Biomedical subjects
Publications and source records attributed to C E de Maat.
A 71-year-old woman presented with a rapidly growing goitre which was diagnosed as chronic autoimmune thyroiditis. Despite treatment with levothyroxine, she developed progressive airway obstruction. Biopsy revealed a primary thyroid lymphoma which was successfully treated with radiotherapy.
A 45-year-old Caucasian woman presented with superficial thrombophlebitis of the right arm and right anterior thoracic wall after bilateral breast surgery followed by spontaneous left anterior thoracic vein thrombophlebitis 3 months later. Besides breast surgery and use of oral contraceptives, hereditary protein C deficiency and anticardiolipin antibodies were found as causes for this bilateral Mondor's disease.
Kikuchi's lymphadenitis was first recognized almost 25 years ago in Japan as a histopathologically specific reactive lymphadenitis without clear clinical correlates. The benign self-limiting clinical course and the notorious danger of misdiagnosis as malignant lymphoma together make it important to recognize this lymph node reaction type. We describe 2 typical case histories-young women with a cervical localisation.
Patients with prosthetic cardiac valves have an increased risk of developing bacterial endocarditis. The causative micro-organism in bacterial endocarditis may be a guide to the portal of entry. In this case report, we describe a patient with a prosthetic cardiac valve who suffered from recurrent endocarditis with different micro-organisms from the gastrointestinal tract.
In two patients, a man aged 55 years (patient A) and a man aged 67 years (patient B), severe immediate (type I) and severe delayed (type IV) local reactions to injections of human insulin, respectively, were diagnosed. There had been no previous treatment with insulin of animal origin. The diagnosis of type I allergy was based on the typical early local reaction with biphasic course, the positive immediate skin test and the raised specific IgE level against insulin. The diagnosis of type IV allergy was based on the characteristic late local reaction after 12 hrs, the delayed positive skin test and the negative specific IgE. The first attempt to desensitise patient A in 10 days was not successful, but he was desensitised successfully in 25 days. Patient B recovered spontaneously.
The development is described of a massive right pleural effusion in a patient with alcoholic cirrhosis of the liver and alcoholic hepatitis, but without ascites. The literature is reviewed.
Two case reports are presented of adrenal insufficiency due to bilateral adrenal haemorrhage following surgery. This unusual complication with its non-specific manifestations may result in unexpected clinical deterioration of the postoperative patient. Corticosteroid replacement and repletion of sodium and water deficits should be given promptly when adrenal haemorrhage is suspected.
Foetal heart block occurred in the second pregnancy of an apparently healthy 23-yr-old woman. Her mother and sister were known for 10 yr with hypergammaglobulinaemia which was due to a disproportionate polyclonal elevation of serum IgG1 and with a high titre of rheumatoid factors. No associated disease was obvious. A third-trimester foetal death had occurred with each of these patients. In the sera of these three women circulating anti-SS-A (Ro) antibodies were detected, which are known to be associated with congenital heart block. IgG subclass imbalance, consisting of a disproportionate polyclonal elevation of IgG1, has been recognised as being associated with a characteristic autoantibody pattern. Familial occurrence of this syndrome as such has hitherto not been reported.
A 79-yr-old man was known for a year with a deteriorating clinical condition, vague abdominal complaints and an elevated erythrocyte sedimentation rate; he was afebrile. Extensive evaluation revealed no cause for his progressive disease. Eventually an infected aneurysm of the abdominal aorta was diagnosed, from which Listeria monocytogenes was cultured. After resection of the aneurysm the patient recovered initially very well. Regrettably, therapy-resistant chylous ascites developed, and the patient died due to surgical complications following a second laparotomy. Infected aortic aneurysms can present as an insidious disease, which may have catastrophic consequences if undiagnosed. A high index of suspicion is required to make a correct diagnosis. L. monocytogenes is an emerging, food-borne pathogen that can cause a wide spectrum of human diseases.
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Purulent meningitis was diagnosed in a 75-yr-old splenectomised woman nine days after a dog bite. The original wound was apparently uninflamed. The causative microorganism proved to be a dysgonic fermenter 2 (DF-2) bacterium (renamed Capnocythophaga canimorsus). This is a recently recognised Gram-negative bacterium, belonging to the normal canine mouth flora, to which asplenic individuals seem to be particularly susceptible.
We report the case of a young adult who visited us because of thrombocytopenia and bleeding, clinically and cytologically compatible with autoimmune thrombocytopenic purpura (AITP). He was seropositive for HIV-1 and therefore HIV associated thrombocytopenia was diagnosed. Recent insights in the pathogenesis of this novel disease entity are discussed. The treatment is the classical AITP therapy. It is important, however, to refrain from therapy as long as possible, since a significant part of these patients improve spontaneously. We conclude that HIV associated thrombocytopenia will be increasingly important in the differential diagnosis of bleeding disorders.
A case is reported of pericardial fibrosis after busulfan treatment in a man with chronic myeloid leukaemia. In the absence of any other explanation, we assume that busulfan may have been the cause of pericardial fibrosis in this patient. Other drugs causing pericardial fibrosis are discussed.
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