Lege Artis Medicinae

[A RARE CAUSE OF CYANOSIS - A CASE REPORT ON SULFHEMOGLOBINEMIA]

HARANGI Mariann, MÁTYUS János, NAGY Erzsébet, NAGY Emőke, PARAGH György, BALLA József, OLÁH V. Anna

JANUARY 21, 2006

Lege Artis Medicinae - 2006;16(01)

[INTRODUCTION - Sulfhemoglobinemia (SHb) is an uncommon cause of cyanosis that is predominantly caused by drugs in adults. CLINICAL CASE - We report on an unusual case of sodium sulfate induced sulfhemoglobinemia in a 61-year-old woman after surgical polypectomy. Fractional hemoglobin derivates were assayed by spectrophotometry and high-performance liquid chromatography (HPLC). The sulfhemoglobinemia ratio was 8.6% in the first sample, and 3.77% a month later measured by spectrophotometry. In the hemolysate a new peak was identified as sulfhemoglobinemia by HPLC. It showed the presence of 9.37% sulfhemoglobinemia in the first sample and 4.88% a month later. After omitting the suspected toxic agent the cyanosis decreased significantly. CONCLUSIONS - The findings underline the importance of routine sulfhemoglobinemia analysis in cases of cyanosis of unknown origin.]

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Lege Artis Medicinae

[THE RESULTS OF MOLECULAR BIOLOGY IN THE MANAGEMENT OF MYELOMA MULTIPLEX]

JÁKÓ János

[Among heamatological diseases, myeloma multiplex is the disease demanding the greatest attention. This statement could refer to the difficulties in diagnosis through the success or failure of a medical treatment and to the unavoidable deterioration of condition caused by complications. The illness, as it is known, is incurable but can be treated for a long period of time. The results of molecular biology offer new possibilities to secure the collection of instruments facilitating future recovery. These new modalities are targeted radiotherapy, the abundance of new drugs attacking the subcellular organellums of affected cells (thalidomid, Neovastat, oblimersen, bortezomib, etc.) and immunotherapy against myeloma cells. The introduction of new therapies, however, is to be permitted only with the greatest caution because the crossing of roads cannot be calculated and this could bring about deterioration too. The delay in theoretical considerations and experience however, allows the possibility to do a critical analysis. The application would become reality after collecting numerous experiences.]

Lege Artis Medicinae

[Varietas Delectat An Interview with Gastroenterologist/Radiologist István Balogh MD, by Elemér Nemesánszky, LAM’s Editor-in-Chief]

NEMESÁNSZKY Elemér, GYIMESI Andrea

Lege Artis Medicinae

[AUTOIMMUNE PATHOGENESIS IN THE BACKGROUND OF PULMONARY ALVEOLAR PROTEINOSIS]

LOSONCZY György

[Pulmonary alveolar proteinosis (PAP) is a rare form of interstitial lung disease. The etiology and pathogenesis of PAP has remained uncertain. It is characterized by the accumulation of surfactant in alveolar space, which leads to impaired oxygen diffusion and lung restriction. Patients develop chronic respiratory failure. Traditional treatment of the disease has been whole-lung lavage. In recent years the role of alveolar macrophages in the removal of surfactant has been discovered with granulocyte-macrophage colony-stimulating factor (GM-CSF) triggering this function of macrophages. In the most frequent “idiopathic” subtype of this disease autoantibodies against GM-CSF have been shown to be present in blood. These autoantibodies block GM-CSF-induced surfactant removal by the alveolar macrophages. Clinical studies indicated that longterm, high dose therapy with GM-CSF can be effective in the cleaning the alveolar space and treating respiratory failure. This new treatment modality makes high-risk whole-lung lavage avoidable.]

Lege Artis Medicinae

[Wishes and reality]

FRENKL Róbert

Lege Artis Medicinae

[The 8th Congress of the Hungarian Society of Thrombosis and Hemostasis]

BLASKÓ György

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Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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