RESUMEN
A 66-year-old female patient was treated for a posterior mediastinal tumour with unknown histology. During thoracotomy, repetitive hypertensive crises had to be treated. The tumour was completely resected. Pathology revealed an extra-adrenal pheochromocytoma. Diagnosis of pheochromocytoma is usually made on the basis of clinical presentation and elevated catecholamine levels in serum or urine. Imaging is used primarily for localizing tumours prior to surgery. Complete surgical excision is the primary treatment. The only absolute indicator of malignancy is the identification of distant metastases to bone, liver, lung or lymph nodes.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/patología , Mediastino , Feocromocitoma/patología , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Feocromocitoma/diagnóstico por imagen , Feocromocitoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Although the diagnosis of fat embolism syndrome is usually based on clinical findings, we describe ill-defined centrilobular and subpleural nodules in addition to ground-glass opacities and consolidation on a computed tomography scan of the chest in a trauma patient with fat embolism syndrome. The nodules presumably represent alveolar oedema, microhaemorrhage and an inflammatory response secondary to ischaemia and cytotoxic emboli in fat embolism syndrome. The literature of computed tomography findings in patients with fat embolism syndrome is reviewed and summarized.
Asunto(s)
Embolia Grasa/diagnóstico , Traumatismo Múltiple/complicaciones , Embolia Pulmonar/diagnóstico , Accidentes de Tránsito , Adolescente , Terapia Combinada , Cuidados Críticos/métodos , Embolia Grasa/etiología , Embolia Grasa/terapia , Servicio de Urgencia en Hospital , Femenino , Estudios de Seguimiento , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/cirugía , Embolia Pulmonar/etiología , Embolia Pulmonar/terapia , Radiografía Torácica , Medición de Riesgo , Índice de Severidad de la Enfermedad , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
Multiple myeloma (MM) is a malignant disease that results from an excess of monotypic plasma cells in the bone marrow (BM). This malignancy is characterised by complex karyotypic aberrancies. In 60% of all MM there are recurrent primary translocations involving the heavy chain gene locus. The MM cells strongly interact with the BM microenvironment, which is composed of endothelial cells, stromal cells, osteoclasts, osteoblasts, immune cells, fat cells and the extracellular matrix. This interaction is responsible for the specific homing in the BM, the proliferation and survival of the MM cells, the resistance of MM cells to chemotherapy, the development of osteolysis, immunodeficiency and anaemia. New therapeutic agents target both the MM, as well as the interaction MM cell - BM microenviroment.
Asunto(s)
Células de la Médula Ósea/fisiología , Mieloma Múltiple/metabolismo , Mieloma Múltiple/patología , Animales , Humanos , Mieloma Múltiple/epidemiología , Mieloma Múltiple/fisiopatologíaRESUMEN
The aim of the study was to compare the angiogenic status, potential qualitative differences in microvessels and carbonic anhydrase IX expression in bone-marrow (BM) metastases and different haematological tumours at time of diagnosis. The microvessel density (MVD), endothelial-cell proliferation (ECP) and carbonic anhydrase IX (CA IX) immunoreactivity were determined on 210 trephine biopsies from 57 patients with multiple myeloma (MM), 13 with acute myeloid leukaemia (AML), 48 with chronic myeloproliferative syndrome (CMPS), 26 with chronic lymphocytic leukaemia (CLL), 25 with epithelial BM metastases, 18 with monoclonal gammopathy of undetermined significance (MGUS) and from a control group composed of 23 patients without haematological neoplasm. There was an increased MVD and ECP in epithelial BM metastases, MM, AML, CMPS and in a part of CLL. While an ECP greater than 0 was detected in 72% of MM, 75% of CMPS and 92% of AML, it was invariably observed (100%) in the BM metastases. The absence of ECP together with a MVD comparable with the control group in our MGUS cases supports the view that MGUS is a pre-angiogenic condition. Qualitative differences in microvessels were associated with growth patterns in MM and CLL and were observed between the different entities of CMPS. In one-third of the epithelial BM metastases, there was a focal CA IX immunoreactivity, which was never observed in the haematological diseases.
Asunto(s)
Antígenos de Neoplasias/metabolismo , Neoplasias de la Médula Ósea/secundario , Anhidrasas Carbónicas/metabolismo , Endotelio Vascular/patología , Neoplasias Hematológicas/patología , Neovascularización Patológica/patología , Paraproteinemias/patología , Biomarcadores de Tumor/metabolismo , Biopsia , Neoplasias de la Médula Ósea/enzimología , Capilares/patología , Capilares/fisiopatología , Anhidrasa Carbónica IX , División Celular , Neoplasias Hematológicas/enzimología , Humanos , Inmunohistoquímica , Microcirculación , Paraproteinemias/enzimologíaRESUMEN
To investigate the antioxidant response of respiratory epithelium to the chronic airway inflammation in asthma, the major intracellular antioxidants [copper and zinc-containing superoxide dismutase (Cu,Zn-SOD) and manganese-containing SOD (Mn-SOD), catalase, and glutathione peroxidase] were quantitated in bronchial epithelial cells of healthy control and asthmatic individuals. Although catalase and glutathione peroxidase in bronchial epithelium of asthmatics were similar to control SOD activity in asthmatics not on inhaled corticosteroid (-CS) was lower than asthmatics on inhaled corticosteroid (+CS) and controls. Investigation of Mn-SOD and Cu,Zn-SOD activities revealed that the lower SOD activity in asthmatics -CS was because of decreased Cu,Zn-SOD activity. However, Mn-SOD and Cu,Zn-SOD mRNA and protein levels were similar among asthmatics -CS, asthmatics +CS, and controls. Importantly, Cu,Zn-SOD specific activity in asthmatics -CS was decreased in comparison with control and asthmatics +CS. Furthermore, in paired comparisons of asthmatics -CS and +CS, inhaled corticosteroids resulted in normalization of bronchial epithelial Cu,Zn-SOD specific activity. These findings suggest loss of Cu,Zn-SOD activity in asthma is related to inflammation, perhaps through oxidant inactivation of Cu,Zn-SOD protein.
Asunto(s)
Corticoesteroides/uso terapéutico , Asma/tratamiento farmacológico , Asma/enzimología , Bronquios/enzimología , Superóxido Dismutasa/metabolismo , Administración por Inhalación , Corticoesteroides/administración & dosificación , Adulto , Asma/patología , Bronquios/efectos de los fármacos , Bronquios/patología , Epitelio/efectos de los fármacos , Epitelio/enzimología , Epitelio/patología , Femenino , Expresión Génica , Humanos , Masculino , Oxidorreductasas/genética , Oxidorreductasas/metabolismo , Superóxido Dismutasa/genéticaRESUMEN
Nitric oxide (NO) is an important mediator of inflammatory responses in the lung and a key regulator of bronchomotor tone. An airway NO synthase (NOS; EC 1.14.13.39) has been proposed as a source of endogenous NO in the lung but has not been clearly defined. Through molecular cloning, we conclusively demonstrate that NO synthesis in normal human airways is due to the continuous expression of the inducible NOS (iNOS) isoform in airway epithelial cells. Although iNOS mRNA expression is abundant in airway epithelial cells, expression is not detected in other pulmonary cell types, indicating that airway epithelial cells are unique in the continuous pattern of iNOS expression in the lung. In situ analysis reveals all airway epithelial cell types express iNOS. However, removal of epithelial cells from the in vivo airway environment leads to rapid loss of iNOS expression, which suggests expression is dependent upon conditions and/or factors present in the airway. Quantitation of NOS activity in epithelial cell lysates indicates nanomolar levels of NO synthesis occur in vivo. Remarkably, the high-level iNOS expression is constant in airway epithelium of normal individuals over time. However, expression is strikingly decreased by inhaled corticosteroids and beta-adrenergic agonists, medications commonly used in treatment of inflammatory airway diseases. Based upon these findings, we propose that respiratory epithelial cells are key inflammatory cells in the airway, functioning in host defense and potentially playing a role in airway inflammation.