Pediatric case of the day. Ewing sarcoma of the rib with intraspinal extension

Nitric oxide (NO) synthase (NOS)-containing cerebrocortical neurons degenerate in patients with amyotrophic lateral sclerosis (ALS) and dementia, and in transgenic mice expressing a mutated superoxide dismutase gene (G93A) associated with familial ALS. The cerebral cortex of transgenic mice displayed decreased NOS activity (p<0.001) and cGMP levels (p<0.01), but no changes in NOS content indicating that less NO is produced. Therefore, NOSN degeneration is not caused by elevated NO.     

US case of the day. Diffuse large B-cell lymphoma (posttransplant lymphoproliferative disorder [PTLD])

OBJECTIVE: We describe two new CT findings of congestive heart failure (CHF): enlarged mediastinal lymph nodes and hazy heterogeneous mediastinal fat. MATERIALS AND METHODS: Forty-six patients were retrospectively identified who had major and minor clinical signs of congestive heart failure and had undergone chest CT during their symptomatic period. Two radiologists reviewed the CT studies and by consensus documented the presence or absence of imaging findings of CHF, including interstitial abnormalities, vascular redistribution, axial thickening, pleural effusions, cardiac enlargement, and mediastinal abnormalities. RESULTS: Smooth septal thickening, bilateral pleural effusions, vascular redistribution, and cardiac enlargement were the most common CT findings in patients with CHF. Enlarged mediastinal lymph nodes and hazy mediastinal fat were seen in 55% and 33% of cases, respectively. In a cohort of 17 patients with elevated pressures in the pulmonary capillary wedge documented within 24 hr of CT, CT scans revealed lymphadenopathy in 14 patients (82%) and inhomogeneous fat in 10 patients (59%). CONCLUSION: Enlarged mediastinal lymph nodes and hazy mediastinal fat occur in patients with CHF and are revealed by CT. Lymphadenopathy in patients with CHF does not necessarily indicate malignancy or an infectious process.     

HELLP syndrome on the 6th puerperal day. Presentation of case reports

We show by two case reports, that the HELLP-syndrome is the most severe form of pre-eclampsia and associated with a relative high maternal and perinatal mortality because of the sudden onset of the complications. In the first case report we describe the development of this syndrome after two eclamptical convulsions on the 6th day of puerperal period. A similar case has not been published yet in all literature. In the second report a mother died by rupture of the capsule of liver because of the HELLP-syndrome 72 hours after Section caesarea. We want to show, that caesarean section cannot avoid this complication. It is not in all cases the most advantageous procedure of delivery in patients with HELLP-syndrome.     

Unstable bladder and Sj?gren syndrome. Clinical case

PURPOSE: A 53-year-old female patient was treated with combined radiochemotherapy with 5-fluorouracil (5-FU) because of adenocarcinoma of the lung. She died after the 2nd day of the first course on fatal myocardial infarction. The histological evaluation of the heart revealed no severe chronic fibrosis. In our opinion the myocardial infarction was partly 5-fluorouracil-related in this case. PATIENTS AND METHODS: Published case reports on this theme were reviewed and discussed. RESULTS: The review of the literature showed a 5-FU associated cardiotoxicity in 98 cases. Most of the patients were without evidence of pre-existing myocardial disorders. The discussion about the reasons of the 5-FU-associated cardiotoxicity is still going on. Cardiotoxicity will rise up in 1.1% to 4.5% of the patients treated with 5-FU. Patients with a history of cardiac disease were at significantly increased risk for 5-FU-induced cardiotoxicity. CONCLUSION: In high-risk-patients 5-FU should not be given without electrocardiographic monitoring. The continuous infusion is better than a bolus treatment.