Incidental Discovery of Multiple Myeloma, Presenting as an Amyloid Tumor with Plasmacytic Elements of the Thoracic Wall.

Multiple myeloma is characterized by monoclonal proliferation of bone marrow plasma cells causing multiple bone lesions and overproduction of a monoclonal protein (M-protein) that could deposit in tissues (amyloidosis). Dissemination of the multiple myeloma outside the bone is rare. We present a case of a 76 years old woman presenting with dry cough. Chest X-ray showed a giant tumor of the upper right lung. Contrast enhanced CT revealed a tumor that most probably originated from the structures of the thoracic wall. The transthoracic biopsy was inconclusive. The tumor was resected and the histopathological examination showed amyloid tumor of the thoracic wall with plasmacytic elements and lambda light chains deposits. A bone marrow aspiration was performed that found diffuse plasmacytic infiltrate of 20-60% and the serum proteins electrophoresis with immunofixation revealed elevated IgA and lambda light chains. The patient was diagnosed with IgA and lambda light chains multiple myeloma with consequent AL amyloidosis presenting as thoracic mass.

Focal nodular hyperplasia (FNH).

Focal nodular hyperplasia (FNH) is a benign tumour of the liver (hepatic tumour), which is the second most prevalent tumour of the liver (the first is hepatic hemangioma). It has a higher incidence in females, 20-40 years old, but also occurs in men and even in children. It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential. This tumour was once often resected because it was difficult to distinguish from hepatic adenoma, but with modem multiphase imaging it is now diagnosed strictly by imaging criteria, and not resected. We present the case of a 78 years old man who presented to emergency room (ER) with a history of dry cough, chest pain and mild dyspnea. Chest X-ray showed ascension of the right hemidiaphragm, and a homogeneous round opacity of 6/6.2 cm in the right cardiophrenic angle. The first suspicion was of pulmonary tumor, but the final diagnosis was FNH, confirmed by CT scan. We discuss the differential diagnosis and prognosis of this entity. The particularities of the case are the presentation with respiratory symptoms and pulmonary mass, and the age of the patient.

Lyme disease.

Lyme disease (Borreliosis), also called the "disease of 1000 faces", is produced by a bacterium called Borrelia burgdorferi, transmitted by the Ixodes tick. The clinical picture is non-specific and polymorph, with multisystemic involvement. Diagnosis is most often one of exclusion, and certain diagnosis is based on the presence of Borellia antibodies. The treatment is done differently depending on the stage of the disease and the severity of injuries, being used antibiotics like Doxycycline, Amoxicillin, Erythromycin or Penicillin. Under treatment the disease quickly heals without sequel, in the early stages, but advanced stages are usually resistant to treatment and chronic injuries can occur. Symptoms get worse without treatment and become chronic. We present the case of a woman of 66-year-old with a complex history of disease, which began one year prior to admission, through multiple and nonspecific symptoms; she presented herself in numerous medical services (gastroenterology, rheumatology--where an immunosuppressive treatment was initiated, hematology) without determining a final diagnosis. She was admitted in our service with altered general state and worsening symptoms, predominantly fever, muscle pain, joint pain, the patient being immobilized in bed. After multiple investigations and the problem of differential diagnosis with multiple pathologies, we finally established the diagnosis of Lyme disease. The peculiarities of the case are represented by the severity of the clinical manifestations and fulminant disease evolution under the unjustified administration of immunosuppressive treatment, and atypical joint involvement regarding localization and evolution that raised the issue of differential diagnosis with osteosarcoma or bone tuberculosis.

Psychometric evaluation of Romanian version of Job Content Questionnaire in physicians.

UNLABELLED: With the development of modern civilization and with continuous changing of job characteristics, occupational stress becomes increasingly important. Physicians are an exposed category and they are prone to develop stress-related disease and risk behaviors. METHODS: We conduct a study among 118 physicians. The Romanian version of Job Content Questionnaire was mailed to all the subjects. We investigate the main scales of JCQ: decision latitude (DL), psychological job demands (PJD) and social support (SoS), along with the prevalence of risk behaviors, depression and sleeping problems. RESULTS: The final response rate was 112 (94.9%). The differences between women and men are significant for psychological demands (36.55 versus 32.9, P < 0.01), decision latitude (73.83 versus 67.05) and skill discretion (36.47 versus 34.6). Age positively correlated with SD (r = 0.40), DA (r = 0.40) and PJD (r = 0.29) in women and negatively with CoS (r = -0.39) in men. PJD negatively correlated with SS (r = -0.5) and CoS (r = -0.28) in women and with CoS (r = -0.54) in men. Smoking (32% women and 56% men) and sedentary behavior (over 60% women and men) positively correlated with PJD and negatively with social support in both men and women. DISCUSSIONS: The issue of professional stress is very important in modern medicine. Age and gender can be determinants of job strain, but also of job characteristics. Many studies have shown positive relations between job strain, and some harmful habits such as tobacco smoking and sedentary lifestyle; we have to outline again the importance of organizational factors in managing both stress and satisfaction at workplace.