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Biomedical subjects

M J Maxit

Publications and source records attributed to M J Maxit.

12 recordsLinked to original sources
PubMed2001

[Diffuse plane xanthoma with arthritis, serositis, erythema nodosum, vasculitis and myelomonocytic leukemia. Description of a case with autopsy].

A 57-year-old woman consulted for a severe xanthelasma followed by a severe and complex systemic disease and died ten years later with xanthomas extended to the face and trunk. Her lipid and cholesterol levels were normal but HDL was below normal values. Diabetes as well as amyloidosis, paraproteinemia and Bence Jones protein in urine were not found. Three years after her initial consultation monocytosis appeared in most but not all of her hemograms. Soon after her spleen was palpable and became very large. She had three bone marrow biopsies showing progressive white cell hypercellularity that was considered as possibly reactive. During her long illness she had recurrent conjunctivitis and systemic complications such as arthritis, pleural and pericardial effusions, vasculitis, sudden deafness with Ménière-like vertigo, erythema nodosum and myositis that responded, at least partially, to steroid treatments though she remained corticoid dependent in order to control her more severe symptoms. Those complications were considered to be probably due to vasculitis or immune phenomena. After a long follow up it was clear that her disease was better classified as diffuse plane xanthoma (DPX) related to a myeloproliferative syndrome and vasculitis. Her final hospitalization was due to a severe esophageal moniliasis and she died a few days later. An autopsy was performed and a chronic myelomonocytic leukemia was the final diagnosis. The ultimate cause of death was a perforated acute duodenal ulcer with peritonitis. Possible relations between DPX, immunologic reactions and myelomonocytic leukemia are discussed.

Arthritis↗
PubMed2000

[Fisher's one and half syndrome with facial palsy as clinical presentation of giant cell temporal arteritis].

An ischemic stroke in an old patient is commonly due to thrombosis or embolism. A restriction in the differential diagnosis and not considering another etiology could occasion the loss of effective therapy and prevent major complications. We report the case of a patient who suffering from systemic symptoms for a few months, was admitted to the hospital with the one and a half syndrome described by Fisher, together with right facial palsy, both products of an ischemic pontine lesion. Bilateral biopsies of the temporal arteries were diagnostic of temporal arteritis and MRN of the cranium confirmed multiple ischemic lesions involving the pons. In conclusion, the diverse clinical presentations of temporal arteritis oblige us to consider it among the etiological options in older patients with neurological signs affecting the vertebral-basilar system, accompanied by systemic signs and symptoms and a high VSG. To avoid anterior ischemic optic neuropathy and other complications a quick diagnosis and treatment are necessary.

Aged↗
PubMed1998

[The internist and ovarian cancer].

For the purpose of evaluating the role and participation of the internist in the diagnosis of Epithelial Ovarian Cancer (EOC), 81 medical records belonging to patients with EOC, were analyzed. The mean age of the patients was 63.5 years old (SD 12.33). Of these patients 21% were asked about their personal and familiar oncology history during their first office visit. Thirteen patients (16%) were asymptomatic in the first consultation. The more frequent symptoms were pain and abdominal distention. During this first examination, 46 patients (56.8%) presented some evident physical sign, and EOC was suspected in 35 patients (P = 0.00000004): the most frequent sign was an abdominopelvic mass in 34 patients (74%). Forty-six patients with EOC (56.8%) consulted an internist and twenty-four patients (29.6%) a gynecologist at first evaluation, without significant differences in diagnostic suspicion. Internists did not perform an abdomino-pelvic palpation. Gynecologists performed the abdomino-pelvic palpation in 74 patients, and 58 (78.4%) were found to be abnormal. The mean age of patients examined by internists was 68.2 years old, that is ten years older than the patients examined by gynecologists (P = 0.0007) and 70% were in Stages III and IV (P = 0.02). Gynecologists examined 9 asymptomatic patients (P = 0.0003) and 42% in Stages III and IV. The more frequent reasons for consultation to internists were abdominal pain (23 patients) and distention (17 patients). On the other hand metrorrhagia (9 patients) was the most common reason to consult a gynecologist. In conclusion, internists were frequent receptors of women with ovarian cancer at the first consultation. Their patients were older and with a more advanced disease stage. The interrogation concerning the oncology history was insufficient and the gastrointestinal symptoms were the most frequent cause for consulting an internist. The presence of some physical signs was associated with more diagnostic suspicion. The gynecologists examined more asymptomatic patients.

Family Practice↗
PubMed1998

[Systemic Buschke's scleredema with cardiomyopathy, monoclonal IgG kappa gammopathy and amyloidosis. Case report with autopsy].

A 73 year old retired truck driver and blacksmith was studied in June 1996 for thoracic pain and was diagnosed as acute pericarditis which responded well to steroid treatment. In January 1997, he noted swelling of the abdominal skin, genitalia and limbs, sparing the feet. He was euthyroid, did not have evidence of diabetes or a Raynaud's phenomenon. His proteinogram showed an IgG-Kappa monoclonal paraprotein M component, 1.31 g/oo. TSH and tetraiodotironine were normal; ESR 16 mm in the first hour. As he did not respond to treatment he was referred to our hospital in March 1997. On physical examination the most relevant findings were a non-pitting edema of the abdomen and lower limbs, sparing the feet. An echocardiogram was consistent with an infiltrative cardiomyopathy. Soon after his hospitalization his condition worsened suddenly with severe bradicardia (28/minute) due to a junctional rhythm and righ bundle branch block. He suffered a cardiac arrest and died. The autopsy findings favoured the diagnosis of systemic scleredema adultorum of Buschke. Amyloid deposits were also found although not abundant, with a similar distribution except in the skin. In this article the clinical and autopsy findings are presented in a patient showing coexistence of systemic Buschke's scleredema with an infiltrative cardiomyopathy, IgG Kappa gammopathy and amyloidosis.

Aged↗
PubMed1997

[Antineurotrophil cytoplasmic antibodies (ANCA) in the elderly].

Aging in animals and human beings is frequently accompanied by a disarray of the immune response. In subjects 70 years of age or older the frequency of some autoantibodies (anti-nuclear, RF, antithyroid anti-parietal cell and others) without any associated pathology is clearly increased when compared against a younger population. ANCA (antineutrophil cytoplasmic antibodies) is considered to be a good marker for necrotizing systemic vasculitis. This auto-antibody is known to show two patterns when investigated by indirect immunofluorescence on alcohol fixed normal neutrophils: c-ANCA (cytoplasmatic fluorescence) and p-ANCA (perinuclear fluorescence), each one associated with different pathologies. The purpose of this work was to investigate how frequently was ANCA found in subjects 70 years of age or older without evidence of any associated pathology. ANCA was investigated in 447 ambulatory patients from our hospital and the only requirement to be included was age. The ANCA+ patients were divided into having or not clinical suspicion of vasculitis, according to the medical charts we reviewed. The same methodology was applied to investigate the frequency of antinuclear antibodies (ANA+) without clinical evidence of any associated pathology. This frequency was compared with that described in the literature as "ANA+ in healthy old subjects". In the 447 patients studied, 8 were positive for ANCA (1.8%), 3 for c-ANCA and 5 for p-ANCA. None of the 3 c-ANCA and only 1 of 5 p-ANCA belonged to patients without any associated pathology. A possible relationship between c-ANCA and cancer is discussed. As ANCA+ cases were very few no relationship with gender or age was investigated. The extremely low finding of ANCA+ in the absence of pathology, even considering old people's frequent immunological disarray suggests that in opposition to other autoantibodies, the presence of ANCA is always related to disease. The frequency of ANA+ without associated pathology was 2.9%, being this value on the lower limits of what is described in the literature. This can be due to different methodology or to the scope of the definition of "without associated pathology".

Aged↗
PubMed1991

[Bacterial endocarditis in patients over 60 years of age].

Bacterial endocarditis (BE) is a disease difficult to diagnose and with poor prognosis in older people. A total of 76 episodes of this disease occurring in 73 patients were studied with particular attention to clinical manifestation, underlying heart disease, etiological germs, hospitalary mortality and prognosis within 6 months from diagnosis. All patients were 60 years old or older. Mean age was 72 +/- 7 years and male/female relation 1.7/1 Fever and heart murmur were present in 93% and 89% of patients, respectively; 33% of patients complained of vertebral or paravertebral pain which can be an early symptom of this disease. BE was suspected in 47% of patients at admission. Hospitalary mortality was 33% and increased to 47% within 6 months. The mean age of survivors was 71.7 +/- 7 years, versus 73.9 +/- 6 in the deceased (p = 0.08). Lack of suspicion of BE at admission was related with increased mortality (p = 0.04). The germ more frequently isolated was Streptococcus (73%). 53% of patients had some underlying heart disease. Aortic valve was involved in 50% and mitral valve in 21% of the cases. Of all the patients that in retrospect would have had indication of surgery (n = 25) 9 patients were operated, 6 during the first admission with a mortality of 17%. In those patients who were not operated, the mortality was 100% (16/16), making this difference statistically significant, p less than 0.001.

Age Factors↗