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Cardiac sarcoidosis: A review on the work-up and management

100%
Solun B., Marcoviciu D., Belnik Y., Azran T., Dicker D., Perek Y., Goitein O.
Open Medicine
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2013
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vol. 8
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issue 1
107-116
EN
Sarcoidosis is a multisystem granulomatous disease of unknown etiology and with variable presentation. Skin, lymph nodes, lungs, eyes and the central nervous system are mostly involved. Cardiac sarcoidosis (CS) is a rare condition with clinical manifestations in about 5% of patients. Since it increases the risk of acute cardiac failure, ventricular arrhythmia, conduction disturbances and even sudden death, it aggravates markedly the prognosis. The early diagnosis of CS is difficult, requiring the use of diagnostic tools such as electrocardiographic monitoring, two-dimensional echocardiography, radionuclide scan, cardiac magnetic resonance imaging, positron emission tomography and endomyocardial biopsy. Once the diagnosis of CS is established, there is a need for early corticosteroids treatment, with or without immunosuppressive therapy, to prevent deterioration of cardiac function. In patients with refractory ventricular tachyarrhythmia, markedly reduced left ventricular ejection fraction and high risk of sudden death, prophylactic insertion of a pacemaker or implantable defibrillator is recommended. We had the opportunity to treat a patient with CS and to review the currently accepted diagnostic and treatment approach.
2
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Severe hiccups associated with intra-articular corticosteroid injection - A case report

100%
Solun B., Ori Y.
Open Medicine
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2012
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vol. 7
|
issue 1
63-65
EN
A hiccup is a sudden contraction of the inspiratory and diaphragmatic muscles followed by an abrupt closure of the glottis; that produces a characteristic noise resulting from vibrations of the vocal cords. Brief episodes of hiccups are common in humans at all stages of life and are usually benign. Prolonged attacks that last for days or weeks are considered a more serious phenomenon and may indicate an underlying disorder warranting a comprehensive medical evaluation. These attacks have been associated with significant burden and morbidity. The most common triggers for acute hiccups are linked with gastro-intestinal causes, such as the gastric distension that occurs after an abundant meal, or with gastroesophageal disease. Sudden changes in temperature, excessive alcohol consumption, as well as excitement or emotional stress, may also set off acute hiccups. Certain drugs, including benzodiazepines, barbiturates, and many others, have been reported to induce hiccups. Drug-induced hiccups are diagnosed by exclusion of other causes and represent a very unusual side-effect of drugs like corticosteroids. We present a case of hiccups associated with intra-articular Diprospan (Betamethasone Sodium Phosphate) administration.
3
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Recurrence of retroperitoneal fibrosis with pancreatic involvement - the importance of imaging methods

75%
Djerassi R., Krupev M., Nikolova M., Naumov N., Marianovski V., Elenkov C., Postadjian A.
Open Medicine
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2008
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vol. 3
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issue 3
365-369
EN
Retroperitoneal fibrosis (RPF) is a rare disease associated with the development of chronic inflammation and fibrogenesis in the retroperitoneal space. The disease usually manifests with acute or acute over chronic renal failure and/or urosepsis. Pancreatic involvement in RPF is rare but has been described in the literature. The diagnosis of RPF is made mainly by imaging methods. Abdominal echography scan reveals the presence of an obstruction with or without inflammation; computed tomography and magnetic resonance imaging show the type and the spreading of fibrosis. Here, we report a 50-year-old female patient diagnosed with RPF during operative intervention in 2003. Initial treatment with corticosteroids and tamoxifen lead to remission. In 2007, late recurrence was observed, with tumor-like lesions over the upper, posterior, and anterior surfaces of the pancreas, spreading to intraperitoneal structures and more pronounced on the left side. Abdominal echography on day 30 showed that corticosteroid treatment lead to a decrease in the tumor-like lesions.
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