Hemofilia adquirida como manifestación inicial de recidiva de adenocarcinoma colorrectal / Acquired hemophilia as the initial manifestation of colorectal cancer's recurrence

Resumen Presentamos el caso de un varón de 86 años con un hematoma espontáneo en el músculo ilíaco izquierdo y diagnóstico previo de cáncer de colon en 1998 (estadio pT3N0M0), tratado quirúrgicamente mediante colectomía transversal, considerado en remisión completa. Tras realización de estudios complementarios se demostró la presencia de autoanticuerpos inhibidores del Factor VIII que confirmaron el diagnóstico de hemofilia adquirida. Durante el ingreso el paciente presentó un sangrado digestivo bajo que conllevó al descubrimiento de recidiva del adenocarcinoma colorrectal tratado previamente. Respondió de forma favorable a la terapia inicial con corticoides sistémicos y el complejo coagulante anti inhibidor que incluye el Factor VII activado [FEIBA].

Abstract We report the case of an 86-year-old man presenting with a spontaneous hematoma in the left iliac muscle and previous diagnosis of colon cancer in 1998 (stage pT3N0M0) treated with transverse colectomy and considered in complete remission. After a complete study, it was possible to identify the presence of Factor VIII inhibitors antibodies that confirmed the presence of acquired hemophilia. During hospitalization the patient presented a lower gastrointestinal bleeding leading to the diagnosis of recurrence of a previously treated colorectal adenocarcinoma. He responded to initial therapy with systemic corticoids and anti-inhibitory coagulant complex which includes activated VII Factor [FEIBA].

Hipervitaminosis B12: Nuestra experiencia y una revisión / Hypervitaminosis B12. Our experience and a review

Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.

Evaluation of lipopeptide [surfactin] production by bacillus subtilis

Lipopeptides are the bioactive peptides and some constituents of these compounds are surfactin, fengycin and Turing A, B and C, mycosubtilins and bacillomycins. Among these lipopeptides, surfactin is produced by Bacillus subtilis that has strong anti-microbial properties. Surfactin can be obtained by cultivation of bacteria and possesses various biological activities; anti-microbial, anti-viral, anti-tumour, haemolytic, blood anticoagulant and fibrinolytic activities. The present study was evaluated for optimisation of media components [Carbon source, N, P. and K] and environmental factors for the growth and production of lipopeptides by Bacillus subtilis. It was a quasi experimental study. Surfactin production was optimised with different factors including Mannitol, Phosphate, Nitrogen, Carbon, Potassium, and pH by inoculating B. subtilis on standard mineral salt [SMS] medium using fermentation technology. Showed that all the optimised factors have contributed their role in the production of lipopeptides by B. subtilis. The increasing concentrations of mannitol and nitrogen produced maximum lipopeptides with O.D 2.110 and 2.375 respectively. Production of surfactin by B. subtilis might be increased by using different factors optimised in medium and these compounds have potential applications both in medical and biotechnological fields

Ventricular tachycardia; prevalence and prognosis

Frequent or complex patterns of ventricular ectopic activity, whether occurring during routine activity or induced by exercise, are often a marker for serious heart disease and a harbinger of sudden death. The detection of such arrhythmias is thus an important responsibility of the physician. To find the prevalence, associated characteristics and prognostic significance of exercise induced non-sustained VT in a representative population. Nishtar Hospital, Multan. 1000 patients. Two years. Descriptive, analytical study. Convenient probability sampling done. Ten subjects, 7 men and 3 women, with exercise induced VT were identified, representing 1.1% of those tested; only 1 was young than 65 years. All episodes of VT were asymptomatic and non-sustained. In 9 of 10 subjects, VT developed at or near peak exercise. The longest run of VT was 6 beats; multiple runs of VT were present in 4 subjects. Two subjects had exercise induced ST segment depression, but subsequent exercise thallium scintigraphic results were negative in each. Compared with a group of age and sex matched control subjects. those with asymptomatic, non-sustained VT displayed no difference in exercise duration, maximal heart rate, or the prevalence of coronary risk factors or exercise induced ischemia as measured by electrocardiography and thallium scintigrahy. Over a mean follow period of 2 years, no subject has developed symptoms of heart disease or experienced syncope or sudden death. Thus, exercise induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not portend increased cardiovascular morbidity or mortality rates over a 2 year period of observation. Exercise induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not show increased cardiovascular morbidity or mortality rates over a 2 year period of observation

Variant angina; comparison of patients with and without fixed severe coronary artery disease

The syndrome of variant angina occurs in patients with a wide spectrum of coronary artery obstructions, ranging from normal coronary arteries to severe 3-vessel coronary artery disease [CAD]. Treatment of these patients is, in large part, determined by the extent and severity of the underlying fixed coronary obstructions. To determine the clinical features of variant angina with and without fixed severe coronary artery disease. Nishtar Hospital, Multan. Two years. Descriptive, comparative analytical study. Sample size 108 patients. Sampling technique: Convenient probability sampling done. 43 patients with variant angina who had less than 50% fixed coronary luminal diameter narrowing [group-I] were compared with 65 patients with variant angina who had 70% or greater diameter narrowing [group-II]. Statistically significant differences were found in 3 clinical features between group-I and group-II i.e. [1] a more than 3 months history of angina at rest before diagnosis [80% vs 23%, P <0.001]; [2] an abnormal electrocardiogram at rest [19 vs 48%, P <0.01]. [3] an abnormal stress test [26% [8 of 30] vs 84% [15 of 18], P <0.01. However, these features were not clinically reliable in separating patients with variant angina with and without fixed severe obstructions because of overlap between the two groups. No difference was found between the 2 groups in age, sex, predominant symptoms at the time of catheterization, history of exertional angina, syncope with angina, prolonged angina, previous artery disease. Coronary arteriography should be performed to define the underlying coronary anatomy and to determine optimal therapy in patients with variant angina

Measurement of serum cholesterol and triglyceride; evaluation in patients with diabetes; hypertension and cerebrovascular accident in south Punjab

Lipid disorders occur in patients with hypertension, cerebrovascular accident [CVA] and NIDDM. However their detection and subsequent intervention remains under-estimated throughout the world due to one or another reason. The aim of this study was to evaluate the status of lipids in our diabetic, hypertensive and stroke patients regardless of their hypertensive and glycemic control, age and sex. This study was carried out on 300 cases of diabetes mellitus, hypertension and cerebrovascular accident at Medical Unit-II of Nishtar Hospital, Multan. Out of 300 patients, 93 [31%] patients showed isolated stroke, 114 [38%] patients showed isolated diabetes mellitus. Isolated hypertension was found among 21 [7%], six [2%] patients out of 300 showed combined, hypertension, CVA and diabetes mellitus. 18% [6%] patients exhibited combined hypertension and stroke. 20 [6.7%] patients were having combined diabetes mellitus and Hypertension. 7 [2.3%] patients out of 300 exhibited combined diabetes mellitus and stroke

frequency of complications during heamodialysis

The commonly used renal replacement therapy for the end stage renal disease is the maintenance haemodialysis. Only 30% are having approach to renal transplantation, a gold standard treatment. The maintenance haemodialysis is the substitute for kidney functions. On one hand it is blessing for chronic renal failure patients, the complications may also occur on the other hand. This prospective study was conducted at Nephrology section of Medical Unit-II, Nishtar Hospital, Multan. The objective of the study was to determine the frequency of different complications during haemodialysis in patients having end stage renal disease. The patients with acute renal failure having haemodialysis were excluded from the study. The most frequently observed complications were depressive illness, vomiting, fever, itching and hypotension. The causative relations of the complications with other parameters were also assessed. Results indicate that predialysis, thorough work up of patients and certain steps help to decrease the frequency of complications

Serum adenosine deaminase [ADA] level in the cases of tuberculous pleural effusion

Pleural biopsy is conventionally considered as a sole important procedure for the diagnosis of tuberculous pleural effusion even though pleural fluid contain sensitive biochemical markers like adenosine deaminase [ADA] gamma interferon and tumour necrosis factor. This prospective study was conducted at Nishtar Hospital, Multan. The objective of the study was to assess the value of adenosine deaminase activity for the diagnosis of tuberculous pleural effusion without performing needle pleural biopsy. Sixty patients with history and clinical examination suggestive of tuberculous pleural effusion admitted in four medical units and chest unit of Nishtar Hospital, Multan were included in this study and these were labeled as group-I. In addition as a control of study, the pleural fluid was also aspirated in 20 selected patients having transudative pleural effusion secondary to congestive cardiac failure and cirrhosis of liver, denoted as group-II. The selection criteria for the patients was the history, clinical examination and lymphocytic exudative pleural effusion. Pleural biopsy was performed in all the patients of group-I and ADA activity in the pleural aspirate of all the subjects of group-I and group-II was estimated by Giusti G method1. The ADA activity was compared in both the groups by setting a cut off value 40 U/L. The results were statistically analyzed by applying chi square test. The ADA activity of the group-I was 40.2 + 10.82 U/L while that of group-II was 24 + 11 U/L. Thirty three in group-I and one of group-II had ADA activity above cut off value. The p value was <0.001. The results of this study favor the application of ADA activity in pleural fluid as the diagnostic tool for tuberculous pleural effusion without performing an invasive procedure like the pleural biopsy