[The role of holotranscobalamin in examination of vitamin B12 status].

INTRODUCTION: Holotranscobalamin contains biologically available cobalamin because only holotranscobalamin promotes the uptake of the cobalamin therein by all cells, via specific receptors. Therefore holotranscobalamin has been proposed as a potentially useful alternative indicator of vitamin B12 status. The aim of the present study was to assess usefulness of holotranscobalamin in the evaluation of vitamin B12 status. MATERIAL AND METHODS: We examined serum level of holotranscobalamin in 135 subjects divided in four groups according to the serum concentration of vitamin B12: 30 subjects with vitamin B12 <154 pmol/l, 50 subjects with vitamin B12 154-250, 30 subjects with vitamin B12 2251-350 pmol/l, 25 subjects with vitamin B12 >350 pmol/l. RESULTS: The results show that in subjects with low vitamin B12 serum level there are those with normal holotranscobalamin concentration (60%) and that in subjects with normal vitamin B12 there are those with low holotranscobalamin concentration (22%). The obtained results also show positive significant correlation between levels of holotranscobalamin and vitamin B12 (r = 0.62, p < -0.001). CONCLUSION: We can conclude that biologically active cobalamin, holotranscobalamin, is a useful tool when examining vitamin B12 status especially in subjects with borderline and low vitamin B12 concentrations. Measurements of the serum holotranscobalamin may be superior to total serum cobalamin.

[Chest computed tomography in the localisation of pathologic processes in lymphomas].

INTRODUCTION: The anatomic localisation of Hodgkin disease and Non-Hodgkin lymphoma is very important in the disease prognosis and therapy treatment. Intrathoracic localisation in Hodgkin disease is very frequent and usually occurs in the form of lymph node enlargement. The most frequent manifestation of the thoracic Non-Hodgkin lymphoma is mediastinal and hilarlympha-denomegalia. The purpose of this research study is to analyse chest computed tomography findings in patients suffering from Hodgkin disease and Non-Hodgkin lymphoma prior to any applied therapy. MATERIAL AND METHODS: This retrospective study encompassed 73 patients diagnosed as having Hodgkin disease or Non-Hodgkin lymphoma. They were subjected to III chest CT examinations. The initial occurrence of the disease was found in 35 patients (24 patients suffering from Hodgkin disease and 11 suffering from Non-Hodgkin lymphoma). Simultaneously, analyses of the pretherapy chest CT findings were made. RESULTS AND DISCUSSION: Positive findings were reported in 66.66% patients suffering from Hodgkin disease and 45.45% patients suffering from Non-Hodgkin lymphoma. Enlarged lymphnodes were found in the region of the upper mediastinum (parathracheal and prevascular group) in more than 55% of the patients suffering from Hodgkin disease and in more than 35% of the patients suffering Non-Hodgkin lymphoma. CONCLUSION: The findings of this study coincide to a great extent with the findings presented in world literature.

[Current differential diagnosis of hypereosinophilic syndrome].

INTRODUCTION: Hypereosinophilic syndrome (HES) is a group of idiopathic disorders associated with single or multiple organ system dysfunction. HES must be distinguished from reactive eosinophilia in parasitic infections, allergic diseases, and especially from hematological diseases of clonal origin. REACTIVE EOSINOPHILIA DUE TO INFECTIOUS AND PARASITIC DISEASES: Tissue helminth infections, especially toxocariasis, cause severe and long-standing hypereosinophilia. Despite specific therapy, eosinophilia may persist for over a year after diagnosis, and decreases slowly. Other helminth infections, such as trichinellosis, strongyloidosis, and rarely taeniasis and cysticercosis may also be diagnosed in patients with eosinophilia. HEMATOLOGIC AND OTHER NEOPLASTIC DISEASES: Numerous neoplastic diseases, like Hodgkin's and other malignant lymphomas, myeloproliferative diseases, systemic mastocytosis etc., may be associated with marked eosinophilia. We had two patients with clinical and histological features resembling chronic eosinophilic leukemia, and many others with T-cell lymphoma, planocellular or adenocarcinoma etc. where eosinophilia persisted DRUG-INDUCED EOSINOPHILIA: Drugs associated with eosinophilia include penicillins, tetracyclines, especially minocycline, clarithromycin, tetrazepam, mefloquine, and many, others. Toxins associated with L-tryptophan cause eosinophilia-myalgia syndrome and toxic oil syndrome, also belonging in this group. Treatment includes drug discontinuation and administration of corticosteroids. HYPEREOSINOPHILIA WITH ORGAN DYSFUNCTION: Many severe diseases, such as sarcoidosis, Churg-Strauss syndrome, pemphigus vulgaris, eosinophilic gastrointestinal diseases, inflammatory bowel disease and many others are associated with hypereosinophilia and target organ damage, e.g. involvement of the heart, lungs, skin, or nervous tissue. CONCLUSION: Eosinophilia can be classified as either familial or acquired. Hypereosinophilic syndrome is a subcategory of idiopathic eosinophilia. If the differential diagnosis of hypereosinophilia fails to resolve the etiology succesfully, the diagnosis of idiopathic HES remains.

[Von Meyenburg complex associated with adult polycystic liver disease].

INTRODUCTION: The von Meyenburg complex (bile duct hamartoma) is a rare developmental disorder, manifested by multiple bile ducts. The polycystic liver disease is a rare congenital anomaly which may remain undiscovered until adult life, occurring more frequently in women. It is mostly asymptomatic, but sometimes surgical intervention is necessary. In the majority of cases, it is combined with cysts in the kidney and, rarely, in other organs as well. The cysts may vary in diameter from 1 mm to 20 cm, or even more. CASE REPORT: A 55-year-old woman underwent surgery based on clinical diagnosis: suspected Echinococcus liver cyst. Liver biopsy was performed, and a parenchymal tissue of 6.5x4x3 cm, with a cyst with a diameter of 2.5 cm, was resected. Within the cyst lumen there was a necrotic, mushy, yellow contents. Microscopically examined, it showed plenty of cholesterol crystals. The wall of the cyst consisted of hypocellular connective tissue. In the surrounding liver parenchyma, there were cystical formations of the same structure, measuring 1-2 mm. Also, there were some multiple bile duct hamartomas. The ducts were encircled by a delicate connective tissue. DISCUSSION AND CONCLUSION: These changes correspond to von Meyenburg complex, i.e. biliary microhamartoma combined with adult polycystic disease. In our case, in the wall of the cyst there were numerous cholesterol crystals, pointing to its retention character and, probably, to the mechanism of its origin. After degeneration of biliary epithelium, the cyst wall grew very thick, due to proliferation of the connective tissue evoked by the aggressive chemical contents of the bile. Frequent development of cholangiocarcinoma within the cyst wall also points to long-term chemical irritation.