As the prevalence of tuberculosis is on the rise in western countries, we present a 79-year-old man who developed a pulmonary tuberculosis-like syndrome following immunotherapy with BCG for carcinoma of the urinary bladder. The symptoms subsided following 3-drug antitubercular treatment, and the addition of steroids following negative cultures for Mycobacterium tuberculosis. The course of this disease, named BCG-osis, is much more favorable than miliary tuberculosis, even with milder treatment. It is important to keep in mind this phenomenon now that there is increasing treatment of cancers with BCG.
Nine patients with cavernous hemangioma of the liver were examined by nuclear magnetic resonance imaging (MRI) with a 0.5 T superconductive magnet. Spin-echo technique was used with varying time to echo (TE) and repetition times (TR). Results were compared with 99mTc red blood cell (RBC) scintigraphy, computed tomography (CT), echography, and arteriography. Four illustrated cases are reported. It was possible to establish a pattern for MRI characteristics of cavernous hemangiomas; rounded or smooth lobulated shape, marked increase in T1 and T2 values as compared with normal liver values. It is concluded that, although more experience is necessary to compare the specificity with that of ultrasound and CT, MRI proved to be very sensitive for the diagnosis of liver hemangioma, especially in the case of small ones which may be missed by 99mTc-labeled RBC scintigraphy.
Delta waves, similar to those observed in the Wolff-Parkinson-White syndrome, are currently observed in the ECG tracings of patients with endocardial pacing. With the aid of standard ECG and vectorcardiography (VCG), we studied the initial QRS forces during right endocardial pacing in 20 patients. More details were obtained by VCG concerning the amplitude duration, electrical axis and shape of the delta waves of paced ventricular beats, than by ECG. It is remarkable that delayed initial QRS forces, diagnosed by VCG analysis, were present in only 9 of 20 patients with delta waves in their ECG. In other patients, the slurring or thickening at the onset of the R waves in the ECG resulted from the perpendicular direction of the initial QRS vectors to the lead axis, or from multiple changes in the direction of the early, nondelayed QRS vectors. The superiority of VCG in the study of the initial QRS forces, particularly in the diagnosis of delayed initial QRS forces, is discussed.
There is substantial difficulty in the diagnosis of progressive systemic sclerosis where visceral involvement precedes cutaneous expression of the disease.
Objectives
To describe clues to the diagnosis of progressive systemic sclerosis sine scleroderma (ssSSc).
Methods
Report of 3 cases and review of the MEDLINE database concerning ssSSc.
Results
Tweny five patients from the literature and 3 from our unit fulfilled the inclusion criteria, 13 females and 15 males, mean age 51.2(SD17.2) years. Conditions motivating the search for ssSSc were pulmonary fibrosis (44%), congestive heart failure (19%), esophageal dysfunction (7%), malabsorption (11%), nephropathy (11%), fever of unknown origin (3.5%) and seizures (3.5%). An overt undifferentiated connective tissue disease was present in 7 pts. Multisystem involvement became apparent when carefully searched for in all but one patient. ANA and RF were found in 13 of 17 and “scleroderma pattern” was noted in 9 of 13 patients on nailfold capillaroscopy. Taut skin developed later in 57% of pts following extracutaneous presentation by 1 month to 7 yrs (mean 2.3 yrs).
Conclusion
Clues to the diagnosis of ssSSc can be classified as: 1) background conditions – unclassified system disorder, Raynaud’s, polyarthritis 2) evolving visceropathy of obscure provenience – dysphagia, malabsoption, pulmonary fibrosis, heart failure, nephropathy 3) corroborative laboratory and clinical features – hyper/hypopigmentation, telangiectasis, calcinosis, typical nailfold capillaroscopy 4) confirmatory evidence – visceral biopsy, appearance of taut skin.
It has been stated that it is inappropriate to conduct an extensive search for occult malignancy in patients with thromboembolism, unless there is some more specific indication. The present study defines those specific indices. By analyzing the clinical features of 11 consecutive patients with occult cancer presenting with thromboembolism (TE), criteria which differentiate TE in occult cancer from TE complicating other disorders were defined. These are the absence of an apparent cause for the TE at the time of the patient's admission, age more than 50 years, multiple sites of venous TE, associated venous and arterial TE, TE resistant to therapy with oral anticoagulants, and the presence of associated paraneoplastic syndromes. The incidence of these parameters in case reports from the literature was also analyzed. The six criteria that were prevalent in our series of patients with paraneoplastic TE, were observed to occur with similar incidence in different groups of historical cases. These criteria may be useful for stratification of patients with TE with regard to the probability of the presence of an occult cancer and the indications for further investigations.
Isolated retroperitoneal malignant lymphoma may be asymptomatic until late in its clinical course, or, alternatively, may be manifest by early systemic symptoms such as fever, pruritus or weight loss. In some instances, these rapidly enlarging tumors present with local signs, attributable to compression of nearby structures by growing lymph node masses (1). We wish to call attention to an unusual clinical presentation of retroperitoneal lymphoma - namely unilateral chest wall edema and ipsilateral pleural effusion.
