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Kumar S, Narasimhan C. Diagnosis and management of Granulomatous Myocarditis. Indian Pacing Electrophysiol J 2022; 22:179-181. [PMID: 35777855 DOI: 10.1016/j.ipej.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Sharath Kumar
- Department of Electrophysiology, Asian Institute of Gastroenterology, Gachibowli, Hyderabad, India
| | - Calambur Narasimhan
- Department of Electrophysiology, Asian Institute of Gastroenterology, Gachibowli, Hyderabad, India.
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Bohora S, Mumtaz Z, Phadke M, Bhute V, Bhatia V, Vora A, Naik A, Nabar A, Jankharia B, Vaideeswar P, Panicker G, Bhure U, Lokhandwala Y. Long-term, real world experience of ventricular tachycardia and granulomatous cardiomyopathy. Indian Pacing Electrophysiol J 2022:S0972-6292(22)00052-3. [PMID: 35398517 DOI: 10.1016/j.ipej.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Granulomatous cardiomyopathy(GCM) is relatively uncommon in patients presenting with ventricular tachycardia(VT). Sarcoidosis and tuberculosis are the most common causes of GCM with VT. The aim of study was to evaluate their clinical characteristics and the long-term outcomes. METHODS We retrospectively analyzed patients from March 2004 to January 2020, presenting with VT and subsequently diagnosed to have GCM. Patients were divided into three groups (sarcoid, tuberculosis and indeterminate) based on serologic tests, imaging and histopathology. The response to anti-arrhythmic and disease specific therapy on long-term follow-up were analysed. RESULTS There were 52 patients, comprising 27 males and 25 females, age 40 ± 10 years. The follow-up period was 5.9 ± 3.9 years. Sarcoidosis was diagnosed in 20(38%); tuberculosis(TB) in 15(29%) and 17(33%) patients were indeterminate. Left ventricular ejection fraction(LVEF) of the entire cohort was 0.45 ± 0.14. Erythrocyte Sedimentation Rate(ESR) was found to be significantly higher in TB(43.6 ± 18.4) patients vs sarcoid(18.9 ± 6.7)p < 0.0001, but not the indeterminate group(36.2 ± 21.1), p = 0.3. Implantable Cardioverter Defibrillator(ICD) implantation was performed in 12/20(60%) patients in the sarcoid group, in 4/15(27%) patients in the TB group and in 10/17(59%) patients in the indeterminate group. At a mean follow-up of six years, VT recurrences were noted in 6, 2, and 7 patients in the sarcoid, TB and indeterminate groups respectively. CONCLUSION Despite the advances in diagnostic modalities for tuberculosis and sarcoidosis, in real-world practice, almost one-third of the patients with VT and GCM have uncertain etiology. Long term outcomes of patients presenting with GCM and VT with mild left ventricle dysfunction treated appropriately seems favorable.
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Pichler Sekulic S, Sekulic M. Case Report: Isolated and Focal Non-necrotizing Granulomatous Inflammation of Mitral Valves: A Report of Two Cases. Front Cardiovasc Med 2021; 8:615707. [PMID: 33718447 PMCID: PMC7946834 DOI: 10.3389/fcvm.2021.615707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
Cardiac valve inflammation is seen in the setting of autoimmune or infectious processes, and rarely is valvulitis characterized by granulomatous inflammation. We present two patients who underwent surgical repair of prolapsing/regurgitating mitral valves. Excised valve tissue in both cases revealed commonly encountered nodular fibrosis and calcification, however each also revealed an isolated focus of non-necrotizing granulomatous inflammation. Typical implicating etiologies for non-necrotizing granulomatous inflammation were not present for either patient based on clinical history, or radiologic and laboratory data. In a review of 1048 cardiac valves excised at our institution, the finding of non-necrotizing granulomatous inflammation was seen in only the two described cases (prevalence of 0.19%). The description of non-necrotizing granulomatous inflammation within cardiac valves is limited in the literature, and the significance of the detailed isolated and incidental finding is unclear and requiring further investigation.
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Affiliation(s)
- Simona Pichler Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, United States
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, United States
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Mehta OH, Anderson R, Gonzales M. Large pericardial effusion and tamponade in young male with Niemann-Pick disease type C. Intern Med J 2018; 48:742-744. [PMID: 29898264 DOI: 10.1111/imj.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ojas H Mehta
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
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5
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Gupta K, Rawat A, Agrawal P, Jindal A, Nada R, Saikia B, Chan KW, Lau YL, Minz RW, Singh S. Infectious and non-infectious complications in primary immunodeficiency disorders: an autopsy study from North India. J Clin Pathol 2017; 71:425-435. [PMID: 28970295 DOI: 10.1136/jclinpath-2017-204708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Primary immunodeficiency disorders (PID) include a wide spectrum of inherited disorders characterised by functional abnormalities of one or more components of the immune system. Recent updates from the genomic data have contributed significantly to its better understanding with identification of new entities. Diagnosis is always challenging due to their variable clinical presentation. With the evolution of molecular diagnosis, many of these children are being diagnosed early and offered appropriate therapy. However, in developing countries, early diagnosis is still not being made: as a result these patients succumb to their disease. Autopsy data on PID is notably lacking in the literature with histopathological evaluation of PID being limited to rare case reports. OBJECTIVE To analyse the clinical, immunologic (including mutational) and morphologic features at autopsy in 10 proven and suspected cases of primary immunodeficiency disorders diagnosed at our Institute over the past decade. METHODS Study includes a detailed clinico-pathological analysis of 10 proven and suspected cases of primary immunodeficiency disorders. RESULTS A varied spectrum of infectious and non-infectious complications were identified in these cases of which fungal infections were found to be more frequent compared with viral or bacterial infections. Rare and novel morphological findings, like granulomatous involvement of the heart in a patient with chronic granulomatous disease, systemic amyloidosis in a teenage girl with X-linked agammaglobulinemia, are highlighted which is distinctly lacking in the literature. CONCLUSIONS The present study is perhaps the first autopsy series on PID. Even in the molecular era, such analysis is still important, as correlation of pathological features with clinical symptoms provides clues for a timely diagnosis and appropriate therapeutic intervention.
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Affiliation(s)
- Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Rawat
- Department of Paediatrics (Allergy and Immunology Unit), Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Parimal Agrawal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Jindal
- Department of Paediatrics (Allergy and Immunology Unit), Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Biman Saikia
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | - Koon Wing Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Ranjana Walker Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
| | - Surjit Singh
- Department of Paediatrics (Allergy and Immunology Unit), Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Winkler J, Buder-Bakhaya K, Ellert E, Herpel E, Martens U, Enk A, Hassel J. Acute heart failure as a result of granulomatous myocarditis: case report on a patient with metastatic melanoma treated with dabrafenib and trametinib. J Eur Acad Dermatol Venereol 2017; 32:e31-e32. [DOI: 10.1111/jdv.14467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J.K. Winkler
- Department of Dermatology and National Center for Tumor Diseases (NCT); University Hospital Heidelberg; Heidelberg Germany
| | - K. Buder-Bakhaya
- Department of Dermatology and National Center for Tumor Diseases (NCT); University Hospital Heidelberg; Heidelberg Germany
| | - E. Ellert
- Department of Pathology; University Hospital Heidelberg; Heidelberg Germany
| | - E. Herpel
- Department of Pathology; University Hospital Heidelberg; Heidelberg Germany
| | - U.M. Martens
- Department of Internal Medicine (Hematology/Oncology); SLK-Klinikum Heilbronn; Heilbronn Germany
| | - A. Enk
- Department of Dermatology and National Center for Tumor Diseases (NCT); University Hospital Heidelberg; Heidelberg Germany
| | - J.C. Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT); University Hospital Heidelberg; Heidelberg Germany
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du Toit-Prinsloo L, Saayman G. “Death at the wheel” due to tuberculosis of the myocardium: a case report. Cardiovasc Pathol 2016; 25:271-274. [DOI: 10.1016/j.carpath.2016.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022] Open
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Affiliation(s)
- Kirti Gupta
- Department of Histopathology; and Pediatric Allergy-Immunology Unit, Department of Pediatrics; PGIMER, Chandigarh. India. Correspondence to: Dr Kirti Gupta, Additional Professor, Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Lehrke HD, Johnson CK, Zapolanski A, Kasatki A, Grau JB, Maleszewski JJ. Intracardiac juvenile xanthogranuloma with presentation in adulthood. Cardiovasc Pathol 2014; 23:54-6. [DOI: 10.1016/j.carpath.2013.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022] Open
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Saini-Chohan HK, Mitchell RW, Vaz FM, Zelinski T, Hatch GM. Delineating the role of alterations in lipid metabolism to the pathogenesis of inherited skeletal and cardiac muscle disorders: Thematic Review Series: Genetics of Human Lipid Diseases. J Lipid Res 2011; 53:4-27. [PMID: 22065858 DOI: 10.1194/jlr.r012120] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As the specific composition of lipids is essential for the maintenance of membrane integrity, enzyme function, ion channels, and membrane receptors, an alteration in lipid composition or metabolism may be one of the crucial changes occurring during skeletal and cardiac myopathies. Although the inheritance (autosomal dominant, autosomal recessive, and X-linked traits) and underlying/defining mutations causing these myopathies are known, the contribution of lipid homeostasis in the progression of these diseases needs to be established. The purpose of this review is to present the current knowledge relating to lipid changes in inherited skeletal muscle disorders, such as Duchenne/Becker muscular dystrophy, myotonic muscular dystrophy, limb-girdle myopathic dystrophies, desminopathies, rostrocaudal muscular dystrophy, and Dunnigan-type familial lipodystrophy. The lipid modifications in familial hypertrophic and dilated cardiomyopathies, as well as Barth syndrome and several other cardiac disorders associated with abnormal lipid storage, are discussed. Information on lipid alterations occurring in these myopathies will aid in the design of improved methods of screening and therapy in children and young adults with or without a family history of genetic diseases.
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Affiliation(s)
- Harjot K Saini-Chohan
- Department of Pharmacology and Therapeutics, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
CONTEXT Sarcoidosis is a granulomatous disease of unclear etiology. It is not commonly fatal, but when sarcoidosis is fatal, it is most often from cardiac involvement and when sarcoidosis involves the heart, it frequently causes death. The disease presents diagnostic challenges both clinically and histologically. OBJECTIVES To review the histology of cardiac sarcoidosis and the histologic differential diagnosis of cardiac granulomatous disease and to review the epidemiology and gross pathology of cardiac sarcoid as well as discuss current controversies, clinical diagnostic criteria, and proposed mechanisms of pathogenesis. DATA SOURCES We reviewed the literature searchable on PubMed as well as selected older studies revealed by our review of the recent literature. Photographs were taken from cases on file at the University of Pittsburgh Medical Center (Pittsburgh, Pennsylvania) and Columbia University Medical Center (New York, New York). CONCLUSIONS Sarcoidosis is a focal or disseminated granulomatous disease that likely represents the final common pathway of various pathogenic insults in a genetically susceptible host. The type of insult may influence the specific sarcoid phenotype. Controversy still abounds, but many areas of investigation around sarcoidosis are yielding exciting discoveries and bringing us closer to a richer understanding of this puzzling disease.
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Affiliation(s)
- Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
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Quinn MT, Schepetkin IA. Role of NADPH oxidase in formation and function of multinucleated giant cells. J Innate Immun 2009; 1:509-26. [PMID: 20375608 DOI: 10.1159/000228158] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 05/08/2009] [Indexed: 01/03/2023] Open
Abstract
Macrophages play essential roles in a wide variety of physiological and pathological processes. One of the unique features of these phagocytic leukocytes is their ability to fuse, forming multinucleated giant cells. Multinucleated giant cells are important mediators of tissue remodeling and repair and are also responsible for removal or sequestration of foreign material, intracellular bacteria and non-phagocytosable pathogens, such as parasites and fungi. Depending on the tissue where fusion occurs and the inflammatory insult, multinucleated giant cells assume distinctly different phenotypes. Nevertheless, the ultimate outcome is the formation of large cells that can resorb bone tissue (osteoclasts) or foreign material and pathogens (giant cells) extracellularly. While progress has been made in recent years, the mechanisms and factors involved in macrophage fusion are still not fully understood. In addition to cytokines and a number of adhesion proteins and receptors, it is becoming increasingly clear that NADPH oxidase-generated reactive oxygen species (ROS) also play an important role in macrophage fusion. In this review, we provide an overview of macrophage multinucleation, with a specific focus on the role of NADPH oxidases and ROS in macrophage fusion and in the function of multinucleated giant cells. In addition, we provide an updated overview of the role of these cells in inflammation and various autoimmune diseases.
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Affiliation(s)
- Mark T Quinn
- Department of Veterinary Molecular Biology, Montana State University, Bozeman, Montana 59717, USA.
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De Ravin SS, Naumann N, Cowen EW, Friend J, Hilligoss D, Marquesen M, Balow JE, Barron KS, Turner ML, Gallin JI, Malech HL. Chronic granulomatous disease as a risk factor for autoimmune disease. J Allergy Clin Immunol 2008; 122:1097-103. [PMID: 18823651 DOI: 10.1016/j.jaci.2008.07.050] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/23/2008] [Accepted: 07/25/2008] [Indexed: 01/17/2023]
Abstract
Chronic granulomatous disease (CGD) is characterized by recurrent infections and granuloma formation. In addition, we have observed a number of diverse autoimmune conditions in our CGD population, suggesting that patients with CGD are at an elevated risk for development of autoimmune disorders. In this report, we describe antiphospholipid syndrome, recurrent pericardial effusion, juvenile idiopathic arthritis, IgA nephropathy, cutaneous lupus erythematosus, and autoimmune pulmonary disease in the setting of CGD. The presence and type of autoimmune disease have important treatment implications for patients with CGD.
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Affiliation(s)
- Suk See De Ravin
- National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD 20892-1456, USA.
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Abstract
To this day the aetiology of sarcoidosis continues to elude definition. Partially as a consequence of this, little in the way of new therapies has evolved. The enigma of this condition is that, unusually for a disease with the potential for devastating consequences, many patients show spontaneous resolution and recover. Cardiac involvement can affect individuals of any age, gender or race and has a predilection for the conduction system of the heart. Heart involvement can also cause a dilated cardiomyopathy with consequent progressive heart failure. The most common presentation of this systemic disease is with pulmonary infiltration, but many cases will be asymptomatic and are detected on routine chest radiography revealing lymphadenopathy. Current advances lie in the newer methods of imaging and diagnosing this unusual heart disease. This review describes the pathology and diagnosis of this condition and the newer imaging techniques that have developed for determining cardiac involvement.
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Affiliation(s)
- Simon W Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK.
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Fenton H, Judge DP, Yuh DD, Halushka MK. Intracardiac giant cells after left ventricular assist device placement. J Heart Lung Transplant 2007; 26:417-20. [PMID: 17403488 DOI: 10.1016/j.healun.2007.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 12/10/2006] [Accepted: 01/07/2007] [Indexed: 11/16/2022] Open
Abstract
Multinucleated giant cells are seen in the heart in several distinct pathologic conditions, including giant cell myocarditis, sarcoidosis and infectious etiologies. We describe the first report of solitary multinucleated giant cells scattered throughout the heart after placement of a left ventricular assist device (LVAD) and transient Candida glabrata infection. The pathologic findings were noted in the explanted heart of a patient undergoing orthotopic cardiac transplantation 7 months after LVAD surgery. The presence of solitary giant cells without adjacent inflammation was a distinct histologic finding in this case. An awareness of this entity is important to avoid making a diagnosis of a more severe giant cell-related pathologic disease, which may recur in a transplanted heart.
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Affiliation(s)
- Hubert Fenton
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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Schilling T, Kozian A, Pfau G, Friedl A, Hachenberg T. Anesthetic management of a patient with Niemann-Pick type B disease undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2006; 21:428-31. [PMID: 17544902 DOI: 10.1053/j.jvca.2006.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Schilling
- Department of Anesthesiology and Intensive Care, Otto-von-Guericke University, Magdeburg, Germany.
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Abstract
In this report, clinical, echocardiographic, and pathologic findings of a patient with multiple masses caused by tuberculosis both in the left and right side of the heart are presented. After antituberculosis treatment some of the masses disappeared and some became smaller. Although an intracardiac mass caused by tuberculosis is very rare, it should be considered in the list of masses detected by echocardiography.
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Affiliation(s)
- Necla Ozer
- Department of Cardiology, Hacettepe University, School of Medicine, Ankara, Turkey.
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Abstract
Cardiac involvement in patients with sarcoidosis is an important consideration for those who are concerned with this strange disease. Sarcoidosis is not an acute malignant disease but may be noticed at the time of sudden, expected death as fatal myocardial sarcoidosis at autopsy. Even with modern advances in our ability to diagnose heart disease, cardiac sarcoidosis is still often overlooked because of its subclinical disease progression. In view of this, an extensive review of previously published literature and of our own case analyses has been carried out because of the authors' long-term experience with performing Konno's endomyocardial biopsy, which was originally developed in 1962 at the author's institution. However, the sensitivity of endomyocardial biopsy in detecting sarcoid granuloma is low (20-30%), and, instead, various kinds of nongranulomatous pathologies are often seen. During the course of our research it was found that there might exist a racial difference in cardiac sarcoidosis. Cardiac death was much more frequent in Japanese patients. The possibility that heart disease in sarcoidosis is caused by cor pulmonale due to advanced pulmonary fibrosis should be reevaluated because only a limited amount of background data is available. The author's review clarified the fact that cardiac sarcoidosis is caused by myocardial or pericardial involvement, resulting in various kinds of bradyarrhythmias or tachyarrhythmias and/or congestive heart failure. Electrocardiographic (ECG) and Holter monitor readings provide a simple and effective method for early detection of this disease. The incidence of ECG abnormalities in a total of 963 sarcoidosis patients was 22.1%, which was more frequent than that of the sex- and age-matched healthy control subjects (17.9%; p < 0.025). Echocardiography and radionuclide studies also provide useful clinical information. Careful follow-up and early corticosteroid administration followed by small maintenance doses may prevent the progression of the disease and improve prognosis. Owing to the progress in antiarrhythmic drugs and pacemaker implantation, the primary cause of death in cardiac sarcoidosis has changed from sudden death (1976 report) to congestive heart failure (1985 report).
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Affiliation(s)
- M Sekiguchi
- 1st Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan
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Abstract
Successful osseointegration of endosseous titanium implants is thought to be dependent upon close apposition of bone to the implant surface. The integration of implants in this patient was achieved despite the lipid-laden histiocytic infiltration of the bone marrow. Presumably, enough unaffected stromal cells were present to allow sufficient bone formation for osseointegration of the implant fixtures. This result invites speculation regarding both the mechanism of osseointegration and the minimum surface area of bone-implant interface necessary for achieving and maintaining osseointegration of titanium implants. This patient is periodically examined to determine if the loaded fixtures will remain clinically immobile for a prolonged period.
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Affiliation(s)
- J S Brahim
- Clinical Investigations and Patient Care Branch, National Institutes of Health, National Institute of Dental Research, Bethesda, Md
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Abstract
Erdheim-Chester disease is a rare histiocytosis also known as lipoid granulomatosis. Oral findings have not been reported previously to our knowledge. This case report documents evidence of oral sequelae of Erdheim-Chester disease. A patient whose course was followed for 10 years at the National Institutes of Health had premature alveolar bone resorption. He underwent full-mouth extraction at age 29 years because of severe periodontitis. Histopathologic evidence of Erdheim-Chester disease was demonstrated in the periodontal soft tissues. In the ensuring years, accelerated resorption of the residual ridges precluded the use of conventional dentures. We recommend early preventive dental management for patients with Erdheim-Chester disease.
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Affiliation(s)
- I H Valdez
- National Institute of Dental Research, National Institutes of Health, Bethesda, Md
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