ABSTRACT
Continuous intravenous infusion of prostacyclin is an effective treatment for primary pulmonary hypertension (PPH), and has recently been shown to be of benefit in PH associated with scleroderma (SSc). Pulmonary capillary hemangiomatosis (PCH) is a rare cause of PPH. Prostacyclin therapy has been complicated by pulmonary edema in cases of PCH. We describe a case of PH associated with limited SSc, where treatment with prostacyclin was complicated by pulmonary edema. Autopsy revealed PCH as the pathologic basis for the PH. There were no clinical features of PCH prior to initiation of vasodilator therapy, illustrating the potential difficulty in establishing the diagnosis. This is the first reported case of PCH in SSc.
Subject(s)
Epoprostenol/therapeutic use , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/drug therapy , Pulmonary Edema/complications , Scleroderma, Systemic/complications , Aged , Female , Hemangioma, Capillary/complications , Hemangioma, Capillary/diagnosis , Humans , Lung/pathology , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Radiography, Thoracic , Respiratory Function TestsABSTRACT
OBJECTIVE: To determine whether antiphospholipid antibodies (aPL) are more prevalent in cardiac patients taking procainamide than in a control population of similar elderly cardiac patients and to determine whether these antibodies react in an ELISA in which the primary antigen is beta 2-glycoprotein I (beta 2-GPI). METHODS: aPL and antibodies to beta 2-GPI were measured in 66 patients taking procainamide from a Veterans Administration Medical Center population and a control group of 30 similar cardiac patients not taking procainamide. RESULTS: 21% of the patients taking procainamide and no control patients were found to have moderate to high aPL. There were similar results in an assay that measured anti-beta 2-GPI in the absence of exogenous phospholipids. aPL were associated with antinuclear antibodies and antihistone antibodies but not with diabetes or clinical manifestations of drug related lupus. There was no increase in cholesterol or past thrombotic history associated with aPL, but there was a frequent history of noncardiac thrombosis in patients taking procainamide (25.7%). CONCLUSION: The predictive significance of procainamide induced aPL remains unknown but beta 2-GPI dependent aPL may be of some concern in this elderly population already at high risk for thrombosis.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Antibodies, Antiphospholipid/blood , Glycoproteins/blood , Heart Diseases/immunology , Procainamide/therapeutic use , Adult , Aged , Aged, 80 and over , Enzyme-Linked Immunosorbent Assay , Female , Heart Diseases/drug therapy , Humans , Male , Middle Aged , beta 2-Glycoprotein IABSTRACT
A total of 54 patients with culturally proven tropical dermatomycoses, comprising 23 with various types of dermatophytoses, one with foot infection due to Trichosporon beigelii and one with foot infection due to Geotrichum candidum, two with candidosis of the groin and 27 with pityriasis versicolor, were included in a clinical trial of efficacy of 1% isoconazole cream (Travogen, Schering, Berlin, Germany). Five patients were not evaluable. A clinical and mycological cure was achieved in 29 cases in 3-4 weeks. In 15 (31%) of the remaining patients treatment was required for 5-6 weeks, while another three patients required treatment for 8 weeks. In two patients the disease proved to be resistant to treatment with the drug.
