1/5. Late blood pool images after Tc-99m tetrofosmin injection in a patient with monoclonal gammopathy of uncertain significance and immunologic disorders.The authors report a case of abnormal biodistribution of Tc-99m tetrofosmin in a patient with immunologic disorders who underwent rest-stress myocardial perfusion scintigraphy to assess the operative risk for surgery of possible relapse of adenocarcinoma of the left maxillary sinus. The patient had monoclonal gammopathy of uncertain significance with a serum electrophoretic pattern of both monoclonal immunoglobulin a and free kappa light chain components and a mild form of idiopathic immunohemolytic anemia. Two different images at rest after injection of Tc-99m tetrofosmin showed a typical blood-pool pattern with absence of detectable myocardial uptake. Other patients injected with the same batch of radiopharmaceutical showed myocardial uptake. A change of the molecular characteristics of tetrofosmin after the injection could not be a factor, because the values of the main chemical and physical parameters of the blood were in the normal range. Accordingly, the authors propose the hypothesis that the monoclonal immunoglobulin a or the free kappa light chains of this patient accidentally recognized one or more epitopes of the tetrofosmin molecule, binding it with high affinity and causing an abnormal biodistribution, characterized by late blood-pool imaging. No similar experiences have been described in the scientific literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Biclonal gammopathy in multiple myeloma: a case report.Monoclonal gammopathy is a group of B-cell disorders which result in the production of a specific and unique monoclonal immunoglobulin (M-component). Biclonal gammopathy is characterized by the simultaneous appearance of two different M-components. The incidence is about 1% of all monoclonal gammopathy. This paper reports on a 48-year-old male who had a chief complaint of back-pain beginning 7 months earlier. A physical examination was unremarkable, except for anemia and tenderness in the back. Hemoglobin was 5.4 g/dl, white blood cells 4.5 x 10(3)/microliter, platelets 157 x 10(3)/microliter, and reticulocytes 0.9%. serum iron was 79 mg/dl, and total iron-binding capacity was 210 mg/dl. A blood smear showed the formation of rouleaux, but no plasma cells were found. serum creatinine was 5.4 mg/dl, with a creatinine clearance of 18.1 ml/min. serum electrolytes were normal except for serum calcium which was 14.4 mg/dl. The urinalysis showed strongly positive proteinuria ( 2), with negative bence jones protein. serum protein electrophoresis showed an increase and a spike pattern of beta-2 globulin (2.8 g/dl) and alpha-2 globulin (1.5 g/dl), with normal gamma globulin. By nephelometry technique, serum IgG was normal (1388 mg/dl), IgA was high (900 mg/dl), and IgM was also high (517 mg/dl). Advanced and extensive osteolytic lesions were found in the clavicle, ribs, skull, humerus, femur, and columna vertebralis. plasma cells (myeloma cells) in bone marrow were 32%. The clinical diagnosis was multiple myeloma (biclonal gammopathy) stage IIIB (Durie and salmon staging system). Clinical response was good after two series of conventional chemotherapy, with normal serum electrophoresis, decreasing serum creatinine and serum calcium. Based on the above data, the diagnosis of multiple myeloma with biclonal gammopathy was confirmed. This is a rare case with a combination of IgA and IgM M-components.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Microvasculitic paraproteinaemic polyneuropathy and B-cell lymphoma.Microvasculitis may play a greater part in the pathogenesis of paraproteinaemic neuropathies than is generally recognised, producing tissue destruction by convergent immune and physical mechanisms. We present a patient with a clinical syndrome of mononeuritis multiplex and a circulating IgM lambda paraprotein, in whom bone marrow aspiration revealed a lymphoplasmacytoid lymphoma. Microvasculitic changes were present in the first nerve biopsy, and the second showed extensive destruction of neural architecture and deposition of IgM-related material. A 2-stage pathogenic cascade is postulated and explored with a review of the relevant literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Itch: a symptom of occult disease.BACKGROUND: pruritus, (the Latin word for itch), is defined as the 'desire to scratch'. It is a distressing, subjective symptom that may interfere significantly with the quality of a patient's life. OBJECTIVE: This article summarises the systemic causes of pruritus, describes the assessment of a patient presenting with itch without dermatological cause, and discusses the management of itch in patients with cancer. DISCUSSION: patients with pruritus that does not respond to conservative therapy should be evaluated for underlying systemic disease. Causes of systemic pruritus include cholestasis, thyroid disease, polycythaemia rubra vera, uraemia, hodgkin disease, and hiv. A thorough history and a complete physical examination are central to the evaluation of pruritus. In the absence of skin lesions, diagnostic testing is directed by the clinical evaluation and may include a complete blood count, liver function tests, serum creatinine, blood urea nitrogen levels, measurement of thyroid stimulating hormone, and chest X-ray. Removal of the causative agent and appropriate investigation and treatment of the underlying disease are essential first line measures in the treatment of pruritus.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Neuropathy in IgM lambda paraproteinemia. Immunoreactivity to neural proteins and chondroitin sulfate.In axonal neuropathies associated with IgM paraproteinemia, reports of antigen specificity of the M-protein are few. A patient with IgM paraproteinemia presented with progressive mononeuritis multiplex. IgM was found deposited in striking amounts in endoneurium and shown to bind specifically to neural proteins and chondroitin sulfates. Direct immune mechanisms, as well as the physical effects of IgM deposition, likely contributed to the development of the neuropathy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |