Subcutaneous panniculitis-like T-cell lymphoma in type 1 neurofibromatosis: a case report.

Neurofibromatosis 1 (NF-1) is an autosomal dominant genodermatosis with an increased risk of developing mesenchymal malignancies. A 28-year-old woman with NF-1 was admitted to our Department for deep ulcers on the right thigh. The ulcerations had appeared about two years earlier, and were initially diagnosed as pyoderma gangrenosum. The patient received immunosuppressive therapy but only marginal improvement was observed. Several months later, the disease progressed, so a skin biopsy was taken, establishing cytophagic histiocytic panniculitis. The patient was admitted to our Department for further therapy. After re-evaluation of histological slides, while taking into account the clinical presentation and previously established histological diagnosis, subcutaneous panniculitis-like T cell lymphoma (SPTL) was diagnosed. Chemotherapy (combination of fludarabine and cyclophosphamide) was started, resulting in almost complete remission of malignant lesions. To the best of our knowledge, this is the first report of the development of SPTL in NF-1.

Pyoderma gangrenosum-like skin changes after subcutaneous administration of low molecular weight heparin.

In the present report, we would like to comment a case of patient with diabetes mellitus type 2 manifesting the rare complication of heparin subcutaneous administration in a form of pyoderma gangrenosum-like skin changes which were induced probably by an immune-modulating activity of heparin.

Henoch-Schönlein purpura (HSP) and high-dose immunoglobulin treatment in patient with familiar prostatic adenocarcinoma.

A 52-y old man was admitted to our Department because of abdominal pains and diarrhea with fresh blood, with concomitant purpura over the whole body and edema of the both tarsal joints. The medical history of the patient included skin changes of similar character identified once 10-12 y before. The family history revealed prostate cancer (brother and father) and pulmonary carcinoma (mother and mother's sister). An administration of immunoglobulins in the course of HSP is a non-standard clinical procedure and in case of our patient--clinically effective. In the literature, we have found only few articles about intravenous immunoglobulin treatment for acute, adult-onset HSP and only one article about GI bleeding from colonic ecchymoses in HSP. In these cases HSP wasn't associated with prostate cancer. In the first article, authors had seen dramatic responses to intravenous immunoglobulin, like in the case presented by us. IV-IG acts as an immunomodulator by suppression of antibody production, Fc-receptor blockade and anti-idiotypic reaction. In our case, the last two mechanisms could be perceived as favorable effects of IV-IG.

Is the zinc neuroprotective effect caused by prevention of intracellular zinc accumulation?

Zinc plays an important role in the functioning of all cells, including neurons. The precise mechanisms responsible for its neurotoxic and neuroprotective effects remain unclear despite extensive investigations. Similar Zn(+2) effects can also be observed in cells outside the nervous system, and their lower sensitivity to hypoxia prolongs the cytotoxic effect of excess zinc. The evident dualism of zinc's effects depends primarily on the energetic state of the particular cell and the efficacy of ion pumps; on genetically conditioned mechanisms regulating Zn efflux from cells and Zn sequestration inside the cell; and on the concentration of extracellular free Zn.

Immune-complex-like disease in the course of Enterobacter cloacae sepsis due to cholelithic cholecystitis preceded by influenza vaccination.

This case report describes a 52-y-old male patient who, one week after influenza vaccination, presented with abdominal symptoms: pain in the right epigastrium followed by liver dysfunction and pyrexia, as well renal failure, muscles pain and consciousness disorders. Immune-complex-like disease and Enterobacter cloacae sepsis due to cholelithic cholecystitis were diagnosed. In this case, a correlation between vaccination and immune complex-like-disease was suspected based on the onset of symptoms a few days after vaccination and clinical improvement after plasmapheresis. The etiopathogenesis of immune-complex-like disease in this case possibly could relate to the similarity of the vaccine antigens and E. cloacae antigens as well a genetic predisposition.

The content of elements in rainwater and its relation to the frequency of hospitalization for chronic lymphocytic leukemia and chronic myeloid leukemia in Opole Voivodship, Poland, during 2000-2002.

Environmental factors play an essential role in the etiology of diseases of the hematopoietic system. Such factors include soil and water pollution and the presence of metals and toxic compounds in the air. Measuring the content of metallic elements in rainwater has become an accepted procedure for environmental pollution monitoring. In accordance with the above, it was decided to study relations between the content of selected elements in rainwater and hospitalization frequency due to chronic lymphocytic leukemia (CLL, C91 on ICD-10) and chronic myeloid leukemia (CML, C92 on ICD-10). It can be assumed that hospitalization frequency is a reliable indicator of exacerbations of these diseases. The annual average of hospitalizations due to a given disease during the years 2000-2002 was correlated with the annual average content of a given element in rainwater using the Spearman's correlation indicator to describe the relationship between the element content and the disease that is possibly a consequence of the element's presence in rainwater. In cases of CLL for all the subjected population and for men, no statistically significant correlations were found. For women, statistically significant correlations were found for chromium (r = 0.66), lead (r = 0.58), copper (r = 0.58), and cadmium (r = 0.51). For CML in all the studied population significant, negative correlations were found for magnesium (r = -0.6) and zinc (r = -0.52). In men, significant negative correlations were seen for magnesium (r = -0.69 and zinc (r = -0.55). No significant correlations were found in women. These results indicate the need of taking into account the environmental and gender factors in research connected with these diseases, which can be probably of help in improvements of therapy efficiency.

The content of elements in rainwater and its relation to the frequency of hospitalization for gastric and duodenal peptic ulcers in Opole Voivodship, Poland, during 2000-2002.

The relationship between chemical elements in rainwater and the frequency of hospitalizations for gastric and duodenal peptic ulcers was studied on the population of the province (Voivodship) of Opole, Poland, during the years 2000-2002. There is a high positive correlation between hospitalized cases of gastric peptic ulcers with chromium in rainwater (r = 0.71), cadmium (r = 0.63), and lead (r = 0.70). Mild positive correlations were found with zinc (r = 0.55), copper (r = 0.56), iron (r = 0.57), chloride (r = 0.60), and sulfate (r = 0.52). These correlations were higher on men, suggesting that there are gender correlations involved. In duodenal peptic ulcers, we observed a high positive correlation between chromium in rainwater and hospitalized cases (r = 0.61) and mild positive correlations with lead (r = 0.57), copper (r = 0.52), and cadmium (r = 0.51). Significant gender differences were not found. These positive correlations may be due to the biological activity of the elements, such as their cytotoxic activity, enhanced local adrenergic stimulation on mucosal vasculature, ion channel (mainly calcium channels) remodeling, and, for example promoting infection by Helicobacter pylori.

The content of elements in rainwater and its relation to the frequency of hospitalization for atrial fibrillation in Opole Voivodship, Poland, during 2000-2002.

The elemental composition of rainwater is a suitable indirect indicator of the presence of chemical elements in airborne dust. As such, rainwater is considered a suitable monitor for environmental or natural pollution. The yearly content of chemical elements in rainwater may be considered a good indicator for determining the influence of these environmental factors on human body. We decided to investigate the relationship between chemical elements in rainwater and the frequency of hospitalizations for atrial fibrillation (I48, ICD10) on the population of the region of Opole Voivodship, Poland during the years 2000-2002. The voivodship or province has a population of one million and is divided into 12 counties that have between 44,000 and 151,000 inhabitants. We calculated the yearly average number of hospitalizations by reasons of atrial fibrillation per 10,000 inhabitants in particular counties. The average content of the chosen chemical elements in kilograms per hectare per year was calculated for each county individually and the data evaluated by means of Spearman's correlation coefficient. There is a high positive correlation between chromium in rainwater and hospital admissions for atrial fibrillation (r = 0.62) and mild positive correlation with cadmium (r = 0.57), lead (r = 0.57), zinc (r = 0.50), and chloride (r = 0.48). There are no significant differences between male and female patients. The biological activities of these elements, which may include enhanced adrenergic stimulation, remodeling of calcium or other ion channels, or the cytotoxic effects of hexavalent chromium may explain the positive correlations here reported.

The content of elements in rainwater and its relation to the frequency of hospitalization for diabetes and obesity in Opole Voivodship, Poland, during 2000-2002.

Environmental factors significantly influence the incidence and course of metabolic syndrome diseases such as diabetes and obesity. The content of elements in rainwater is an indirect indicator of their presence in dust suspended in the air. In this paper we present the relationships between the content of selected elements in rainwater and hospitalization frequencies due to diabetes (E10-E13) and obesity (E66). It was assumed that the hospitalization frequency could be taken as a measure of deterioration of the metabolic process in the course of diabetes and its complications. The observations concerned the population of Opole Voivodeship, Poland (one million inhabitants), distributed in small communities of 44,000 to 151,000 inhabitants during the years 2000-2002. In cases of diabetes E10-E13 for all subjects relevant correlation indicators were found for chromium (r = 0.71), cadmium (r = 0.65), and lead (r = 0.66). Borderline relevance was seen for copper (r = 0.57) and zinc (r = 056). For diabetic men the statistically relevant correlations were chromium (r = 0.79), lead (r = 0.77), cadmium (r = 0.74), copper (r = 0.70), chloride (r = 0.69), zinc (r = 0.68), and iron (r = 0.64). For women the only relevant correlations were chromium (r = 0.62) and cadmium (r = 0.55). No significant correlations were found in obese individuals of both sexes.

Frequency of hospitalization for angina pectoris, stroke, and peripheral venous thrombosis and its relationship to elements in rainwater in Opole Voivodship, Poland, during 2000-2002.

The content of elements in rainwater is an indirect indicator of its occurrence in air dust. This is sometimes referred to as rain fallout and is investigated in applied environmental pollution monitoring schemes. The annual content of elements in rainwater may be recognized as good index for assessing influence of those environmental factors on human body. The possible relationship between the concentrations of selected elements in rainwater and the frequency of hospitalization by reason of angina pectoris, stroke, and peripheral venous thrombosis was investigated in the Opole Voivodship (Poland) area during the period 2000-2002. There is a relatively high or partly significant correlation between frequency of hospitalization by reason of these conditions and content of lead, cadmium, chromium, zinc, and chloride in rainwater. Significant gender-dependent differences were observed only in peripheral venous thrombosis, where important correlations with lead, cadmium, and chromium were found only in men.

Gender differences in correlations between the content of elements in rain water and the frequency of hospitalization for arterial hypertension, chronic obstructive pulmonary disease, and psoriasis in Opole Voivodship, Poland, during 2000-2002.

The aim of this work is to show and give a plausible explanation to gender-dependent differences in correlations between the content of selected elements in rainwater and the frequency of hospitalization by reason of arterial hypertension, chronic obstructive pulmonary disease (COPD), and psoriasis in the area of Opolskie Voivodeship, Poland, during the period 2000-2002. The elements analyzed were sodium, potassium, calcium, magnesium, manganese, iron, total phosphorus, total nitrogen, ammonium nitrogen, zinc, copper, lead, cadmium, nickel, chromium, chloride, nitrate, and sulfate. Hospitalization due to arterial hypertension was more frequent in women, whereas those for COPD and psoriasis were more frequent in men. In the case of women hospitalized for arterial hypertension, the correlations were low, except for zinc (r = 0.47) and for cadmium (r = 0.43). In men hospitalized for COPD, all of the correlation coefficients were higher than 0.4, except for phosphorus. The coefficients for nickel, ammonia nitrogen, and total nitrogen ranged from 0.5 to 0.6 and the remaining elements from 0.6 to 0.7. In women, the correlation was limited to five elements where the coefficient was r > 0.4 for chloride, calcium, nitrate, phosphorus, and chromium. In cases of hospitalization for psoriasis, the correlation in men was between 0.4 and 0.5 for chloride, phosphorus, copper, lead, and total nitrogen and greater than 5 for sulfate, potassium, calcium, iron, manganese, nitrate, and ammonium nitrogen. The correlation in women was between 0.48 and 0.5 for ammonium nitrogen and phosphorus.

The content of elements in rainwater and its relation to the frequency of hospitalization for arterial hypertension, chronic obstructive pulmonary disease, and psoriasis in Opole Voivodship, Poland during 2000-2002.

The content of chemical elements in rainwater is a suitable indirect indicator of its presence in airborne dust, sometimes referred to as rain fallout. Rainwater is considered a suitable monitor for environmental or natural pollution. The yearly content of chemical elements in rainwater may be considered as a good indicator for determining the influence of these environmental factors on the human body. We decided to investigate the relationship between chemical elements in rainwater and the frequency of hospitalizations for arterial hypertension, chronic obstructive pulmonary disease, and psoriasis. There is a mild correlation between zinc and cadmium and cases of arterial hypertension. For obstructive pulmonary disease, there is a strong correlation with the content of potassium, calcium, iron, manganese, lead and nickel, and with chloride, sulfide, total nitrogen, and nitrites. There is also a mild correlation with magnesium, zinc, copper, cadmium and chromium, and with ammonium nitrogen. In cases of hospitalization for psoriasis, a correlation was revealed with such elements as potassium, ammonium nitrogen, and phosphorus.

The role of zinc in thrombosis and pulmonary embolism in the course of antiphospholipid syndrome (APS)--short review.

Antiphospholipid antibodies may occur in the course of various diseases, but its presence is not necessarily associated with clinical symptoms. Zinc has multiple biological roles. For example, it stabilizes the cell's membrane and regulates its functions by influencing the synthesis of phospholipids and its distribution. The present review focuses on the possible associations between zinc and antiphospholipid antibodies and with the symptoms of antiphospholipid syndrome.

Role of zinc in hemostasis: a review.

Zinc is a multi-functional element that is found in almost 300 enzymes where it performs catalytic, co-catalytic, and/or structural functions. In 1982, Gordon et al. (Am J Clin Ntr 35:849-857, 1982) found that a low zinc diet caused poor platelet aggregation and increased bleeding tendency in adult males. This fact drew interest to the role of zinc in blood clotting. It has been shown that hyperzincemia predisposes to increased coagulability, and hypozincemia to poor platelet aggregation and increased bleeding time. The blood clotting disturbances can be regressed by appropriate zinc intake management. Considering the importance of zinc as an essential element, its participation in regulation of the equilibrium between pro- and anti-thrombotic factors originating in platelets and endothelium prompted further investigations.

Zinc supplementation or regulation of its homeostasis: advantages and threats.

To accomplish its multifunctional biological roles, zinc requires precise homeostatic mechanisms. There are efficient mechanisms that regulate zinc absorption from the alimentary tract and its excretion by the kidney depending on the organism demands. The regulatory mechanisms of cellular zinc inflow, distribution, and zinc outflow are so efficient that symptoms of zinc deficiency are rare, and symptoms connected with its massive accumulation are even more rare. The efficiency of homeostatic mechanisms that prevent zinc deficiency or excessive zinc accumulation in the organism is genetically conditioned. It seems that an essential element of zinc homeostasis is the efficiency of zinc transmembrane exchange mechanisms. Intracellular free zinc concentration is higher than in extracellular space. Physiologically, the active outflow of zinc ions from the cell depends on the increase of its concentration in extracellular space. The ion pumps activity depends on the efficiency by which the cell manages energy. Considering the fact that zinc deficiency accelerates apoptosis and that excessive zinc accumulation inside cells results in a toxic effect that forces its death brings about several questions: Is intensification and acceleration of changes in zinc metabolism with age meaningful? Is there a real zinc deficiency occurring with age or in connection with the aforementioned pathological processes, or is it just a case of tissue and cell redistribution? When discussing factors that influence zinc homeostasis, can we consider zinc supplementation or regulation of zinc balance in the area of its redistribution? To clarify these aspects, an essential element will also be the clear understanding of the nomenclature used to describe changes in zinc balance. Zinc homeostasis can be different in different age groups and depends on sex, thus zinc dyshomeostasis refers to changes in its metabolism that deviate from the normal rates for a particular age group and sex. This concept is very ample and implies that zinc deficiency may result from a low-zinc diet, poor absorption, excessive loss of zinc, zinc redistribution in intra- and extracellular compartments, or a combination of these factors that is inadequate for the given age and sex group. Such factor or factors need to be considered for preventing particular homeostasis disorders (or dyshomeostasis). Regulation of zinc metabolism by influencing reversal of redistribution processes ought to be the main point of pharmacologic and nonpharmacologic actions to reestablish zinc homeostasis. Supplementation and chelation are of marginal importance and can be used to correct long-term dietary zinc deficiency or zinc poisoning or in some cases in therapeutic interventions. In view of its biological importance, the problem posed by the influence of zinc metabolism requires further investigation. To date, one cannot consider, for example, routine zinc supplementation in old age, because changes of metabolism with age are not necessarily a cause of zinc deficiency. Supplementation is warranted only in cases in which deficiency has been established unambiguously. An essential element is to prevent sudden changes in zinc metabolism, which lead to dyshomeostasis in the terms defined here. The primary prophylaxes, regular physical activity, efficient treatment of chronic diseases, are all elements of such prevention.

Selected zinc metabolism parameters and left ventricle mass in echocardiographic examination in primary arterial hypertension.

The basal systolic and diastolic blood pressure, body mass index, left ventricular mass, serum and lymphocyte zinc levels, serum aldosterone, plasma rennin and angiotensin-converting enzyme activities, sodium and potassium levels, and the total and ouabain-dependent rate constants of zinc efflux from lymphocytes were measured in a group of 41 individuals of both sexes (overall age 46.3 +/- 11.4 years), of which 18 were women (48.5 +/- 7.1 years old) and 23 were men (44.7 +/- 13.8 years old). There were no significant differences between these parameters while dividing the subjects into groups according to sex, despite differences in weight, left ventricle mass, plasma rennin activity, and serum aldosterone content. Only the total and ouabain-dependent rate constants of zinc efflux from lymphocytes slightly negatively correlated to left ventricular mass, r = -0.30 to r = -0.36. This may constitute indirect evidence of zinc deficiency in cardiomyocytes of some hypertensive individuals with left ventricular hypertrophy.

Significance of zinc in nephrotoxicity of contrast media used in imaging diagnostics of the cardiovascular system.

Nephrotoxicity is an undesirable reaction of contrast media used in X-ray or magnetic resonance diagnostics. In addition to a direct toxic effect on renal tubules, the hemodynamic factor is considered to be the main cause of kidney damage and malfunction. The factors that increase the probability of a nephrotoxic effect of contrast media include oldage, diabetes, arterial hypertension, circulatory system insufficiency, neoplastic diseases, and prior kidney damage. Decreased serum zinc is observed in all those conditions. In this article, the influence of contrast media on zinc homeostasis and the possibility of a nephrotoxic reaction caused by these agents is discussed.

Zinc ions efflux from lymphocytes in vitro in the presence of a calcium and magnesium ionic environment and its changes following administration of verapamil.

The total and ouabain-dependent rate constants of efflux of zinc (Zn) ions from lymphocytes isolated from healthy subjects were measured in vitro in an environment containing calcium (Ca) and magnesium (Mg) ions. Both the total (ERCt-Zn) and ouabain-dependent (ERCos-Zn) rate constants were higher in the presence of Mg2+, with the the oubain-dependent efflux significantly different 0.29+/-0.07 vs 0.13+/-0.02 with and without Mg2+, respectively (p<0.001). After the addition of verapamil, an increase of ERCE-Zn was observed in both ionic environments and was higher and statistically significant in the presence of Mg2+: 1.94+/-0.64 vs 2.97+/-1.16 (p<0.025). These results suggest that verapamil has an enhancing effect on Zn efflux from isolated lymphocytes, suggesting that calcium channel blockers might result in better Zn homeostatic regulation in diseases of the cardiovascular system.

Role of zinc in regulation of arterial blood pressure and in the etiopathogenesis of arterial hypertension.

Increased gastrointestinal absorption and urinary excretion of zinc has been confirmed in experimental and clinical studies on primary arterial hypertension as a result from changes of intracellular and extracellular zinc content. In arterial hypertension, the levels of zinc in serum, lymphocyte, and bone decrease while increasing in heart, erythrocytes, kidney, liver, suprarenal glands and spleen. These changes result in the loss of zinc homeostasis that leads to various degrees of deficiency, not entirely compensated by nutritional factors or increased absorption in the gastrointestinal tract. Loss of zinc homeostasis can be both cause and effect of high blood pressure. In the present review, the role of zinc metabolism changes and its mechanisms in arterial hypertension are discussed.