Lemierre's syndrome and genetic polymorphisms: a case report

Background  

Lemierre's syndrome presents a classic clinical picture, the pathophysiology of which remains obscure. Attempts have been made to trace genetic predispositions that modify the host detection of pathogen or the resultant systemic reaction.     

Thymic cysts: a report of six cases

Thymic cysts are rarerly encountered lesions which are only 1 to 2% of all mediastinal masses. We present six patients with thymic cysts diagnosed between 2000 and 2004 in this report. There were three male and three female patients whose ages ranged from 34 to 64 years (mean age, 46 years). Four patients are nonsmoker. None of the patients had a previous history of an etiologic factor such as trauma, surgical procedure or evidence of significant inflammation. While one patient was asymptomatic, there were chest pain in three patients, cough in two patients, hemoptysis in two patients and dyspnea in one patient. Thymic cyst was located in anterior mediastinum in five patients and in upper mediastinum in one patient. Cysts were resected with thoracotomy in four cases and with sternotomy in two cases. Their size ranged from 5 to 9 cm in diameter. In pathologic examination, two cysts were multilocular. In conclusion, thymic cysts are rare masses. Differential diagnosis of mediastinal masses, especially anterior mediastinal masses should be included thymic cysts.     

Lemierre's syndrome: unusual cause of internal jugular vein thrombosis--a case report

Lemierre's syndrome is an uncommon septic thrombophlebitis of the internal jugular vein. The authors present the case of a 52-year-old woman with literature review. She developed flu-like symptoms and fever, and then painful swelling of the left side of her neck and left arm. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein, subclavian vein, and brachiocephalic vein and diffuse soft tissue inflammation around the veins. No microorganism was identified in the blood and venous thrombus, which was obtained by percutaneous aspiration thrombectomy. Systemic antibiotics and anticoagulation therapy achieved complete resolution of the symptoms. Recanalization of the thrombosed veins with no residual thrombi was observed on duplex scanning after 3 months. No pulmonary embolism or other metastatic infection was observed. Clinical suspicion seems to be essential to make an accurate diagnosis during the early stage of the disease, which is critical to obtain a successful outcome for Lemierre's syndrome.     

Venlafaxine withdrawal syndrome: report of six cases and review of the literature

INTRODUCTION: Venlafaxine is an antidepressant that selectively inhibits serotonin reuptake and is a norepinephrine inhibitor. Withdrawal syndromes can occur after abrupt drug discontinuation of long-term regimens. EXEGESIS: We report six cases of withdrawal symptoms after venlafaxine discontinuation. CONCLUSION: Physicians must be aware of the frequency, rapidity and potent severity of these withdrawal syndromes.     

Carcinoid of the duodenum: a report of six cases

Duodenal carcinoid tumors are rare. Six cases of primary duodenal carcinoid tumors are presented. Analysis of these cases indicates that the radiographic appearance can vary from a benign-appearing intramural submucosal mass lesion to a large bulky ulcerating lesion. All cases in this series followed a benign course. One patient has survived over 30 years with proven regional and hepatic metastases. This patient showed regression of the duodenal lesion following embolization for control of severe hemorrhage.     

Lemierre's syndrome: Porphyromonas asaccharolytica as a putative pathogen

A case of Lemierre's syndrome is reported in which metastatic abscesses resulted from septic thrombophlebitis of the internal jugular vein secondary to bacterial pharyngitis. A 32-year-old male suffering from a painful left-sided neck mass, sore throat, and fever was admitted to our hospital. Computed tomography revealed thrombosis of the left internal jugular vein, septic pulmonary emboli, and a liver abscess. Blood culture showed Porphyromonas asaccharolytica. Although empyema occurred transiently during the treatment, the patient recovered following prolonged antimicrobial therapy. Although Fusobacterium species are a well-known cause of Lemierre's syndrome, cases in whom Porphyromonas species was isolated have scarcely been reported. Moreover, case reports from Japan have been few.     

Variable clinical presentations of histoplasmosis: a report of six cases

Histoplasma is a dimorphic fungus that primarily involves the lungs and the environmental reservoir is soil. It has emerged as an important opportunistic fungal infection in immunocompromised patients. Six cases of histoplasmosis with variable clinical presentations diagnosed either on cytology or histopathology are discussed - three were HIV-positive. The possibility of histoplasmosis should always be borne in mind, especially in immunocompromised patients, as it can have variable clinical presentations.     

Pleomorphic carcinoma of the lung: a report of six cases

We presented six patients with pleomorphic carcinoma of the lung. There were 4 male and 2 female whose ages ranged from 43 to 64 years, with a mean age of 54.3 years. While two patients were nonsmoker, four patients were current smoker, with a mean smoking history of 52.5 (30-90) pack-years. Bronchoscopic examination detected endobronchial lesion in three patients. The diagnosis of pleomorphic carcinoma was established with cutting needle biopsy in one case and with thoracotomy in five cases. Epithelial component was squamous cell carcinoma in three cases and adenocarcinoma in the other three cases. There was bone metastasis in one case. She received chemotherapy and died two months after therapy. Among five patients who underwent surgery, pathologic staging was Stage IB in two patients, Stage IIB in two patients and Stage IV in one patient. Treatment modality was lobectomy in three cases and pneumonectomy in two cases. Survival time for patients after surgery was 2 to 20 months. In conclusion, pleomorphic carcinoma is a rare tumor of the lung. Diagnosis is frequently established with thoracotomy. These tumors have poor prognosis.     

Primary pancreatic lymphoma： Report of six cases

AIM: To heighten recognition of primary pancreatic lym phoma (PPL) in clinical practice. METHODS: A retrospective review of the clinical presentation, imaging characteristics and pathological features of PPL patients were presented, as well as their diagnosis and treatment, in combination with literature review. RESULTS: Histological diagnosis was made in four patients by surgery and in two patients by EUS-FNA. The six PPL patients (5 males and 1 female; age range, 16-65 years; mean age, 46 years) had the duration of symptoms for two weeks to three months. The primary presenting symptoms, though not characteristic, were abdominal pain, abdominal masses, weight loss, jaundice, nausea and vomiting. One of the patients developed acute pancreatitis. In one patient, the level of serum CA19-9 was 76.3μg/L. Abdominal CT scan showed that three of the six tumors were located in the head of pancreas, two in the body and tail, and one throughout the pancreas. Diameter of the tumors in the pancreas in four cases was more than 6 cm, with homogeneous density and unclear borders. Enhanced CT scan showed that only the tumor edges were slightly enhanced. The pancreatic duct was irregularly narrowed in two cases whose tumors were located in the pancreatic head and body, in which endoscopic retrograde cholangiopancreatography (ERCP) showed that the proximal segment was slightly dilated. Two patients underwent Whipple operation, one patient underwent pancreatectomy, and another patient underwent operative biliary decompression. PPL was in stage I E in 2 patients and in stage II E in 4 patients according to the Ann Arbor classification system. The diagnosis of B-cell non-Hodgkin's lymphoma was made in all patients histopathologically. All six patients underwent systemic chemotherapy, one of whom was also treated with gamma radiometry. One patient died two weeks after diagnosis, two patients lost follow-up, two patients who received chemotherapy survived 49 and 37 mo, and the remaining patient is still alive 21 mo, after diagnosis and treatment. CONCLUSION: PPL is a rare form of extranodal lympho-ma originating from the pancreatic parenchyma. Clinical and imaging findings are otherwise not specific in the differentiation of pancreatic lymphoma and pancreatic cancer, which deserves attention. EUS-guided fine-needle aspiration (EUS-FNA) of the pancreas requires experienced cytopathologists as well as advanced immunohis-tochemical assays to obtain a final diagnosis on a small amount of tissue. Surgery and adjuvant chemotherapy or radiotherapy can produce fairly good outcomes.     

Human intestinal sarcosporidiosis: report of six cases

Specimens of resected small intestine from six patients aged 3 to 70 years with acute enteritis contained sexual forms of sarcosporidia. Histopathologically, the diagnoses were either segmental eosinophilic enteritis or segmental necrotizing enteritis. The presence of sarcosporidia in market beef (Bos indicus), and the patients' habit of eating the beef uncooked in the form of chili-hot dishes, suggest that the species is an ox-man parasite similar to Sarcocystis hominis (Railliet and Lucet, 1891) Dubey, 1976. Presence of numerous Gram-positive bacilli in segmental necrotizing enteritis suggests an interplay between two etiological agents in producing the hosts' inflammatory responses. Five patients recovered after resection, but one died due to extensive necrosis of the intestinal wall and leakage at the site of anastomosis. Only conventional antibiotics were given after the operations. None of the five surviving patients has had recurrent enteritis for at least 1 year.     

Fire-eater's lung: report of six cases]

Lung damage due to inhalation of inflammable products, especially Kerdane, is mainly observed in young subjects. Lung damage is rarely severe and the diagnosis is facilitated by the notion of inhalation. These conditions regress favorably in a few days. We report six cases.     

变应性肉芽肿性血管炎累及大中动脉六例报道并文献复习

目的 总结变应性肉芽肿性血管炎(CSS)合并大、中动脉病变的临床表现及治疗,以提高对CSS合并大、中动脉病变的认识.方法 回顾性分析诊断明确且合并大、中动脉病变的6例CSS患者.并进行文献复习.结果 CSS累及大、中动脉病变的类型有闭塞、狭窄、栓塞、夹层、假性动脉瘤、动脉炎及动脉周围炎等.累及的动脉可包括冠状动脉、视网膜中央动脉、肠系膜动脉、椎动脉、基底动脉、颈动脉、主动脉及四肢动脉等.CSS累及大、中动脉病变似乎与年龄、病程及抗中性粒细胞胞质抗体无关.早期积极应用激素加免疫抑制剂,绝大部分患者预后好,部分患者需要手术及抗凝治疗.CSS累及冠状动脉时病情凶险,死亡率高.结论 CSS可以累及大、中动脉,且累及的动脉十分广泛,动脉病变类型多样,临床上应予以重视.     

Pacemaker syndrome: a report of 6 cases

Six patients suspected to have "pacemaker syndrome" were studied with hemodynamic and electrophysiologic methods. Symptoms appeared after implantation of ventricular pacemaker (VVI). Mile symptoms such as dizziness and fatigue and severe symptom of heart failure were noted. The results of the study suggested that cardiac output decreases due to loss of atrial contribution to ventricular filling and also as a result of increase of systemic venous pressure. If the patient has V-A conduction, cardiac output will decrease further. Restoration of atrioventricular synchronization is essential in the treatment of the pacemaker syndrome.     

Susac综合征--附二例报告

目的：讨论Susac综合征的临床表现及诊断。方法：对2例Susac综合征进行临床及辅助检查资料分析。结果：Susac综合征好发于青年女性,表现为急性、亚急性起病的多发、弥散神经症状、听力下降和视野缺损。典型表现：大脑MRI T2加权相显示白质及灰质内大量小灶增强信号、视网膜动脉闭塞、中到低频单侧或双侧感音性耳聋。结论：Susac综合征容易误诊,通过仔细询问病史及体格检查并结合辅助检查可以在疾病的早期阶段确诊。MRI、单光子发射计算机体层摄影术、视网膜荧光血管造影及听力测定有助于诊断。