Chronic thrombotic thrombocytopenic purpura masquerading as other disease entities.

A 37-year-old woman with a chief complaint of nausea, headache and, prolonged menses was diagnosed with thrombotic thrombocytopenic purpura based on a peripheral smear with active microangiopathic hemolytic anemia and a platelet count of 4,000/mm3. Her past medical history was significant for several conditions including multiple sclerosis, Bell's palsy, Raynaud's syndrome and HELLP syndrome. In retrospect, it appears that this patient's clinical history was most consistent with one unifying diagnosis, chronic thrombotic thrombocytopenic purpura. Physicians should search for the elusive clinical and laboratory clues for chronic thrombotic thrombocytopenic purpura that can masquerade as other disease entities.

Survival of patients with metastases from uveal melanoma.

The authors evaluated a series of 145 consecutive patients with metastases from uveal melanoma, after proton beam irradiation, to assess the effect of early diagnosis and treatment for metastases on survival. Metastases were diagnosed between 7 weeks and 8.3 years (median, 2.4 years) after proton beam irradiation. Most patients (n = 94) were symptomatic before diagnosis; the remainder were first detected during screening examination. Liver involvement was documented in nearly all patients (n = 136). The majority of patients had died from metastases by the close of the study (n = 137). Significantly longer survival occurred among patients diagnosed during screening examination (P = 0.004) and among young patients (P = 0.03). The majority of patients received some form of treatment for metastases (69%). Median survival was 2.0 months for patients receiving no treatment compared with 5.2 months for those receiving treatment for metastases (P = .0001). However, the overall 1-year survival rate was poor (13%). Prophylactic adjuvant therapy could be explored as a means to increase disease-free survival in patients with uveal melanoma.