Thromboangiitis obliterans with cryoglobulinemia

Thromboangiitis obliterans [TAO], or Buerger's disease, is a vascular occlusive disease associated with cigarette smoking. It typically affects medium sized vessels of extremities. Basic pathology of TAO is described to be endothelial activation with highly inflammatory intraluminal thrombosis preserving internal elastic membrane. Cryoglobulins are immunoglobulins that precipitate in the cold and dissolve on re-warming. Cryoglobulinemic vasculitis is a typical small vessel disease associated with cryoglobulinemia commonly bearing typical purpuric skin lesions. An association of TAO with cryoglobulinemia is not reported yet. We report a 34-year-old male heavy cigarette smoker seen for extremity pain and cyanosis of left little finger along with skin rashes characteristic of small vessel disease. Initial presentation of his symptoms at winter and unusual purpuric skin lesions led to search for cold-agglutinating globulins in his plasma. He had severe cryoglobulinemia while the other laboratory tests were normal. TAO associated with cryoglobulinemia merges as a possibility

Digital panoramic radiography as a useful tool for detection of bone loss: a comparative study

This study was aimed to investigate the use of panoramic radiography in patients with low bone mineral density [BMD] in order to diagnose and prevent osteoporotic fractures. Panoramic radiographs of 60 patients [20 men and 40 women] aged from 40 to 70 years with cortical thicknesses of less than 3 mm in the mandibular angle were selected from patients referred to a dentomaxillofacial radiology clinic and were then examined for mandibular cortical angles. These were measured using Computed Radiography [CR] software. The bone densitometry was carried out using Dual Energy X-ray Absorptiometry [DEXA]. Cortical thicknesses at the lower border of the mandibles were also measured by panoramic radiographs. Statistics analyses were then undertaken using Fisher's exact test, Chi-square, t-test, ANOVA and receiver operating characteristic [ROC] curve. In most cases, no significant difference in mandibular angle cortical thickness was found between those patients with a normal BMD and those patients with a lowered BMD [P=0.621]. There was a relationship between the cortical thicknesses of the mandibular lower border, and vertebral and femoral BMD [P<0.0001], and there was a significant difference between the thickness of the mandibular lower border and BMD. The results of this study also revealed a new marker of osteoporosis on the mandibular lower border under the third molar. A thickness of 2.80 mm of the mandibular lower border was detected as a threshold for the measurement of bone densitometry in the chosen Iranian population. Panoramic radiography is effective for screening patients who are at risk of having decreased bone mineral density. Patients with a threshold of 2.80 mm thickness of the mandibular lower border should be considered as individuals likely to have osteoporosis associated low bone density

Nicolau syndrome following intramuscular penicillin injection

Nicolau Syndrome [NS] is a rare but severe localized adverse reaction at the site of intramuscular drug injection. The typical presentation is intense pain around the injection site soon after injection, followed by erythema, purplish network discolouration of the skin, haemorrhagic patch, and finally tissue necrosis. Here in, we report a 9 years old boy, the third Nicolau Syndrome [NS] reported from Iran after a single intramuscular injection of penicillin

Lymphomatoid granulomatosis with splenomegaly and pancytopenia / 中国肺癌杂志

Lymphomatoid granulomatosis (LG) is an angiocentric lymphoproliferative disease. It usually involves lung, skin, and central nervous system, but splenomegaly and pancytopenia are the rare manifestations of the disease. We report a 15-year-old boy presented with fever, dry cough and dyspnea from two months ago, after admission patient had nodular lesions on the left leg and hepatosplenomegaly. Then he manifested neurologic signs such as seizure, aphasia and right-sided hemiplegia. Chest X-ray and CT scan revealed bilateral pulmonary nodules predominantly in lower lobes and peripheral lung fields. Laboratory exams showed pancytopenia. Skin biopsy was done, and histopathological examination and immunohistochemistry evaluation confirmed lymphomatoid granulomatosis. He was treated with steroid and cyclophosphamide but succumbed by neurologic involvement.

Antiphospholipid antibodies in venous thromboembolism patients younger than 50 years old

Antiphospholipid antibodies are among the most important risk factors of arterial and venous thrombosis. Various studies have demonstrated that these antibodies are seen in patients with deep vein thrombosis [DVT] and pulmonary embolism [PE] more than normal individuals but there are a few studies about prevalence of these antibodies in patients younger than 50 years old with venous thromboembolism [VTE]. This study aimed to evaluate these antibodies in this age group. This was a case-control study. Fifty patients younger than 50 years old with venous thromboembolism [DVT, PE or both] who were diagnosed according to the standard criteria were compared with 48 subjects in the control group. Subjects in the control group were age and sex matched with patients and had no history of venous thromboembolism. Both groups had no history of malignancy or other chronic diseases. Lupus anti-coagulant and serum anticardiolipin antibodies [IgG and IgM] were measured in both groups. Data were analyzed using SPSS version 11.5 software. Fifty VTE patients younger than 50 years of age enrolled in this study [28 males and 22 females; mean age: 38.14 +/- 6.5 yrs]. Forty-eight subjects were selected as healthy controls [27 males and 21 females; mean age: 38.35 +/- 5.06 yrs]. Mann-Whitney test showed a significant difference between serum IgM anticardiolipin antibody levels of VTE patients [8.04 MPL units/ml] and those of healthy subjects [1.85 MPL units/ml] [P=0.001]. Also, a significant difference was found between serum IgG anticardiolipin antibody levels of VTE patients [8.29 GPL units/ml] and those of healthy subjects [3.51 GPL units/ml] [P=0.001]. In VTE group, 7 patients [M/F=4/3] had an IgG level >10 GPL units/ml and 6 patients [M/F=2/4] had an IgM level >10 MPL units/ml while none of the healthy subjects had IgG or IgM levels higher than 10 [P[IgM] = 0.015 and P[IgG] = 0.007]. Lupus anti-coagulant was positive in four [8%] but negative in all healthy subjects [P=0.04]. This study demonstrated that antiphospholipid antibodies were more prevalent in VTE patients younger than 50 years old compared to healthy subjects. Considering the fact that these patients need stronger and longer treatment, it seems necessary to evaluate every VTE patient younger than 50 yrs for antiphospholipid syndrome