RESUMO
We report a case of portal hypertension and neutrocytic ascites in a 52 year old man with POEMS syndrome. POEMS syndrome is an association of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammapathy and skin changes. Portal hypertension is rare in POEMS syndrome and this is the first time that culture negative neutrocytic ascites has been described with this syndrome.
Assuntos
Ascite/etiologia , Hipertensão Portal/etiologia , Cirrose Hepática/etiologia , Síndrome POEMS/complicações , Biópsia por Agulha , Evolução Fatal , Humanos , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
Between January 1985 and July 1989 we diagnosed asymptomatic stage I multiple myeloma according to Durie and Salmon [Durie and Salmon: Cancer 36:842, 1975] in 91 patients. All patients were followed without chemotherapy. Disease progression occurred in 41 patients and the median time to progression for all patients was 48 months. In the Cox multivariate regression analysis, hemoglobin levels < 12 g/dl (P < .01), bone marrow plasmacytosis > 25% (P < .01), and M-component size > or = 30 g/l for Ig G or > or = 25 g/l for Ig A (P < .01) were the only significant prognostic factors for progression. The 38 patients without any harmful factor remained free of progression for a median of more than 50 months. The 18 patients with two or three of these characteristics (high-risk group) had the shortest median time to progression of 6 months. Despite different times to progression, the response rate and survival after chemotherapy were similar for all groups of patients. Patients in the high-risk group for progression have to be frequently monitored for disease progression and might benefit from early treatment.
Assuntos
Mieloma Múltiplo/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ciclofosfamida/uso terapêutico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Prednisona/uso terapêutico , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Microglobulina beta-2/metabolismoRESUMO
We report two cases of retroperitoneal desmoid tumours in patients with Gardner's syndrome. These tumours are rare and of poor prognosis. In our two cases, the predominant clinical manifestations were caused by compression of the ureters, bladder and nerve roots. In the first patient, the tumours developed after colectomy, while in the second patient the discovery of the desmoid tumour preceded that of a cancer of the colon. Finally, in the first patient, an attempted treatment with a non-steroidal anti-inflammatory agent (sulindac) had to be discontinued after 4 months on account of side-effects.
Assuntos
Fibroma/etiologia , Síndrome de Gardner/complicações , Neoplasias Peritoneais/etiologia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antagonistas de Estrogênios/uso terapêutico , Feminino , Fibroma/diagnóstico , Fibroma/radioterapia , Fibroma/terapia , Humanos , Masculino , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/radioterapia , Neoplasias Peritoneais/terapia , PrognósticoAssuntos
Hemocromatose/etiologia , Yersiniose/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Central nervous system (CNS) involvement is a rare complication of chronic lymphoid leukaemia (CLL). The occurrence of lymphocytic meningitis in the course of CLL suggests either CNS involvement by the leukaemic process or infection (especially tuberculosis) related to continuous immunodepression. We report a case of CLL in which leukaemic cells had surface IgM and produced IgM kappa without significant depression of other immunoglobulins. When the patient developed meningitis, measurement of serum and CSF albumin IgG and IgM levels showed that 88% of CSF IgM resulted from local synthesis, while 70% of CSF IgG resulted from serum transsudation. These results suggest that a large number of neuromeningeal lymphoid cells produce the same class of IgM as leukaemic cells and therefore constitute a localization of the disease. Complete remission of the meningitis by intrathecal anti-leukaemic chemotherapy confirmed this hypothesis.
Assuntos
Leucemia Linfoide/complicações , Neoplasias do Sistema Nervoso/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Líquido Cefalorraquidiano/imunologia , Ciclofosfamida/administração & dosagem , Humanos , Imunoquímica , Imunoglobulinas/análise , Injeções Espinhais , Leucemia Linfoide/diagnóstico , Leucemia Linfoide/tratamento farmacológico , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso/diagnóstico , Neoplasias do Sistema Nervoso/tratamento farmacológico , Fatores de Tempo , Vincristina/administração & dosagemRESUMO
Two cases of staphylococcal spondylodiscitis after insertion of a Mobin-Uddin caval "umbrella" filter are reported. This complication, not previously described, occurred as result of staphylococcal septicaemia with secondary inoculation of the intervertebral disc. The patients were cured after the umbrella filters were removed.