WCIM 2014 SEOUL KOREA 49
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0012 Immunology
Retroperitoneal Fibrosis Related to Periaortitis - When to Think of It?
Helena Lobo MARTINS1, Nadejda POTLOG1, Antonio MARINHO1, Isabel ALMEIDA1, Carlos VASCONCELOS1
Centro Hospitalar do Porto - Hospital Geral De Santo António, Portugal1
Retroperitoneal fi brosis (RF) is a rare condition characterized by the presence of in- fl ammatory and fi brous retroperitoneal tissue that may be idiopathic or secondary to other causes. Idiopathic RF is part of the spectrum of chronic periaortitis, a condition characterized by infl ammation and fi brosis surrounding the aorta and iliac arteries.
The pathogenesis of idiopathic retroperitoneal fi brosis is unclear. The authors report the case of a 66 year-old woman with RF diagnosis related to infrarenal infl ammatory aortitis in 2009, following the study of a hypochromic microcytic anemia and in- creased infl ammatory parameters, confi rmed by imaging. She has a history of stenos- ing ileal Crohn’s disease, underwent surgery in 2006, with recurrence of ileal disease two years ago, treated and currently stable. As other relevant pathological anteced- ents, she contacted patients with pulmonary tuberculosis. She starting anti-tuberculo- sis therapeutic in September 2009 for nine months, because she has positive Mantoux test. The patient began high-dose corticosteroids with clinical benefi t, however with reduction in dose to about 20mg/day clinical worsening was observed with marked in- crease in infl ammatory parameters. Azathioprine was added during a short period due to myelosuppression. Subsequently started methotrexate with good response at an early stage but with need to change to cyclosporine due to worsening of infl ammatory parameters. Although there was an initial response to this drug, a sustained analytical and clinical response could only be achieved through the introduction of anti-TNF-al- pha (Infl iximab). It was systematically excluded neoplastic, infectious, autoimmune and other infl ammatory diseases. The authors argue the importance of knowing and diagnosing rare diseases such as retroperitoneal fi brosis. It presents insidiously, often making the diagnosis diffi cult, thus you need to think about these diseases for suc- cessful diagnose. We point out the importance of knowing the biological drugs as potential therapeutic weapons in these cases.
PS 0013 Bioethics
Horizon Towards a Healthier Tomorrow: Exploring Doc- tor Patient Relationship!
Amol KODAN1, Pallavi KODAN2, Amit HOODA3, Ashish CHAUDHARY4, Parul KODAN5 Ambience School, India1, Delhi University, India2, Christian Medical College, India3, Yes Bank, India4, Kasturba Medical College, Manipal University, India5
Background: Horizon towards a healthier tomorrow... from the healing touch of a doctor to the blessings from the patient to doctor…or doctor fees and medicolegal aspects…we as society often neglect the varied aspects of doctor patient relationship.
We attempted to unravel the realms of this unsaid complex perplexing and yet ignored relationship.
Methods: We attempted to discover the aspirations, motives, expectations and expe- riences on both sides. We interviewed 50 physicians, 20 students aspiring to becoming doctors and 50 patients who shared there viewpoints with us. We conducted a survey in this group to fi nd the most common reason to choose this profession and other relevant questions. Questionnaire to patients included questions which revealed their experiences and expectations from their doctor. We analyzed the survey using SSP4 software.
Results: The interview and questionnaire on patient doctor relation revealed to us that 62%doctors had chosen this profession to serve the society, however only 45% found this profession satisfying and more than 50 % felt that they should be better paid for there services. On the other hand, patients think 40% doctor’s primary aim is to earn money and 35%believed that there doctor truly served the society. More than 90% of both patient and doctors believed that the relation of doctor and patient needs to be strengthened and both sides should make an effort for that.
Conclusions: The fast pacing materialistic world seems to have eroded the era where this noble profession was always believed to have a golden healing touch. We appre- ciate the noble doctors who are relentlessly serving the society and hope both doctors and patients should understand each other’s point of view and move towards a beau- tiful and healthier tomorrow!
PS 0014 Cardiology
Patients with Atrial Fibrillation – Risks of Thrombotic and Bleeding Complications
Khovasova NATALIA1, Vertkin ARKADY2, Nosova ANNA3
Internal Medicine, Clinical Pharmacology and Emergency Medical Service, Moscow State Medical Stomatology University, Russia1, Internal Medicine, Clinical Pharmacology and Emergency Medical Ser- vice, Moscow State Medical Stomatology University, Russia2, Internal Medicine, Clinical Pharmacology and Emergency Medical Service, Moscow State Medical Stomatology University, Russia3
Background: to determine retrospectively the risks of thrombotic and bleeding com- plications in the deceased patients with the atrial fibrillation and the therapeutic approach regarding the prophylaxis of the cardio-embolic stroke.
Methods: the clinical records of the deceased patients with atrial fi brillation were analyzed retrospectively. The risk of thrombotic (CHA2DS2-VASc scale) and bleeding (HAS-BLED scale) complications was evaluated, as well as the anticoagulant therapy as the prophylaxis ofthe cardio-embolic stroke.
Results: The retrospective analysis of 323 clinical records of the deceased patients with atrial fi brillation showed that 319 (98,7%) patients, while alive, had the risk of thrombotic complications equal to 1 and more points according to CHA2DS2-VASc scale, while 87% had 3 and more points which required administration of oral antico- agulants. However, oral anticoagulants were received by only 21 (6,5%) persons. The treatment of choice was warfarin, and nobody received the new oral anticoagulants.
The low risk of bleeding complications had 259 (80,2%) patients and the high one – 64 (19,8%), which didn’t exclude administration of oral anticoagulants but just required close monitoring of the patients. According to the post-mortem examination data 217 (67,2%) patients died from cardio-embolic stroke, and 94 (29,1%) patients died from thromboembolism of pulmonary artery, and only 12 (3,7%) had gastrointes- tinal hemorrhage.
Conclusions: 1. In the thumping majority of cases the risk of thrombotic complications exceeds the risk of bleeding complication in the patients with atrial fi brillation.
2. The main causes of death in the patients with atrial fi brillation were thrombotic complications, most of which were cardio-embolic strokes (67,2%) and thromboem- bolism of pulmonary artery ( 29,1%).
3. The oral anticoagulants are administered in isolated cases (6,5%) which doesn’t accord with modern recommendations.
PS 0018 Cardiology
“Double Trouble”: Wolff Parkinson White Syndrome and Mitral Stenosis Presenting as a Stroke in the Young
Manalo Jaime AHERRERA1, Lauro ABRAHAN1, Anastacio DEGAYO1, Michael AGBAYANI1, Michael REYES1, Wilfred DEE1
Philippine General Hospital, Philippines1
Synopsis: The Wolff Parkinson White syndrome and mitral stenosis (MS) is a un- fortunate combination, with less than 15 patients reported in literature. They are individually associated with supraventricular arrhythmias and their combination may have profound hemodynamic consequences. Our case is a young male presenting with neurologic deficits who was newly diagnosed with the WPW syndrome and mitral stenosis.
Case: A 25 year old male sought consult syncope, palpitations, and dizziness. On the day of admission, he experienced persistent palpitations then subsequently lost consciousness. He had a diastolic rumble, right sided hemiparesis, and dysarthria. A cranial CT scan revealed a left basal ganglia infarction. Electrocardiogram showed sinus rhythm and left atrial enlargement, a short PR interval, wide QRS complexes, and delta waves. Holter monitoring showed episodes of atrial fl utter with rapid ventricular rates. QRS complexes were narrow during other episodes of tachycardia. Echocardio- gram revealed moderate mitral stenosis and a dilated LA with no thrombus. Diagnosis was WPW syndrome and rheumatic MS manifesting as a stroke in the young. Percu- taneous transvenous mitral commissurotomy (PTMC) was done. He is now on regular follow up on chronic anticoagulation and medical therapy for the WPW syndrome.
Conclusion: To our knowledge, this is the fi rst case of a WPW syndrome with rheu- matic MS presenting as a stroke in the young who was successfully managed with PTMC for MS and anti-arhrythmics for the WPW syndrome. This unfortunate combi- nation may have potentiated the risk for cardioembolic events which emphasizes that detection of these entities is of paramount importance. Though either of the two en- tities may have caused the stroke, treatment is warranted for both entities as to avoid future episodes of cardioembolic phenomena.
