Complete heart block due to limited Wegener's granulomato-sis: a case report

Complete heart block is a rare manifestation of various cardiac involvements seen in Wegener's granulomatosis. To our knowledge there have only been two previous cases of complete heart block reported in patients with limited form of Wegener's granulomatosis in English literature. We describe a 62-year-old Iranian woman presenting with complete heart block who was candidate for pacemaker insertion. Limited Wegener's granulomatosis was suspected because of bloody nasal discharge, fatigue, fever, arthralgia, dacrocystitis, and history of recurrent subglutic stenosis, but no renal involvement. The diagnosis was subsequently confirmed by presence of granuloma in nasal mucosal biopsy and also high level of serum anti-proteinase 3. Prednisolone and cyclophosphamide therapy was started and her electrocardiography returned to normal sinus rhythm. Awareness of unusual presentation of Wegener's granulomatosis is important for proper diagnosis and management of the potentially fatal cardiac involvement of the disease. Complete heart block may be reversed by appropriate medical therapy of Wegener's granulomatosis

[ relationship between major depression and bone density]

Major Depression is associated with alterations in the neuroendocrine system, dysfunction of hypothalamic-pituitary-adrenal axis, and elevated blood cortisol levels. These changes may result in an increased risk of osteoporosis in depressed patients. The aim was studying the relationship between bone density and major depression. In a historical cohort study, we performed bone densitometry in 75 persons; 25 of them suffered from major depression, the remaining 50 were healthy volunteers as controls. The groups were matched for age, sex, BMI, supplemental calcium intake, regular exercise and menstrual status. Bone mineral density [BMD] was measured by the DXA method. The two groups were compared regarding T-score and BMD of lumbar and pelvic regions. BMD [gr/cm[2]] of total femur, femoral neck, and lumbar regions were all significantly lower in cases than controls, [0.94 +/- 0.13 versus 1.16 +/- 0.15, 0.92 +/- 0.12 versus 1.09 +/- 0.14, and 1.05 +/- 0.22 versus 1.32 +/- 0.21, respectively]. Osteoporosis was more frequent in patients with depression than in controls, 32% versus 4% in total femur region [Odds ratio: 5.4, CI 95%: 1.4%-20.3%], and 36% versus 14% in lumbar region [Odds ratio: 3.5, CI 95%: 1.1%-10.8%]. In this study major depression was associated with lower bone density and increased frequency of osteoporosis. Based on these findings, it seems reasonable to advice that patients with depression should be screened for osteoporosis