Medical Blog - Part 7

Sjogren’s Syndrome with Multiple Bullae and Pulmonary Nodular AmyloidosisIt is well known that various pulmonary diseases may accompany Sjogren’s syndrome. We report the first case of Sjogren’s syndrome complicated by multiple bullae and pulmonary nodular amyloidosis. asthma inhalers
Case Report
A 53-year-old woman was admitted to our hospital with the chief complaints of cough and exertional dyspnea, which had appeared three years earlier and had steadily progressed. Multiple linear shadows and bullous change were presented on chest roentgenograms six years ago, but at that time, she did not have any pulmonary complaint. She also complained of dryness of the conjunctiva and mouth. The physical examination disclosed only slight crepitations on chest auscultation. Laboratory examination revealed polyclonal hypergammaglobulinemia (29.8 percent) without an M-component in serum or urine. The arterial oxygen pressure was 78.1 mm Hg. Pulmonary function tests indicated obstruction and a decreased diffusing capacity (VC, 2.32 L; FEV„ 1.01 L; FEV./FVC, 45 percent; RV/TLC, 43.8 percent; and Deo, 36 percent of predicted). The results of rose bengal and Schirmer’s tests, sialography, lip biopsy, and anti-SSB antibody testing confirmed the diagnosis of Sjogren’s syndrome.

Mucoepidermoid Carcinoma of the Lung with Intracranial Metastases: DiscussionMucoepidermoid carcinoma of the lung is a rare subtype of bronchial adenoma first described 35 years ago by Smetana et al. Although initially perceived to be a slow-growing neoplasm exhibiting local but not distant spread, dissemination was later described by Ozlu et al in 1961. Widespread metastases have since been described by many authors. Of μg previously reported cases with metastatic disease, most patients reported pulmonary symptoms, such as cough and hemoptysis, that antedated the diagnosis by several months to years. Physical examination, though infrequently described, revealed pulmonary abnormalities such as consolidation or wheezing, consistent with bronchial obstruction. The primary tumor was usually easily identified on the chest roentgenogram, and due to its frequent central location and airway origin, could be visualized and diagnosed by bronchoscopy in the majority of instances. Both lymphangitic and hematogenous routes of dissemination have been demonstrated. my canadian pharmacy online

Pathologic Findings
Gross inspection: Bilateral bullous pulmonary emphysema, particularly of the right upper lobe, was noted. Cross sections through the right upper lobe bronchus revealed mild thickening and narrowing of its first bifurcation. The mucosa overlying this stenotic portion was normal except for congestion and focal granularity The submucosa was expanded. Adjacent lobar lymph nodes and the interlobar, aorto-pulmonic and hilar lymph nodes were extensively involved with metastatic tumor (Fig 2). The neuropathologic examination revealed two well circumscribed metastatic lesions: a right, posterior, frontal lobe mass located 1 cm from the cortical surface, and a left subcortical, white matter mass in the region of the insula. There was extensive atherosclerosis, ischemic infarction of the small bowel, and evidence for a recent myocardial infarction. canadian drug mall

Mucoepidermoid Carcinoma of the Lung with Intracranial MetastasesBronchial adenomas are a group of rare tumors representing less than 1 percent of primary lung neoplasms. Of 298 bronchial adenomas reported from the Mayo Clinic in 1978, 89 percent were classified as carcinoid tumors, 6 percent as adenoid cystic carcinomas, and 4 percent as mucoepidermoid carcinomas. Approximately 100 cases of primary mucoepidermoid carcinoma of the lung have been reported since this subtype was first recognized by Smetana et al in 1952. Histologically, this neoplasm is characterized by the coexistence of epidermoid, mucus-producing, and intermediate tumor cells. As a disease entity, it is distinctive for the infrequency with which it occurs, its variable clinical expression, and the occasional discordance between the tumors histologic grade and biologic behavior. In the majority of reported cases, the tumor has remained localized to the bronchus of origin, although extrabronchial spread occurs in approximately 25 percent of the patients. Exceedingly uncommon are reports of central nervous system involvement. Autopsy demonstration of metastases to the dura mater was documented by Dowling et al in one patient. Turnbull and coworkers also reported three patients with brain metastases. The following is, to our knowledge, the first roentgenographic and post-mortem description of a patient with mucoepidermoid carcinoma of the lung who presented with intracranial metastases. canadian family pharmacy

Vagal fibers to the heart predominantly innervate the sinoatrial node, atrial musculature, and A^ node. Direct vagal stimulation leads to sinus bradycardia which is abolished by administration of atropine.6 Heart rate responses to the Valsalva maneuver in our patient suggested normally functioning vagal efferents to the heart. Electrophysiologic measurements indicated normal function of the conduction system. Thus, vomiting-induced cardiac slowing in our patient was possibly related to excessive stimulation of the vagal afferents from the upper gastrointestinal tract. canadian neightbor pharmacy

Recurrent Paroxysmal Complete Heart Block Induced by VomitingVomiting is a protective reflex stimulated mainly by afferents from the gastrointestinal tract. The efferent control of vomiting is via the vagi and sympathetic system. It is normally accompanied by slight tachycardia or bradycardia. Unlike swallowing, symptomatic disturbances of cardiac rhythm have not been well documented with vomiting. buy antibiotics online
Case Report
A 52-year-old woman, who was otherwise in good health, was admitted following a fainting episode during vomiting which occurred after moderate alcohol intake. While being monitored in the casualty department, she again vomited and felt faint, and it was noticed that she developed transient complete AV block. She admitted to episodes of loss of consciousness, all associated with vomiting, since the age of 10 to 12 years. On admission, detailed clinical examination, including physical examination of the cardiovascular and nervous systems, chest x-ray film, and 12-lead electrocardiogram, did not disclose any abnormality.

Aspergillus spores are ubiquitous and are the most frequently found fungus in the environment. Increased concentrations of spores have been noted in winter months. Pathogenicity of the Aspergillus species has to do with properties of the spores; namely their light weight, thick walls and small size which allow for their growth in terminal bronchioles. Host predisposing factors are most often related to the presence of underlying pulmonary disease such as asthma, possibly cystic fibrosis, old tuberculous cavitary disease, and/or to alterations in immune function such as in chronic granulomatous disease or neoplasia. In acute leukemia, invasive pulmonary aspergillosis classically occurs in the setting of prolonged granulocytopenia and often presents with unremitting fever and development of pulmonary infiltrates in the face of antibiotic therapy. contraceptive pills

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