ABSTRACT
The optimal diagnostic approach and yield for gastrointestinal bleeding (GIB) in patients with ventricular assist devices (VAD) are unknown. We explored the etiology of bleeding and yield of upper and lower endoscopy, balloon-assisted enteroscopy, and video capsule endoscopy in the evaluation of GIB in patients with VADs. Methods. All VAD patients with overt gastrointestinal bleeding and drop in hematocrit from April 1, 2000 to July 31, 2008 were retrospectively reviewed. The endoscopic evaluation of each episode was recorded. Overall yield of EGD, colonoscopy, balloon-assisted, and video capsule endoscopy were evaluated. Results. Thirty-six bleeding episodes occurred involving 20 patients. The site of GIB was identified in 32/36 episodes (88.9%), and the etiology of bleeding was determined in 30/36 cases (83.3%). Five VAD patients underwent VCE. The VCE exams demonstrated a high yield with 80% of exams identifying the etiology of GIB. Endoscopic intervention was successful in 8/9 attempts. No adverse events were recorded. Two patients required surgical intervention for GIB. Conclusion. Upper, lower, video capsule, and balloon-assisted enteroscopies are safe and demonstrate a high yield in the investigation of gastrointestinal bleeding in VAD patients. Medical centers caring for VAD patients should employ a standardized protocol to optimize endoscopic evaluation and intervention.
Subject(s)
Pneumothorax/diagnostic imaging , Adult , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Pulmonary amyloidosis is a rather rare complication of multiple myeloma particularily the rare Ig D myeloma. It is often generalized and is seen in a late stage of the disease. We report a case of an Ig G myeloma complicated of a pulmonary amyloidosis in a 66-year-old man hospitalised for infectious pulmonary disease with a radiologic interstitial syndrome. Discovery of the multiple myeloma and of the amyloidosis was fortuitous.
Subject(s)
Amyloidosis/complications , Immunoglobulin G , Lung Diseases/complications , Multiple Myeloma/complications , Multiple Myeloma/immunology , Aged , Amyloidosis/diagnostic imaging , Humans , Lung Diseases/diagnostic imaging , Male , RadiographyABSTRACT
A liver transplant recipient with hepatitis C presented with unexplained dyspnea, fatigue and edema. Diagnostic evaluation revealed a pericardial effusion with echocardiographic features of tamponade. The patient underwent therapeutic pericardial drainage, resulting in symptomatic relief. The pericardial fluid tested positive for hepatitis C virus (viral quantitation of 200,000 copies/mL, genotype 1b) and negative for other plausible etiologies. Pericardial biopsy revealed normal tissue. This is the fifth case of hepatitis C virus-associated pericardial disease worldwide and the first case in North America. It is the first in a liver transplant recipient. In contrast to previous reports, this patient demonstrated tamponade in the absence of cryoglobulinemia or systemic extrahepatic manifestations of hepatitis C.
