ABSTRACT
BACKGROUND: Fatigue is common in celiac disease. L-Carnitine blood levels are low in untreated celiac disease. L-Carnitine therapy was shown to improve muscular fatigue in several diseases. AIM: To evaluate the effect of L-carnitine treatment in fatigue in adult celiac patients. METHODS: Randomised double-blind versus placebo parallel study. Thirty celiac disease patients received 2 g daily, 180 days (L-carnitine group) and 30 were assigned to the placebo group (P group). The patients underwent clinical investigation and questionnaires (Scott-Huskisson Visual Analogue Scale for Asthenia, Verbal Scale for Asthenia, Zung Depression Scale, SF-36 Health Status Survey, EuroQoL). OCTN2 levels, the specific carnitine transporter, were detected in intestinal tissue. RESULTS: Fatigue measured by Scott-Huskisson Visual Analogue Scale for Asthenia was significantly reduced in the L-carnitine group compared with the placebo group (p=0.0021). OCTN2 was decreased in celiac patients when compared to normal subjects (-134.67% in jejunum), and increased after diet in both celiac disease treatments. The other scales used did not show any significant difference between the two celiac disease treatment groups. CONCLUSION: L-Carnitine therapy is safe and effective in ameliorating fatigue in celiac disease. Since L-carnitine is involved in muscle energy production its decreased absorption due to OCTN2 reduction might explain muscular symptoms in celiac disease patients. The diet-induced OCTN2 increase, improving carnitine absorption, might explain the L-carnitine treatment efficacy.
Subject(s)
Carnitine/therapeutic use , Celiac Disease/complications , Fatigue/drug therapy , Vitamin B Complex/therapeutic use , Administration, Oral , Adult , Biomarkers/metabolism , Biopsy , Carnitine/administration & dosage , Carnitine/pharmacokinetics , Celiac Disease/diagnosis , Celiac Disease/drug therapy , Chromatography, High Pressure Liquid , Dose-Response Relationship, Drug , Double-Blind Method , Electrophoresis, Polyacrylamide Gel , Fatigue/blood , Fatigue/etiology , Female , Follow-Up Studies , Humans , Jejunum/metabolism , Jejunum/pathology , Male , Organic Cation Transport Proteins/metabolism , Pilot Projects , Quality of Life , Solute Carrier Family 22 Member 5 , Surveys and Questionnaires , Treatment Outcome , Vitamin B Complex/administration & dosage , Vitamin B Complex/pharmacokineticsABSTRACT
Paradoxical embolism through a patent foramen ovale (PFO), an increasingly recognized cause of cryptogenic stroke and peripheral embolism, is believed to play little role in the elderly, mainly based on retrospective studies on selected populations. Paradoxical embolism is mostly a presumptive diagnosis, while definite demonstration of a thrombus crossing a PFO is rare. We describe the case of an 84-year-old patient with pulmonary embolism in whom a thrombus in transit through a PFO was found by transesophageal echocardiography (TEE). Treatment with anticoagulants allowed thrombus resolution without evidence of further embolic events. This finding demonstrates that (impending) paradoxical embolism may be present in the 'oldest old'. Its prompt diagnosis may allow effective treatment even with medical therapy alone. We suggest that paradoxical embolism may be not so rare in the elderly. The apparent decline in prevalence with age may be the result of less extensive diagnostic assessment in the elderly, as compared to younger patients.
ABSTRACT
We describe the case of a 73-year-old man with cardiac failure due to hypertensive heart disease, chronic atrial fibrillation, prior ischemic stroke and acute ischemia of the left leg probably embolic in nature, in whom transthoracic echocardiography (TTE) detected a large left atrial mass compatible with thrombus. Transesophageal echocardiography (TEE) was performed to better evaluate the atrial mass. TTE showed a mass that was firmly attached to the wall of the left atrium, compact, homogeneous and stationary, indicating a relatively low embolic risk. On the other hand TEE clearly detected a marked motility and echographic unhomogeneity of the atrial mass, suggesting a poorer prognosis and urgent surgical referral due to high impending embolik risk. This case further supports the superiority of TEE to TTE in the assessment of intracardiac masses and, in particular, of embolik risk in a patient with left atrial thrombosis.
