Amiodarone-induced severe hepatitis mediated by immunological mechanisms.

A 64-year-old man developed a fulminant hepatitis 4 days after initiation of amiodarone treatment and a total dose of 7.1 g. The direct Coombs test was positive and became negative again soon after stopping treatment. Immediately after stopping treatment the extremely increased parameters of hepatic failure returned to normal again. A rechallenge with 200 mg of amiodarone was accompanied by a positive Coombs test which again became negative after several days. We conclude that the occurrence of an acute hepatitis soon after initiation of amiodarone treatment is mediated by immunological mechanisms. There should be high vigilance with respect to this rare life-threatening adverse drug reaction.

[Diagnostic problems in pediatric tuberculosis: a description of two cases]. / Problemy diagnostiyczne gruzlicy wieku dzieciecego--opis dwóch przypadków.

This paper describes two cases of tuberculosis (tbc) in children in whom tbc was misdiagnosed and who were initially treated with antibiotics (and corticosteroids) as for non-specific lower respiratory tract infections. Chest radiograms, good response to antituberculosis drugs (in both children), bacteriologic and histologic examinations and a history of family contact with infectious tbc (in case I) confirmed the diagnosis of tbc. We suggest that the most important factor in rapidly diagnosing tuberculosis is a high index of suspicion in children with respiratory tract infections.

[Mucocutaneous lymph node syndrome (Kawasaki disease) in 2 children]. / Zespól skrno - sluzówkowo - wezlowy (choroba Kawasaki)u 2 dzieci.

Two children with Kawasaki disease (KD), a girl 3 yrs. and a boy 2.5 yrs., were described. The children met all criteria for the diagnosis of KD (fever, conjunctivitis, oral changes, extremity changes, rash, lymphadenopathy), and other diseases were excluded. In both children or one of them other clinical and laboratory findings occasionally detected in KD were observed: arthralgia, hepatomegaly and splenomegaly, slight elevation of transaminases and bilirubin level, slight elevation of CSF pleocytosis, sterile pyuria and hematuria. Electrocardiograms revealed sinus tachycardia and transient disturbances of heart repolarization. In both children changes in blood morphology and biochemical disturbances typical for inflammatory processes were noted. Thrombocytosis was seen in the 2nd week of the illness in the child in whom platelet counts were controlled. The child in whom diagnosis of KD was established in the first week of symptoms was treated with acetylsalicylic acid along with an oral penicillin. A child with retrospectively diagnosed KD was treated with antibiotics and corticosteroids. Clinical and laboratory findings of KD resolved in both children within 4-6 weeks without complications from coronary blood vessels.

[Usefulness of doppler ultrasonography in diagnosing changes in atherosclerotic lesions in lower extremity arteries in hyperlipoproteinemia]. / Przydatnosc sonografii dopplerowskiej w diagnostyce zmian miazdzycowych tetnic konczyn dolnych w hyperlipoproteinemii.

The purpose of this study was to establish the correlation between the intensity of atherosclerosis of the lower extremities found in the course of the Doppler examination, and type of hyperlipoproteinaemia. An attempt was undertaken to analyse the relation of the risk factors of obliterative atherosclerosis to the condition of the arteries in the lower extremities. 53 men at the age of 37 to 63 years (mean age 51 years) were examined. HLP type IIa, IIb, IV, was found in 16, 19, 18 patients respectively. The control group consisted of 30 healthy non-smoking men. The examination was performed using ACUSON 128 with a linear probe 5 and 7 MHz. The Doppler spectrum was registered from the external iliac, common femoral, superficial femoral, deep femoral and popliteal arteries. Simultaneously, a two-dimensional color picture of contrasted vessels, and the Doppler spectrum of blood velocity were recorded. Blood velocity spectrum was quantitatively assessed according to the classification suggested by Jager et al. The results of the Doppler examination confirmed the unfavourable influence of the so called risk factors on the progress of atherosclerosis, especially low serum concentration of HDL cholesterol and cigarette smoking. Besides, the examination has proved the possibility to diagnose even asymptomatic atherosclerotic lesions of the arteries of lower extremities.

[Doppler ultrasonography of arteries of the lower extremities]. / Sonografia dopplerowska tetnic konczyn dolnych.

We examined 90 male nonsmokers aged 22 to 76, without any symptoms of arterial occlusive disease. They were in the I class of the NYHA classification. The subjects were divided into 2 groups according to age: group I 22-49, group II 50-76. The study was performed using an Acuson 128 with linear probe 5 MHz. We examined arteries of the lower extremities from external iliac artery to popliteal artery. On the B-mode image the diameter of the artery and wall irregularities were evaluated. Doppler spectra were evaluated according to 3 criteria. Doppler waveforms differed significantly between two groups. The third wave of spectrum (the diastolic wave toward the probe) was significantly lower in group II. This finding may be caused by decrease in vessel wall compliance in elderly patients. Moreover we found spectral broadening in the presence of atherosclerotic plaques (38% in group II). The authors' examination showed that Doppler sonography is useful in the evaluation of abnormality of an asymptomatic areas. Our study also indicated that subject's age has to be taken into consideration when Doppler waveforms are evaluated.