RESUMEN
This is a case report of a patient with Wegener's granulomatosis (WG), who initially presented with a corneal perforation. In addition to the eye involvement, the pauciimmune necrotizing glomerulonephritis with crescent formation, E.N.T. and pulmonary involvement were diagnosed. The patient also suffered from the acute myocardial infarction, most likely due to coronal arteritis. In addition to the coronal ischaemia she also had vasculitis of the aortic valve due to the WG. Another rare complication was the massive intestinal bleeding. The patient had also a skin vasculitis and non-specific symptoms such as artralgias and fever. The correct diagnosis was supported by positive cANCA. A clinical and laboratory remission of the disease was achieved by combined immunosuppressive therapy. Subsequently, she developed a subglotic stenosis possibly due to reparative changes.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Adulto , Enfermedades de la Córnea/complicaciones , Femenino , Hemorragia Gastrointestinal/complicaciones , Granulomatosis con Poliangitis/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Enfermedades Pulmonares/complicaciones , Masculino , Infarto del Miocardio/complicacionesRESUMEN
We report three case reports of different, less frequent causes of thrombocytopenia--autoimmune thrombocytopenic purpura (AITP), thrombotic thrombocytopenic purpura (TTP) and heparin-induced thrombocytopenia (HIT). Pathophysiology of these conditions is also discussed. AITP is an autoimmune disorder characterized by destruction of thrombocytes by autoantibodies targeted to platelet antigens. The cause of thrombocytopenia in TTP is an endothelial disorder with subsequent formation of platelet aggregates. HIT type I is a frequent, mild form of thrombocytopenia caused by reversible aggregation of thrombocytes following to heparin administration. HIT type II is a late, more severe form of thrombocytopenia caused by immunologic mechanisms.
Asunto(s)
Púrpura Trombocitopénica Idiopática/diagnóstico , Púrpura Trombocitopénica Trombótica/diagnóstico , Trombocitopenia/inducido químicamente , Adulto , Anticoagulantes/efectos adversos , Femenino , Heparina/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Fcgamma receptors convey to phagocytic cells the ability to recognize, bind, and internalize IgG-coated cells and microorganisms. The present study demonstrates the use of adenovirus (Ad)-mediated gene transfer of human Fcgamma receptor IIA cDNA to convert normally nonphagocytic cells (hepatocytes) into functional equivalents of phagocytic cells. Ad vector in vitro transfer and expression of FcgammaRIIA cDNA in primary rat hepatocytes was confirmed by flow cytometry anti-FcgammaRIIA immunodetection, and the function of the receptor was demonstrated by enhanced binding and phagocytosis of (51)Cr-labeled IgG-opsonized erythrocytes. After in vivo gene transfer to rats, expression of FcgammaRIIA cDNA in hepatocytes was confirmed by Northern analysis and immunohistochemistry. Rats infected with the Ad vector carrying the FcgammaRIIA cDNA demonstrated enhanced clearance of opsonized erythrocytes, but not nonopsonized erythrocytes, from the circulation with increased sequestration within the liver. Together, these data demonstrate that Ad-mediated FcgammaRIIA gene transfer can convert normally IgG-nonphagocytic cells into phagocytic cells capable of recognizing, binding, and ingesting an opsonized particulate antigen, suggesting that gene transfer strategies might be used to transiently augment host defense by enhancing the clearance of immune complexes.
Asunto(s)
Antígenos CD/metabolismo , Eritrocitos/metabolismo , Hígado/fisiología , Fagocitosis , Receptores de IgG/metabolismo , Animales , Antígenos CD/genética , Células Cultivadas , ADN Complementario , Femenino , Técnicas de Transferencia de Gen , Hígado/citología , Ratas , Ratas Sprague-Dawley , Receptores de IgG/genéticaRESUMEN
Fcgamma receptors on the surface of phagocytic cells bind the Fc region of IgG and mediate binding, phagocytosis, and destruction of particulate antigens opsonized by the antigen-specific IgG molecule. The present study evaluates the feasibility of converting lung epithelial cells into phagocytic cells using adenovirus (Ad) vector-mediated gene transfer of FcgammaRIIA cDNA to induce expression of the human FcgammaRIIA receptor. Binding and phagocytosis of opsonized sheep red blood cells (SRBCs) by the A549 human lung epithelial cell line after Ad-mediated FcgammaRIIA gene transfer was demonstrated using light and fluorescence microscopy and phagocytic assays with (51)Cr-labeled SRBCs. When A549 cells were infected with an Ad vector expressing a FcgammaRIIA mutant in which 2 of 3 cytoplasmic tyrosines have been replaced with phenylalanine, only binding, but not phagocytosis, of opsonized SRBCs was observed. In vivo expression of FcgammaRIIA in the lung after intratracheal administration of the AdFcgammaRIIA enhanced clearance of opsonized Pseudomonas aeruginosa from the lung in normal rats and in mice deficient in Fcgamma receptor expression. Similar results were observed with a chimeric FcgammaRIIA construct containing the extracellular domain of FcgammaRIIIA. Together, these data demonstrate that Ad-mediated FcgammaRIIA receptor cDNA expression can mediate the binding and phagocytosis of opsonized particulate antigens by normally nonphagocytic cells, suggesting that gene-transfer strategies might be used to utilize nonphagocytic cells to clear bacteria or other opsonized particulate antigens from the respiratory tract.
Asunto(s)
Técnicas de Transferencia de Gen , Pulmón/inmunología , Pulmón/microbiología , Pseudomonas aeruginosa/inmunología , Receptores de IgG/genética , Animales , Línea Celular , ADN Complementario/genética , Células Epiteliales/inmunología , Células Epiteliales/microbiología , Eritrocitos/inmunología , Humanos , Pulmón/citología , Ratones , Proteínas Opsoninas , Fagocitos/inmunología , Fagocitosis , Pseudomonas aeruginosa/patogenicidad , Ratas , Receptores de IgG/deficiencia , OvinosRESUMEN
Currently, talc is the most effective and widely-used agent for chemical pleurodesis in the treatment of both malignant pleural effusion and pneumothorax. Its popularity has been growing due to the low incidence of side effects, low cost and higher success rate in comparison with other agents (tetracyclines, bleomycin, Corynebacterium parvum). The guidelines for talc pleurodesis are summarized and the history of the Corynebacterium parvum as an agent for chemical pleurodesis is mentioned. Its production in the Czech Republic has been halted due to the increased interest in the talc as a chemical sclerosant.
Asunto(s)
Derrame Pleural Maligno/terapia , Pleurodesia , Talco/administración & dosificación , Humanos , Pleurodesia/métodosRESUMEN
We present a case of AL-type amyloidosis involving pulmonary parenchyma and hilar and mediastinal lymph nodes in a patient with Waldenström's macroglobulinemia. Direct infiltration of pulmonary parenchyma by lymphocytes and plasma cells is an important factor in the etiology and pathogenesis of pulmonary manifestations of the disease. Despite detailed examination, we did not find amyloid depositions in any extrapulmonary site.
Asunto(s)
Amiloidosis/complicaciones , Enfermedades Pulmonares/complicaciones , Macroglobulinemia de Waldenström/complicaciones , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Using radioimmunoassay method the alpha-subunit of human chorionic gonadotropin (alpha-HCG) serum levels were measured in 112 bronchogenic carcinoma patients and in 48 patients with various non-cancerous lung diseases. The aim of this study was to assess the utility of alpha-HCG as a tumor marker for differential diagnosis of lung cancer. The incidence of elevated alpha-HCG serum level bronchogenic carcinoma group was 4.4%, in non-cancerous diseases group it was 4.1%, respectively. The difference between these two groups wasn't statistically significant. The elevation of the alpha-HCG was unrelated to the histologic type of lung cancer. The finding suggest that alpha-HCG serum level can't help in discriminating between patients with bronchogenic carcinoma and those with non-cancerous lung diseases.