[Differential diagnostic problems in Lyme disease (Borrelia infection resulting in acute exogenous psychosis)]. / Differenciáldiagnosztikai problémák Lyme-kórban (Borrelia fertözés okozta akut exogen reakciós típusú psychosis).

Case of a 31 years old woman suffering from I and II type atrioventricular heart block, acute exogenic psychosis, intermittent type of fever and arthritis of right knee was described by the authors. The non typical clinical picture, the extremely elevated erythrocyte sedimentation rate and the exogenic type of psychosis caused differential diagnostic difficulties. Besides polysymptomatic autoimmune disorder, Lyme disease as emerged although there were no data of vector bite. In the consequence of steroid and combined antibiotic treatment the patient became immediately apyretic and the sedimentation rate returned to the normal limit. The psychotic symptoms have disappeared only two weeks following Ceftriaxon's and Doxycyclin's management. The high titer Borrelia seropositivity reserved to apply the diagnosis of Lyme disease.

[Polyglandular autoimmune syndrome type II]. / A II. típusú polyglandularis autoimmun syndroma.

The authors deal with the case of young woman in whom in a 4-year period step by step different endocrine disorders developed after a virus infection. Finally a severe immunthrombocytopenia evolved. On the basis of these the rare polyglandular autoimmune syndrome type II. was diagnosed. Substituent therapy and stoss therapy with steroid was performed, but because of the insufficient therapeutic effect and the strong thrombopenic bleeding Cyclosporin therapy was necessary. The effect of the later therapy caused total remission of the illness. At present the patient is under their control. The case could arose interest because of the rarity of the illness and the very good effect of Cyclosporin therapy.

Treatment of polyglandular autoimmune syndrome with cyclosporin-A.

The case history of a 30-year-old female patient is reported. Following an unknown viral infection that had occurred four years earlier, insulin-dependent diabetes mellitus vitiligo, Addison's disease, amenorrhoea, hyperthyreosis and, finally, severe pancytopenia with dominant thrombocytopenia developed. On the basis of clinical aspects and laboratory findings, an infrequent polyglandular autoimmune syndrome (type II) was verified. Substituent therapy and steroid stoss therapy also was introduced, without any sign of improvement. For the lack of therapeutic effect and owing to serious thrombocytopenic bleeding, treatment with Cyclosporin-A was indicated, which produced total remission of the illness. Nowadays the patient being on follow-up, has no sign of disease activity.

Data on the clinical aspects and therapy of primary gastrointestinal lymphomas.

Fifteen cases of primary gastrointestinal lymphoma diagnosed over 8 years are reviewed. In the period 1980 to 1982 there was a cumulative appearance of GI lymphomas, nine out of 15 cases were diagnosed in that period. According to its localization, lymphoma occurred in 12 cases in the stomach, and in 3 in the small intestines and the colon. One case of gastric lymphoma was Hodgkin type, the others were non-Hodgkin types. The clinical symptoms were not characteristic of lymphoma. The age of the patients was, on the average, ten years lower than the mean age of carcinoma patients. Preoperative diagnosis by gastric biopsy was successful in four cases. In patients with lymphoma of the colon not subjects to surgery, colonoscopy verified the origin of lymphoma. Exact clinical classification in the majority of cases was made intraoperatively. In the non-operated cases, sonography and lymphography were performed. In general, operation was attempted, but patients in stage II, in very poor condition, were possibly not operated. The possibility and indications of the "second look" operation are discussed. Histological typing was made according to the Kiel classification. In the literature, in the most controversial question of therapy, individual consideration of the cases is recommended. Based on our experience, in devising therapy or therapeutic strategy as well as concerning prognosis, the degree of malignancy according to histological type, clinical stage and anatomical localization seem to be the most decisive factors. In exceptionally malignant cases a protocol with doxorubicine + bleomycin + teniposide and prednisolone was applied.