ABSTRACT
HISTORY AND CLINICAL FINDINGS: A 54-year old man had suffered from advanced multiple myeloma for two years. After initially good response the myeloma was refractrory to treatment with dexamethasone, cyclophosphamide, bortezomibe, zoledronate and additionally doxorubicine. The patient then complained of dyspnea without clinical signs of cardiopulmonary disease. INVESTIGATIONS: Arterial blood gas analysis showed hyperventilation with respiratory alkalosis and normal alveolo-arterial gradient as the reason for the dyspnea. With a normal MRI of the brain and lumbal puncture, a neurological disease could be excluded. Serum calcium, creatinine and serum viscosity were normal. Eventually, serum ammonia levels were found to be substantially elevated (144â µmol/l) and hyperammonemic encephalopathy was diagnosed. TREATMENT AND COURSE: Therapy with bortezomib and high dose dexamethason was repeated, and the patient also received bendamustin. Despite this treatment, he lost consciousness and died after two weeks because of aspiration pneumonia. CONCLUSION: The existence of respiratory alkalosis and multiple myeloma should prompt a search for hyperammonemia.
Subject(s)
Multiple Myeloma/diagnosis , Rett Syndrome/diagnosis , Alkalosis, Respiratory/diagnosis , Alkalosis, Respiratory/drug therapy , Ammonia/blood , Bendamustine Hydrochloride , Boronic Acids/therapeutic use , Bortezomib , Dexamethasone/therapeutic use , Drug Therapy, Combination , Dyspnea/drug therapy , Dyspnea/etiology , Fatal Outcome , Humans , Male , Middle Aged , Multiple Myeloma/drug therapy , Nitrogen Mustard Compounds/therapeutic use , Pyrazines/therapeutic use , Rett Syndrome/drug therapyABSTRACT
We report the case of a 39 years old patient with sudden onset of abdominal distension and icterus. Occlusion of the liver veins discovered by doppler ultrasound caused the portal hypertension and liver disease. Given the erythrocytosis the detection of JAK 2-mutation proved polycythemia vera as underlying disease for the Budd Chiari syndrome. The implantation of a TIPS wasn't successful because of an early thrombotic occlusion. Therefore a surgical mesocaval shunt was done. At the moment the patient is therapied with oral anticoagulation and hydroxycarbamide and is fully capable of work again.
Subject(s)
Ascites/etiology , Budd-Chiari Syndrome/diagnosis , Jaundice/etiology , Polycythemia Vera/diagnosis , Waist Circumference , Adult , Budd-Chiari Syndrome/therapy , Diagnosis, Differential , Humans , Liver Function Tests , Male , Paracentesis , Polycythemia Vera/therapy , UltrasonographyABSTRACT
Gallbladder polyps are a common incidental finding in ultrasound. They may be clinically significant, because adenomas have a malignant potential, in contrast to the benign cholesterol polyps occuring more frequently. As non-neoplastic polyps and neoplastic polyps cannot be morphologically discriminated in ultrasound, maximal diameter of a polyp has proven to be the best predictor for malignancy. Cholecystectomy is widely accepted as the treatment of choice for patients with polyps >1 cm. Patients with polyps <1 cm should have a follow-up check for a longer period of time (with the exception of very small polyps).
Subject(s)
Gallbladder Neoplasms/diagnosis , Polyps/diagnosis , Algorithms , Cell Transformation, Neoplastic/pathology , Cholecystectomy , Gallbladder/pathology , Gallbladder Neoplasms/pathology , Gallbladder Neoplasms/surgery , Humans , Polyps/pathology , Polyps/surgery , Predictive Value of Tests , Ultrasonography , Watchful WaitingABSTRACT
We report the case of a 68 year old immuncompetent woman with persisting fever. Symptomatic acute CMV infection with a partial thrombosis of the left portal vein branch was diagnosed.
Subject(s)
Cytomegalovirus Infections/diagnosis , Fever of Unknown Origin/etiology , Hepatitis, Viral, Human/diagnosis , Portal Vein , Thrombosis/diagnosis , Aged , Diagnosis, Differential , Female , Humans , Liver Function Tests , Tomography, X-Ray ComputedABSTRACT
We report a case of a 64 year old woman with spontaneous hematomas. A prior history of bleeding disorder was not known up to now. The result of investigation of coagulation was an isolated prolonged aPTT that was caused by an inhibitor of factor VIII without underlying disease (idiopathic acquired hemophilia A). Therapy with steroids and cyclophosphamid resulted in partial remission.
Subject(s)
Factor VIII/antagonists & inhibitors , Hematoma/blood , Hematoma/etiology , Hemorrhagic Disorders/blood , Hemorrhagic Disorders/etiology , Partial Thromboplastin Time , Algorithms , Cyclophosphamide/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Female , Hematoma/drug therapy , Hemophilia A/blood , Hemophilia A/diagnosis , Hemophilia A/drug therapy , Hemorrhagic Disorders/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Methylprednisolone/therapeutic use , Middle Aged , Prednisolone/therapeutic useSubject(s)
Physical Education and Training/history , Sex Characteristics , Sports/history , Female , History, 20th Century , Humans , SwitzerlandABSTRACT
We report the case of a 39-year old patient with septicemia treated for pharyngitis with antibiotics since a few days. She wasn't able to swallow her antibiotics anymore because of dysphagia. Radiologic examination revealed pulmonary infiltrates and Vena iugularis interna-thrombosis. These findings and anamnesis led to the diagnosis of Lemierre syndrome inspite of lacking detection of bacteria. After changing the antibiotic therapy and start of anticoagulation further course of illness was favorable. The long duration of hospitalization was indepted to high morbidity typically seen in Lemierre syndrome.
Subject(s)
Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Bacterial Agents/administration & dosage , Deglutition Disorders/etiology , Fever of Unknown Origin/etiology , Fusobacterium Infections/diagnosis , Fusobacterium necrophorum , Jugular Veins , Pneumonia, Bacterial/diagnosis , Sepsis , Thrombosis/diagnosis , Tonsillitis/diagnosis , Tonsillitis/drug therapy , Adult , Anticoagulants/therapeutic use , Ceftriaxone/therapeutic use , Clindamycin/therapeutic use , Deglutition Disorders/drug therapy , Diagnosis, Differential , Drug Therapy, Combination , Female , Fever of Unknown Origin/drug therapy , Fusobacterium Infections/drug therapy , Humans , Pneumonia, Bacterial/drug therapy , Syndrome , Thrombosis/drug therapy , Tomography, X-Ray Computed , UltrasonographyABSTRACT
We report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominal pain and diarrhea. She fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. Hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by Group A Streptococcus which was cultivated in blood and ascites. Therapy with penicilline and clindamycine resolved symptoms. During hospitalisation Clostridium difficile colitis occurred. This complication leaded to prolonged hospitalisation.
Subject(s)
Abdomen, Acute/etiology , Bacteremia/diagnosis , Diabetes Mellitus, Type 1/diagnosis , Diarrhea/etiology , Peritonitis/diagnosis , Shock, Septic/diagnosis , Streptococcal Infections/diagnosis , Streptococcus pyogenes , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Appendicitis/diagnosis , Bacteremia/drug therapy , Clostridioides difficile , Diagnosis, Differential , Enterocolitis, Pseudomembranous/chemically induced , Enterocolitis, Pseudomembranous/diagnosis , Female , Humans , Laparoscopy , Necrobiosis Lipoidica/diagnosis , Peritonitis/drug therapy , Shock, Septic/drug therapy , Streptococcal Infections/drug therapy , Ultrasonography , Young AdultABSTRACT
We report the case of a 62 year old women with chronic idiopathic myelofibrosis who developed acute lymphadenopathy. At the same time diabetes insipidus, osteolytic bone lesions and exanthema of the skin were diagnosed. Suspected Langerhans cell histiocytosis could be proven by repeated biopsies of affected organs. Therapy was started in accordance with the recommendations of the Histiocyte Society.
Subject(s)
Diabetes Insipidus/diagnosis , Histiocytosis, Langerhans-Cell/diagnosis , Lymphatic Diseases/diagnosis , Primary Myelofibrosis/diagnosis , Biopsy , Comorbidity , Diabetes Insipidus/pathology , Female , Histiocytosis, Langerhans-Cell/pathology , Humans , Lymph Nodes/pathology , Lymphatic Diseases/pathology , Middle Aged , Primary Myelofibrosis/pathology , Skin/pathologyABSTRACT
We report the case of a 34-year old mother presenting in the emergency unit because of fever and odynophagia. Herpetic esophagitis with Herpes simplex virus primoinfection in a immunocompetent patient was diagnosed. The virus was transmitted by her own child which came to be hospitalised because of herpetic stomatitis. In the blood chemistry pancreas enzymes were elevated which we interpreted as herpetic pancreatitis because of coincidence with herpetic esophagitis.
Subject(s)
Deglutition Disorders/etiology , Esophagitis/diagnosis , Herpes Simplex/diagnosis , Pain/etiology , Vomiting/etiology , Adult , Amylases/blood , Diagnosis, Differential , Female , Gastroesophageal Reflux/complications , Herpes Simplex/transmission , Humans , Lipase/blood , Pancreatitis/diagnosisABSTRACT
We report a case of 34 year old woman how has been hospitalized at the age of 6 month with persistent vomitus. The vomitus was found to be caused by adrenal insufficiency with lack of all hormones of steroidobiosynthesis. The phenotypical femal child was diagnosed to have congenital lipoid adrenal hyperplasia with 46,XY DSD. 24 years later a homozygote mutation in the StAR-gene (L260P), which was first described in Switzerland, has been identified.
Subject(s)
Addison Disease/complications , Adrenal Hyperplasia, Congenital/complications , Disorders of Sex Development , Mythology , Addison Disease/diagnosis , Adrenal Hyperplasia, Congenital/diagnosis , Adult , Algorithms , Diagnosis, Differential , Disorders of Sex Development/complications , Disorders of Sex Development/diagnosis , Disorders of Sex Development/genetics , Female , Homozygote , Humans , Infant , MutationABSTRACT
BACKGROUND: Lower blood folate levels have been associated with depression in cross-sectional surveys, but no studies have examined the relationship prospectively to determine whether the relationship is causal. A follow-up study was designed to examine whether lower blood folate levels predict incident depressive symptoms. METHOD: Women aged 20-34 years registered in general practices in Southampton, UK, were asked to participate. Baseline assessment included the general health questionnaire (GHQ-12) measure of anxiety and depression, and socioeconomic factors, diet, smoking and alcohol intake. Two years later, participants' general practice (GP) records were examined for evidence of incident symptoms of depression. RESULTS: At baseline, 5051 women completed the GHQ-12 and had red cell folate levels measured, of whom 1588 (31.4%) scored above the threshold for case level symptoms of anxiety and depression on the GHQ-12. Two years later, GP records for 3996 (79.1%) were examined, but 1264 with baseline evidence of depression were excluded from follow-up analysis. Incident depressive symptoms were recorded for 307 (11.2%) of the remaining 2732. Lower red cell folate levels were associated with caseness on the GHQ-12 (adjusted prevalence ratio 0.99 per 100 nmol/l red cell folate, 95% CI 0.98 to 1.00). No relationship was found between red cell folate levels and incident depressive symptoms over 2 years (adjusted hazard ratio 1.00, 95% CI 0.97 to 1.03). CONCLUSIONS: Low folate levels were not associated with subsequent depressive symptoms. This suggests that lower blood folate levels may be a consequence rather than a cause of depressive symptoms.
Subject(s)
Depression/blood , Folic Acid/blood , Adult , Anxiety/blood , Anxiety/diagnosis , Biomarkers/blood , Depression/diagnosis , Depression/epidemiology , England/epidemiology , Erythrocytes/chemistry , Female , Humans , Longitudinal Studies , Proportional Hazards Models , Surveys and Questionnaires , Young AdultABSTRACT
We report the case of a 72-year old woman with known metastatic breast cancer who presented to the emergency department with progressive dyspnea on exertion and chest pain. The diagnosis of pulmonary embolism could be established by pulmonary scintigraphy after computed tomography and ultrasound of the lower extremities had been negative in spite of a moderate clinical pretest probability (Wells score). This case shows that even if we manage suspected pulmonary embolism using algorithms combining clinical probability, computed tomography and ultrasound we must remain aware of eventually missing the diagnosis and carry on investigating cases with elevated clinical probability.
Subject(s)
Angiography , Breast Neoplasms/complications , Diagnostic Errors , Dyspnea/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Tomography, Spiral Computed , Aged , Algorithms , Dyspnea/etiology , Female , Humans , Paraneoplastic Syndromes/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Thrombophilia/complicationsABSTRACT
HISTORY AND CLINICAL FINDINGS: A 34-year-old previously healthy woman presented with a five-day history of subacute onset of a numb chin. Examination on admission revealed isolated hypesthesia on the left side of the chin and lower lip. INVESTIGATIONS: Brain magnetic resonance imaging (MRI) demonstrated a lesion involving the pontine trigeminal fibers and multiple periventricular T2-hyperintense white matter lesions suggestive of inflammatory /demyelinating disease. Cerebrospinal fluid analysis revealed oligoclonal IgG bands (only in cerebrospinal fluid) and an increased IgG index. A follow-up MRI after four months demonstrated new supratentorial brain lesions, confirming a syndrome, highly suggestive of multiple sclerosis as the likely underlying diagnosis. TREATMENT AND FOLLOW-UP: The facial sensory disturbance resolved spontaneously. Prophylactic treatment with interferon-beta was started. CONCLUSION: The numb chin syndrome may be the initial presentation of a clinically isolated syndrome suggestive of multiple sclerosis. Prophylactic immunomodulatory treatment may be started after the suspicion of inflammatory/demyelinating activity is confirmed.
Subject(s)
Hypesthesia/etiology , Multiple Sclerosis/diagnosis , Adult , Brain/pathology , Chin , Diagnosis, Differential , Female , Humans , Hypesthesia/diagnosis , Immunoglobulin G/cerebrospinal fluid , Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Lip , Magnetic Resonance Imaging , Multiple Sclerosis/complications , Multiple Sclerosis/drug therapy , Syndrome , Trigeminal Nerve/pathologySubject(s)
Fecal Impaction/complications , Hydronephrosis/etiology , Aged , Diagnosis, Differential , Diagnostic Imaging , Fecal Impaction/diagnosis , Humans , Hydronephrosis/diagnosis , Male , Megacolon/complications , Megacolon/diagnosis , Ureteral Obstruction/diagnosis , Ureteral Obstruction/etiologyABSTRACT
1. Glycoprotein and protein synthesis in and release from pig isolated, enriched gastric mucous cells were measured by the incorporation of N-acetyl-[14C]-D-glucosamine and [3H]-L-leucine, respectively, into cellular and released acid precipitable material. 2. Histamine and activators of the adenosine 3':5'-cyclic monophosphate (cyclic AMP) system maximally stimulated total protein and glycoprotein synthesis in and release from the cells at concentrations of histamine (10 microM), forskolin (10-100 microM), 3-isobutyl-1-methylxanthine (100 microM), and dibutyryl cyclic AMP (1-3 mM), respectively. In the presence of 3-isobutyl-1-methylxanthine (30 microM) histamine stimulation was enhanced. 3. As shown by gel chromatography, stimulation by histamine (100 microM), forskolin (10 microM), 3-isobutyl-1-methylxanthine (100 microM) and dibutyryl cyclic AMP (1 mM) resulted in a release of high molecular weight (approximately 2 x 10(6) daltons) glycoproteins from the cells. The histamine H2-receptor antagonist, ranitidine (100 microM), blocked the effect of histamine. 4. We conclude that cyclic AMP-dependent processes are involved in the regulation of protein and glycoprotein synthesis in and the release of high molecular weight (mucous) glycoproteins from pig gastric non-parietal cells and that histamine may be a physiological activator of this system.
Subject(s)
Cyclic AMP/metabolism , Gastric Mucosa/drug effects , Glycoproteins/metabolism , Histamine/pharmacology , Protein Biosynthesis , 1-Methyl-3-isobutylxanthine/pharmacology , Animals , Bucladesine/pharmacology , Cell Separation , Chromatography, Gel , Colforsin/pharmacology , Gastric Mucosa/cytology , Gastric Mucosa/metabolism , Glycoproteins/biosynthesis , In Vitro Techniques , Molecular Weight , Ranitidine/pharmacology , SwineABSTRACT
We studied the effects of prostaglandin (PG) E2, carbenoxolone, cholecystokinin-octapeptide (CCK-OP), and the thromboxane-mimetic U46619, all known to stimulate gastric mucus secretion in vivo, on protein and glycoprotein synthesis in and release from isolated and enriched pig gastric mucous cells, as measured by the incorporation of [3H]L-leucine and N-acetyl-[14C]D-glucosamine respectively into cellular and released acid insoluble material. PGE2 stimulated glycoprotein and protein synthesis (EC50 7 and 30 nmol/L, respectively) and release (EC50 50 and 140 nmol/L, respectively) in a concentration-dependent manner, whereas carbenoxolone, CCK-OP and U46619 failed to enhance the incorporation of the tracers. We conclude that stimulation of mucus secretion by PGE2 is related to direct effects on protein and glycoprotein production of gastric non-parietal cells, whereas indirect effects may be involved in the stimulation by carbenoxolone, CCK-OP, and U46619.
Subject(s)
Carbenoxolone/pharmacology , Dinoprostone/pharmacology , Gastric Mucosa/metabolism , Glycoproteins/biosynthesis , Prostaglandin Endoperoxides, Synthetic/pharmacology , Protein Biosynthesis , Sincalide/pharmacology , 15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid , Acetylglucosamine/metabolism , Animals , Gastric Mucosa/cytology , Gastric Mucosa/drug effects , In Vitro Techniques , Phosphotungstic Acid , Swine , Trichloroacetic AcidABSTRACT
The purpose of this study is to evaluate the effects of different prostaglandin derivatives on protein and glycoprotein synthesis and secretion in isolated and enriched pig gastric mucous cells, as measured by the incorporation of [3H]L-leucine and N-acetyl-[14C]D-glucosamine respectively into acid insoluble macromolecules (AIM). PGE2 and 16,16-dimethyl-PGE2 enhanced the incorporation of the amino sugar into cellular (EC50 8 and 75 nmol/l) and secreted (EC50 30 and 270 nmol/l) AIM in a concentration dependent manner during a 20 hours incubation. After incubation for eight hours or more they also stimulated the incorporation of [3H]L-leucine into cellular AIM. PGF2 alpha was considerably less potent (EC50 greater than 1 mumol/l) than the E-type prostaglandins. Iloprost, a stable prostacyclin analogue, was ineffective.
Subject(s)
16,16-Dimethylprostaglandin E2/pharmacology , Dinoprost/pharmacology , Dinoprostone/pharmacology , Gastric Mucosa/drug effects , Prostaglandins E, Synthetic/pharmacology , Protein Biosynthesis , Animals , Cell Separation , Gastric Mucosa/metabolism , Glycoproteins/biosynthesis , SwineABSTRACT
The production of glycoprotein and protein by isolated pig gastric non-parietal cells was measured by incorporation of N-acetyl-[14C]-D-glucosamine [( 14C]GlcNAc) and [3H]-L-leucine [( 3H]Leu), respectively, into acid insoluble material (AIM). Histamine enhanced incorporation of the tracers into cellular and released AIM in a concentration-dependent manner. The H2 receptor antagonist ranitidine completely blocked the effects of histamine (100 mumol/l) on [3H]Leu incorporation into cellular and released AIM (IC50 37 and 32 mumol/l, respectively) but had no inhibitory effect on the 16,16-dimethylprostaglandin-E2 - and forskolin-stimulated tracer incorporation. The H1 receptor antagonist mepyramine did not inhibit the histamine effect. We conclude that histamine is a stimulant of protein, via H2 receptors, and glycoprotein production of isolated pig gastric non-parietal cells.
Subject(s)
Gastric Mucosa/metabolism , Glycoproteins/biosynthesis , Histamine/pharmacology , Protein Biosynthesis , 16,16-Dimethylprostaglandin E2/pharmacology , Acetylglucosamine/metabolism , Animals , Colforsin/pharmacology , Gastric Mucosa/cytology , Histamine H1 Antagonists/pharmacology , Histamine H2 Antagonists/pharmacology , Leucine/metabolism , Pyrilamine/pharmacology , Ranitidine/pharmacology , Receptors, Histamine H1/drug effects , Receptors, Histamine H2/drug effects , Swine , TritiumABSTRACT
Glycoprotein and protein production of isolated pig gastric mucosal cells were determined by the incorporation of N-acetyl-[14C]D-glucosamine ([14C]GlcNAc) and [3H]L-leucine ([3H]Leu) into acid-insoluble macromolecules (AIM). In four cell fractions (F1-F4), obtained by counterflow centrifugation, specific [14C]GlcNAc incorporation was greatest in the mucous cell-enriched F2. Tracer incorporation by F2 cells, proceeded linearly up to 20 h, was inhibited by cycloheximide or incubation at 0 degree C, and enhanced by PGE2 1 mumol/l. Gel chromatography of released AIM revealed that PGE2-stimulated [14C]GlcNAc incorporation was predominantly directed into high molecular weight (2 X 10(6) daltons) glycoproteins, whereas [3H]Leu incorporation was mainly related to proteins of albumin-like molecular weight. We conclude that incorporation of [14C]GlcNAc by enriched pig gastric mucous cells (F2), further analyzed by gel chromatography, is a suitable probe to study the production of high molecular weight gastric mucous glycoproteins in vitro.