Recurrent stroke associated with thymoma and anticardiolipin antibodies

A 44-year-old woman developed recurrent thrombotic cerebral cortical infarctions. IgG and IgM anticardiolipin antibodies were found, as was a thymoma. To our knowledge, these antiphospholipid antibodies, which may inhibit prostacyclin formation and alter platelet function, have not been previously associated with this thymic neoplasm, an association we believe is not coincidental.

Atypical progressive stroke syndrome associated with oral contraceptives and cigarette use

We report a case of progressive multifocal intracranial distal arterial branch occlusive disease in a young adult who smoked heavily and used oral contraceptives. The distribution of the angiographic lesions and the associated telangiectasias and rete mirabile resemble Moya-Moya disease except for clearly absent proximal carotid arterial disease. This type of distal multifocal cerebral arterial occlusive pattern appears to be a very rare manifestation of cigarette and oral contraceptive use. The patient has remained without symptoms for greater than 3 years off oral contraceptives and cigarettes and on antiplatelet agents.

Cerebrovascular ischemia associated with lupus anticoagulant

The lupus anticoagulant, an acquired circulating serum gamma-globulin, prolongs all phospholipid-dependent coagulation tests. Recent associations of the lupus anticoagulant and focal cerebral and/or ocular ischemia have been made. We present 5 cases of lupus anticoagulant-associated cerebrovascular ischemia and review all reported cases for the first time. Clinical spectra, cerebral angiographic findings, associated conditions, and response to therapy are presented. Typical features include a relatively young age (mean 39 years), female preponderance, transient ischemic attacks (including amaurosis fugax) or stroke, and normal or large vessel occlusions on angiography. Commonly associated conditions were systemic lupus erythematosus (34%), noncerebral venous thrombosis (31%), hypertension (28%), false-positive VDRL (28%), and spontaneous abortions (22%). Four of our 5 patients (all without systemic lupus erythematosus) and 11 of the 20 (55%) patients in the literature without systemic lupus erythematosus had other definite stroke risk factors coexisting. Response to therapy was highly variable, with no clear beneficial effect of corticosteroids.

Regression of metastatic renal cell carcinoma: a case report and literature review

The literature provides few examples of regression of documented metastatic renal cell carcinoma. We report a case of cytologically documented pulmonary metastases from a renal cell carcinoma, which resolved following nephrectomy and hormonal therapy. The patient has been followed for 6 years without evidence of recurrence.

Ventricular arrhythmias during exercise testing: mechanism, response to coronary bypass surgery and prognostic significance

To investigate the determinants and prognostic significance of ventricular arrhythmias during exercise testing, 86 patients with such arrhythmias were identified from a consecutive series of 446 patients who underwent treadmill exercise testing and cardiac catheterization. The prevalence of these arrhythmias was 19% in the total group but increased to 30% in the 120 patients with 3-vessel or left main coronary artery disease. Patients with exercise-induced arrhythmias were more likely to have 3-vessel or left main coronary artery disease, a lower resting ejection fraction, greater than or equal to 2 mm of ischemic ST depression and more severe segmental wall motion abnormalities than patients without this finding (p less than 0.05). Repeat exercise testing in 22 patients with exercise-induced arrhythmias after coronary bypass surgery revealed that persistence of these arrhythmias was associated with either severe wall motion abnormalities preoperatively or residual ischemic ST depression during the post-operative exercise testing. At a mean follow-up period of 5.3 years, the presence of exercise-induced ventricular arrhythmias was not associated with increased cardiac mortality in the medically treated patients.

Noninvasive localization of urinary tract infection: clinical investigations and experience

Previously we evaluated new methods to localize the source of bacteriuria in monkeys with experimental urinary tract infection. A high level of diagnostic accuracy was obtained with studies of antibody coating of urinary bacteria by immunofluorescence, 131iodine hippuran quantitative scintillation camera studies with the patient in the hydropenic state and 67gallium citrate scintiphotos. We identified unique patterns that differentiated cystitis, ureteritis, pyelonephritis and renal or perinephric abscess. Herein we review our clinical experience with these combined techniques in 40 patients and correlate the degree of accuracy of these studies with that of standard radiographic examinations. In 20 patients diagnostic studies also were compared to the findings of split ureteral urine cultures or bacteriologic culture of renal tissue obtained from surgical specimens or autopsy. The use of the quantitative scintillation camera studies done with the patient in a state of controlled hydropenia increased clearly the level of diagnostic sensitivity in demonstrating the source of a urinary tract infection compared to urine culture and excretory urography alone. In patients with an abnormal 131iodine hippuran study the performance of 67gallium renal imaging on the same day usually provided information that allowed specific localization of the source and extent of an infection. Both studies must be performed with a high degree of resolution over the renal areas and then must be interpreted carefully to ensure accuracy. Study of antibody coating of urinary bacteria was helpful in suggesting the presence or absence of upper urinary tract disease but was less sensitive and accurate than the combined radionuclide studies.

Hypomagnesemia and ventricular tachycardia: a complication of ulcerative colitis and parenteral hyperalimentation in a nondigitalized noncardiac patient

A nondigitalized patient without heart disease, but with ulcerative colitis on parenteral hyperalimentation, developed ventricular tachycardia in association with hypomagnesemia. Magnesium infusions were successful in suppressing the arrhythmia, but because of ongoing fecal losses, hypomagnesemia and ventricular tachycardia recurred each time the infusion was stopped. After total colectomy, the patient remained normomagnesemic and free of arrhythmias. The few previous descriptions of arrhythmias attributed to hypomagnesemia in nondigitalized patients are reviewed. The importance of recognizing hypomagnesemia as an easily reversible cause of arrhythmias is stressed.