Scintigraphic diagnosis of intrathoracic extramedullary hematopoiesis in alcohol-related macrocytosis.

We report the scintigraphic diagnosis of thoracic extramedullary hematopoiesis in a case of alcohol-related macrocytosis. A patient with liver cirrhosis and alcohol-related macrocytosis showed multiple rounded masses in the low thoracic paraspinal region on chest radiography and CT. Whole-body scintigraphy and SPECT imaging of the thorax, after nanocolloid administration, demonstrated expansion of the bone marrow in the humeri and femora and uptake of the tracer in the mediastinal masses, establishing the diagnosis of mediastinal extramedullary hematopoiesis. Thoracic extramedullary hematopoiesis may occur in conjunction with alcohol-related macrocytosis. Scintigraphy with 99mTc-nanocolloids is a suitable noninvasive method to establish the presence of extramedullary marrow.

Carbamazepine hypersensitivity syndrome: report of 4 cases and review of the literature.

We report 4 patients who developed a severe systemic hypersensitivity reaction when taking carbamazepine, To prove hypersensitivity to carbamazepine, we performed patch tests and in vitro lymphocyte transformation tests. Patch tests were uniformly and strongly positive in patients and negative in controls. Lymphocyte transformation tests were positive in 3 of 4 patients. We reviewed the literature on reports of carbamazepine-induced pseudolymphoma and other severe systemic hypersensitivity reactions. Considering the many common clinical, biochemical, and pathologic characteristics, we propose to group these reactions under the term "carbamazepine hypersensitivity syndrome." The syndrome is characterized by the development of fever, rash, and lymphadenopathy between 1 week and 3 months after the introduction of carbamazepine. A variety of other target organs may be involved, including the liver, kidneys, and lungs. The carbamazepine hypersensitivity syndrome is a clinical diagnosis. Patch tests and lymphocyte transformation tests are valuable tools to confirm the diagnosis, but are reliable only after all signs subside. Similar syndromes have been described with the other aromatic anticonvulsants (phenytoin, the other hydantoins, and phenobarbital), and there is evidence of a cross-reaction between carbamazepine and phenytoin. It is unknown whether the carbamazepine hypersensitivity syndrome should be considered a premalignant state, with an increased risk for the development of malignant lymphoma.

Behaviour of 12 trace elements in serum of uremic patients on hemodiafiltration.

The concentrations of the trace elements As, Au, Cd, Cs, Cu, Fe, Hg, Mo, Rb, Se and Zn were studied in the serum of 5 patients with end-stage renal failure who were undergoing treatment with hemodiafiltration. The concentrations of the following elements differ significantly from the reference values: As, Cd, Cu, Hg and Mo are higher, while Rb, Se, Zn and some of the Cs values are lower. The observed concentration deviations may be due to the uremic state and/or the dialysis process. To asses the contribution of the latter, the elements were determined in the substitution fluid and in the dialysate before and after blood contact and passage through the artificial kidney. Our findings suggest that the concentration abnormalities could be related to the substitution fluid for Cs, Rb, Se and Zn and to the dialysate for Mo and Rb.

The effect of adding Br or Zn supplements to the dialysate on the concentrations of Br and Zn in the blood of hemodialysed patients.

The effect of adding Br or Zn supplementation to the dialysate on the concentrations of Br and Zn in the blood of hemodialysed patients, is investigated. Patients with end-stage renal failure on hemodialysis show an abnormal trace element pattern. Our patients showed lowered serum Br and Zn concentrations. Four patients were subjected to dialysates with varying Br content. The impact on their serum and packed cells concentrations was evaluated. The supplementation resulted in an increase in the concentrations in serum and in packed cells. The Br concentration in serum and packed cells closely followed the dialysate content. In order to restore the Zn concentration to the normal level a ZnCl2 solution was added to the dialysate of 4 other patients. Zn accumulated in the patient as a consequence of its diffusion against the concentration gradient.

Interstitial pneumonitis and pulmonary vasculitis in a patient taking an L-tryptophan preparation.

A case is presented of interstitial pneumonitis and pulmonary vasculitis ascribed to the ingestion of an L-tryptophan preparation. An unintended rechallenge supported the causal relationship. There was neither myalgia nor peripheral eosinophilia. Bronchoalveolar lavage fluid contained 12% eosinophils but few were present in the surgical lung biopsy specimen. Lung infiltrates receded after withdrawal of the drug and treatment with steroids. Dyspnoea and pulmonary hypertension persisted. Cyclophosphamide had no effect. Sclerodermiform skin lesions appeared as a late sequel. Chromatographic analysis of the L-tryptophan revealed no suspect impurities.

Intravenous versus nebulized terbutaline in patients with acute severe asthma; a double-blind randomized study.

Twenty-three patients with acute severe asthma were treated in a randomized double-blind way by either intravenous terbutaline two times at an hour interval 6 micrograms/kg or inhaled terbutaline two times 0.1 mg/kg. Peak expiratory flow rate in percent of expected value rose from 89 L/min to 128 L/min (P less than .01) in the intravenous group and from 97 L/min to 122 L/min (P less than .02) in the inhalation group; this was comparable for both groups. PaO2 initially was 7.55 kPa in the intravenous group and rose by 1.4 after 60 minutes (P less than .02) and by 1.33 after 120 minutes (P less than .01). The mean PaO2 did not change in the inhalation group. The pulse rate and blood pressure did not vary significantly in either of the two groups. We conclude that both the intravenous and inhalational administration of terbutaline are effective in acute severe asthma, but that the intravenous route is possibly better for increasing PaO2.

Accuracy of biological trace-element determinations.

Mounting evidence suggests that the accuracy of much of the published information on trace-element concentrations in biological matrices leaves much to be desired. Potential sources of error are: (a) inadequate sample collection and preparation (sampling errors); and (b) inaccuracies at the moment of the measurement (measurement errors). Probably much of what has been maintained on trace elements in human health and disease in the past will have to be revised in the future.

The effect of theophylline and enprofylline on allergen-induced bronchoconstriction.

The effect on the allergen-induced immediate and late bronchoconstriction of theophylline and enprofylline (3-propylxanthine), a new xanthine derivative with negligible ability to antagonize adenosine, was studied in nine patients with asthma. The patients were challenged three times at weekly intervals with the same dose of allergen. FEV1 and SGaw were followed up to 6 hours after challenge. The drugs were administered intravenously. Placebo was always administered on the first occasion. Theophylline and enprofylline were administered on test days 2 and 3 with a double-blind, randomized crossover technique. One hour before the allergen challenge, a loading dose was administered during 60 minutes followed by a constant infusion during 6 hours. The loading infusion was 7.2 mg/kg of theophylline and 2.7 mg/kg of enprofylline. The maintenance dose was 74 mg/hr and 71 mg/hr, respectively. Both theophylline and enprofylline caused a minor initial bronchodilatation. Theophylline and enprofylline slightly but significantly attenuated the immediate bronchoconstricting reaction after allergen inhalation. Theophylline and enprofylline had a significant attenuating effect on the late bronchial reaction. The mean plasma level of theophylline was 0, 10.8, 10.5, and 10.5 mg/L at 0, 1, 4, and 7 hours after the start of the loading infusion, respectively. The corresponding mean plasma levels of enprofylline were 0, 2.6, 2.7, and 2.7 mg/L. Theophylline and enprofylline caused headache in one patient. Two patients developed nausea and vomiting during the enprofylline infusion. The present data suggest that adenosine receptor antagonism may not be the main mode of action of xanthines in inhibiting bronchoconstriction after single dose antigen challenge.

Chylothorax after mantle field irradiation for Hodgkin's disease.

6 years after mantle field irradiation for stage IA Hodgkin's disease, a patient presented with right-sided chylothorax. Even after thorough investigation no etiology for the chylothorax was found. It is suggested that chylothorax can be due to previous radiotherapy.

Desquamative interstitial pneumonia and scar cancer of the lung complicating generalised neurofibromatosis.

A 40-year-old male patient with known generalised neurofibromatosis presented with a radiological pattern of interstitial fibrosis and a coin lesion in the left lung. Closed lung biopsy revealed an adenosquamous carcinoma. The pulmonary complications of generalised neurofibromatosis and the possible pathogenesis of scar cancer in this condition are discussed.

Intrabronchial bleeding and life-threatening atelectasis in pulmonary embolism.

A patient with deep vein thrombosis and pulmonary embolism was admitted after profuse hemoptysis. On the third day of heparin treatment intrabronchial bleeding recurred, leading to life-threatening atelectasis of the left lung. The bleeding coincided with a hypertensive attack. Intrabronchial bleeding after pulmonary embolisation is a rare but potentially lethal complication.