ABSTRACT
A 50-year-old woman was referred to our hospital for shoulder joint stiffness. She had a history of polyclonal hypergammaglobulinemia and an elevated C-reactive protein level. Her laboratory data revealed an elevated serum immunoglobulin G4 (IgG4) level, hypergammaglobulinemia, and rheumatoid factor positivity in the absence of anticyclic citrullinated peptide antibody. [18F]-Fluorodeoxyglucose positron emission tomography showed significant [18F]-fluorodeoxyglucose uptake in multiple lymph nodes (axillary, hilar, para-aortic, and inguinal). Biopsy of the inguinal lymph node showed expansion of the interfollicular areas by heavily infiltrating plasma cells, consistent with multicentric Castleman disease (MCD). Immunohistochemical analysis revealed a 37.3% IgG4-positive:IgG-positive plasma cell ratio, indicating overlapping IgG4-related disease. However, serological cytokine analysis revealed elevated levels of interleukin-6 (9.3 pg/ml) and vascular endothelial growth factor (VEGF) (1210 pg/ml), which are compatible with MCD. Corticosteroid treatment resolved the serological and imaging abnormalities. IgG4-related disease can mimic MCD, and it is crucial to distinguish between these two diseases. Serum interleukin-6 and VEGF levels may help to discriminate MCD from IgG4-related disease.
Subject(s)
Autoimmune Diseases/diagnosis , Castleman Disease/diagnosis , Hypergammaglobulinemia/diagnosis , Immunoglobulin G/blood , Autoimmune Diseases/blood , Autoimmune Diseases/diagnostic imaging , Autoimmune Diseases/pathology , Biopsy , C-Reactive Protein/metabolism , Castleman Disease/blood , Castleman Disease/diagnostic imaging , Castleman Disease/pathology , Diagnosis, Differential , Female , Fluorodeoxyglucose F18 , Glucocorticoids/therapeutic use , Humans , Hypergammaglobulinemia/blood , Hypergammaglobulinemia/diagnostic imaging , Hypergammaglobulinemia/pathology , Interleukin-6/blood , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Middle Aged , Plasma Cells/pathology , Positron-Emission TomographyABSTRACT
We previously started pharmacist blood pressure (BP) management programs using telemonitoring systems for monitoring side effects of antihypertensive drugs in a community pharmacy. The present case demonstrates that pharmacist BP management programs using telemonitoring systems are useful for monitoring side effects of antihypertensive drugs in a community pharmacy.
ABSTRACT
The electroreduction of alkylaryldichlorosilane carried out with Mg cathode and anode in a single compartment cell gave high molecular weight poly(alkylarylsilane) (M(n) = 5200-31000, M(w)/M(n) = 1.4-1.8) in 5-79% yield. The effects of electrode material, monomer concentration, amount of supplied electricity, and ultrasound were investigated. This electroreductive method was also successfully applied to the synthesis of polygermanes, silane-geramane copolymers, and also poly[p-(disilanylene)phenylenes].
