Cardiovascular involvement in Behçet's disease.

Behçet's disease is a chronic relapsing systemic vasculitis that can involve almost every organ and systems in the body with extremely different diverse manifestations. Cardiovascular involvement is one of these manifestations, the involvement of which might present in various patterns in itself. Cardiovascular involvement is relatively uncommon in Behçet's disease; however, Behçet's disease is relatively rather common in certain parts of the world. Therefore, especially in these locations recognizing such miscellaneous presentations are of critical importance, since cardiovascular involvements exceed other presentation in mortality and morbidity rates. Based on these facts, in this review, we summarized the cardiovascular involvements and its different manifestations in Behçet's disease.

Immunoglobulin E: a new diagnostic clue for Behçet's disease? IgE and Behçet's disease.

Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown etiology. Hyperimmunoglobulinemia has been demonstrated in BD; however, its clinical importance has not yet been discovered. In a few reports, an association between BD and plasma immunoglobulin E (IgE) has been noted. In this study, we had three objectives: (1) to investigate plasma levels of IgE and their association with levels of acute phase reactants, (2) to determine whether treatment has any effect upon IgE levels, and (3) to assess whether higher serum levels of IgE provide a clue for the diagnosis of BD. Fifty-two patients with BD, without any accompanying disease or condition that might lead to a rise in IgE, were compared with 51 age-matched healthy controls. Plasma levels of IgE, IgA, IgG, and IgM were analyzed by means of nephelometric analysis. Results showed that among the 52 patients, 23 (44%) had IgE levels that were higher than the upper limits of normal. IgE was not correlated with age, erythrocyte sedimentation rate, or C-reactive protein (p=0.59, p=0.57, and p=0.757, respectively). These relationships remained nonsignificant when multiple regression analysis was performed, with R (2) of 0.187 and p=0.057. Moreover, treatment of patients with elevated IgE did not produce any predictable IgE response. We conclude that Behçet's patients commonly exhibit elevated plasma IgE levels. However, elevated IgE levels are not correlated with levels of acute phase reactants or disease activity. We suggest that IgE levels might be an independent diagnostic clue in Behçet's patients.

The value of urine specific gravity in detecting diabetes insipidus in a patient with uncontrolled diabetes mellitus: urine specific gravity in differential diagnosis.

When a patient with diabetes mellitus presents with worsening polyuria and polydipsia, what is a sensible, cost-effective approach? We report the unique coincidence of type 2 diabetes mellitus and diabetes insipidus. A 46-year-old woman with poorly controlled type 2 diabetes complained of polyuria with a daily output of 5 L. Although urinalysis demonstrated significant glucosuria, diabetes insipidus was suspected owing to a low urine specific gravity (1.008). The low specific gravity persisted during a water deprivation test. Ultimately, diabetes insipidus was confirmed when urine specific gravity and urine osmolality normalized following desmopressin administration. This case emphasizes the importance of accurately interpreting the urine specific gravity in patients with polyuria and diabetes mellitus to detect diabetes insipidus.

Review of data of the patients receiving total parenteral nutrition at the intensive care unit of a university hospital.

Parenteral nutrition is commonly administered to patients in intensive care units who cannot be fed gastrointestinally. Several problems might be encountered during parenteral nutrition. We designed this study to evaluate two years' data of the patients who received parenteral nutrition at the intensive care unit of the university hospital. Forty-five patients who were treated at this hospital between January 1, 2004 and December 31, 2005 were included in this study. Patient data were collected via questionnaires designed based on the information in the literature. Blood, urinary, oropharyngeal and catheter entry site cultures were obtained and analyzed on the third and seventh days of the treatment. We found the following results: 31.1% of the patients received parenteral nutrition due to renal insufficiency; ready-made amino acid/lipid solutions were used in 86.7% of the patients; 77.8% of the solutions were administered through a peripheral vein; 88.6% of total parenteral nutrition solutions given thorough the peripheral vein had higher osmolarities than 800 mOsmol/L; routine Fe and Fe binding capacity, prothrombin time, cholesterol and triglyceride level assessments were not performed before the initiation of treatment; and the culture tests most commonly revealed Staphylococcus epidermidis in the blood, Candido species in urine, Streptococcus in throat, and Staphylococcus aureus at catheter entry sites. Based on these results, we suggest that organizing a nutrition support team would be useful in order to improve the quality of the nursery and to provide close and rational management and follow-up of the patients receiving total parenteral nutrition.

Propylthiouracil-related hemorrhagic diathesis: a case report and review of the literature.

We present an unusual case of a drug-related hemorrhagic diathesis. One month prior to admission, the patient was diagnosed at another medical center as having Graves' disease and propylthiouracil therapy (PTU) was initiated. Since clinical recovery was not achieved, the PTU was quickly increased to an unconventional daily dose of 1,000 mg. The patient was referred to our hospital because of spontaneous epistaxis, multiple ecchymoses and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), which developed soon after the increase in PTU dose. Drug-related hemorrhagic diathesis was considered, after other possible causes had been eliminated. To the best of our knowledge, this is the first reported case of spontaneous hemorrhage due to PTU use.