Carotid endarterectomy in a young symptomatic patient with B-thalassemia major.

ß-Thalassemia major promotes atherosclerotic process, although the debating literature concerning the lipidic profile of young patients; it is well accepted that there is early vascular destruction in these homozygous patients either as a direct consequence of the genetic disorder per se or because of the repeated transfusions and the iron overload. Despite the potential of the disease for local brain thrombotic events, accelerated atheromatosis can lead to early thromboembolic events. We present an interesting case of a 36-year-old man with unilateral embolic infarcts (repeated transient ischemic attacks) originated from a near occlusion right carotid stenosis with additional peripheral thrombus. The patient underwent a successful carotid endarterectomy with primary arterial closure with uneventful postoperative course, confirmed by a clear postoperative angiography; he remains asymptomatic 18 months later. To the best of our knowledge, this is the first case of a young symptomatic patient with ß-thalassemia major who underwent carotid repair.

Rare association of polyneuropathy and Crohn's disease: a clinicopathological study of 4 cases.

The purpose of this study is to investigate the clinical, electrophysiological and pathological features of neuropathy in patients with Crohn's disease. Biopsies were selected from over 700 sural nerve biopsies. The diagnosis of Crohn's disease was based on established clinicopathological criteria. Complete laboratory, clinical, electrophysiological and pathological studies were performed in all cases. Nerve biopsies of 4 patients were diagnosed as neuropathy and Crohn's disease. Distal symmetrical sensorimotor polyneuropathy was the pattern of neuropathy. The pathological features were mixed, demyelination with predominant axonal degeneration and a varying pattern of myelinated fiber loss. There were no vasculitic changes found. We conclude that patients with Crohn's disease are complicated frequently with polyneuropathy, and as remission depends on immunosuppressive therapy, it is important to recognise it in the early stage. The diagnosis of polyneuropathy is based on clinical and electrophysiological studies, but precise histology, immunohistochemistry and morphometric studies of the peripheral nerve biopsy may be decisive in establishing the diagnosis.