SPONTANEOUS COLONIC HEMATOMA: ENDOSCOPIC APPEARANCE

Intramural colonic hematoma is a rare complication of anticoagulation therapy. We report a patient under therapy with acetylsalicylic acid, low‐molecular‐weight heparin and clopidogrel for unstable angina, who presented with massive lower gastrointestinal bleeding secondary to spontaneous intramural colonic hematoma, with unremarkable coagulation tests. Diagnosis was promptly made by colonoscopy, and the patient was successfully managed with a conservative approach, with complete resolution of symptoms after 7 days. This is the first report of spontaneous intramural colonic hematoma presumed to be related to acetylsalicylic acid, enoxaparin and clopidogrel.     

Psychosomatic aspects of urinary incontinence

Psychosomatic aspects of urogynecological disorders may play an important role in their clinical presentation. 72 patients presenting to the urogynecological clinics and a control group of 34 healthy women were included in this study. After informed consent had been obtained, all patients were subjected to (1) a detailed enquiry about personal- and medical history (2) psychological tests (Freiburg's personality inventory, a questionaire focused on anxiety and anger, and Beck's depression inventory) and (3) routine urodynamic measurement. Patients with stress incontinence had a mean duration of symptoms of 59 months. In 67% there was a combination with clinical urge symptoms. 53% of the patients did not have regular sexual intercourse. Of those who had regular intercourse 23% had incontinence during intercourse and 25% were anorgasmic. 59% of the patients had dysmenorrhea and a negative attitude to their menarche. Urodynamic evaluation showed stress, urge or no incontinence in 39%, 12% and 39%, respectively. Analysis of the psychosomatic tests did not show a specific psychosomatic influence. Negative sexual life correlated with depressive mood, which was not based on the urogynecological problem. There was no causal relationship between personality traits and urogynecological problems. The individual perception of incontinence, however, may depend on or influence personality structure. Received: 16 June 1998 / Accepted: 18 November 1998     

Apoptosis and changes in contractile protein pattern in the skeletal muscle in heart failure.

Chronic heart failure is characterized as a clinical disorder by exercise intolerance. There are two factors that are independently responsible for the reduced exercise capacity: (a) a shift from myosin heavy chain 1 (MHC1) to MHC2a and MHC2b and (b) muscle atrophy. We have demonstrated, both in experimental models of heart failure and in man, that the more severe the heart failure, the greater the magnitude of skeletal muscle apoptosis. In the monocrotaline treated rat, that develops a severe right-sided heart failure, the increased number of apoptotic nuclei was paralleled by increasing levels of circulating TNFalpha. In agreement with some recent observations showing that sphingolipids can mediate programmed cell death, we found that in animals with heart failure and high number of apoptotic nuclei, circulating levels of sphingosine were significantly increased. In a study conducted in patients with heart failure we found a correlation between exercise capacity limitation and skeletal myocytes apoptosis. There was also a correlation between degree of muscle atrophy and magnitude of apoptosis. The shift in MHCs, although with a different mechanism, is also responsible for the reduced exercise capacity in these patients. In fact there is a strong correlation between indices of severity of CHF and MHC composition. Muscle fatigue, appears earlier in patients that have a greater skeletal muscle expression of 'fast' MHCs. We have also demonstrated that MHCs shift and apoptosis can be prevented by using angiotensin II converting enzyme inhibitors and angiotensin II receptor blockers.     

Comminuted periprosthetic humeral fracture after reverse shoulder prosthesis

Periprosthetic fractures represent a severe complication after joint replacement. A case of comminuted displaced humeral fracture around the stem of a SMR reverse shoulder prosthesis is reported. The patient was a 81-year-old lady who had had a total shoulder replacement 28 months previously. The surgical solution consisted of a partial revision of the modular implant with conservation not only of the glenoid component but also of the prosthetic humeral body, which was well fixed in the humeral metaphysis. The humeral stem was removed and a long uncemented revision stem was implanted providing fracture stabilisation and allowing early mobilisation.     

Fatal Mediterranean spotted fever in Greece

Forty-five days after the first confirmed and fatal Crimean–Congo haemorrhagic fever (CCHF) case in Greece in 2008, a female patient with similar signs and symptoms (high fever, thrombocytopaenia) ‘nd resident of the same area, was admitted to the University General Hospital of Alexandroupolis. Before admission, she had visited a local hospital where a cephalosporin was prescribed. A rash manifested over subsequent days, which was misdiagnosed as an allergy to the drug. Upon admission to the University Hospital, she was given further antibiotics, including doxycycline; a few hours later, ribavirin was added because CCHF was suspected. After the patient's death, rickettsiosis caused by Rickettsia conorii conorii (Meditteranean spotted fever; MSF) was diagnosed. Extremely high values of interleukin (IL)-1ra, IL-6, interferon-γ-inducible protein-10, monocyte chemoattractant protein-1 and an absence of tumour necrosis factor-α were observed. MSF is a potentially severe and even fatal disease resembling viral haemorrhagic fevers that has to be included in the differential diagnosis of febrile syndromes combined with thrombocytopaenia, even when a tick bite is not reported, and an eschar is absent. Physicians have to be aware of MSF in patients with severe disease who are returning from the Mediterranean area.     

Necrotizing periodontitis as a possible manifestation of common variable immunodeficiency

Common variable immunodeficiency (CVID) is an inherited disease characterized by hypogammaglobulinaemia and impaired humoural immunoresponse and is mainly associated with recurrent infections of the airway and the digestive tract. An 18-year old female with a diagnosis of CVID associated with a devastating necrotizing periodontitis, ultimately resulting in complete destruction of the periodontium and loss of all teeth, is reported. Clinical, biochemical, microbiological and radiographic examinations are presented. The report highlights the likely importance of immunoglobulin replacement and intensive dental hygiene in CVID patients, and the devastating effect of non-compliance in such patients.