Internal medicine
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Case Reports
Mixed connective tissue disease with severe pulmonary hypertension and extensive subcutaneous calcification.
The results of the autopsy of a 38-year-old female with mixed connective tissue disease who had suffered from painful subcutaneous calcification in her buttocks and extremities for 14 years and died from rapidly progressive pulmonary hypertension are reported. On autopsy, her heart and lungs revealed changes of severe pulmonary hypertension with intimal thickening and plexiform lesions in the small pulmonary arteries which had resulted in the collapse of both lungs and caused marked dilatation and hypertrophy of the right ventricle of the heart. Microscopic examinations of the subcutaneous calcified tissues indicated that the calcification may have been caused by repeated panniculitis.
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Editorial Comment
Pulmonary hypertension complicating mixed connective tissue disease.
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Autologous blood transfusion is an endorsed blood conservation strategy that has become widely practiced in elective surgical procedures. We review ten years' experience in this arena, along with emerging strategies designed to continue to minimize allogeneic blood exposure but reduce the costs associated with autologous blood procurement. We conclude that point-of-care autologous blood procurement (acute normovolemic hemodilution and intraoperative autologous blood salvage) can replace the predonation of autologous blood in surgical patients when transfusion medicine specialists, anesthesiologists, and surgeons develop a prospective, comprehensive approach to blood conservation.
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We evaluated the influence of the levels of glycosylated hemoglobin (HbA1C) and fasting plasma glucose on the variation in low density lipoprotein (LDL) peak particle size in 210 subjects who were undergoing an annual check-up. Univariate analysis showed that LDL particle size was significantly and positively correlated with high density lipoprotein (HDL) cholesterol levels, and was inversely correlated with the levels of total plasma cholesterol, triglycerides, fasting glucose, fasting insulin, HbA1C, and body mass index (BMI). ⋯ The results indicate that HbA1C levels have a significant effect on LDL particle size. This suggests that small LDL particles would be present in subjects with non-insulin-dependent diabetes mellitus regardless of plasma lipid concentrations.
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Case Reports
Cervical spinal epidural abscess following acupuncture: successful treatment with antibiotics.
A 67-year-old man with poorly controlled diabetes mellitus (DM) had acupuncture several times a month for chronic shoulder muscle stiffness. A few days after acupuncture in the posterior nuchal region, a low-grade fever and backache developed, and subacutely progressed. ⋯ Conservative treatment with antibiotics was effective and it was well documented by following serial MRIs. This case suggested that needle acupuncture should be avoided for immunocompromised subjects such as patients with poorly controlled DM.