Massive pulmonary embolism with cardiac arrest treated with continuous thrombolysis and concomitant hypothermia.

This case report describes the clinical course in a 49-year-old man with repeated cardiac arrests due to massive pulmonary embolism. He was successfully treated with intravenous tenecteplase followed by catheter-based alteplase infusion during external cooling. The case illustrates that vitally important bolus thrombolytic therapy may be continued as catheter-based treatment along with hypothermia without significant bleeding complications.

[Anemia and neutropenia in primary empty sella syndrome]. / Anemi og nøytropeni ved primaert tom sella-syndrom.

BACKGROUND: A 64-year-old man was admitted to our hospital with significant weight loss and symptoms of fatigue. He had normocytic anaemia and absolute neutropenia in peripheral blood. MATERIAL AND METHODS: Further haematological and endocrinological investigations were performed. RESULTS: Bone marrow aspiration and biopsy showed dysplastic signs. Immunophenotyping and cytogenetics did not provide evidence of primary haematological disease. Endocrinological testing demonstrated secondary adrenal insufficiency. Magnetic resonance imaging of the sella turcica showed an empty sella. Cortisol substitution eliminated the symptoms of the patient and normalised his peripheral blood values. The disturbed maturity and hypoplasia of the bone marrow were also normalised. INTERPRETATION: Normalisation of haematopoiesis after cortisol substitution indicates that cortisol plays an important role in the regulation of haematopoiesis. Primary empty sella syndrome with isolated ACTH cortisol deficiency is a very rare cause of disturbed haematopoiesis.