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Biomedical subjects

S J Vukelja

Publications and source records attributed to S J Vukelja.

At least 37 records · Page 2Linked to original sources
PubMed1992

Hypercoagulable states. Their causes and management.

Recognition of patients who should be evaluated for either hereditary or acquired hypercoagulable states is important so that treatment may be instituted if necessary to prevent thrombosis. Close attention to the medical history, medications, family history, and circumstantial risk factors can help identify patients at risk so that morbidity and mortality may be reduced. Patients with hereditary thrombosis should receive lifelong anticoagulation.

Blood Coagulation Disorders↗
PubMed1992

Nonbacterial thrombotic endocarditis clinically mimicking veno-occlusive disease of the liver complicating autologous bone marrow transplantation.

Nonbacterial thrombotic endocarditis is an uncommon, but well-described, complication of bone marrow transplantation. We describe a case of nonbacterial thrombotic endocarditis following autologous bone marrow transplantation that was marked by weight gain, hepatomegaly, ascites, and extreme hyperbilirubinemia leading to a clinical diagnosis of hepatic veno-occlusive disease. Autopsy revealed nonbacterial thrombotic endocarditis of the tricuspid and pulmonic valves, and passive congestion of the liver, but there was no evidence of veno-occlusive disease. We discuss the pathophysiology and clinical features of nonbacterial thrombotic endocarditis and review its occurrence in association with bone marrow transplantation. Nonbacterial thrombotic endocarditis is often difficult to detect clinically and should be a diagnostic consideration in patients who develop systemic emboli or congestive heart failure after bone marrow transplantation.

Bone Marrow Transplantation↗
PubMed1991

Hemophagocytic syndrome: a cause of pancytopenia in human ehrlichiosis.

A 67-year-old white man with human ehrlichiosis infection complicated by pancytopenia, hemophagocytic syndrome, disseminated intravascular coagulopathy and septic shock is presented. The patient had been on a three-week camping trip to California, Colorado, Utah, and New Mexico. The diagnosis of human ehrlichiosis was confirmed by sixteen-fold rise in antibody titer to Ehrlichia canis, and supported by the characteristic cytoplasmic inclusions. Human ehrlichiosis should be considered in the differential diagnosis in patients with fever and cytopenia associated with hemophagocytosis. Pancytopenia associated with ehrlichiosis is transient; however, it may be severe, and appears to be associated with destruction of normal blood elements.

Aged↗
PubMed1991

Unusual serpentine hyperpigmentation associated with 5-fluorouracil. Case report and review of cutaneous manifestations associated with systemic 5-fluorouracil.

A variety of cutaneous reactions have been reported with the use of systemic 5-fluorouracil. Our patient had serpentine hyperpigmented streaks appearing 5 days after bolus infusion of 5-fluorouracil. The patient also had other skin eruptions, that is, inflammation of actinic keratoses and folliculitis limited to the forehead; these reactions have been reported previously with 5-fluorouracil medication. We report this case and review the literature on skin manifestations associated with 5-fluorouracil therapy.

Adenocarcinoma↗
PubMed1991

Chemotherapy of disseminated Merkel-cell carcinoma.

Six patients developed metastatic merkel-cell carcinoma and were treated with a combination chemotherapy frequently used for small-cell lung cancer. Five of six patients had a complete response for a median of 3.5 months. Overall survival from initiation of chemotherapy was a median of 6.5 months. Two patients died from major complications of therapy.

Adult↗
PubMed1991

Angiofollicular lymph node hyperplasia and peripheral neuropathy. Case report and literature review.

A man with multicentric angiofollicular lymph node hyperplasia and a polyclonal gammopathy developed a debilitating sensory-motor peripheral neuropathy that resolved with plasma-pheresis and immunosuppressive therapy. Fourteen similar cases have been reported in the literature; however, to our knowledge, this is the first report of successful treatment with plasma-pheresis. Severe peripheral neuropathy usually occurs in the setting of multicentric, plasma cell-type disease with hypergammaglobulinemia and is often responsive to immunosuppressive therapy.

Aged↗
PubMed1991

Hemorrhagic subcutaneous bursitis.

Hemarthrosis is a well recognized complication of a number of conditions. Hemorrhagic subcutaneous bursitis is less understood. We encountered a patient with a myeloproliferative disease who developed hemorrhagic olecranon bursitis. Upon reviewing other patients with subcutaneous bursitis, we found that hemorrhagic bursitis also occurs in the setting of traumatic or idiopathic bursitis, rheumatoid arthritis, gout, and septic bursitis.

Bursitis↗
PubMed1991

Neurologic manifestations of vitamin B-12 deficiency in a military hospital.

Although it is well recognized that patients with cobalamin (vitamin B-12) deficiency can develop neuropsychiatric problems, primary care physicians do not frequently realize that patients presenting with only vague neurologic complaints can have vitamin B-12 deficiency as the etiology. During a 1-year period, six patients presented to the Neurology Clinic at Brooke Army Medical Center, Fort Sam Houston, Texas, after evaluation at the primary care level for their neurologic complaints. All six had cobalamin deficiency, and none were anemic. Military primary care physicians should be aware of the various neurologic presentations of these patients.

Aged↗
PubMed1990

Enlargement of mediastinal masses on simulation films: a radiotherapeutic problem in the management of patients with Hodgkin's disease.

The size of the mediastinal mass on standard posterior-anterior chest radiograph in stage I and stage II Hodgkin's disease has both prognostic and therapeutic importance. But the actual treatment is based on the anterior-posterior supine simulation film. Problems arise when the prognosis (whether all the disease can be effectively contained in an irradiation port) and toxicity (more lung and heart irradiated or chemotherapy required) are changed when the mass is markedly enlarged on the radiation simulation films. Differences in the direction of the X-ray beam, distance from the subject, and patient position are shown to increase artificially the size of a mediastinal mass on simulation films. The staging and therapeutic implications are discussed.

Adult↗
PubMed1990

Synchronous Hodgkin's disease and myelofibrosis terminating with granulocytic sarcoma and acute megakaryocytic leukemia.

Our patient had stage IIIAI Hodgkin's disease with synchronous myelofibrosis and myeloid metaplasia. A slowly progressive myeloproliferative disease developed over 9 1/2 years and terminated in a painful osteolytic bone disease, spinal extradural granulocytic sarcoma and acute megakaryocytic leukemia. It is likely that this was a result of the myeloproliferative disease rather than a late complication from combination chemotherapy. Our case demonstrates the importance of a curative approach to Hodgkin's disease even in the face of a coexistent disease with a long or unknown natural history.

Hodgkin Disease↗
PubMed1989

Resolution of pure red cell aplasia and lymphoma: response to intravenous gammaglobulin and combination chemotherapy.

Pure red cell aplasia (PRCA) rarely occurs in nonthymic lymphoproliferative disorders. This report describes the clinical course and therapy of a patient with a history of Sjogren syndrome who developed well-differentiated lymphocytic lymphoma associated with PRCA and severe hemolytic anemia. Life-threatening hemolytic anemia combined with the presence of multiple antibodies and lack of erythroid precursors was treated successfully with a single dose of intravenous gammaglobulin. A sustained, complete remission and normalization of the bone marrow was achieved following six courses of an aggressive chemotherapy regimen. Thus, occasionally low-grade lymphomas can produce life-threatening complications, requiring a more aggressive therapeutic intervention than those routinely applied.

Anemia, Hemolytic↗
PubMed1989

Testicular relapse in adult acute lymphocytic leukemia: a case report and literature review.

In the pediatric age group, acute lymphocytic leukemia (ALL) may involve the testicles during complete remission of the disease in the marrow. We report a case of testicular involvement with ALL in an adult and review 11 cases of this phenomenon reported previously, to draw attention to the fact that it can occur at any age. Recognition of this fact is important, because testicular involvement may be the first manifestation of systemic relapse. The treatment of choice is irradiation to both testicles and combination chemotherapy.

Adult↗
PubMed1989

Postoperative toxic shock syndrome: a case report and review of the literature.

Toxic shock syndrome is a rare and potentially lethal postoperative complication. The recognition of this disorder can be delayed by the fact that the offending wounds in postoperative toxic shock syndrome are classically benign in appearance. The infrequency with which this syndrome is encountered can also prolong the interval between the onset of symptoms and institution of effective therapy. A case of toxic shock syndrome complicating an abdominoplasty performed at the Plastic Surgery Service of Walter Reed Army Medical Center is presented, and the literature available on toxic shock syndrome in the postoperative patient is discussed.

Abdomen↗
PubMed1988

Eosinophilia associated with adult T-cell leukemia/lymphoma.

Eosinophilia is associated with a number of disorders including malignancies. A patient is described who had eosinophilia associated with adult T-cell leukemia/lymphoma (ATL) induced by human T-lymphotropic virus type I (HTLV-I). Both tissue and peripheral blood eosinophilia and high titers of HTLV-I antibody were present. The eosinophilia was most likely caused by the malignant cells producing one or more lymphokines. The patient has achieved a durable complete remission from combination chemotherapy. Because durable remissions in ATL are rare with any known therapy and eosinophilia has not previously been associated with ATL, it is possible that the tumor in this patient was derived from a T-cell subset not usually transformed by HTLV-I. ATL is another malignancy now known to cause eosinophilia.

Adult↗