ABSTRACT
Bone marrow infiltration by a solid tumor is an uncommon event. We report about a female patient presenting with shortness of breath und abnormalities of blood counts. A bone marrow aspiration showed the infiltration due to adeno carcinoma. The detection of the primary was not successful. Our patient died within 6 days due to disseminated intravascular coagulation.
Subject(s)
Adenocarcinoma/secondary , Bone Marrow Neoplasms/secondary , Disseminated Intravascular Coagulation/diagnosis , Neoplasms, Unknown Primary/diagnosis , Paraneoplastic Syndromes/diagnosis , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Aged , Biopsy , Bone Marrow/pathology , Bone Marrow Neoplasms/diagnosis , Bone Marrow Neoplasms/pathology , Diagnosis, Differential , Disease Progression , Disseminated Intravascular Coagulation/pathology , Female , Follow-Up Studies , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Lung Neoplasms/secondary , Lymphatic Metastasis/pathology , Neoplasms, Unknown Primary/pathology , Neoplastic Cells, Circulating , Paraneoplastic Syndromes/pathologyABSTRACT
The induction of diabetes has been recognised as adverse effect of the immunsuppressive drug FK506/Tacrolimus. The aim of this study was to clarify whether insulinopenia or insulin resistance dominates and whether islet cell autoantibodies are present in patients treated by FK506. We investigated 58 patients 1-3 years after liver transplantation while under therapy with FK506 or CsA and prednisolone (0-7.5 mg) for basal blood glucose levels and islet-cell specific autoantibodies. A subgroup of 20 patients on FK506, 10 patients on cyclosporin and 15 healthy volunteers were metabolically tested by oGTT. Five patients had diabetes pre-transplantation. After transplantation, 9/28 FK506-treated patients developed newly diagnosed diabetes compared to 0/25 cyclosporin-treated patients (p<0.01). Both patient groups showed significantly higher fasting blood glucose, insulin or C-peptide levels compared to controls. Through the oGTT, FK506-treated patients without diabetes, but not cyclosporin-treated patients, had higher C-peptide levels compared to controls (p<0.05). Five/32 patients on FK506 compared to 0/26 patients on cyclosporin (p<0.05) had islet cell specific autoantibodies, mainly ICA without GAD- or IA2-Ab, a feature described for latent autoimmune diabetes in adults. ICA positivity was correlated to the diabetes associated HLA haplotype DR4/DQ*0302 (p<0.05). Although the interpretation of our metabolic data in patients with concomitant liver disease and prednisolone therapy has limitations, we suggest insulin resistance caused by treatment with FK506. However, manifestation of diabetes was associated with relative insulinopenia rather than insulin resistance in patients on FK506. Immunsuppressive therapy by FK506 was not able to suppress islet cell autoimmunity, and may even induce it in genetically predisposed patients.
Subject(s)
Autoimmunity/immunology , Diabetes Mellitus/chemically induced , Immunosuppressive Agents/adverse effects , Islets of Langerhans/immunology , Tacrolimus/adverse effects , Adult , Blood Glucose/metabolism , C-Peptide/metabolism , Cyclosporine/adverse effects , Diabetes Mellitus/epidemiology , Female , Glucose Tolerance Test , Humans , Lipids/blood , Liver Transplantation/physiology , Male , Middle AgedABSTRACT
The effects of vitamin B12 deprivation and exposure to nitrous oxide were studied in growing rats. A significant synergistic retardation of growth was seen in rats deprived of vitamin B12 and exposed to nitrous oxide for 90 minutes each day.
