Schwannoma of the breast: an unexpected diagnosis by magnetic resonance. / Schwannoma mamario: un diagnóstico inesperado por resonancia magnética.

Schwannomas consist of benign tumors that arise from the nerves, however, they are not frequent in the breast. Our search criteria only found 28 cases described in Literature. We show the case about a 63 years old woman who underwent a breast magnetic resonance (MR) because of high risk for breast cancer, in which a lession on her left breast was found. Not only MR features seemed to be benign, but ultrasound and mamography features, too. The diagnosis of schwannoma was confirmed by ultrasound-guided biopsy. Findings in conventional radiology were correlated with those described in the reviewed literature. In our opinion, this case results valuable due to the inicial diagnosis by MR, which is not an imaging proof for bening tumors, innitially. According to the revised bibliography these features are pretty funny, as mamography and ultrasound, with histological findings, are the clues for the usual diagnosis.

Total IgG and IgG subclass specific antibody responses to insulin in diabetic patients.

Abnormal antibody responses to insulin in diabetic patients have been associated with syndromes of insulin hypersensitivity and abnormal insulin pharmacokinetics. In this study, we evaluated total and IgG subclass antibody responses to insulin in 70 diabetic subjects on insulin distributed into five clinical groups, and in two control groups using ELISAs with CDC/WHO recommended monoclonal antibodies. As expected, levels of total IgG insulin antibody were greater in diabetic patients treated with insulin than in the control group of diabetic patients on oral agents or nondiabetic controls. Insulin antibody responses of the IgG2 subclass were negligible to absent in all groups. Adult diabetic patients on insulin without complications and those with insulin associated anaphylaxis had mean values of IgG1, IgG3, and IgG4 insulin antibodies no different from those of controls. Patients with local hypersensitivity had elevated IgG1 responses. Type I diabetic patients had elevated IgG3 responses. A group of Type II diabetic patients selected for high levels of total IgG insulin antibodies had elevated levels of IgG1, IgG3, and IgG4 antibody responses. Thus, the IgG subclass response to insulin primarily involves IgG subclasses 1, 3, and 4 and varies with the type of diabetes and complications of insulin therapy.

Sarcoidosis presenting as antinuclear antibody positive glomerulonephritis.

A 43 year old woman who initially presented with the nephrotic syndrome, glomerulonephritis, and antinuclear antibodies (ANAs) was given the diagnosis of systemic lupus erythematosus (SLE). One year later the patient developed progressive subcutaneous nodules on her forearms, with histopathology of non-caseating granulomas. Further evaluation of the patient showed mediastinal lymphadenopathy and interstitial lung disease with numerous granulomas, establishing the diagnosis of sarcoidosis. The presence of autoimmune antibodies and glomerulonephritis has been reported in sarcoidosis, but this case is believed to be the first in which both glomerulonephritis and ANAs are present in a sarcoid patient.

Anaphylaxis. Why it happens and what to do about it.

Anaphylaxis is an often severe, potentially life-threatening symptom complex. Urticaria, airway edema, vascular collapse, asthma, abdominal pain, and diarrhea are common clinical signs. Recently recognized syndromes of anaphylaxis include reactions due to exercise, food preservatives, aspirin, steroids, dialysis, various serums, and human seminal fluid. Initial therapy is directed at maintaining an effective airway and circulatory system. Administration of aqueous epinephrine is always indicated. Other measures may include oxygen delivery by controlled flow, administration of an aerosolized beta agonist, slow infusion of aminophylline, and rapid infusion of intravenous fluid. Patients with severe acute reactions should be monitored in-hospital.