Pediatric sarcoidosis presenting with hypertensive encephalopathy.

A 3-year-old girl with simultaneous presentation of hypertensive encephalopathy, subcutaneous nodules, hepatosplenomegaly and proteinuria was presented. The sarcoidosis was confirmed by histologic demonstration of non-caseating granulomas in the liver, left kidney, a cervical lymph node and subcutaneous nodules. The proteinuria resolved spontaneously. During the six-month period of steroid therapy, the renal mass and hepatosplenomegaly were dissolved but the cervical lymphadenopathy still persisted. The hypertensive state was difficult to control which required a multiple antihypertensive drug regimen.

Microsatellite instability in Epstein-Barr virus associated with nasopharyngeal carcinoma.

The result reported here represents the first human genomic screen for MSI in Epstein-Barr-Virus associated NPC. The analysis revealed the incidence of MSI only 1 of 23 cases (4%) which indicates that MSI is less common in NPC development.

Loss of heterozygosity for chromosome 11 in Epstein-Barr-virus associated nasopharyngeal carcinoma.

In order to demonstrate and define possible tumor suppressor gene loci on chromosome 11 associated with NPC, we used 7 STR to test for LOH on 25 NPC samples. LOH was detected in 46 per cent of cases. Most LOH loci were clustered on the long arm. Further study demonstrated 22 per cent and 45.5 per cent of cases with LOH on 11q13 and 11q23 respectively.

Granulomatous interstitial nephritis in renal transplant recipient.

Tuberculosis of a transplanted kidney is a rare and serious complication. Search for renal tuberculosis as the cause of deterioration of graft function is mandatory in a renal transplant recipient with tuberculosis of other organs e.g. pulmonary tuberculosis in this patient. Renal histopathology is required for the diagnosis. Treatment with anti-tuberculosis drugs can improve renal function. Drug interactions should be considered when rifampicin is administered with cyclosporin A.

Intrarenal hemodynamic abnormality in severe form of glomerulonephritis: therapeutic benefit with vasodilators.

Intrarenal hemodynamic and tubular function has been assessed in 16 patients who presented clinically with hypertension, hematuria and severe renal functional impairment. Twelve of these 16 patients had histopathologic classification as DPGN (3 cases), MPGN (3 cases) and FSGS (6 cases). The initial assessment of intrarenal hemodynamics in 11 patients revealed strikingly increased afferent (RA) and efferent arterioles (RE), filtration fraction (FF), intraglomerular capillary hydrostatic pressure (PG), whereas, there was marked reduction in renal plasma flow (RPF), in ultrafiltration coefficient (KFG) and in glomerular filtration rate (GFR). Tubular transporting defect as being reflected by enhanced fractional excretions of solutes was also observed. Both enhanced TXB2 production and diminished PGI2 may be in part responsible for the marked reduction of RPF and elevated intrarenal resistance. In light of the preceding intrarenal hemodynamics alteration, therapeutic intervention with vasodilators consisting of dipyridamole, calcium channel blocker and angiotensin convertase inhibitor has been accomplished with clinical improvement in glomerular and tubular functions following the improvement in intrarenal hemodynamics. Thus, this abnormal intrarenal hemodynamics renders a supportive view of the hemodynamically mediated glomerulo-tubulo-interstitial injury to be central to the pathogenetic mechanism.

Case report with review of Aeromonas infection.

A 31-year-old woman with A. sobria infection and septicemia was reported. The patient was a known case of ANLL,M4 with incomplete remission following successive courses of chemotherapy. There were abscesses in the subcutaneous tissue of right knee and the liver at necropsy. Leukemic cell infiltration in various organs as well as the aforementioned organs were observed. Reported cases of Aeromonas infection with or without diarrhea were also reviewed. According to our knowledge the present case is the first reported case with A. sobria infection with liver abscess in Thailand.

Massive cerebral hemorrhage from metastatic hepatocellular carcinoma.

Metastasis of hepatoma to the brain is a rare event. Even rarer is massive hemorrhage of the brain associated with metastatic hepatoma. A 57-year-old man had cirrhosis of the liver with hepatocellular carcinoma. The tumor spread to the lungs and left occipital lobe of the brain. The primary and secondary neoplasms were negative in detection of mucin, but were immunohistochemically positive to cytokeratin CAM 5.2 and KC; the finding supported the hepatocellular origin of the tumor. The metastatic tumor formed papillae in the lung and produced massive hemorrhage in the left occipital lobe. This case raised the total number of intracranial metastatic hepatic carcinomas to 34 cases. Five of 34 hepatic carcinomas metastatic to brain, including the current one, were hepatocellular carcinoma that produced massive hemorrhage.

Nocardiosis: report of 2 cases with review of literature in Thailand.

Two cases of nocardiosis with underlying SLE are presented. Both were female patients aged 19 and 34 years and had been treated with steroid and endoxan for some time. Death from lesions in the respiratory tract and right kidney with growth of Nocardia asteroides at autopsy was noted in the first case. The second patient exhibited fever with dyspnea and subsequent peripheral neuromuscular dysfunction. Disseminated nocardial abscesses in multiple organs including lungs, liver, spleen, lymph nodes and subcutaneous tissue were disclosed postmortem. Moreover, intravascular dissemination of the organisms had resulted in thrombosis of several blood vessels supplying the spinal cord resulting in widespread myelomalacia. Recent infarction of a few spinal nerve roots was also observed.

Malignant lymphomas: retrospective analysis from 25 autopsy cases.

Twenty-five cases of malignant lymphomas from the Autopsy file in Department of Pathology, Faculty of Medicine, Chulalongkorn University from 1978 to 1987 were studied retrospectively. Over half of the cases were in between the fourth and the seventh decades with male to female sex ratio 2:1. The majority was in the advanced stage of nodal lymphoma of Non-Hodgkin's. Diffuse large cell (histiocytic) was the most frequent followed by small lymphocytic (well differentiated lymphocytic) and lymphoblastic type respectively. Thirteen patients died from infection whereas the remaining cases died from hemorrhage, complications at the terminal stage of the disease and from unrelated malignancy.