Sequential respiratory syncytial virus cytomegalovirus pneumonia following bone marrow transplantation

A 6-month-old child with familial hemophagocytic lymphohistiocytosis (FHL) experienced early sequential pneumonia due to respiratory syncytial virus (RSV) and cytomegalovirus (CMV) following bone marrow transplantation (BMT). The patient was deficient in natural killer (NK) cell activity (as found frequently in patients with FHL), and this risk factor may have played a major role in the concomitant infection by the two viral pathogens. Rapid diagnostic methods for both viruses are essential and early specific treatment may serve to ameliorate RSV- and CMV-induced lung injury in these life-threatening infections. © 1995 Wiley-Liss, Inc.     

Multiple myeloma presenting as a sellar plasmacytoma and mimicking a pituitary tumor: Report of a case and a review of the literature

A case of multiple myeloma presenting as a plasmacytoma and mimicking a pituitary tumor is reported. The importance of recognizing the existence of plasmacytoma in the differential diagnosis of sellar and parasellar tumors is stressed, as it leads to important differences in management. The literature is reviewed. Patients presenting with plasmacytoma with symptoms of a pituitary adenoma have an average age of 58 years; the male to female ratio is 3:1; diplopia, headache, and progressive visual loss are the most important symptoms; third, sixth, and fourth cranial nerve palsies are the most common signs; and pituitary function is usually normal. CT scan of the sellar region is the imaging modality of choice; pathologically, light and electron microscopy are invaluable in making the correct diagnosis. Making the correct diagnosis allows further appropriate investigation for systemic disease and consequent management.     

Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke

Introduction  

Quicker recanalization results in better clinical outcomes in patients with acute ischemic strokes. We describe our experience with the use of a self-expanding, fully retrievable stent in acute intracranial occlusions.     

Thyrotoxicosis during sunitinib treatment for renal cell carcinoma

Context Sunitinib malate is an oral tyrosine kinase inhibitor used in the treatment of renal cell carcinoma (RCC) and gastrointestinal stromal tumours. Hypothyroidism has been observed in patients treated with sunitinib, but the mechanism whereby sunitinib induces hypothyroidism is unknown. Objective To describe a series of six patients who developed thyrotoxicosis while on sunitinib for metastatic RCC. Setting The study was conducted at Austin Health, a tertiary teaching hospital in Melbourne, Australia. Results Two patients developed severe thyrotoxicosis within 10 weeks after commencing sunitinib. In contrast, in the four patients who presented with later onset (16–30 weeks) thyrotoxicosis, the thyrotoxicosis was relatively mild, self‐limiting and rapidly progressed to hypothyroidism. These patients experienced recurrent episodes of thyrotoxicosis in temporal relation to their cyclical sunitinib treatment. One patient had cytological evidence of lymphocytic thyroiditis. Conclusions These findings suggest that sunitinib‐induced hypothyroidism may be a consequence of preceding thyroiditis with associated transient thyrotoxicosis. As predictive factors are currently unknown, we suggest regular monitoring of thyroid function in all patients commenced on sunitinib. Clinicians treating patients with sunitinib or other similar kinase inhibitors should to be alerted to thyroid dysfunction as a potential toxicity of these agents.     

Pulsed doppler echocardiography in diagnosis of pulmonary regurgitation: Its value and limitations

Ninety-eight patients were studied with two dimensional echocardiography combined with pulsed Doppler echocardiography to assess the usefulness and limitations of the Doppler technique in the diagnosis of pulmonary regurgitation. The diagnosis of pulmonary regurgitation by pulsed Doppler echocardiography depended on subjective interpretation of the audio signal and objective interpretation of the time interval histogram for the presence of wide frequency dispersion. During cardiac catheterization in 53 of the 98 patients, indocyanine green was injected into the pulmonary artery, and simultaneous sampling was performed from the right ventricle and femoral artery to diagnose pulmonary regurgitation. Pulmonary regurgitation was confirmed by pulmonary arteriogram in one patient. Among 62 patients with adequate pulsed Doppler echocardiographic studies, diastolic turbulence was noted in 21. When diastolic turbulence was less than 50 percent of the period of diastole, no pulmonary regurgitation was demonstrated in patients studied by indicator-dilution technique. However, three of the four patients with diastolic turbulence greater than 50 percent had positive evidence of pulmonary regurgitation. Audio output was more sensitive than the time interval histogram, and only five patients' findings suggested pulmonary regurgitation. Three of these patients underwent dye-dilution studies; two studies were positive for pulmonary regurgitation and one was negative.Thus, interpretation of pulmonary regurgitation based on the time interval histogram alone produces a large number of false positive results. When diastolic turbulence is greater than 50 percent of the period of diastole, both the sensitivity and specificity of diagnosis of pulmonary regurgitation are increased. Combining audio output and the time interval histogram results in improved diagnostic capability.