RESUMO
Angiotropic large B cell lymphoma (angiotropic LCL) or intravascular large cell lymphoma (IVLCL) was diagnosed by liver and bone marrow biopsies and immunohistochemical studies in a 52 year old Caucasian male. IVLCL is a very rare disease characterized by widespread intravascular proliferation of lymphoma cells. Although it most commonly affects the central nervous system or skin and occasionally bone marrow, angiotropic LCL may be present without evidence of localized disease, as seen initially in our patient. To date, only a few cases of intravascular malignant lymphomatosis associated with parathyroid hormone related protein (PTH-rP) induced humoral hypercalcemia have been published. Our extraordinary case was diagnosed mainly by liver biopsy. The neoplastic lymphoid cells stained diffusely and strongly positive with CD-20 (Pan B) and were negative for CD-3 (Pan T) immunostain. The most significant, initial clinical finding was severe, unexplained hypercalcemia (until 18.6 mg/dl). Plasma PTH-rP showed a ten-fold increase at 8 pmol/L (normal value less than 0.8 pmol/L). Very unusual cytogenic abnormalities were found. The patient received the massive third generation combination chemotherapy comprising of Methotrexate, Doxorubicine, Cyclophosphamide, Vincristine, Prednisone and Bleomycin and developed, complete although temporary, clinical, humoral and cytogenetic remission.
Assuntos
Hipercalcemia/diagnóstico , Linfoma de Células B/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Hormônio Paratireóideo/sangue , Proteínas/análise , Neoplasias Vasculares/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Hipercalcemia/complicações , Israel , Cariotipagem , Linfoma de Células B/complicações , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Proteína Relacionada ao Hormônio Paratireóideo , Neoplasias Vasculares/complicações , Neoplasias Vasculares/tratamento farmacológico , População BrancaRESUMO
We describe an elderly woman with a deep hyperphosphatemic hypocalcemic coma, hypernatremia, hypokalemia, metabolic acidosis, pancytopenia and respiratory and circulatory failure secondary to phosphate intoxication following the overdose administration of hypertonic sodium phosphate enema. The causes of increased colonic retention and absorption and decreased renal excretion are discussed. We recommend the use of the safer and less toxic cathartic medications or at least a very cautions use of such enemas in anyone with renal failure.
Assuntos
Coma/etiologia , Enema/efeitos adversos , Hipocalcemia/etiologia , Fosfatos/sangue , Fosfatos/intoxicação , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/terapia , Overdose de Drogas , Feminino , Humanos , Hipernatremia/etiologia , Soluções Hipertônicas/efeitos adversosRESUMO
We report a case of a 37-year-old symptomatic male with anterior myocardial ischemia. Coronary angiography demonstrated systolic obstruction of the midportion of the left anterior descending coronary artery due to myocardial bridging. The patient was treated with a supra-arterial myotomy. Two years postoperatively, the patient is without evidence of myocardial ischemia. Angiography, 2 years postoperatively, shows no evidence of systolic narrowing of the left anterior descending coronary artery.
