JAMA : the journal of the American Medical Association
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An 81-year-old man suffered a spontaneous rupture of the thoracic aorta through an atheromatous plaque, leading to total dysphagia and eventual esophageal infarction.
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Tuberculous mycotic aneurysm has been reported with surprising frequency, especially in the aorta. Because the diagnosis can often be made on clinical and roentgenologic grounds, and because of the very poor prognosis if untreated and surgical curability if recognized, experience with three cases is reported. ⋯ Contiguous tuberculosis in the form of lymphadenitis or Pott abscess is generally responsible for the aortic involvement that results in the aneurysm. Miliary tuberculosis, which is often present, is probably a result rather than the cause.
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Seventy-one children with the diagnosis of systemic lupus erythematosus (SLE) (39 cases), dermatomyositis (25 cases), or scleroderma (7 cases) were studied retrospectively. The children with SLE were much sicker than those with the other two diseases and were found to have a poorer prognosis than adults with SLE. In general, the earlier the age of onset, the poorer the prognosis. ⋯ Corticosteroids were the main therapeutic agents. The patients with scleroderma also received varying doses of vitamin E, penicillamine, chloroquine hydrochloride, and salicylates. The antimetabolites were used to treat SLE starting in the late 1960s.