A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome

Abstract

Zakynthinos EG, Vassilakopoulos T, Kontogianni DD, Roussos C, ). A role for transoesophageal echocardiography in the early diagnosis of catastrophic antiphospholipid syndrome (Case Report). J Intern Med 2000; 248: 521±526.We describe a previously healthy 28-year-old woman who presented with the clinical picture of large vessel occlusions (stroke with left hemiparesis, myocardial infarction) and developed multi-organ failure (i.e. kidneys, heart, brain, liver, blood, skin) over a very short period of time. Peripheral blood smear was consistent with thrombotic thrombocytopenic purpura. Transesophageal echocardiogram was supportive of the diagnosis of catastrophic antiphospholipid syndrome (CAPS), revealing Libman±Sacks endocarditis. Blood cultures were negative, anticardiolipin antibodies were highly increased and lupus anticoagulant was positive. Cerebral and coronary angiograms were negative, suggesting possible microthrombotic occlusive disease in the setting of CAPS.

Catastrophic Antiphospholipid Syndrome

“…Cardiac troponins are sensitive markers of myocardial injury and are independent predictors of mortality among patients admitted to the ICU for reasons other than acute coronary syndrome [31]. Transesophageal echocardiogram might help make an early diagnosis based on finding of Libman-Sacks endocarditis-small vegetations with "clublike" appearance (located away from the leaflet tips and not performing chaotic, flopping motion, as the vegetations of infective endocarditis usually do) [32]. A shock state in CAPS can also result from severe sepsis or from adrenal infarction and failure.…”

Inquiring Quality Assurance of the Table Olive Products

“…During the fermentation of edible olives, no significant change is observed [7].  Sugars such as glucose, fructose, mannose, galactose and sucrose [8]. Greek varieties are considered poor in fermentable components compared to their Spanish counterparts.…”

“…from the flesh to the brine, so the debittering of the fruit is achieved by the gradual hydrolysis of the oleuropein in the brine. At the same time, the extraction of the ingredients turns the brine into a nutrient substrate suitable for the growth of microorganisms [8]. More specifically, the olives are placed in brine with a NaCl concentration of 8-14% (w/v).…”

“…The high concentrations of NaCl in the brine ensure that spoilage of the final product, which is caused by bacteria, is avoided. A low concentration of NaCl in the brine allows the growth of proteolytic bacteria and the creation of an undesirable odor [8].…”

“…During the fermentation and the stay of the olives in the brine, the NaCl is transferred into the flesh of the olive and thus the strength of the brine is reduced. The balance between the brine and skin lasts long after the olives are placed in the brine, since the skin of naturally ripe olives maintains its selective permeability for some time [8].…”