[Show abstract][Hide abstract] ABSTRACT: Superficial siderosis is an increasingly common diagnosis due to advances in imaging. Resulting from the presence of blood in the subarachnoid space, it leads to progressively debilitating ataxia, deafness and myelopathy. Magnetic resonance imaging has revolutionized diagnosis and management of this condition. In one-third of patients with this diagnosis, no subarachnoid bleed can be identified. A lack of sensitivity in our ability to detect subarachnoid bleed is a possible explanation in this group of patients. A novel approach would be to consider defects in the body's defense against intracranial iron overload as a possible cause of this disease. A disproportionately few patients develop superficial siderosis compared with the number who develop subarachnoid bleed from various clinical conditions. Normal physiological protective mechanisms exist in the central nervous system to protect it from damage by blood, haeme or free iron. Deficiency and defect of these protective mechanisms can provide insight into the pathogenetic mechanism of the group of patients where no subarachnoid haemorrhage is identified.
[Show abstract][Hide abstract] ABSTRACT: Heparin is integral to the treatment of acute coronary syndromes, deep vein thrombosis and its prophylaxis. An undesirable result of recurrent heparin use is rapid onset heparin-induced thrombocytopenia (HIT) within hours of exposure. This catastrophic condition is frequently diagnosed too late for therapy to be effective. We describe a case of fatal rapid onset HIT, analyze current evidence to diagnose this condition and propose a way so that it can be prevented.
[Show abstract][Hide abstract] ABSTRACT: We have documented a unique instance of diabetic ketoacidosis (DKA)-induced stress-related cardiomyopathy (CMP) in a 46-yr-old Caucasian female with type I diabetes mellitus. In times of stress, tissues with high capacity for aerobic metabolism, like myocardium, can preferentially change their metabolic substrate to ketones. The myocyte has a decreased ability to metabolize glucose and free fatty acids in stress CMP. To the best of our knowledge this is the first report of stress CMP complicating DKA. A possible mechanism for the same is hypothesized.
[Show abstract][Hide abstract] ABSTRACT: A white diabetic patient on insulin therapy presented with recurrent hypoglycemia despite very high glycosylated hemoglobin (HbA1c) values. Hemoglobin (Hb) variants, chemically modified Hb, and abnormalities of red cell turnover cause errors in HbA1c measurement. Widely prevalent Hb variants affecting HbA1c estimation include HbS and HbC in African Americans, HbE in southeast Asians, and carbamyl-Hb in uremic patients. In addition, there are at least 893 other Hb variants as of 2005, many of which affect HbA1c estimation. HbA1c values are also affected by methodology of estimation. Our patient had HbJ, which is rare amongst whites. The relationship between HbA1c values and mean plasma glucose allows estimation of expected HbA1c. Significant discrepancy between expected and measured HbA1c should be evaluated. Considering Hb variants, evaluating for the same and estimating HbA1c with the appropriate method under such circumstances are described. Numerous new or rare Hb variants will be diagnosed if suspicion is appropriately entertained.
The American Journal of the Medical Sciences 06/2008; 335(5):382-6. DOI:10.1097/MAJ.0b013e3181461679 · 1.39 Impact Factor