[Hematological changes in hyperthyroidism. A case report]

A case of microcytic anemia, leukopenia (with lymphocytic reduction prevalence) and light thrombocytopenia is reported. The case occurred to a 63-year old diabetic woman suffering from Basedow's disease. The thyropathy was diagnosed first and the patient did not undergo to any previous treatment with antithyroid agents. The bone marrow aspiration only showed slight dyserythropoietic notes, with slight reduction of myeloid-erythroid ratio. The blood cell indexes rapidly normalized as soon as euthyroidism was achieved by radioiodine therapy (I131, 4mCi), and this led to think there was a relationship between thyropathy and blood modifications. The patient was subsequently treated with levothyroxine because of the occurrence of a iatrogenic hypothyroidism. Two years later, during a follow-up, all the hematologic parameters were normal, as well as the serum concentration of thyroid hormones and TSH (during opotherapy). We report the hematologic alterations most frequently observed in hyperthyroidism and underline the peculiarity of this case as it shows the simultaneous alterations of different cellular lines in the same patient.

[Temporal arteritis associated with hyperthyroidism and complicated by angina pectoris. A case report]

A case of temporal arteritis is described in a woman of 67, affected by non insulin dependent diabetes mellitus, associated with polymyalgia rheumatica and complicated by angina pectoris. Angina, which appeared a few days after diagnosis, was coupled with electrocardiographic alterations, which did not seem sensitive to nitrates but went back when steroid at full dose was added. The patient was also affected by Basedow disease, which was present during the whole course of the vasculitis. Furthermore islet-cell antibodies (ICA) were present. HLA typing showed the presence of the B8, DR3 haplotype. The patient died after 22 months from the diagnosis of digestive hemorrhage, probably favoured by extended cortisone therapy, while signs of arteritis were still evident.

POEMS syndrome in a female Italian patient. A case report

POEMS syndrome is an uncommon association of polyneuropathy, organomegaly (liver, spleen, lymph nodes), endocrinopathy (hypogonadism primary hypothyroidism, diabetes mellitus, adrenal insufficiency), monoclonal gammopathy and skin changes; bone lesions (generally osteosclerotic, less frequently osteolytic or mixed) are nearly always present in this multisystem disease. We describe the first case of a female Italian patient with POEMS syndrome. Therapy with prednisone was of scant benefit and the patient died of cardiogenic shock some days after temporary pacemaker implantation, performed for recurrent episodes of bradycardia. From the beginning of steroid therapy she survived about fifteen months.

[Heart sarcoidosis. A case of mitral and ascending aorta involvement]

We describe a case of cardiac sarcoidosis manifested by arrhythmias, shock, chest pain, mitral valve prolapse and incompetence, aortic vascular involvement. Steroid therapy corrected shock and arrhythmias, but was unable to prevent the progression of the mitral valve insufficiency. Subsequently pulmonary and tricuspid valve incompetence were also observed.

[A comparative evaluation of tumor markers (TPA and CEA) in various malignant neoplasms at an advanced stage]

Radioimmunology was used to measure serum levels of CEA (carcinoembryonic antigen) in 108 patients with a variety of different advanced malignant neoplasms and in a control group of 60 healthy subjects. TPA proved more sensitive as a tumour marker than CEA, since increased TPA was found in 76% of the cancer cases compared to 42% for CEA. No significant increase in diagnostic sensitivity was obtained by using both markers rather than PTA alone.

[A case of thrombotic thrombocytopenic purpura]

Thrombocytopenic thrombotic purpura is a comparatively rare disease and little is known about its aetiopathogenesis. Once almost invariably negative, the prognosis has been changed by the introduction of plasmapheresis. A particularly complex clinical case is described and a number of conclusions are drawn from it: 1) there is no criterion for opting for any particular therapeutic approach; 2) evaluation of the clinical response is the only criterion for monitoring the effectiveness of ongoing treatment; 3) plasmapheresis is proposed as the treatment of choice; 4) vincristine is a useful alternative in the treatment of recalcitrant cases.

[2 clinical cases of hypopotassemia during treatment with indapamide]

Indapamide, an antihypertensive drug with diuretic and vasodilative effect, causes a reduction in plasmatic potassium concentration that is generally moderate and not such as to cause damages. In the present article two cases are described that showed severe changes due to hypokalaemia resulting from treatment with indapamide.

[2 cases of metabolic acidosis during therapy of portosystemic encephalopathy with branched-chain amino acids]

Two patients known to be suffering from liver cirrhosis were admitted to hospital in a state of coma. The apparent ineffectiveness of treatment with branched chain amino acids was found in reality to be due to the onset of metabolic acidosis. The suspension of treatment and balancing of the metabolic imbalance with an infusion of bicarbonate solutions led to lessening of the neurological symptomatology.