Infusion of lymphocytes obtained from a donor immunised with the paraprotein idiotype as a treatment in a relapsed myeloma

A 48-year-old patient with IgA k multiple myeloma received a BMT from his HLA-matched sibling. After transplantation, the disease relapsed. Melphalan therapy followed by reinfusion of haemopoietic blood stem cells collected from the patient led to the improvement of the clinical status, although mixed chimerism and an elevated serum IgA persisted. Successful donor immunisation against an immunogenic preparation of the recipient monoclonal protein was performed before the infusion of donor T lymphocytes (DLI) into the patient. Ten weeks after the lymphocyte infusions, no monoclonal band was evidenced and donor complete chimerism was detected. The patient did not develop GVHD. Once complete remission was achieved, the idiotype vaccine was administered to the patient. Nineteen months after DLI, the patient remains in remission. Bone Marrow Transplantation (2000).     

Facilitating patient acceptance of a psychiatric referral

There are five common ways in which a patient may object to a physician's suggestion of a psychiatric referral. The patient may reject the referral because of the social stigma of being a psychiatric patient; because the referral damages his or her self-esteem; because the patient does not understand the role of emotions in physical discomfort; because the patient feels rejected by the referring physician; or because of the effects of psychiatric illness. Following a thorough medical workup, the physician can best discharge his or her responsibility to the patient by paying attention to these possible misunderstandings. The physician can discuss the role of social stigma, offset the blows to the patient's self-esteem, educate the patient about the psychosomatic model of disease, and assure the patient of the physician's continuing interest and involvement.     

Transmission of HIV-1 from an obstetrician to a patient during a caesarean section

We describe a probable case of HIV-1 transmission from a healthcare worker (HCW) to a patient during a caesarean section. Genetic distance comparisons of the viral sequence of the C2V4 region of the viruses from the patient and the obstetrician showed an average nucleotide sequence divergence of 3% (2.8-3.1). HIV can be transmitted from an infected HCW to a patient when percutaneous injuries with subsequent exposure of the patient to the blood of the HCW can occur.     

Multicentric reticulohistiocytosis in a patient with malignant melanoma: a response to cyclophosphamide and a unique cutaneous feature

We describe a patient with multicentric reticulohistiocytosis and a history of malignant melanoma. His widely disseminated disease did not affect the site of surgical removal of the malignant melanoma nor the donor site of a skin graft. The multicentric reticulohistiocytosis progressed while the patient was taking nonsteroidal antiinflammatory agents, but showed significant response during a 10-month course of cyclophosphamide. While he was taking the cyclophosphamide, however, his melanoma recurred, and the patient subsequently died.     

Clinical application of a new colonoscope with variable insertion tube rigidity: a pilot study

BACKGROUND: Colonic loop formation can prolong colonoscopy, increase patient discomfort, and preclude complete examination. A colonoscope with variable insertion tube rigidity may facilitate colonoscopy. Our aim was to determine whether the use of a colonoscope with variable insertion tube rigidity reduces insertion time and improves patient acceptance of colonoscopy. METHODS: Fifty patients were randomly assigned to undergo colonoscopy with a conventional colonoscope or a variable rigidity colonoscope (VRC). Patient acceptance, dosage of medication, use of abdominal pressure, and patient repositioning were assessed. Statistical analysis was performed by the 2-sample Wilcoxon rank sum test and an extension of Fisher exact test. RESULTS: The groups were comparable with respect to age, gender, and medications required during colonoscopy. The cecum was reached in all 25 patients who underwent colonoscopy with the VRC, including 1 patient in whom the cecum was not reached at a previous colonoscopy with a conventional instrument. In the conventional colonoscopy group, the cecum was not reached in 4 patients (2 poor preparation, 2 loop formation). There was no significant difference between the 2 groups with respect to insertion time. In the group that underwent colonoscopy with the variable rigidity instrument, less abdominal pressure was required (p = 0.05), and nursing assessment of patient discomfort was more favorable (p = 0.05). There were no complications and no significant differences in the intubation time to cecum or in repositioning, patient acceptance, or patient assessment of abdominal pain. CONCLUSION:The use of a variable rigidity colonoscope reduced the frequency of abdominal pressure but did not affect intubation time to cecum, repositioning, patient acceptance, or patient assessment of abdominal pain.     

Deformation of a coronary stent as a sequela of resuscitation]

We report a case of LAD-stent deformation by extracorporeal cardiopulmonary resuscitation (CPR) shortly after stent implantation. To our knowledge, this is the first reported case. During an emergency PTCA, stents were implanted into the RCA and LAD. Patency was proven by angiography before the patient left the cardiac laboratory. Thirty minutes later the patient underwent CPR because of ventricular fibrillation. The patient died in cardiogenic shock. Postmortem examination showed a distinctly deformed LAD-stent. The case proves the possibility of a deformation of a coronary stent by resuscitation.     

Mycobacterium monacense in a patient with a pulmonary tumor

We report on a Mycobacterium monacense infection associated with a pulmonary tumor in a Chinese patient. To our knowledge, this is the first case of M. monacense described in a non-European patient with a tuberculosis-like disease. Further evaluation of the human pathogenic potential of M. monacense is needed.     

Chemoradiotherapy for a patient with a giant esophageal fistula

We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with metastases was treated with chemoradiotherapy. However, a giant esophagomediastinal fistula appeared due to shrinkage of the massive tumor, and all anti-cancer treatment was suspended. However, chemoradiotherapy was restarted at the request of the patient despite the presence of the fistula. After restarting treatment, the giant esophageal fistula was naturally closed despite intensive chemoradiotherapy, and the patient became able to eat and drink. Although the patient finally died, her QOL and prognosis seemed to be improved by the chemoradiotherapy. Anti-cancer treatment could be safely performed despite the presence of a giant fistula. The giant fistula closed while intensive chemotherapy was administered to the patient. Therefore, the presence of a fistula may not be a contraindication for curative chemoradiotherapy. Completion of treatment with proper management and maintenance of patients would be of benefit to patients with fistula.     

Significant envenomation from a preserved rattlesnake head (in a patient with a history of immediate hypersensitivity to antivenin)

We present a case of significant envenomation from a severed, preserved rattlesnake head in a 22-year-old man. The patient was treated successfully with 15 vials of Crotalidae polyvalent antivenin despite a history of severe immediate hypersensitivity reaction to antivenin. The patient developed a mild case of serum sickness five days after antivenin infusion that was treated successfully with a course of steroids. The patient experienced complete recovery. This case demonstrates the hazard of even preserved snake heads and fangs.     

Primary renal candidiasis associated with a penile prosthesis in a diabetic man

Infectious complications of penile prostheses are unusual even in diabetic patients, and generally involve Staphylococcus or gram-negative enteric organisms. This paper presents a diabetic patient who developed fatal, primary renal candidiasis associated with an infected penile prosthesis. He is the fourth patient we have seen with refractory nauses and vomiting associated with a cryptic urinary infection. Invasive Candida should always be considered in a diabetic patient with evidence of a urinary tract infection.     

Left atrial myxoma in a patient with heart failure after myocardial infarction - a case report

A case of a 54-year-old male patient with left atrial myxoma, coronary heart disease, heart failure and multiple cardiovascular risk factors is described. The patient did not present typical symptoms of myxoma. Diagnosis and treatment of cardiac myxoma as well as the importance of echocardiographic examination in every patient with decompensated chronic heart failure are discussed.     

Xanthoma tendinosum in a normolipemic ectodermal dysplasia patient

A female patient with congenital ectodermal dysplasia is described, who developed xanthoma tendinosum in her hands simulating rheumatoid arthritis. The serum lipids of this patient were normal. Both ectodermal dysplasia and xanthoma tendinosum in a normolipemic patient are rather uncommon and to our knowledge have not been previously reported in one and the same patient.     

Spontaneous remission of anemia associated with a myelodysplastic syndrome with disease evolution into a myeloproliferative state

A red cell transfusion-dependent patient with a myelodysplastic syndrome had progression into a myeloproliferative state with thrombocytosis. At the same time, the patient became transfusion independent, and a subsequent bone marrow examination revealed a previously undetected loss of chromosome 7. The patient remains well with control of thrombocytosis by anagrelide therapy.     

Ventricular dysfunction in a patient with Plummer's disease: a case report

A 76-year-old female patient complained of intermittent palpitation, shortness of breath, and orthopnea for 10 days. The patient was found to have cardiomegaly, left ventricular dilatation secondary to moderate regurgitation, with impaired ventricular dysfunction and persistent sinus tachycardia. The patient also had a nodular goiter with increased uptake on radionuclide scan on the right side of the thyroid gland, low serum thyroid-stimulating hor-mone, with normal triiodothyronine, and free thyroxine. Plummer's disease with ventricular dysfunction was diagnosed. We present this rare case and a review of the literature. Received: May 28, 2001 / Accepted: October 19, 2001     

Cardiac revascularisation in a high-risk patient--case report

A case of a patient with left main stem stenosis and significant stenosis in the other coronary arteries is presented. The patient was disqualified from coronary artery bypass grafting (CABG) because of many surgical risk factors and underwent successful coronary angioplasty. Three months later the patient returned to the hospital because of unstable angina. Control coronary angiography revealed in-stent restenosis. The patient underwent CABG and drug-eluting stent implantation with good clinical result.     

Hypersensitivity to warfarin in a patient with a mechanical aortic prosthesis.

The case of a patient with a prosthetic aortic valve and warfarin hypersensitivity is presented. On rechallenging the patient with warfarin, a spongiotic dermatitis with heavy superficial perivascular lymphocytic infiltrates with eosinophils was seen. The patient was finally discharged on aspirin therapy alone and is doing well to date. Warfarin hypersensitivity is rare, and only incidental reports exist regarding its incidence and management. It is conceivable that newer antiplatelet agents, whether alone or in combination with aspirin, will provide better control of thromboembolic events in patients with warfarin intolerance.     

Colonic cancer in a patient with intestinal malrotation: a case report

We present a case of a 76-year-old patient with intestinal malrotation, with incomplete rotation of the small intestine and abnormal positioning of the duodenum and superior mesenteric vessels over the transverse colon. Furthermore, the patient suffered of a concomitant cancer of the ascending colon.     

The patient coordinator in a liver transplant program

The specific role of patient coordinator varies among different transplantation centers. Their role is often dependent upon the total number of patients that are being followed at a given center. With continued success of a program and continued patient survival, the functions of the patient coordinator will increase. However, the coordinator's primary mission will remain principally that of patient educator and liaison with the transplant center.     

Association of a thyrotropin-secreting pituitary adenoma and a thyroid follicular carcinoma.

The different factors involved as etiological agents in thyroid cancer have in common long term thyroid follicle stimulation. On this base, a patient with a TSH-producing pituitary adenoma could be at high risk for developing thyroid cancer. A patient consulting for a single thyroid nodule was studied in our unit. He was diagnosed as having a TSH-producing pituitary adenoma and the Thyroid nodule was shown to be a follicular carcinoma following removed. We speculate that elevated TSH levels could have contributed to neoplastic transformation of the thyroid in this patient.     

Bronchoalveolar lavage plasmacytosis in a patient with a plasma cell dyscrasia

A patient with serum monoclonal gammopathy, Bence-Jones proteinuria, and bone marrow plasmacytosis underwent fiberoptic bronchoscopic study for evaluation of interstitial lung disease. Bronchoalveolar lavage fluid contained 47 percent plasma cells, which were monoclonal by immunoperoxidase staining. This is the first time BAL plasmacytosis has been demonstrated in a patient with a plasma cell dyscrasia.