Takotsubo syndrome: the broken-heart syndrome

Takotsubo syndrome – also known as broken-heart syndrome, Takotsubo cardiomyopathy, and stress-induced cardiomyopathy – is a recently discovered acute cardiac disease first described in Japan in 1991. This review aims to update understanding on the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of Takotsubo syndrome, highlighting aspects of interest to cardiologists and general practitioners.Key words: broken-heart syndrome, stress cardiomyopathy, Takotsubo cardiomyopathy, Takotsubo syndrome     

Myelodysplastic syndrome accompanied by Evans syndrome

Various cases of myelodysplastic syndrome (MDS) with diverse immunological disorders have been reported by many investigators. In this case report, we present a 70-year-old woman who had been diagnosed as having MDS and liver cirrhosis (LC) type C for 20 months, and who finally developed autoimmune phenomena against autologous blood cells. She was admitted to our hospital in order to evaluate her advanced anemia, thrombocytopenia and fatigue. The laboratory data at admission were as follows: hemoglobin 5.3 g/dl, red blood cell count 109 x 10(4)/microliter, white blood cell count 1,760/microliter, platelet count 4.3 x 10(4)/microliter and reticulocyte count 1.3%. The direct Coombs test was positive. In addition, anti-platelet antibody was positive, using the MPHA method. With these results, Evans syndrome secondary to MDS or LC was diagnosed. The mechanisms for the development of immunological disorders in patients with MDS or LC have not been fully elucidated. To our knowledge, this patient is one of the rare cases with MDS and Evans syndrome reported in the literature. During the generation process of autoantibodies, the role of HCV antigen in the pathogenesis of Evans syndrome was of interest in this patient.     

Broken-heart syndrome (Takotsubo syndrome)

We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.     

Sweet's syndrome associated with myelodysplastic syndrome

A 49-year-old man was hospitalized because of cutaneous plaques and pancytopenia. Hematological findings, and the skin eruption suggested Sweet's syndrome associated with myelodysplastic syndrome (refractory anemia with excess of blasts; RAEB). Treatment for pancytopenia was attempted without effect. Also we tried treatment with antibiotics. The skin lesions healed and the body temperature returned to normal. This case was unusual in the association of myelodysplastic syndrome with Sweet's syndrome.     

Cronkhite-Canada syndrome associated with myelodysplastic syndrome

We report a case of Cronkhite-Canada syndrome (CCS) associated with myelodysplastic syndrome (MDS). A 54-year-old woman, diagnosed as MDS the prior year after evaluation of anemia, visited our hospital with the chief complaint of epigastric discomfort. She also had dysgeusia, alopecia, atrophic nail change, and pigmentation of the palm, all of which began several months ago. Blood tests revealed severe hypoalbuminemia. Colonoscopy (CS) showed numerous, dense, red polyps throughout the colon and rectum. Biopsy specimens showed stromal edema, infiltration of lymphocytes, and cystic dilatation of the crypt. Her clinical manifestations and histology were consistent with CCS. We prescribed corticosteroids, which dramatically improved her physical findings, laboratory data, and endoscopic findings. This is the first report of CCS in a patient with MDS.     

睡眠呼吸暂停综合征与COPD-重叠综合征

1　概念　　睡眠呼吸暂停综合征 (ｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ ,ＳＡＳ)是具有潜在危险的常见病、多发病 ,其患病率估计约为 3 4 %。而慢性阻塞性肺疾病 (ｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅｐｕｌｍｏｎａｒｙｄｉｓｅａｓｅ ,ＣＯＰＤ)也是一种常见的慢性进展性呼吸系统疾病 ,患病率约为 3%。鉴于各自的多发性 ,两者同时发生于同一患者的机会较大 ,且病情可因相互影响而更为严重。Ｆｌｅｎｌｅｙ将ＳＡＳ合并ＣＯＰＤ或其它呼吸系统疾病 (如肺囊性纤维化、肺间质纤维化等 )者称之为“重叠综合征 (ｏｖｅｒｌａｐｓｙｎｄｒｏ…     

多囊卵巢综合征与代谢综合征

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是引起女性月经稀发和不孕的常见妇科疾病.PCOS与代谢综合征之间有许多相似之处,均存在胰岛素抵抗、血脂紊乱、高血压和中心性肥胖.目前尚不清楚它们之间存在着何种关联,胰岛素抵抗可能是联系这两种疾病的重要因素.由于诊断标准不同,有关PCOS患者代谢综合征发生率的报道也不一致,大体上介于30%～50%之间.根据Rotterdam诊断标准可以将PCOS分为以下几种类型:(1)完全型:月经稀发、多囊卵巢和高雄激素血症;(2)排卵型:高雄激素血症和多囊卵巢;(3)NICHD(National Institute of Child Health and HumanDevelopment)型:高雄激素血症和月经稀发;(4)非高雄激素型:月经稀发和多囊卵巢.     

合并库欣综合征的McCune-Albright综合征

McCune-Albright综合征(MAS)是由于受精卵形成后激动型G蛋白的α亚基(Gsα)发生激活突变所致,Gsα与细胞表面的许多激素受体相耦联.因突变体细胞的性质及其在受累组织中分布的不同,该病临床表现多样;除经典的性早熟、骨纤维结构不良和牛奶咖啡色斑三联征外;还包括非内分泌系统的表现如肾脏磷排泄增加、肝胆功能障碍和心脏病.     

Polycystic ovarian syndrome and the metabolic syndrome

Polycystic ovarian syndrome (PCOS), first described in 1937, was defined by specific ovarian histopathology and a constellation of signs and symptoms. Through the years, the etiology remained elusive, with heated debates focusing in turn on the ovary and then the pituitary as the causative agents. In the last several decades, it has become clear that insulin resistance makes up a very important component of this syndrome. With this knowledge, new therapies have emerged along with the realization that PCOS and the metabolic syndrome are closely related through their shared insulin resistance. In this review, the diagnosis, pathophysiology, and therapy of PCOS are discussed and upon this background, those areas held in common by PCOS and the metabolic syndrome are explored.