Excessive salivation as an anginal equivalent: a sequela to Ramsay Hunt syndrome
Article Abstract:
The occurrence of a heart attack may be associated with disturbances of the autonomic nervous system, which controls involuntary body functions. One study showed that 41 of 71 heart attack patients had increased activity of the vagus nerve, which resulted in slow heart rates and a drop in blood pressure. (The vagus nerve is an important nerve of the autonomic system.) When sensory receptors, or specific sites, in the wall of the heart become stimulated, they send impulses along the vagus nerve, leading to the activation of the parasympathetic nervous system. This portion of the autonomic nervous system causes constriction of the pupil of the eye, contraction of muscles in the gastrointestinal tract and airways, slowing of the heart rate, and increased secretion from glands other than the sweat glands. A case is described of a 71-year-old man who was admitted to the hospital with complaints of excessive salivation and chest heaviness. He had a history of heart attack, which was treated by surgery to renew blood flow to the heart. The patient was also previously diagnosed with the Ramsay-Hunt syndrome, which is characterized by the development of facial palsy, or paralysis of the facial nerve, and lesions in the facial area caused by herpes virus infection. Herpetic lesions may affect the activity of nerves in the facial area, including the vagus nerve, which also controls salivation. Results from electrocardiography, or recordings of the heart's electrical activity, and coronary angiography, or X-ray of the coronary arteries which supply the heart, showed that the patient had blockages of portions of the coronary arteries, and had suffered a heart attack. Surgery was again performed to renew the blood supply to the heart, and heart-related symptoms and exertion-induced salivation resolved. In this case, the herpes infection may have destroyed the nerve connection to the salivary glands, leading to increased sensitivity of the glands to hormones in the bloodstream. The development of myocardial ischemia, or insufficient blood supply to the heart, would contribute to the release of hormones that increase salivation. Hence, treatment of ischemia resulted in the improvement of excessive salivation with exertion. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Psittacosis-associated hemophagocytic syndrome
Article Abstract:
Infection with the bacteria-like organism Chlamydia psittaci, is most often transmitted by bird droppings, and is characterized by fever, respiratory illness, an increase in the levels of antibody, or immune protein, directed against C. psittaci, and rarely, blood disorders. A case is described of a 55-year-old woman with C. psittaci infection complicated by severe pancytopenia, or a decrease in the numbers of all blood cells. She was admitted to the hospital with fever, headache, general discomfort, cough with a whitish sputum, a purplish discoloration over the extremities, and deteriorating mental function. The patient reported having a pet bird at home for about one year. Blood tests revealed pancytopenia, and examination of bone marrow specimens showed an increase in histiocytes, which are cells with the ability to phagocytose, or ingest and break down, particles. These histiocytes were capable of phagocytosing red blood cells, white blood cells, and platelets (cells involved in blood clotting). In this patient, the histiocytes accounted for five percent of all bone marrow cells with a nucleus. The patient was diagnosed with reactive hemophagocytic syndrome, a condition characterized by the overgrowth of unusual histiocytes that phagocytose blood cells, fever, enlargement of the spleen and liver, and pancytopenia. She was treated with the antibiotics erythromycin, carbenicillin, and amikacin, and her fever resolved within 48 hours. The numbers of blood cells recovered to normal values within two weeks. Reactive hemophagocytic syndrome is most often associated with viral infection and lymphoma, a cancer of the lymphatic system. This is the first reported case of reactive hemophagocytic syndrome associated with C. psittaci infection. Patients with reactive hemophagocytic syndrome should be assessed for infection with C. psittaci. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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