[Effect of high dose of oral amoxicilin on local lymphadenopathies of the head and neck]

Most of solitary head and neck lymphadenopathic patients, due to similar symptoms and histories, are evaluated by special paraclinical tests and even unneccessary biopsies. The aim of this study was to investigate the effect of high does of oral amoxicilin on solitary head and neck lymphadenopathies during a limited period of time. This descriptive-interventional study was conducted in census form. The experimental populations were solitary head and neck lymphadenopathic patients suffering for a period of less than two months with the lymph node size of 1.5 cm or more. Patients with weight of more than 27 kg, were treated by 2 gr of amoxicilin every six hours for three days and received the drug daily as follow up. For individuals weighted less than 27 kg, the drug was prescribed as 100 mg / kg daily divided in four equal doses. At the end of the third day to the end of the seventh day from the treatment onset, amoxicilin offering was continued by a lower dose of one gram every six hours. Data obtained on the lymph node size were analyzed using Mann-Whitney test [p < 0/05]. Seventeen patients developed complete improvement, but eight did not respond to this treatment regimen. The failure was found to be due to the existence of tumoral tissue, infection or treatment resistance, and lymphocytic infiltration without any particular etiology in two, two, and remaining four cases, respectively. According to the results of this study, it is concluded that prescribing high dose of amoxicillin, for a limited period of time, for all questionable solitary head and neck lymphadenopathic patients, considering the previous descriptive conditions, would be a useful diagnostic-treating approach

Sinus histiocytosis with massive lymphadenopathy [Rosai-Dorfmans Disease] as cause of isolated hilar lymphadenopathy and complete remission after high dose steroid

Rosai-Dorfman's Disease, also known as sinus histiocytosis with massive lymphadenopathy SHML, is a rare histiocytic proliferative disorder and a distinct clinico-pathological feature of unknown origin. Painless cervical lymphadenopathy is the most common clinical presentation. Different treatment modalities have been tried with variable responses, however, there is no consensus on the best modality of treatment. Here, we present a case report of SHML causing isolated hilar lymphadenopathy with complete remission for more than 6 years, after a short course of high dose steroid dexamethasone 20 mg daily for 3 days

Macrophage Activation Syndrome in Juvenile Rheumatoid Arthritis Successfully Treated with Cyclosporine A: A Case Report

Macrophage activation syndrome (MAS) is one of the serious complications of juvenile rheumatoid arthritis (JRA) and recently, cyclosporine A has been found to be effective in patients with corticosteroid-resistant MAS. A 29-yr-old male was admitted with high fever and jaundice for one month. He was diagnosed as juvenile arthritis 16 yr ago. Physical and laboratory results showed hepatosplenomegaly, high fever, pancytopenia and impaired liver and renal function tests, elevated triglyceride and serum ferritin levels. Bone marrow biopsy showed hyperplasia of histiocytes with active hemophagocytosis. He was diagnosed as MAS associated with juvenile rheumatoid arthritis and managed with high-dose corticosteroids initially, but clinical symptoms and laboratory findings did not improve immediately. Finally, he completely recovered after treatment with cyclosporine A (3 mg/kg/day).

Nail Changes During Docetaxel Containing Combination Chemotherapy

Nail toxicity following systemic chemotherapy is common. Onychopathy during the period of neutropenia following chemotherapy may cause subungual abscesses and serious infection. Despite taxoid-related toxicity being increasingly reported since 2000, there are still phase II systemic chemotherapy studies using taxoid that have never mentioned nail changes. Recently, new criteria for the evaluation of nail toxicity have been suggested. The present report is the first of its kind, in Korea, to describe a case of docetaxel-associated onychopathy, which improved following a reduction in the docetaxel dose.

Diagnóstico de adenopatías en niños: rol de la punción con aguja fina / Fine needle aspiration biopsy for the diagnosis of lymphadenopathy in children

Background: Lymphadenopathy in children can be a challenging clinical situation that requires a careful approach. Aim: To report the experience with fine needle aspiration biopsy for the diagnosis of lymphadenopathy. Patients and methods: Analysis of 95 pediatric patients, aged 3 months to 19 years old, referred by primary care physicians for the study of lymphadenopathy. All were subjected to a complete medical examination, laboratory tests and fine needle aspiration biopsy. Results: Seventy seven per cent of enlarged lymph nodes were located in the neck. Fine needle aspiration showed a hyperplastic adenitis in 44 patients (46 percent). In 13 patients, an infectious adenitis, sometimes suppurated was observed. In 9 patients a BCG or tuberculous adenitis with caseum was found. In 13 patients, citology disclosed a non lymphatic mass, in four patients a Hodgkin discase and in one, malignant cells of unknown origin. Four patients had a normal lymph node and in 2 the sample was insufficient for cytological analysis. Conclusions. Fine needle aspiration biopsy is a simple and safe diagnostic method for lymphadenopathy in children

Sarcoidose gangliopulmonar: a propósito de dois casos / Ganglio-pulmonary sarcoidosis: apropos of 2 cases

Os autores relatam dois casos de sarcoidose com manifestaçoes intratorácicas envolvendo gânglios linfáticos e pulmoes (tipo radiológico II), além de comprometimento cutâneo peculiar em um dos pacientes. Abordam as bases clínicas para o seu reconhecimento e a importância dos exames complementares para o diagnóstico preciso desta doença multissistêmica, salientando os aspectos fundamentais de sua história natural, prognóstico e tratamento.

Linfadenopatias na leishmaniose tegumentar americana: consideraçöes sobre dois casos / Lynphadenopathies in American cutaneous leishmaniosis: comment on 2 cases

Em dois pacientes, com suspeita clínica de linfoma ou escrofuloderma - por apresentarem linfadenopatias cervicais importantes -, o estudo dos linfonodos removidos para exame histológico revelou um processo necrótico-granulomatoso e a presença de leishmanias (amastigotas) no interior de macrófagos. Lesöes cutâneas mucosas, características da leishamniose tegumentar americana, näo foram percebidas, embora um dos pacientes viesse posteriormente a desenvolvê-las, como provável efeito de tratamento para toxoplasmose. O achado fundamenta a suspeita de que os agentes da doença, após penetrarem no organismo do hospedeiro, podem alojar-se em órgäos do sistema monocítico-fagocitário, aí permanecendo durante muito tempo, talvez mesmo por toda a vida do indivíduo infectado. Eventualmente, sob a açäo de fatores diversos, capazes de afetar a resistência do hospedeiro, migrariam os parasitos para a pele ou as mucosas, determinando lesöes secundárias ou de reativaçäo

Sindrome hemofagocitico benigno: primer caso confirmado en Panama / Benign hemaphagocytic syndrome: first confirmed case in Panama

Se estudia la história clínica del primer caso de Síndrome Hemofagocítico Benigno (SHB) diagnóstico en Panamá. La paciente presentó un cuadro clínico caracterizado por fiebre, anemia, linfadenitis cervical, hepatomegalia, linfocitosis e histofagocitosis de células rojas y linfocitos de neutrófilos y plaquetas. La remisión de la fiebre se produjó setenta días después del comienzo de la enfermedad. No obstante que no se pudo demostrar serológicamente que el síndrome hemofagocítico era debido a la Toxoplasmosis de tipo agudo se le prescribió Sulfadiazina y Pirimetamina, por quince días (a los 37 días de hospitalización) y Clindamicina, por 10 días (desde los 53 días) en forma consecutiva. La remisión se produjo 70 días después del comienzo de la fiebre. Un segundo examen serológico por toxoplasma (IFA) demostró que la reacción fue nuevamente de 1:2048, nueve meses después de la anterior

Reticulohistiocitosis multicéntrica / Multicenter reticulohistiocytosis

Se comunica un caso de reticulohistiocitosis multicéntrica en una mujer que inició su enfermedad con astenia y manifestaciones articulares, instalando luego lesiones en piel cuya biopsia estableció el diagnóstico. Los análisis de laboratorio fueron normales incluyendo perfil lipídico, función tiroidea e inmunológico. Ante el fracaso del tratamiento con aspirina y otros antiinflamatorios se instituyó corticoideoterapia a dosis inmunosupresoras, con rápida y excelente respuesta. Dado que no existen alteraciones inmunológicas demostradas en la R.H.M., los autores proponen que los corticoides podrían haber actuado por su efecto antiinflamatorio y sugieren usar en nuevos casos dosis menores (antiinflamatorias) de corticoides