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81.
Pulmonary immunologic features of alveolar septal amyloidosis associated with multiple myeloma 总被引:1,自引:0,他引:1
A 74-year-old man presented with interstitial pulmonary disease which was proven to be alveolar septal amyloidosis by transbronchial biopsy. Multiple myeloma was diagnosed on the basis of monoclonal IgG-lambda protein in serum, monoclonal lambda light chains in urine, a bone marrow plasmacytosis of 22 percent, and serum IgA and IgM levels less than 100 mg/dl and 50 mg/dl, respectively. Appropriate investigations failed to show additional sites of deposition of amyloid. Analysis of fluid from bronchoalveolar lavage showed an increase in total cells recovered, a lymphocytosis with a ratio of T helper over T suppressor cells greater than that in peripheral blood, the presence of an IgG-lambda paraprotein, and an IgG/albumin ratio greater than that in serum. While plasma cells could not be identified in the recovered cell population, cultured cells from bronchoalveolar lavage fluid showed increased production of IgG. These findings provide evidence of an ongoing pulmonary immune response resulting in excess IgG-lambda protein in the pulmonary compartment, a factor which may contribute to the development of amyloidosis. 相似文献
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A CT‐based medina classification in coronary bifurcations: Does the lumen assessment provide sufficient information?
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Stella‐Lida Papadopoulou MD Chrysafios Girasis MD Frank J. Gijsen PhD Alexia Rossi MD Jade Ottema MD Alina G. van der Giessen PhD Johan C. Schuurbiers BSC Hector M. Garcia‐Garcia MD PhD Pim J. de Feyter MD PhD Jolanda J. Wentzel PhD 《Catheterization and cardiovascular interventions》2014,84(3):445-452
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Jon Banks Fiona M Walter Nicola Hall Katie Mills William Hamilton Katrina M Turner 《The British journal of general practice》2014,64(629):e775-e782
Background
The challenge for GPs when assessing whether to refer a patient for cancer investigation is that many cancer symptoms are also caused by benign self-limiting illness. UK National Institute for Health and Care Excellence (NICE) referral guidelines emphasise that the patient should be involved in the decision-making process and be informed of the reasons for referral. Research to date, however, has not examined the extent to which these guidelines are borne out in practice.Aim
To assess the degree to which patients are involved in the decision to be referred for investigation for symptoms associated with cancer and their understanding of the referral.Design and setting
Qualitative interview study of patients referred to secondary care for symptoms suspicious of lung and colorectal cancer. Patients were recruited from two regions of England using maximum variation sampling.Method
Transcribed interviews were analysed thematically.Results
The analysis was based on 34 patient interviews. Patients in both symptom pathways reported little involvement in the decision to be referred for investigation. This tended to be accompanied by a patient expectation for referral, however, to explain ongoing and un-resolving symptoms. It was also found that reasons for referral tended to be couched in non-specific terms rather than cancer investigation, even when the patient was on a cancer-specific pathway.Conclusion
GPs should consider a more overt discussion with patients when referring them for further investigation of symptoms suspicious of cancer. This would align clinical practice with NICE guidelines and encourage more open discussion between GPs and primary care patients around cancer. 相似文献87.
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Salma I. Mohammed MD FFPMRCA Sam Eldabe MD FFPMRCA Karen H. Simpson MD FFPMRCA Morag Brookes PG Dip Grace Madzinga Dip HE Ashish Gulve Ganesan Baranidharan MD FFPMRCA Helen Radford BHSc Tracey Crowther BSC Eric Buchser MD Christophe Perruchoud MD Alan Mark Batterham PhD 《Neuromodulation》2013,16(6):576-582