Anticardiolipin antibodies in patients with type 2 diabetes mellitus

BACKGROUND

There is controversy about an increased prevalence of antiphospholipid antibodies in diabetic patients. The possible implications are little known.

METHODS

We prospectively studied all consecutive outpatients with type 2 diabetes mellitus (DM) attended to in an Internal Medicine office. IgM and IgG anticardiolipin antibodies (ACA) were determined by standardized enzyme-linked immunoassay.

RESULTS

Fifty-six patients were included. Only one patient (1.8%) had a titer of IgM ACA higher than 15 MPL units and no patient had a titer of IgG ACA higher than 15 GPL units. Six patients (10.7%) had low IgM ACA titers (4-15 MPL units) and 18 patients (32.1%) had low IgG ACA titers (4-15 GPL units). There were no differences in the frequencies of a low IgM or IgG ACA titer or in the means of IgM and IgG ACA titers in patients with complicated and uncomplicated DM, with and without cardiovascular disease, with and without nephropathy, or with and without retinopathy.

CONCLUSIONS

Moderate to high ACA titers must be exceptional in patients with type 2 DM. Low ACA titers may occur in patients with type 2 DM. These low titers do not seem to be associated with complicated DM, cardiovascular disease, nephropathy or retinopathy.

Favourable outcome of multiple pyogenic liver abscesses with conservative treatment

We describe a patient with multiple pyogenic liver abscesses treated only with antibiotics with a favourable outcome. This conservative treatment may be an option in some patients with multiple pyogenic liver abscesses.

Predictors of an intermediate ventilation/perfusion lung scan in patients with suspected acute pulmonary embolism

BACKGROUND

An intermediate ventilation/perfusion (V/Q) lung scan lacks diagnostic utility in excluding acute pulmonary embolism (PE).

OBJECTIVE

To identify the potential predictors of an intermediate V/Q lung scan in patients with suspected acute PE.

METHODS

A review of the medical records of 306 consecutive patients with suspected acute PE, in whom a V/Q lung scan was performed (interpretation using modified Prospective Investigation of Pulmonary Embolism Diagnosis criteria).

RESULTS

A total of 274 patients (89.5%) had a non-intermediate V/Q lung scan: 88 (28.8%) high probability, 149 (48.7%) low probability, and 37 (12.1%) near normal/normal. Thirty-two patients (10.5%) had an intermediate V/Q lung scan. Patients with an intermediate V/Q lung scan presented a significantly greater frequency of age greater than 70 years (81.2 versus 50.4%, P=0.01), previous cardiopulmonary disease (75 versus 46.3%, P=0.003), chronic obstructive pulmonary disease (34.4 versus 15.7%, P=0.01), and chest radiograph evidence of emphysema (18.7 versus 4.7%, P=0.008). We found no other significant differences in the rest of the characteristics studied between patients with an intermediate and a non-intermediate V/Q lung scan.

CONCLUSION

The possibility of an intermediate V/Q lung scan is higher in elderly patients and in patients with previous cardiopulmonary disease (especially with chronic obstructive pulmonary disease). Emphysema is the only chest radiograph abnormality associated with a greater possibility of an intermediate V/Q lung scan.

Bilateral pleural effusion and ascites in the ovarian hyperstimulation syndrome

We describe a pregnant woman with ovarian hyperstimulation syndrome with bilateral pleural effusion and ascites. Ovarian hyperstimulation syndrome is an iatrogenic complication of ovarian stimulation, characterized by a massive crossing of a protein-rich fluid from the vascular compartment into the peritoneal, pleural, or to a lesser extent, pericardial cavities. Management is usually conservative, with fluid and electrolytes correction and thromboprophylaxis. Prevention is very difficult, but an age younger than 35 years, low body mass index, polycystic ovarian disease, a high number of follicles, a high plasma oestradiol concentration, pregnancy, hyperandrogenism, and hypothyroidism are predisposing factors.

Low-grade and high-grade fever at presentation of acute pulmonary embolism

We retrospectively reviewed the medical records of 154 consecutive patients with acute pulmonary embolism (PE) admitted to an Internal Medicine Service. At presentation, fever (temperature > 37 degrees C) without other identified causes was present in 28 patients (18.2%): 27 patients had low-grade fever (temperature 37-39 degrees C) and one patient had high-grade fever (temperature > 39 degrees C). Epidemiological and clinical characteristics, electrocardiographic and chest radiograph abnormalities and mortality rate were similar in patients with and without fever. Fever, including high-grade fever, is a possible presenting feature in patients with acute PE. Patients with acute PE and fever have similar characteristics compared with those without fever.