Lege Artis Medicinae

[MUMMIFIED ANCYLOSTOMA DUODENALE IN THE DUODENUM CAUSING SEVERE ANAEMIA]

KOVÁCS Valéria, SZABÓ Andrea, GODA Mária, MAGYAR Éva, RÁCZ István

JUNE 21, 2006

Lege Artis Medicinae - 2006;16(06)

[INTRODUCTION - We report on a patient with the remains of a mummified hookworm (Ancylostoma duodenale) found in his duodenal bulb which was later successfully removed with a polypectomy snare. CASE PRESENTATION - An 81-year-old man who took 100 mg aspirin daily was admitted because of severe iron-deficiency anaemia. After transfusion with 5 units of packed red blood cells upper endoscopy was performed. On the anterior wall of the duodenal bulb an 8 to10 mm long thread-like foreign body was found embedded in a sessile polyp-like mucosal protuberation with ulcerated inner margin. The entire pathologic structure was removed by mucosectomy. Histologically the thread-like body was found to be a lifeless female Ancylostoma duodenale containing a large amount of eggs and the surrounding ulcerated mucosa was also deeply infiltrated by hookworm particles. Follow-up endoscopy after four months showed normal gastroduodenal mucosa. CONCLUSION - An interesting case of hookworm infection is reported where an old infection caused chronic mucosal injury with reactive inflammation and mucosal ulceration. Aspirin therapy provoked chronic occult bleeding causing severe anaemia. With the endoscopic removal of the unusual structure total mucosal and clinical healing was achieved.]

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Lege Artis Medicinae

[TREATMENT OF ANAEMIA IN A PATIENT WITH SMALL CELL LUNG CANCER]

TAMÁSI Lilla, WOLLÁK András

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Clinical Neuroscience

Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT

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Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine

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Clinical Neuroscience

CANOMAD syndrome with respiratory failure

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CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.