1/5. Autoimmune disorders complicating adolescent Hodgkin's disease.Four adolescents with Hodgkin's disease also developed autoimmune diseases. There were two idiopathic thrombocytopenic purpura (ITP), one polymyositis, and one scleroderma. The first two patients developed ITP in the absence of a spleen, and with their Hodgkin's disease in remission. The first patient with Hodgkin's disease has been continuously free of cancer for over five years. The second patient was a 17-year-old male whoe Hodgkin's disease recurred, but whose disease was in remission at the time the ITP occurred. The polymyositis occurred in an 18-year-old youth when he was in his initial remission for his Hodgkin's disease, but his disease subsequently recurred two years later. This youth presented with Coombs positive autoimmune hemolytic anemia. The polymyositis did not respond to therapy, and he is left with severe muscle wasting and weakness; however, the polymyositis is now quiescent. The scleroderma occurred in an 18-year-old female who had been continuously free of Hodgkin's disease for eight years. The scleroderma did not respond to drug therapy and she now has moderate skin changes, but remains in continuous remission of her Hodgkin's disease. Although there are a few reports of Hodgkin's disease and concurrent autoimmune disorders, physicians dealing with cancer in adolescents should be aware of this association.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Musculoskeletal syndromes associated with malignancy.Evidence has been presented supporting a causal relationship between malignancies and musculoskeletal syndromes. This discussion has dealt primarily with lesser known relationships, more common associations such as hypertrophic osteoarthropathy and dermatomyositis being reviewed elsewhere. The ones discussed herein closely mimic primary connective tissue diseases and offer an insight into the study of the pathogenesis of these primary diseases. In view of the natural history of malignant disease, the hope for such patients arises from the physicians early diagnosis and treatment of the underlying malignancy. early diagnosis and treatment may in turn be entirely dependent on the physician's awareness of a musculoskeletal syndrome being the presenting feature of an otherwise occult neoplasm. Several connective tissue syndromes appear to predispose to the development of malignancy, and increasing evidence suggests that this development of malignancy may be further enhanced by immunosuppressive therapy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/5. stroke and gangrene: complications of therapeutic plasma exchange therapy.Two patients underwent therapeutic plasma exchange therapy. One patient with advanced rheumatoid arthritis developed a stroke after his fifth exchange. The other patient, with progressive systemic sclerosis, required a below the knee amputation secondary to shunt problems. These cases are presented to caution physicians in selecting patients for pheresis procedures and suggest that major complications can occur with this technique.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Scleroderma after silicone augmentation mammoplasty: report of a case.The development of connective tissue diseases in patients who have had silicone gel breast implants has not been previously described in taiwan. Herein, we report a 44-year-old female patient who underwent a silicone gel breast implant approximately 10 years prior to the onset of scleroderma. She developed generalized sclerosis, severe defective esophageal clearance, and severe reduction of gas exchange with DLco 37% of predicted value. immunologic tests revealed that the antinuclear antibody titer was 1:2,560 with speckled pattern and positive anti-Scl-70 antibody. In spite of prednisolone and D-penicillamine treatment, her condition deteriorated. However, following the removal of the prosthesis, short-term subjective and objective improvements in both skin lesions and pulmonary function were noted. It is important that plastic surgeons, rheumatologists, and dermatologists, as well as primary care physicians, be aware of the possible association of sclerosis with silicone gel breast implants.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Acute renal failure occurring in scleroderma treated with cyclosporin A: a report of three cases.Cyclosporin A, which is a nephrotoxic agent, has been a mainstay antirejection drug in heart, kidney and lung transplant programmes for about 10 yr. Renal transplant physicians have become adept in balancing its powerful immunosuppressive effects with its undoubted potential nephrotoxicity. Here we report three of eight systemic sclerosis (SSc) patients treated with cyclosporin A who developed acute renal failure. Consideration is given to the evidence of benefit from this agent in SSc and to the management of acute hypertensive renal failure in this disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |