Venous involvement in Takayasu's disease: does it exist?

We describe the case of a 46-year-old man with an isolated superior vena cava syndrome, which was relieved by surgery. Pathologic examination revealed segmental involvement of the superior vena cava with dense collagen sclerosis. Histiomonocytic inflammatory transmural infiltration of all layers was histologically compatible with lesions described in Takayasu's disease. Although not previously described, this pathologic aspect suggests the possibility of venous involvement in this disease.

Overwhelming strongyloidiasis in a diabetic patient following ACTH treatment and keto-acidosis.

A non insulin-dependent Zairian patient developed ketoacidosis and then overwhelming strongyloidiasis following ACTH treatment. Severe cardiovascular and respiratory failure, associated with severe acute hypoprotidemia, preceded death, which occurred within three days. Pathologic examination revealed a massive parasitic infiltration of the gastro-enteric mucosa, mesenteric lymph nodes, and the pulmonary tissue and vessels. We suggest that ACTH treatment and keto-acidosis induced immune deficiency and triggered the acute parasitic episode, in a patient originating from an endemic area. Badly controlled diabetes should be known as a risk factor of hyperinfection by Strongyloides stercoralis in latent carriers.

[Enlarged heart caused by massive subepicardial lipomatosis with idiopathic dilatation of the right cavities]. / Gros coeur par monstrueuse lipomatose sous-épicardique avec dilatation idiopathique des cavités droites

The case is reported of a man of 48 with known longstanding gross cardiomegaly which was completely asymptomatic. Angiocardiography and coronary arteriography showed dilatation of the right side of the heart, and especially of the auricle. In addition, the ventricle was separated from the diphragm by a transparent non-fluid area. At operation, gross dilatation of the right atrium was confirmed, but no causative lesion could be found; there was also marked lipomatosis which involved particularly the area beneath the right ventricle. It is difficult to classify this most unusual case as either a classical dilatation of the right atrium, idiopathic or secondary, or as a cardiac lipoma or lipomatosis.