[Neurology and somatic medicine].
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Therapeutic plasma exchange has been used in a wide range of disorders in which circulatory macromolecules are thought to be pathogenic. In this review, we discuss briefly the practical aspects of the procedure, and consider the evidence for its benefit.
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Recent medical advances have greatly improved the prognosis for people who sustain spinal cord injury (about 10 000 people initially survive spinal cord injury each year in the US). Physicians may become involved with the acute care of spinal cord injured persons or care for complications which develop later. Certain conditions such as heterotopic bone formation and autonomic dysreflexia are seen almost exclusively in this group of patients; other complications such as urinary tract and soft tissue infections occur quite often. Common medical complications of spinal cord injured persons are reviewed, as well as their diagnosis and treatment.
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Neoplasms can produce a variety of remote effects on the host; these are referred to as paraneoplastic syndromes. The syndromes may affect any of the systems of the body, may precede or follow the diagnosis of the underlying neoplasm, and may or may not parallel the course of the neoplasm in severity. The diagnosis of and therapy for these syndromes can be challenging to a physician, but successful therapy may bring about worthwhile relief for the patient. In addition, the syndromes and the substances that cause them are sometimes useful in diagnosing and in following the course of certain neoplasms. Perhaps of greater importance, study of these remote effects of neoplasia may shed light on the nature of the neoplastic process itself.
The authors report a case of urticaria pigmentosa with systemic mastocytosis and review the literature on this occasion. The onset of the disease was marked by the development of ascites. Ascites is rarely mentioned in this affection and remains, as with other manifestations of systemic mastocytosis, without any explanation. The diagnosis was established first on the diffuse mastocyte-infiltration especially in the bone-marrow and second, on the hypersecretion of hormonal factors especially histamine by mastocytes. The symptomatic treatment of this affection is based on histamine inhibitors and disodium cromoglycate seems to be an efficient drug. With the possible development of acute leukemia, the eventual association with a carcinoma and the frequency of serious digestive bleeding, the prognosis may be very poor.