisoprolol and no history of psychiatric or neurological disease, presented to our emergency department with neurological symptoms including confusion, disorientation, lethargy, generalized weakness, tremor and multifocal myoclonus. Those manifestations appeared one day after colonoscopy preparation with Fleet Phospho-Soda. She was also tachycardic (100/minute) and had hypertension (180/90 mmHg). The laboratory investigation revealed severe hypoosmolar hiponatremia (238mOsm/Kg, 118 mmol/L), hypocalcemia (7,6 mg/dL) and hypocaliemia (2,9 mmol/L). Computed tomography of the head was normal. No electrolyte abnormalities previous to the colonoscopy preparation existed. She fully recovered and was discharged after correction of the electrolyte disturbances. We present a case of AME following preparation for colonoscopy with an aqueous sodium phosphate containing regime as Fleet Phospho-Soda. Those types of regimens appear to be better tolerated and are safe in most healthy individuals. However, a growing number of reports have demonstrated serious electrolyte and renal complications in patients with certain risk factors, including age.
S5
Fig 1. Varicose veins of the thoracicabdominal wall
Fig 2. IVC Agenesis ( Angio MRI).
Methods: Bibliographic review. Results: The results of this literature review reaffirm the rarity of the subject. Conclusion: Anatomical changes of IVC are an important risk factor for DVT and need to be emphasized during the screening of these patients. Finally, we would like to remind all physicians to be aware of these anatomical changes in order to diagnose and manage them.
SCHNITZLER’S SYNDROME: ANOTHER CASE OF SUCCESSFUL TREATMENT WITH ANAKINRA
DILATED CARDIOMYOPATHY AS A COMPLICATION OF CYTOMEGALOVIRUS CHRONIC MYOCARDITIS
Beatriz Amaral, Ana Margarida Carvalho, Ana Paula Vilas. Internal Medicine Department, Saint Mary’s Hospital, Lisbon, Portugal
Marta Amorim, Eduardo Oliveira, Rui Veiga, José Artur Paiva. Department of Intensive Care Medicine, Hospital de São João, Porto, Portugal
Background: Schnitzler’s syndrome is a rare disorder characterized by chronic urticaria in association with a monoclonal gammopathy and at least two of the following: fever, joint and/or bone pain, lymphadenopathy, hepato- or splenomegaly, increased ESR, leukocytosis and bone abnormalities. Case report: A 68-year-old man presented with a 8-year history of a chronic pruritic urticarial rash, a 4-year history of chills and bone pain and a 6-month history of recurrent fever. Investigation disclosed leukocytosis, an elevated ESR and CRP, a monoclonal IgMN gammopathy and positive ANA and antiSSA. The skin biopsy showed findings of neutrophilic urticaria. The body CT scan had no significant changes. Bone scintigraphy showed increased concentration of the radioactive tracer in the costocondral and metatarsal joints. Until 2008, he was on and off steroid therapy. Then he began continuous oral deflazacort (minimum dose 30mg/day), but this caused only partial remission of symptoms. In 2011, Schnitzler's syndrome was diagnosed. Anakinra, an interleukin-1 receptor antagonist, was then commenced at a daily dose of 100mg subcutaneously. A rapid complete remission followed. The patient remains symptom free even after steroid cessation. Discussion: Unusual features of the reported case include the rash being pruritic from the onset of disease and the positive ANA and anti-SSA. A complete remission following Anakinra occurred, as described in many other cases. Conclusion: Published data (and the presented case) support monotherapy with Anakinra as the most promising treatment for Schnitzler’s syndrome.
Background: Myocarditis is an inflammatory heart disease classified by clinical, immune, and histopathological criteria, commonly caused by infectious agents. In Western countries, viral infections are the most common cause. Usually a benign and self-limited disease, viral myocarditis may evolve towards a chronic inflammatory process leading ultimately to a dilated cardiomyopathy that at end-stage is a major cause for cardiac transplantation. Methods and Results: We present a 27-year-old female patient, with a history of a child delivery 18 months before, and a recent hospital admission for acute cytomegalovirus (CMV) hepatitis. Shortly after discharge (<1 month) she developed acute respiratory distress, hemodynamic instability and altered mental status, with admission to an Intensive Care Unit. A cardiogenic shock secondary to a dilated cardiomyopathy unresponsive to vasopressors with associated multiorganic dysfunction was diagnosed. Given the patient’s serious clinical condition extracorporeal membrane oxygenation was used as a bridge for cardiac transplantation, successfully performed one week after hospital admission. CMV serology was positive (only IgG) and CMV genome was detected in patient’s blood (> 500 copies/mL). The anatomopathological exam of the patient’s heart revealed a dilated cardiomyopathy secondary to a chronic pancarditis; immunohistochemical assay for CMV was negative. Conclusion: It’s our belief that in spite of lack of adequate microbiological findings to determine the myocarditis’ etiology (viral serology is insufficient for an accurate diagnosis) this clinical condition was caused by CMV infection. This case illustrates the difficulties in establishing a proper etiology for viral myocarditis given the several limitations of the diagnostic methods currently available.
INFERIOR VENA CAVA AGENESIS – ATTENTION TO THIS DIAGNOSIS Antonio Amorim, Gabriela Correia, Carina Carvalho, Leonor Monjardino. Hospital Of Santo Espírito Background: Inferior Vena Cava (IVC) agenesis is a malformation caused by a disturbance of embryological development occurring between the sixth and the tenth weeks of gestation and requires specific attention and management. We report the case of a 39-year-old male who attended the Emergency Department to treat sores of the lower limbs. He had 3 episodes of deep venous thrombosis (DVT) of both lower limbs between the ages of 20 and 23. He has been under anticoagulation therapy since then. The physical examination showed serious venous insufficiency of the lower limbs with active ulcers (class 6- CEAP classification) and Varicose veins in the thoracic-abdominal wall (Fig.1). D. Dimers were at the normal range. We followed up with assessment of both pro coagulation states (which results were negatives) and venous abnormalities by imaging studies (Fig.2) that diagnosed “IVC agenesis and left kidney agenesis associated”. This rare condition has recently been confirmed as a major risk for development of deep venous thrombosis, especially in young patients.
ADMISSION CHARACTERISTICS OF PATIENTS PRESENTED WITH ACUTE ABDORMINAL PAIN Apostolos Pappas1, Hara Toutouni1, Emmanuel Lagoudianakis2, Vasiliki Drantaki1, George Andrianopoulos1, Athanasios Panoutsopoulos1, Konstantinos Toutouzas2, George Zografos2. 1Internal Medicine Department, General Hospital of Argos, Greece; 2First Department of Propaedeutic Surgery, Hippokrateion General Hospital, Athens Medical School, University of Athens, Greece Background: Abdominal pain is one of the most common presenting complaints of emergency department (ED) patients. In order to achieve maximum efficiency in managing these patients it would be of benefit to identify clinical and laboratory parameters that would indicate a serious underlying disease process, and therefore warrant more expedited evaluation and treatment. The purpose of this study is to investigate the factors that influence hospital admission for abdominal pain.
S6
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Methods: We retrospectively analyzed the medical records of 903 patients who presented to the ED with symptoms of abdominal pain, over a 12 month period. Univariate and multivariable logistic regression analysis was used to study the effect of various factors in hospital admission. Results: Overall 239 (26%) patients were hospitalized during our study period. Hospitalized subjects were significantly older (55 vs. 40 years) and had a higher proportion of male patients (51.9% vs. 42.1%) (p<0.05). Furthermore hospitalized subjects had a higher proportion of leukocytosis (55.8% vs. 19.3%) and included a higher percentage of febrile patients (10.6% vs. 4.9%) (p<0.05). The multivariable logistic regression analysis showed that only leukocytosis was significantly associated with patients’ admission to the hospital (Exp(B)=0.16, p<0.05) Conclusions: Older and male patients with fever and elevated white blood cell count are more likely to have significant pathology requiring admission to the hospital for further evaluation.
were normal. Serology against of CMV showed Ig G negative with Ig M 95 UI/mL, monoclonal gammapathy (Ig G lambda 0,6 gr/dl). The rest of tests were normal: coproculture, flow cytometry of peripheral blood, HCV, HIV, EBV, Syphilis, ANA, lupus anticoagulant, anticardiolipin antibodies, Factor V Leiden mutation, protein C and S deficiency, Methyltetrahydrofolate reductase mutation, G20210A prothrombin mutation, JAK2V 616 and homocistein levels. Anticoagulant therapy was begun with acenocumarol. After 3 months, the antiphospolipid antibody remained negative, monoclonal gammapathy had disappeared and abdominal CT showed resolution of thrombosis while serological test showed an increased level of Ig G against CMV with mild persistent lymphocytosis. Conclusion: In patients with CMV infection and abdominal symptoms, mesenteric thrombosis should be ruled out, to initiate anticoagulant therapy as early as possible.
PROTECTIVE EFFECT OF APITHERAPY PRODUCTS AGAINST CARBON TETRACHLORIDE-INDUCED HEPATOTOXICITY IN WISTAR RATS
INFLUENCE OF INTERNATIONAL GUIDELINES (TASC II) ON THE MANAGEMENT OF CARDIOVASCULAR RISK FACTORS IN TYPE II DIABETIC PATIENTS WITH PERIPHERAL ARTERIAL DISEASE (PAD)
Ca Ûlin Vasile Andrit¸oiu1, Anca Irina Prisa Ûcaru2, Vasile Andrit¸oiu3, Ionel Marcel Popa1. 1Department of Physical Chemistry, Faculty of Chemical Engineering and Environmental Protection, “Gheorghe Asachi” Technical University, Iaüi, Romania; 2Department of Natural and Synthetic Polymers, Faculty of Chemical Engineering and Environmental Protection, “Gheorghe Asachi” Technical University, Iaüi, Romania; 3Department of Cellular and Molecular Biology, University of Medicine and Pharmacy ,,Gr. T. Popa”, Iaüi, Romania Background: Toxic hepatopathy represents a pathology with a continuously growing occurence. Carbon tetrachloride (CCl4) is a well-known substance used in producing experimental models of chemically induced hepatic injury. This study was designed to investigate the protective effects of the apitherapy products against CCl4 induced hepatotoxicity in Wistar rats. Methods: Hepatic lesion was induced by intraperitoneal injection of CCl4 (dissolved in paraffin oil, 10% solution). Two ml per 100 g were administered, once at 2 days, for 2 weeks. Hepatoprotective effect was achieved with apitherapy products purchased from Laboratory Stupina (Apiregya, ApiImunomod, ApiImunostim, ApiImunostim Forte). Results: Administration of apitherapy diet to laboratory animals with CCl4 induced hepatopathy determines, when compared to the group which was given CCl4 without protection, the following modifications regarding: I) enzymatic profile –decrease of hepatic enzymes: aspartate aminotransferase (385.1 ± 44.95 versus 93.7 ± 13.75), alanine aminotransferase (99.33 ± 21.51 versus 51.81 ± 13.72), alkaline phosphatase (170.4 ± 14.82 versus 110.9 ± 26.3), gamma-glutamyl transferase (0.95 ± 0.34 versus 0.55 ± 0.36); II) lipid profile – decrease of values for: total cholesterol (95.3 ± 11.83 versus 59.6±7.33), triglycerides (181.2±35.24 versus 84.5±18.42), very low density lipoproteins (36±7.03 versus 17±3.74), increase of high-density lipoproteins (36.64±3.4 versus 50.45±6.72); III) protein profile: increase of total proteins levels (5.273±0.53 versus 6.92±0.46), increase of albumin values (15.1±3.28 versus 40.12±3.39), decrease of globulin levels (84.5±3.24 versus 59.9 ± 3.37), increase of albumin/globulin ratio (0.17 ± 0.04 versus 0.67±0.08). Conclusion: Administration of apitherapy products has a significant positive effect on laboratory animals with chemically induced hepatopathy. PORTAL AND MESENTERIC VEIN THROMBOSIS SECONDARY TO CYTOMEGALOVIRUS HEPATITIS Anniccherico-Sánchez F.J., Alonso-Martínez J.L., Urbieta-Echezarreta M. Hospital Complex of Navarra.Dpt of Internal Medicine-A Pamplona. Navarra. Spain Background: Thrombosis is a rare complication of cytomegalovirus (CMV) infecton in immunocompetent patient. There are reports of 40 patients with CMV infection and thrombosis in differents localitations, 18 of them hepaticmesenteric-portal vein thrombosis. We communicate a new case of portal venous thrombosis associated with CMV infection, Case: A man of 66 years old, with history of surgery for hepatic Echinococcus granulosus cyst and surgical reparation of groin hernias in his youth, was admitted for persistent fever and abdominal pain located in epigastrium since one month before. His GP began antibiotic therapy with claritromicin and subsequently levofloxacin for suspected pneumony. No others treatment was taken. A CT of thorax and abdomen showed rests of fibrotics tracts in the liver and thrombosis spleno-portal. Esophagogastroduodeonoscopy and colonoscopy
Dafni Koumoutsea1,2, Konstantina Filioti1, Pantelis Kapralos1, Eleni Antoniadou1,6, Panagiota Thalassinou1, Damianos Aslanoglou2, Nikolaos Christodoulou3, Ioannis Griveas4, Ioannis Megas2, Vasilios Tsiligiris5, Dimitrios Patsios1. 1First Department of Internal Medicine, 401 General Military Hospital of Athens, Greece; 2Department of Endocrinology, 401 General Military Hospital of Athens, Greece; 3Department of Cardiology, 401 General Military Hospital of Athens, Greece; 4Department of Nephrology (Renal Medicine), 401 General Military Hospital of Athens, Greece; 5Department of Vascular Surgery, 401 General Military Hospital of Athens, Greece; 6Health Center of Spata, Athens, Greece Background/Aim: Recent data on the management of cardiovascular risk factors in high risk patients shows that dyslipidemia is still being treated in an inadequate way especially in type II diabetic patients. This study analyzes the influence of the recommendation of the Trans-Atlantic Inter-Society Consensus for the management of PAD (TASC II) on the actual daily practice. Materials - Methods: In this retrospective cohort study we analyzed totalcholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and fasting blood glucose using capillary blood in type II diabetic patients with PAD, who had been admitted to five (5) outpatient departments of the same hospital (internal medicine dept, endocrinology dept, cardiology dept, nephrology dept, vascular surgery dept) for the first time. Besides recording complete medical history and cardiovascular risk factors, an ABI (Ankle-Brachial Index) measurement and a carotid duplex ultrasonography were performed at presentation (on admission). We studied 69 type II diabetic patients with PAD (43 males/26 females) with a mean age (±SD) of 71,7±8,5 years, a mean BMI (±SD) of 28,6±4,8 kgr/m2 and a mean waist circumference (±SD) of 103,4±11,7 cm. The arterial blood pressure levels were within acceptable limits ( 130/80 mmHg) under antihypertensive treatment in 64 patients (92,75%). Metabolic syndrome according to the NCEP-ATP III criteria (2001) was present in 58 patients (84,05%). Results: 29 patients (42,02%) had clinically manifested and objectively documented vascular lesions. Total-cholesterol was 186±42 mgr/dl, LDL-chol: 96±34 mgr/dl, HDL-chol: 44±14 mgr/dl and triglycerides 222±108 mgr/dl. A total of only 34,78% (24 patients) in this high risk cohort attained the LDL-chol target levels according to the TASC II guidelines. A total of 68,11% (47 patients) were on HMG-CoA-reductase inhibitors (statins) and a total of 59,42% (41 patients) were on platelet aggregation inhibitors. Conclusions: According to our results we found poor adherence to international guidelines for secondary prevention in type II diabetic patients with PAD in the above five (5) outpatient departments. PERITONEAL TUBERCULOSIS: CASE REPORT Ana Antunes, André Carneiro, André Santa Cruz, Juliana Martins, Guilherme Gomes. Department of Internal Medicine, Hospital de Braga, Braga Portugal Background: Peritoneal tuberculosis mainly affects patients with risk factors, usually by reactivation of latent infection. Insidious onset and nonspecific clinical presentation retard diagnosis by a mean of 4 months. The most common presentation is abdominal pain, fever and ascites. The gold standard
S5
Fig 1. Varicose veins of the thoracicabdominal wall
Fig 2. IVC Agenesis ( Angio MRI).
Methods: Bibliographic review. Results: The results of this literature review reaffirm the rarity of the subject. Conclusion: Anatomical changes of IVC are an important risk factor for DVT and need to be emphasized during the screening of these patients. Finally, we would like to remind all physicians to be aware of these anatomical changes in order to diagnose and manage them.
SCHNITZLER’S SYNDROME: ANOTHER CASE OF SUCCESSFUL TREATMENT WITH ANAKINRA
DILATED CARDIOMYOPATHY AS A COMPLICATION OF CYTOMEGALOVIRUS CHRONIC MYOCARDITIS
Beatriz Amaral, Ana Margarida Carvalho, Ana Paula Vilas. Internal Medicine Department, Saint Mary’s Hospital, Lisbon, Portugal
Marta Amorim, Eduardo Oliveira, Rui Veiga, José Artur Paiva. Department of Intensive Care Medicine, Hospital de São João, Porto, Portugal
Background: Schnitzler’s syndrome is a rare disorder characterized by chronic urticaria in association with a monoclonal gammopathy and at least two of the following: fever, joint and/or bone pain, lymphadenopathy, hepato- or splenomegaly, increased ESR, leukocytosis and bone abnormalities. Case report: A 68-year-old man presented with a 8-year history of a chronic pruritic urticarial rash, a 4-year history of chills and bone pain and a 6-month history of recurrent fever. Investigation disclosed leukocytosis, an elevated ESR and CRP, a monoclonal IgMN gammopathy and positive ANA and antiSSA. The skin biopsy showed findings of neutrophilic urticaria. The body CT scan had no significant changes. Bone scintigraphy showed increased concentration of the radioactive tracer in the costocondral and metatarsal joints. Until 2008, he was on and off steroid therapy. Then he began continuous oral deflazacort (minimum dose 30mg/day), but this caused only partial remission of symptoms. In 2011, Schnitzler's syndrome was diagnosed. Anakinra, an interleukin-1 receptor antagonist, was then commenced at a daily dose of 100mg subcutaneously. A rapid complete remission followed. The patient remains symptom free even after steroid cessation. Discussion: Unusual features of the reported case include the rash being pruritic from the onset of disease and the positive ANA and anti-SSA. A complete remission following Anakinra occurred, as described in many other cases. Conclusion: Published data (and the presented case) support monotherapy with Anakinra as the most promising treatment for Schnitzler’s syndrome.
Background: Myocarditis is an inflammatory heart disease classified by clinical, immune, and histopathological criteria, commonly caused by infectious agents. In Western countries, viral infections are the most common cause. Usually a benign and self-limited disease, viral myocarditis may evolve towards a chronic inflammatory process leading ultimately to a dilated cardiomyopathy that at end-stage is a major cause for cardiac transplantation. Methods and Results: We present a 27-year-old female patient, with a history of a child delivery 18 months before, and a recent hospital admission for acute cytomegalovirus (CMV) hepatitis. Shortly after discharge (<1 month) she developed acute respiratory distress, hemodynamic instability and altered mental status, with admission to an Intensive Care Unit. A cardiogenic shock secondary to a dilated cardiomyopathy unresponsive to vasopressors with associated multiorganic dysfunction was diagnosed. Given the patient’s serious clinical condition extracorporeal membrane oxygenation was used as a bridge for cardiac transplantation, successfully performed one week after hospital admission. CMV serology was positive (only IgG) and CMV genome was detected in patient’s blood (> 500 copies/mL). The anatomopathological exam of the patient’s heart revealed a dilated cardiomyopathy secondary to a chronic pancarditis; immunohistochemical assay for CMV was negative. Conclusion: It’s our belief that in spite of lack of adequate microbiological findings to determine the myocarditis’ etiology (viral serology is insufficient for an accurate diagnosis) this clinical condition was caused by CMV infection. This case illustrates the difficulties in establishing a proper etiology for viral myocarditis given the several limitations of the diagnostic methods currently available.
INFERIOR VENA CAVA AGENESIS – ATTENTION TO THIS DIAGNOSIS Antonio Amorim, Gabriela Correia, Carina Carvalho, Leonor Monjardino. Hospital Of Santo Espírito Background: Inferior Vena Cava (IVC) agenesis is a malformation caused by a disturbance of embryological development occurring between the sixth and the tenth weeks of gestation and requires specific attention and management. We report the case of a 39-year-old male who attended the Emergency Department to treat sores of the lower limbs. He had 3 episodes of deep venous thrombosis (DVT) of both lower limbs between the ages of 20 and 23. He has been under anticoagulation therapy since then. The physical examination showed serious venous insufficiency of the lower limbs with active ulcers (class 6- CEAP classification) and Varicose veins in the thoracic-abdominal wall (Fig.1). D. Dimers were at the normal range. We followed up with assessment of both pro coagulation states (which results were negatives) and venous abnormalities by imaging studies (Fig.2) that diagnosed “IVC agenesis and left kidney agenesis associated”. This rare condition has recently been confirmed as a major risk for development of deep venous thrombosis, especially in young patients.
ADMISSION CHARACTERISTICS OF PATIENTS PRESENTED WITH ACUTE ABDORMINAL PAIN Apostolos Pappas1, Hara Toutouni1, Emmanuel Lagoudianakis2, Vasiliki Drantaki1, George Andrianopoulos1, Athanasios Panoutsopoulos1, Konstantinos Toutouzas2, George Zografos2. 1Internal Medicine Department, General Hospital of Argos, Greece; 2First Department of Propaedeutic Surgery, Hippokrateion General Hospital, Athens Medical School, University of Athens, Greece Background: Abdominal pain is one of the most common presenting complaints of emergency department (ED) patients. In order to achieve maximum efficiency in managing these patients it would be of benefit to identify clinical and laboratory parameters that would indicate a serious underlying disease process, and therefore warrant more expedited evaluation and treatment. The purpose of this study is to investigate the factors that influence hospital admission for abdominal pain.
S6
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Methods: We retrospectively analyzed the medical records of 903 patients who presented to the ED with symptoms of abdominal pain, over a 12 month period. Univariate and multivariable logistic regression analysis was used to study the effect of various factors in hospital admission. Results: Overall 239 (26%) patients were hospitalized during our study period. Hospitalized subjects were significantly older (55 vs. 40 years) and had a higher proportion of male patients (51.9% vs. 42.1%) (p<0.05). Furthermore hospitalized subjects had a higher proportion of leukocytosis (55.8% vs. 19.3%) and included a higher percentage of febrile patients (10.6% vs. 4.9%) (p<0.05). The multivariable logistic regression analysis showed that only leukocytosis was significantly associated with patients’ admission to the hospital (Exp(B)=0.16, p<0.05) Conclusions: Older and male patients with fever and elevated white blood cell count are more likely to have significant pathology requiring admission to the hospital for further evaluation.
were normal. Serology against of CMV showed Ig G negative with Ig M 95 UI/mL, monoclonal gammapathy (Ig G lambda 0,6 gr/dl). The rest of tests were normal: coproculture, flow cytometry of peripheral blood, HCV, HIV, EBV, Syphilis, ANA, lupus anticoagulant, anticardiolipin antibodies, Factor V Leiden mutation, protein C and S deficiency, Methyltetrahydrofolate reductase mutation, G20210A prothrombin mutation, JAK2V 616 and homocistein levels. Anticoagulant therapy was begun with acenocumarol. After 3 months, the antiphospolipid antibody remained negative, monoclonal gammapathy had disappeared and abdominal CT showed resolution of thrombosis while serological test showed an increased level of Ig G against CMV with mild persistent lymphocytosis. Conclusion: In patients with CMV infection and abdominal symptoms, mesenteric thrombosis should be ruled out, to initiate anticoagulant therapy as early as possible.
PROTECTIVE EFFECT OF APITHERAPY PRODUCTS AGAINST CARBON TETRACHLORIDE-INDUCED HEPATOTOXICITY IN WISTAR RATS
INFLUENCE OF INTERNATIONAL GUIDELINES (TASC II) ON THE MANAGEMENT OF CARDIOVASCULAR RISK FACTORS IN TYPE II DIABETIC PATIENTS WITH PERIPHERAL ARTERIAL DISEASE (PAD)
Ca Ûlin Vasile Andrit¸oiu1, Anca Irina Prisa Ûcaru2, Vasile Andrit¸oiu3, Ionel Marcel Popa1. 1Department of Physical Chemistry, Faculty of Chemical Engineering and Environmental Protection, “Gheorghe Asachi” Technical University, Iaüi, Romania; 2Department of Natural and Synthetic Polymers, Faculty of Chemical Engineering and Environmental Protection, “Gheorghe Asachi” Technical University, Iaüi, Romania; 3Department of Cellular and Molecular Biology, University of Medicine and Pharmacy ,,Gr. T. Popa”, Iaüi, Romania Background: Toxic hepatopathy represents a pathology with a continuously growing occurence. Carbon tetrachloride (CCl4) is a well-known substance used in producing experimental models of chemically induced hepatic injury. This study was designed to investigate the protective effects of the apitherapy products against CCl4 induced hepatotoxicity in Wistar rats. Methods: Hepatic lesion was induced by intraperitoneal injection of CCl4 (dissolved in paraffin oil, 10% solution). Two ml per 100 g were administered, once at 2 days, for 2 weeks. Hepatoprotective effect was achieved with apitherapy products purchased from Laboratory Stupina (Apiregya, ApiImunomod, ApiImunostim, ApiImunostim Forte). Results: Administration of apitherapy diet to laboratory animals with CCl4 induced hepatopathy determines, when compared to the group which was given CCl4 without protection, the following modifications regarding: I) enzymatic profile –decrease of hepatic enzymes: aspartate aminotransferase (385.1 ± 44.95 versus 93.7 ± 13.75), alanine aminotransferase (99.33 ± 21.51 versus 51.81 ± 13.72), alkaline phosphatase (170.4 ± 14.82 versus 110.9 ± 26.3), gamma-glutamyl transferase (0.95 ± 0.34 versus 0.55 ± 0.36); II) lipid profile – decrease of values for: total cholesterol (95.3 ± 11.83 versus 59.6±7.33), triglycerides (181.2±35.24 versus 84.5±18.42), very low density lipoproteins (36±7.03 versus 17±3.74), increase of high-density lipoproteins (36.64±3.4 versus 50.45±6.72); III) protein profile: increase of total proteins levels (5.273±0.53 versus 6.92±0.46), increase of albumin values (15.1±3.28 versus 40.12±3.39), decrease of globulin levels (84.5±3.24 versus 59.9 ± 3.37), increase of albumin/globulin ratio (0.17 ± 0.04 versus 0.67±0.08). Conclusion: Administration of apitherapy products has a significant positive effect on laboratory animals with chemically induced hepatopathy. PORTAL AND MESENTERIC VEIN THROMBOSIS SECONDARY TO CYTOMEGALOVIRUS HEPATITIS Anniccherico-Sánchez F.J., Alonso-Martínez J.L., Urbieta-Echezarreta M. Hospital Complex of Navarra.Dpt of Internal Medicine-A Pamplona. Navarra. Spain Background: Thrombosis is a rare complication of cytomegalovirus (CMV) infecton in immunocompetent patient. There are reports of 40 patients with CMV infection and thrombosis in differents localitations, 18 of them hepaticmesenteric-portal vein thrombosis. We communicate a new case of portal venous thrombosis associated with CMV infection, Case: A man of 66 years old, with history of surgery for hepatic Echinococcus granulosus cyst and surgical reparation of groin hernias in his youth, was admitted for persistent fever and abdominal pain located in epigastrium since one month before. His GP began antibiotic therapy with claritromicin and subsequently levofloxacin for suspected pneumony. No others treatment was taken. A CT of thorax and abdomen showed rests of fibrotics tracts in the liver and thrombosis spleno-portal. Esophagogastroduodeonoscopy and colonoscopy
Dafni Koumoutsea1,2, Konstantina Filioti1, Pantelis Kapralos1, Eleni Antoniadou1,6, Panagiota Thalassinou1, Damianos Aslanoglou2, Nikolaos Christodoulou3, Ioannis Griveas4, Ioannis Megas2, Vasilios Tsiligiris5, Dimitrios Patsios1. 1First Department of Internal Medicine, 401 General Military Hospital of Athens, Greece; 2Department of Endocrinology, 401 General Military Hospital of Athens, Greece; 3Department of Cardiology, 401 General Military Hospital of Athens, Greece; 4Department of Nephrology (Renal Medicine), 401 General Military Hospital of Athens, Greece; 5Department of Vascular Surgery, 401 General Military Hospital of Athens, Greece; 6Health Center of Spata, Athens, Greece Background/Aim: Recent data on the management of cardiovascular risk factors in high risk patients shows that dyslipidemia is still being treated in an inadequate way especially in type II diabetic patients. This study analyzes the influence of the recommendation of the Trans-Atlantic Inter-Society Consensus for the management of PAD (TASC II) on the actual daily practice. Materials - Methods: In this retrospective cohort study we analyzed totalcholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and fasting blood glucose using capillary blood in type II diabetic patients with PAD, who had been admitted to five (5) outpatient departments of the same hospital (internal medicine dept, endocrinology dept, cardiology dept, nephrology dept, vascular surgery dept) for the first time. Besides recording complete medical history and cardiovascular risk factors, an ABI (Ankle-Brachial Index) measurement and a carotid duplex ultrasonography were performed at presentation (on admission). We studied 69 type II diabetic patients with PAD (43 males/26 females) with a mean age (±SD) of 71,7±8,5 years, a mean BMI (±SD) of 28,6±4,8 kgr/m2 and a mean waist circumference (±SD) of 103,4±11,7 cm. The arterial blood pressure levels were within acceptable limits ( 130/80 mmHg) under antihypertensive treatment in 64 patients (92,75%). Metabolic syndrome according to the NCEP-ATP III criteria (2001) was present in 58 patients (84,05%). Results: 29 patients (42,02%) had clinically manifested and objectively documented vascular lesions. Total-cholesterol was 186±42 mgr/dl, LDL-chol: 96±34 mgr/dl, HDL-chol: 44±14 mgr/dl and triglycerides 222±108 mgr/dl. A total of only 34,78% (24 patients) in this high risk cohort attained the LDL-chol target levels according to the TASC II guidelines. A total of 68,11% (47 patients) were on HMG-CoA-reductase inhibitors (statins) and a total of 59,42% (41 patients) were on platelet aggregation inhibitors. Conclusions: According to our results we found poor adherence to international guidelines for secondary prevention in type II diabetic patients with PAD in the above five (5) outpatient departments. PERITONEAL TUBERCULOSIS: CASE REPORT Ana Antunes, André Carneiro, André Santa Cruz, Juliana Martins, Guilherme Gomes. Department of Internal Medicine, Hospital de Braga, Braga Portugal Background: Peritoneal tuberculosis mainly affects patients with risk factors, usually by reactivation of latent infection. Insidious onset and nonspecific clinical presentation retard diagnosis by a mean of 4 months. The most common presentation is abdominal pain, fever and ascites. The gold standard