Gastric and pulmonary sarcoidosis complicated by hypercalcemia and acute renal failure: Case report and literature review.

Gastric sarcoidosis is a very rare manifestation of sarcoidosis. Only few case reports have been described in the literature. We present a case of coexisting gastric and pulmonary sarcoidosis in a 56-year-old female, who presented with gastrointestinal symptoms. Gastric mucosal biopsies, transbronchial needle aspiration, and endobronchial mucosal biopsies revealed noncaseating granulomas. This case report emphasizes on early evaluation of other organ system and initiation of treatment.

Visceral leishmaniasis associated hemophagocytic lymphohistiocytosis--case report and systematic review.

BACKGROUND: The clinical features of leishmaniasis overlap with that of hemophagocytic lymphohistiocytosis (HLH) and the diagnosis of visceral leishmaniasis (VL) related HLH can be challenging. OBJECTIVES: To review information available on disease course, treatment, adjunctive therapy used and the outcomes of VL related HLH. METHODS: We describe an illustrative case and review all reported cases of VL associated HLH in the English literature till March 2007. RESULTS: VL associated HLH is rare, with 56 cases reported in the English literature. Clinical features lack discriminating value to recognize VL as the inciting etiology. Bone marrow aspiration (BMA) establishes the diagnosis in 78% of cases but is often negative at onset of the syndrome due to the pauci-microbial nature of the disease and patchy involvement. Repeated marrow aspiration, liver biopsy, blood cultures and serology may be required to establish the diagnosis. Liposomal amphotericin is the drug of choice. IVIG may be considered when there is an inadequate response to anti-leishmanial therapy in severe and refractory disease. CONCLUSIONS: VL related HLH is often under-recognized because of overlapping clinical features and negative marrow evaluation at onset, leading to high mortality rates.

Balloon mitral valvuloplasty with bifoil catheter: immediate and long-term follow-up results.

This report documents clinical and hemodynamic benefits of balloon mitral valvuloplasty (BMV) using a bifoil balloon catheter from a single center in 415 consecutive cases of rheumatic mitral stenosis (MS). The procedure was successful in 396 (95.2%) patients, with an increase in mitral valve area (MVA) from 0.82+/-0.35 cm2 to 2.21+/-0.24 cm2 (P < 0.001). There were 2 (0.48%) in-hospital deaths, and 6 (1.44%) patients developed acute mitral regurgitation. The procedural and fluroscopy time was reduced significantly from 52+/-11 and 38+/-6 min to 33+/-7 and 19+/-5 min, respectively, after modifications of technique in our last 326 cases. The bifoil balloon catheter technique is safe and effective, and provides excellent hemodynamic benefits which are sustained at long-term follow-up. This technique should be considered as an addition to the existing armamentarium of interventional cardiologists performing mitral balloon valvuloplasty.

Elective coronary artery stenting--immediate and follow up results.

Elective coronary artery stenting was performed in 242 consecutive patients in our centre for complex lesions (Type B, C), proximal lesions, restenotic lesions, total occlusion and venous grafts. The procedural success rate was 94.21%. Three patients (1.23%) required emergency coronary artery bypass surgery. Acute and sub-acute thrombosis rate was 1.26% and 4.13%, respectively. There was one in-hospital death (0.41%). 164 patients were followed up clinically for a mean period of 11 +/- 6 months (range 1 month to 30 months). Angiographic follow up was done in 68 patients with a restenosis rate of 16.17%.

Recurrent pneumothoraces in miliary tuberculosis.

An 18-year-old female patient with miliary tuberculosis presented with bilateral, simultaneous pneumothoraces, which were recurrent with a bronchopleural fistula. The recurrent pneumothoraces were managed with tube thoracostomy and pleurodesis. Various possible pathogenetic mechanisms of this rare complication are discussed.