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Biomedical subjects

P van Hengel

Publications and source records attributed to P van Hengel.

5 recordsLinked to original sources

Sarcoidosis mimicking metastatic disease: a case report and review of the literature.

Osseous and in particular vertebral sarcoidosis is exceedingly rare and a difficult diagnosis to establish because it may simulate many diseases, including even metastatic malignancy. we present a patient with lesions in bones, lungs and lymph nodes, mimicking the presence of extensive metastatic disease. our case emphasises the importance of histological evidence before the diagnosis of osseous sarcoidosis can be made with confidence.

Biopsy↗

Atypical carcinoid presenting as mesothelioma.

Two patients presented with pleuritic pain and dyspnoe together with pleural thickening on the X-ray of the chest. In both a history of exposure to asbestos existed suggesting mesothelioma. A definite diagnosis could not be made and therefore therapy was symptomatic. Autopsy revealed the unexpected diagnosis of atypical carcinoid of the lung. In one case, pleural spread of tumor was seen while in the other an extensive fibrotic pleural reaction existed. To our knowledge these cases represent the first examples of atypical carcinoid causing pseudomesothelioma.

Aged↗

Mannitol-induced acute renal failure.

Mannitol is widely used because of its osmotic diuretic action and its presumed antioxidant properties. In pre-existent renal dysfunction, however, mannitol may accumulate leading to potentially deleterious effects. We describe a 71-year-old woman with moderate chronic renal failure due to diabetic nephropathy who developed acute anuric renal failure after mannitol administration for post-traumatic reflex sympathetic dystrophy. After haemodialysis symptoms of acute renal failure rapidly disappeared with recovery of pre-existent renal function. Daily measurement of the osmolal gap as a simple and accurate way of monitoring patients receiving mannitol infusion is emphasized. A rapid increase in the osmolar gap should prompt adjustment of the dose or even discontinuation of mannitol, especially in the case of pre-existent risk factors.

Acute Kidney Injury↗

Development of pulmonary leukostasis in experimental myelocytic leukemia in the Brown-Norway rat.

The pathogenesis of pulmonary leukostasis in leukemia was studied in a rat model by investigating the course of its development. Leukemia was induced by inoculating rats with leukemic cells. The earliest stage of leukostasis was found from day 14 onward, when leukemic cells appeared in the peripheral blood, and was characterized by accumulation of leukemic cells at the capillary level. Simultaneous with the increase of leukemic cell concentrations in the peripheral blood, accumulation in capillaries increased gradually over a period of several days. This was accompanied by increasing severity of tachypnea. Shortly before death, aggregates consisting almost solely of leukemic cells were found in medium-sized blood vessels. This stage was rapidly followed by the end-stage, characterized by complete obstruction of the lung vasculature--including the largest arteries and veins--by leukemic cell aggregates, giving rise to extensive hemorrhages and edema. The end-stage was considered to be the cause of death, which occurred 18-26 days after the inoculation. The histological and ultrastructural findings in this study suggest that besides the size and stiffness of individual leukemic cells, interactions not only between leukemic cells, but also between leukemic cells and the endothelium play a role in the pathogenesis of pulmonary leukostasis.

Animals↗