18F-FDG PET/CT in the diagnosis of an extranodal relapse of diffuse large B-cell lymphoma (DLBCL): a clinical case with a literature review.

Extranodal lymphoma, secondary to or accompanying nodal disease is uncommon, but not unusual finding. 18-Fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) imaging has an essential role in the staging of lymphoma, in treatment response monitoring, and in detection of recurrence. We present a case of a 52-year-old man with generalized diffuse large B-cell lymphoma (DLBCL) with multiple extranodal sites involvement detected by 18F-FDG PET/CT. With this clinical case we demonstrate that 18F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of viable extranodal involvement of the diffuse large B-cell lymphoma (DLBCL) and should be combined in the monitoring of DLBCL.

Unilateral unique Lupus tumidus: pathogenetic mystery and diagnostic problem.

Lupus tumidus is a rare immunological disorder whose pathogenesis is not fully understood. Although on the one hand there are some differences in (1) the clinical morphology of lesions, (2) the histopathology picture, as well as in (3) serological profile of lupus tumidus patients at the current moment, the disease is regarded as a subform of chronic cutaneous lupus erythematosus. Differential diagnosis requires the exclusion of many diseases such as Jessner Kanoff lymphocytic infiltration, polymorphous light eruption, and reticular erythematous mucinosis. Differentiation between them is not always easy. The standard treatment regimen of patients with lupus tumidus is based on local and systemic application of corticosteroids, azathioprin, dapsone, mepacrine, chloroquine, and hydroxychloroquine. Modern treatment options include the use of pulsed dye laser, tacrolimus 0.1 % ointment and photophoresis. We present a 42-year-old patient with unilateral atypical form of lupus tumidus who was successfully treated with systematically administration of hydroxychloroquine in combination with sunscreen SPF 50. After a 2-month course of treatment with hydroxychloroquine dosage of 200 mg per day and a break of 3 months between courses, we observed a complete remission.

Wilson's disease in association with anetoderma.

BACKGROUND: Wilson's disease is an autosomal recessive disorder of copper homeostasis with predominantly hepatic and neuropsychiatric involvement. Anetoderma is a rare benign condition with focal damage of dermal elastic tissue. Previous reports described this skin disorder in association with prolonged D-Penicillamine therapy. CASE PRESENTATION: A 26-year-old male was referred for evaluation of asymptomatic elevation of aminotransferase levels. Investigations showed negative markers for chronic viral and autoimmune hepatitis, low ceruloplasmin level, and increased copper urinary excretion. Liver biopsy revealed chronic hepatitis with moderate activity and severe bridging fibrosis. Mutation analysis found a compound heterozygote genotype and supported a diagnosis of Wilson's disease. At the time of the primary physical exam, skin lesions were also observed, consisting of numerous white to pale papules less than 7-8 mm in diameter with central protrusion located at the upper part of the body. Primary anetoderma was established based on presentation and skin biopsy findings. Therapy with D-Penicillamine at a daily dose of 1500 mg was started, and, during 12-month follow-up, aminotransferase decreased to normal and skin lesions remained unchanged. CONCLUSION: In our opinion the case is a first reported association between Wilson's disease and primary anetoderma. The possible mechanism behind this relationship is discussed.

Cervix carcinoma and incidental finding of medullary thyroid carcinoma by 18F-FDG PET/CT--clinical case.

Thyroid nodules are encountered in clinical practice during the diagnostic procedures or patients' follow-up due to other diseases quite far from the thyroid gland with prevalence 4-50% in general population, depending on age, diagnostic method and race. The prevalence of thyroid nodules increases with age and their clarification should be done for their adequate treatment. An 18F-FDG PET/CT was done with a PET/CT scanner (Philips Gemini TF), consisting of dedicated lutetium orthosilicate full ring PET scanner and 16 slice CT. The PET/CT scan of the whole-body revealed on the CT portion a hypodense nodular lesion in the left lobe of the thyroid gland with increased uptake of 18F-FDG on the PET with SUVmax 10.3 and demonstrated a complete response to the induction therapy of the main oncological disease of the patient--squamous cell carcinoma. This clinical case demonstrates that whole-body 18F-FDG-PET/CT has an increasingly important role in the early evaluation of thyroid cancer as a second independent malignant localization. Focal thyroid lesion with high risk of thyroid malignancy was incidentally found on 18F-FDG PET/CT.

Gangrenous cystitis: report of a case and review of the literature.

Gangrenous cystitis is an extremely rare condition: only a total of 240 cases worldwide have been reported so far. Most of these cases have occurred in the preantibiotic era. After the advent and widespread use of antibiotics in clinical practice, only sporadic cases have been observed. We report a case of gangrenous cystitis in an 83-year-old woman who presented with symptoms of acute abdomen. The main causative factor was overdistension of the bladder due to urinary retention. The patient underwent total cystectomy and bilateral ureterocutaneostomy with a favorable outcome. The incidence, etiology, diagnosis, management and outcome of gangrenous cystitis are discussed.

Protective effect of BP 2-94, a histamine H3-receptor agonist prodrug, in a model of carbon tetrachloride-induced hepatotoxicity in rats.

UNLABELLED: BP 2-94 is a prodrug of the H3-receptor agonist (R)-alpha-methylhistamine [(R)-alpha-MeHA]. BP 2-94 displayed anti-inflammatory, antinociceptive and ulcero-protective properties in experimental animals. AIM: The aim of the present study was to investigate the effect of BP 2-94 in a model of carbon tetrachloride (CCl4)-induced hepatotoxicity in rats. MATERIALS AND METHODS: In order to investigate the effect of BP 2-94 it was applied to rats either alone (20, 40 and 60 micromol kg(-1), 4 days) or as a pretreatment (20, 40 and 60 micromol kg(-1), 4 days) before the application of CCl4 (0,2 ml kg(-1), 2 days). RESULTS: BP 2-94 in the tested doses did not cause significant changes in the plasma aspartate transaminase (AST) and alanine transaminase (ALT) activities and the liver microscopic appearance was normal. Hepatocyte damage, as evident by local areas of liver necrosis and elevated levels of plasma AST and ALT, occurred in rats following acute exposure to CCl4 (0,2 ml kg(-1), 2 days). BP 2-94 applied as a pretreatment dose-dependently reduced the necrotic changes in rat liver and inhibited the increase of plasma AST and ALT activities in response to CCl4. CONCLUSIONS: BP 2-94 had a hepatoprotective effect in a model of CCl4-induced toxicity in rats. This effect might be due the H3-agonistic activity of its active metabolite (R)-alpha-MeHA.

[Gastrointestinal carcinoid tumors--a retrospective analysis of 12 cases]. / Kartsinoidni tumori na stomashnochrevniia trakt--retrospektiven analiz na 12 sluchaia.

Twelve patients operated for gastrointestinal carcinoid tumors are analyzed retrospectively. Clinically four of the cases (33%) were with signs of bowel obstruction, 4 (33%)--with signs of acute appendicitis, 3 (25%)--with signs of gastric outlet obstruction, and one (9%) with a picture of perforative peritonitis. Carcinoid syndrome was observed in two cases (17%). Five of the tumors (42%) were localized in the small intestine, 4 (33%)--in the appendix and 3 (25%)--in the duodenum. Small bowel resection was performed in 5 cases (42%), appendectomy--in 4 (33%), hemiresection of the duodenum--in 2 (17%) and duodenotomy with excision of the tumor and pyloroplasty--in one. In 2 cases liver metastases were found, and in one--multiple (3) tumors in the gut.

High initial dose combination regimen with interferon-alpha and ribavirin in chronic hepatitis C.

BACKGROUND/AIMS: Combination of interferon-alpha and ribavirin becomes the antiviral therapy of choice for chronic hepatitis C. The aim of this trial was to assess the efficacy of two combination treatment strategies: standard regimen Interferon-alpha 3 MU three times per week (group A) and initial high dose Interferon 6 MU daily for 2 weeks followed by intermittent administration 3 MU three times per week (group B), plus Ribavirin in naive and relapsed patients with chronic hepatitis C. METHODOLOGY: Twenty-four patients (group A, 6; group B, 18) received medication for median 6 months (range, 5-12) and followed for 6 months. Primary end-point of therapy was a sustained virologic response. Statistical analysis was performed with a t test or non-parametric Mann-Whitney and chi-square test. RESULTS: At the end of the follow-up the overall sustained response rate was 42%: 6 of 18 (33.3%) patients with induction and 4 of 6 (66.6%) with standard regimen. Patients with sustained virologic response received higher interferon dose (423.7 +/- 102.2 MU) at extended duration of therapy (9.8 +/- 2.9 months) versus patients with non-sustained response (p < 0.05). The difference in sustained response rate in both treatment regimens was nonsignificant. CONCLUSIONS: High initial dose therapy does not enhance virologic response, compared to standard combination regimen.