1/28. coccidioidomycosis in compromised hosts. Experience at Stanford University Hospital.To determine the frequency and clinical characteristics of infection with coccidioides immitis in immunosuppressed patients at Stanford University Hospital, clinical records of 14 years were examined. Thirteen cases met the diagnostic criteria. Half had Hodgkin's disease. In six the infection was disseminated; five of the six died early in the course of their infectious illness, frequently without diagnosis. Conclusions include: 1. The occurrence of coccidioidomycosis in immunosuppressed patients seen at institutions in or adjacent to the endemic area is not as rare as the literature suggests. 2. Dissemination is frequently explosive and the radiographic appearance of pulmonary involvement may appear late. Widespread pulmonary dissemination may occur within 24 hours after a negative x-ray. 3. Although the skin test loses its diagnostic value, the serology remains valid. Thus immunosuppressed patients with febrile illnesses (with or without radiographically evident pulmonary involvement) who have a history of travel to an endemic area should have serological examinations. 4. Lymphocytopenia correlates with risk of dissemination of coccidioidomycosis. 5. The administration of immunsuppressive chemotherapy correlates with such risk while radiotherapy and the malignant or non-malignant nature of the disease do not.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/28. Bullous amyloidosis: the mechanism of blister formation revealed by electron microscopy.BACKGROUND: Few electron microscopic studies of blister lesions in bullous amyloidosis have been reported, and the mechanism of blister formation remains to be elucidated. This study was designed to examine the nature of bullous amyloidosis ultrastructurally, and clarify the pathogenesis of blister formation. methods: We examined a 47-year-old woman with IgD-lambda type myeloma, suffering from bullous lesions on her hands and feet caused by trauma or rubbing. light and electron microscopic studies were performed. RESULT: Ultrastructurally, amyloid deposits aggregated under the lamina densa. Keratinocyte protrusions penetrated the dermis through the gap in the lamina densa and enfolded amyloid deposits. Amyloid globules were found in enlarged intercellular spaces of keratinocytes. desmosomes were sparsely distributed in some areas of the epidermis. CONCLUSION: These results indicate that keratinocytes enfold the amyloid globules and take them in the intercellular space of epidermis, and that the breakdown of the lamina densa and widening of the intercellular space between keratinocytes induce skin fragility. Trauma or rubbing of her hands and feet appears to act as the localized precipitating factor of blister formation in bullous amyloidosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/28. multiple myeloma as the first manifestation of acquired immunodeficiency syndrome: a case report and review of the literature.Various hematologic malignancies and solid tumors are increasingly diagnosed in patients with human immunodeficiency virus (hiv) infection and may be the presenting manifestation of acquired immunodeficiency syndrome (AIDS). multiple myeloma, however, has never been reported as the presenting manifestation of AIDS. We report on a 34-year-old man who presented with back pain, paresthesias, paraparesis, vertebral bony disease, and an associated soft tissue mass. biopsy of the mass revealed immature plasmacytes with very faint cytoplasmic expression of kappa light chains. bone marrow biopsy revealed 25% infiltration with poorly characterized malignant cells and 15% polyclonal plasma cells. Immunofixation of serum and urine was positive for IgG kappa and kappa light chains, respectively. A bone survey revealed lesions in the skull, left femur bone, and the pelvis. The diagnosis of an anaplastic myeloma was made. Because of the poorly characterized nature of the malignant cells and the difficulties in immunophenotyping, serologic evaluation for hiv was undertaken and was positive. The concept of myeloma as an opportunistic neoplasm defining AIDS was considered. We discuss this view and recommend that patients with multiple myeloma with poorly characterized myeloma cells as well as difficulties in immunophenotyping should undergo testing for hiv infection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/28. Multiple nodular pulmonary amyloidosis. A case report and comparison with diffuse alveolar-septal pulmonary amyloidosis.A case of multiple nodular pulmonary amyloidosis in a 54-year-old Caucasian man is presented. Discrete symptomless radiodensities had developed in this patient's lungs within a period of three years, leading to a suspicion of a neoplastic process. The amyloid nature of these nodules was demonstrated by biopsy. In this case, as in others previously reported, there was no evidence of systemic disease, and immunoglobulins were normal. Local factors probably play an important part in the pathogenesis of this disease. This entity is to be distinguished from the diffuse type of pulmonary amyloidosis, which has a far graver prognosis. Diffuse alveolar septal amyloidosis is usually associated with primary systemic amyloidosis or multiple myeloma and leads rapidly to respiratory distress.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/28. Case of multiple myeloma mimicking an infectious disease with fever, intrahepatic cholestasis, renal failure, and pulmonary insufficiency.We describe a case of multiple myeloma (MM) presenting with high fever, inflammatory chemistry abnormalities, simultaneous acute renal failure, cholestatic hepatitis, and acute lung failure. The extremely aggressive course and pulmonary involvement in the form of pulmonary alveolar proteinosis (PAP) are discussed, stressing the unusual nature of the findings and the variable picture of MM.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/28. Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI.The distinction between malignant and benign compression fractures is a common problem in clinical practice. Various imaging techniques (plain radiography, computed tomography, bone scintigraphy) have been used to differentiate these conditions but they are often inadequate in distinguishing the nature of compression fracture. This review illustrates the magnetic resonance imaging (MRI) features of malignant and benign compression fractures with emphasis on the usefulness, limitations and pitfalls of MRI.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/28. cytodiagnosis of extrapleural tumors in multiple myeloma by fine needle aspiration. A report of three cases.Cytologic and immunocytochemical studies were done on fine needle aspirates of extrapleural tumors from three patients with multiple myeloma. In the first case the cytologic findings were consistent with myeloma, but the immunochemical studies were done improperly and were not interpretable. In the second case the cytologic findings were those of acute inflammation despite the strong clinical suspicion of the thoracic lesion's malignancy. In the third case both the cytologic and immunocytochemical findings were diagnostic of plasmacytoma. Our experience with these cases suggests that an assessment of the nature of the extrapleural tumor is indicated even in patients with known myeloma, that fine needle aspiration (FNA) is the diagnostic procedure of choice under the circumstances and that immunocytochemical studies can enhance the diagnostic accuracy of FNA for plasmacytoma. The best results for assessment of the cytologic FNA findings in extrapleural tumor in myeloma can be achieved by proper execution of both the FNA procedure and immunochemical studies and by interpretation of the cytologic findings within the context of the clinical findings.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/28. multiple myeloma of the thoracic spine developed at the previous trauma site: case report.The precise nature of the underlying plasma cell dyscrasias is not well understood. Even today, no causative factor has been found for this disease. It has been suggested that, several factors may act together in the development of this disease. This is a report of a 62-year-old man who initially had a T7 compression fracture and developed a multiple myeloma two years later at that site and at the adjacent vertebral level (T7-T8), respectively. Although the notion that trauma would initiate such a malignancy is speculative, the preceding trauma may be a causative factor in plasma cell dyscrasias.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/28. The tumor-forming type of multiple myeloma. I. Biological behavior.A total of 45 cases of multiple myeloma has been followed up clinically during the period from 7 to 80 months. Out of these, six patients (13.3%) were diagnosed to be the tumor-forming type; they developed discrete tumor formation at the disease onset or during clinical observation. Biological behavior of these cases is briefly outlined. Histologically, five cases presented with well or moderately well differentiated plasma cells according to the grading made by Pasmantier and Azar. The remaining one case was poorly differentiated in cell maturity, and with electron and immunofluorescence microscopies, proved to be of plasmacytic nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/28. association of osteonecrosis of the jaws and bisphosphonate pharmacotherapy: dental implications.Bisphosphonates are drugs of choice in the management of a variety of bone disorders including osteoporosis, Paget's disease and bone cancer. Recently there have been increasing reports of a possible relationship between bisphosphonate therapy and osteonecrosis of the jaws. osteonecrosis may occur following extractions or dental surgery and, in some cases, may appear spontaneously. Because of the potentially serious nature of these complications and the failure of exposed bone to heal, dentists must be aware of recommended precautions for the management of patients taking bisphosphonate medication.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
| | Next -> |