1.
Pseudoischemic electrocardiogram in myasthenia gravis with thymoma: reversibility after thymectomy.
Chiavistelli, P, Cei, M, Carmignani, G, Bartolomei, C, Mumoli, N
Clinical cardiology. 2009;(6):E75-8
Abstract
Abnormal ST T-wave changes can be found at presentation in various noncoronary disorders; misinterpretation of these patterns as ischemic heart disease can lead to erroneous diagnosis and treatment. Here we present a case of myasthenia gravis (MG) with thymoma, in which the resting electrocardiogram (ECG) led to a misleading diagnosis of myocardial ischemia. After thymectomy, the ECG resumed a normal pattern. Myasthenia gravis is not usually considered in the differential diagnosis of conditions associated with an abnormal ECG. The combination of dysphagia, dyspnoea, ECG changes, and creatine kinase (CK) elevations may easily bring to mind an erroneous and possibly deleterious diagnosis of myocardial ischemia.
2.
Statins in hepatobiliary diseases: effects, indications and risks.
Lowyck, I, Fevery, J
Acta gastro-enterologica Belgica. 2007;(4):381-8
Abstract
BACKGROUND AND STUDY AIMS Statins are among the most frequently used medications. Our aim was to study their indications or contraindications in hepatobiliary diseases. PATIENT AND METHODS This study was stimulated by a patient with PBC, marked hypercholesterolemia and cardiac problems. RESULTS Besides a lipid lowering effect, statins have other benefits, such as prevention of arterosclerosis, reduction of the risk of developing diabetes and inhibition of fibrogenesis. The effects depend on the type of statin, the genetic and acquired characteristics of the patient and the interaction with other medications. Side effects such as myopathy and liver toxicity are rather rare but should be monitored. The use of statins in liver disease is not clearly defined. Hyperlipidaemia is a risk factor for arteriosclerosis in NAFLD (Non Alcoholic Fatty Liver Disease), but fibrates might constitute the treatment of choice. Preliminary data suggest that biochemical and histological improvement in NAFLD might be obtained with atorvastatin or pravastatin. The use of statins in the medical therapy of gallstones remains unclear. Combination with ursodeoxycholic acid therapy might have a beneficial effect in cases of stones with mixed composition. Patients with Primary Biliary Cirrhosis or with chronic cholestasis in general have high HDL-cholesterol levels but a large amount of Lipoprotein X particles, which have a protective effect. As such, statin therapy is often not really indicated. CONCLUSION When cardiovascular problems arise in patients with chronic cholestasis, an underlying factor should be looked for. The lipid abnormalities depend also on the stage of the PBC.
3.
Anal ulceration associated with Nicorandil: case series and review of the literature.
Toquero, L, Briggs, CD, Bassuini, MM, Rochester, JR
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2006;(8):717-20
Abstract
BACKGROUND Use of Nicorandil in the treatment of ischaemic heart disease has been associated with oral, ileal and more recently anal ulceration. We report a series of six cases of peri-anal ulceration in patients on nicorandil therapy, their response to withdrawal of the drug and review the literature. METHODOLOGY Systematic case note review of all patients with anal ulceration presenting to a single colorectal unit. Including detailed medical and drug history, morphological and histological appearances of the peri-anal ulcer after biopsy. Nicorandil therapy stopped in conjunction with physician and the progress of the ulcer monitored. Photographs taken before and after cessation of Nicorandil after informed consent. A literature search on Nicorandil combined with the key words: anal, peri-anal, ulceration and adverse drug effects was performed using the Cochrane Library Medline (January 1966 to June 2005) and Embase (January 1974 to June, 2005). RESULTS Six patients were identified from our hospital records. Histological examination of all ulcers revealed nonspecific chronic inflammation. Five patients demonstrated healing of ulceration within six weeks of withdrawal of Nicorandil, the remaining patient had circumferential involvement of the anal canal and has not improved at 3-month review. One patient was recommenced on Nicorandil after healing due to refractory angina and ulceration recurred. CONCLUSIONS We believe ulceration due to Nicorandil remains widely under diagnosed and the mechanism of ulceration is unclear. Despite diversion colostomy one of our patients continued with peri-anal ulceration, which may suggest a systemic mechanism rather than local irritation. Biopsy of these lesions is essential to exclude neoplastic process and inflammatory bowel disease.