Meningoradiculitis in systemic lupus: role of antiphospholipid antibodies?

A 69-year-old woman underwent the right upper lobectomy, a partial resection of right segment 6 (rt S6) and removal of mediastinal lymph nodes (LN) for adenocarcinoma of the lung (rt S2), stage IIIA (T2N2M0). A chest computerized tomography (CT) taken one month after the operation revealed a pericardial effusion which was milky in color, and contained high levels of triglycerides (TG) of 615 mg/dl (serum, 217 mg/dl). Cytology of effusion for malignant cells was negative. The pericardial effusion gradually decreased in one month by restriction of her fat intake. Chylopericardium following right thoracotomy for lung cancer is extremely rare.     

Scurvy in an adult

The case is reported of a 29-year-old previously healthy female patient who developed the typical clinical picture of scurvy eight months after changing to a diet exclusively containing cooked cereals. Serum levels of B12, folic acid, and calcium were lowered and the alkaline phosphatase was slightly raised due to the dietary lack of vitamins A, D, B12 and folic acid. No clinical signs of these deficiencies could be observed. Addition of vitamin C to this diet resulted in complete cure in a matter of days. Signs and symptoms of scurvy are discussed in the light of the recent literature. This rare disease is particularly worth considering if one of the following situations is encountered: hemorrhages in the skin, muscles, joints or mucous membranes without apparent cause; therapy-resistant ulcers of mucous membranes in elderly patients; Sicca syndrome and/or wounds exhibiting poor healing.     

Cheilo-candidosis in an adult

A rare case of candidal infection of the lips is presented. Predisposing factors appeared to be intra-oral candidal carriage, actinic lip damage and Sj?gren's syndrome. Systemic antifungal therapy with fluconazole resolved the initial infection and a subsequent recurrence.     

Annular pancreas in an adult

Annular pancreas is a rare congenital anomaly which can remain symptom free for a long time and be manifested mainly in adults. 1130 endoscopic retrograde pancreatographies were performed in the author's laboratory during 3.5 years, and annular pancreas was seen in 2 cases. Duodenal obstruction with consecutive ulcers was the clinical manifestation in a young woman requiring duodeno-jejunostomy. Annular pancreas was an accidental finding in an other old woman presenting obstructive jaundice caused by several big stones in the main bile duct. A short review of the literature is given concerning the diagnostic possibilities, eventual complications and treatment modalities of this rare anomaly. It is emphasised that the diagnosis became possible due to the modern radiologic and endoscopic methods.     

Enterovirus meningitis in an adult

Claudication distance and maximum walking distance are both measures of disability. Estimates of the distances which a patient with intermittent claudication can walk are commonly used by vascular surgeons as surrogate measures of handicap. We studied how accurately distance was estimated by 70 patients with intermittent claudication, and by 100 British vascular surgeons. Patients and vascular surgeons estimated actual distances of 30 m and 34 m, respectively. Estimates were 46 m median (range 2.7-402 m) for claudicants, and 46 m median (range 15.2-186 m) for vascular surgeons, median over estimates of 52% and 34% respectively. Claudicants' errors can easily be eliminated by accurate and appropriate measurement of claudication and maximum walking distances but interpretation of the data by surgeons is dependent on their own ability to estimate distance. Flawed perceptions by patients and their surgeons of the disability of reduced walking distance illustrates the need for reliable measures of handicap on which to base therapeutic decisions in patients with intermittent claudication.     

Reliability of revealing deformation bands in an A5456 alloy by acoustic emission

The dynamics of the first deformation bands in an aluminum-magnesium A5456 alloy deformed at a constant rate of increase of stresses $\left( {\dot \sigma _0 = const} \right)$ is studied by acoustic emission and simultaneous high-speed video filming. A linear relation is found between an acoustic signal and the area of the first band during the first 20 ms of its development. Acoustic precursors are shown to be used to trigger devices with a positive or negative feedback to amplify or suppress deformation jumps, respectively.     

Recurrent painful hand crisis in a four-year-old girl, revealing an erythropoietic protoporphyria

We report the case of a 4-year-old girl, who had been suffering for 2 years from a recurrent, painful crisis affecting both hands, following sun exposure. There were no obvious cutaneous lesions, which initially caused us to consider a diagnosis of a psychiatric disorder. However, the diagnosis of erythropoietic protoporphyria was then established by the demonstration of elevated levels of free protoporphyrin in erythrocytes. The present case illustrates the effectiveness of beta-carotene associated with canthaxanthin in erythropoietic protoporphyria.     

Idiopathic pulmonary haemosiderosis in an adult

We report a very, rare case of idiopathic pulmonary haemosiderosis (IPH) occurring in a 68 yr old patient. Following alveolar haemorrhage onset, the diagnosis was obtained by a process of elimination, after clinical, endoscopic, cytohistological and laboratory investigations. The immunoglobulin G directed against myeloperoxidase antigen (C-ANCA), which was detected, can be regarded as indicative of an occult vasculitis to be followed up. Current therapy and perspectives for idiopathic pulmonary haemosiderosis patients are discussed herein.     

Erythematous papules in an adult woman

To assess the relation between immunological disorders and recurrent abortion, 15 pregnant women with previous unexplained recurrent abortivity were submitted to serum screening for antiphospholyeid antibodies syndrome (APA) syndrome. The screening included specific tests for autoimmune diseases (ANA, specific organ antibodies, immune complexes research, etc.), the immunoenzymatic assay (ELISA) for the research of anticardiolipin antibodies (ACA) and the determination of the kaolin coagulation time (KCT) through Exener method for lupus anticoagulant (LAC). Nine gravids out of 15 were positive both to LAC and ACA antibodies, two gravids were positive to only ACA antibodies, while four had no antibody reaction. Therefore, whatever the effective mechanism is, it seems ascertained that several cases of unexplained recurrent abortion are related to APA syndrome. Nowadays the above-mentioned syndrome is successfully treated using corticosteroid immunosuppressors and platelet antiaggregators which reduce autoimmune reaction and thrombotic episodes.     

Cytomegalovirus encephalitis in an immunocompetent adult

Cytomegalovirus encephalitis in immunologically normal patients is rarely reported in the literature. Only seven cases have been previously reported. CMV infection was diagnosed in a 24-year-old, immunologically normal female presenting a severe clinical picture due to encephalitis. Diagnosis was based on detection of CMV DNA in the CSF with the polymerase chain reaction. Administration of ganciclovir was followed by an immediate improvement.     

Congenital bronchoesophageal fistula in an adult

The seroprevalence of human herpesvirus 8 (HHV-8) in the Swiss population was investigated. By enzyme-linked immunosorbent assay, sera reactive to the recombinant HHV-8 antigen orf 65.2 were found in 24% of human immunodeficiency virus (HIV)-positive patients without and in 92% of HIV-positive patients with Kaposi's sarcoma. Surprisingly, 20% of homosexual HIV-negative men, versus only 7% of heterosexual HIV-negative individuals and 5% of blood donors, had antibodies to HHV-8.     

Gastric duplication cyst in an adult

Gastric duplication cysts are rare in adults and usually asymptomatic. In most cases they are discovered incidentally by abdominal ultrasound, CT, or upper gastrointestinal x-rays. Most of the duplications (82%) are cystic and do not communicate with the stomach. Approximately half of the cases are associated with other congenital anomalies. We report a 59-year-old woman operated on for a pancreatic mass that proved to be a gastric duplication cyst. The cyst was resected and the postoperative course was uneventful.     

Spontaneous thymic hemorrhage in an adult

Acute hemorrhage in a normal thymus in neonates and infants has been reported in the literature. These patients were known to have an antecedent cause or defects in coagulation. The case of an adult who developed acute hemorrhage in a normal thymus and who was known not to have any defects in coagulation, hypertension, or other underlying cause is reported.     

Prostatic localization revealing an acute myeloid leukemia. Apropos of a case

Clinical, electrophysiological, and molecular genetic features were investigated in two patients from a family a with dominantly inherited myotonic disease, characterised by painful cramps, stiffness without weakness, fluctuation of symptoms, and cold sensitivity. A reduction in amplitude of the compound muscle action potential was demonstrated on cooling and administration of potassium, although no clinical exacerbation was seen. A heterozygote mutation Val1589Met was identified in the alpha-subunit of the skeletal muscle sodium channel gene in both patients, consistent with the diagnosis of potassium-aggravated myotonia. The phenotype in this family is much milder than that previously described in another family with a mutation at this site.