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P0327 PURIFICATION AND PARTIAL CHARACTERIZATION OF PROCOAGULANT FACTOR (FACTOR V ACTIVATOR FROM IRANIAN VIPERA LEBETINA)
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 (AML) is 3,7/100000 people per year and is higher in men than in women. Approximately 10% of these patients have a skin involvement. Case report: We report a case of a 78-years-old man with coronary heart disease who presented fatigue and a florid, nonpruritic, nonblanching, maculopapular erythematous skin eruption developed on the patient’s anterior chest wall from the last 2 months. History taking and physical examination revealed no abnormal findings. The man was followed up and blood test, cutaneous biopsy, bone marrow aspiration and bone biopsy were performed. The blood test revealed pancytopenia and the bone marrow aspiration was normal. The cutaneous biopsy revealed a diffuse infiltration suggestive of cutaneous manifestation of AML. Conventional induction chemotherapy was performed but the patient died two months later. Conclusion: Sixty to 85% of the patients with AML have a complete remission of the disease with chemotherapy and the 5-years survival rates approach 10 to 30%. It is very important to make the diagnosis quickly in order to start the treatment as soon as possible.
P0325 CANCER:EASY TO SEE BUT HARD TO FIND
Monica Levy, Paula Augusto, Raquel Nazareth, João Pacheco Pereira, Francisco Da Silva, José Pimenta Da Graça. Hospital Egas Moniz Approximately 20 percent (%) of patients have distant metastatic disease at the time of presentation. The incidence of bone metastases in colorectal cancer is small, generally less than 10%. A 63 years old man, resident in Mozambique, was hospitalized with rectal bleeding, fatigue, weight loss of 10kg over the previous 3 months. He had a recent history of malaria treated with Artesiance and back pain medicated with diclofenac and prednisone. Physical examination showed a blood pressure of 150/84 mmHg, pallor, pethequiae in the lower legs, sub-icteric sclera. The results of laboratory studies were as follows: hemoglobin, 7.3 g/dL, white blood cells, 6.8×109 /L; with normal differential count, platelets, 17×109 /L, mean corpuscular volume, 85,7fL, LDH, 5.253UI/L, total bilirrubin, 1.46mg/dL (unconjugated bilirrubin elevated); thick blood smear for plasmodium was negative, alanine aminotransferases, 79UI/L; negative serology to HIV1. Peripheral blood smear showed schistocytes, suggesting hemolytic anemia. Direct and indirect Coombs test and anti-platelets antibodies were negatives. Abdominal ultra-sound revealed:”enlarged spleen (∼14cm), normal liver”. Lumbar and sacral spine CT showed: “diffuse infiltration of lumbar and sacral vertebraes by lytic lesions, pathological fracture of L4”. The bone marrow aspirate and biopsy histology was compatible with colon adenocarcinoma metastasis, Ck20+; CK7-;PSA-. Thoracic, abdominal and pelvic CT identified “exuberant thining of the rectosigmoidal transition, suggesting stenosant lesion”. The patient clinical condition (anemia, thrombocytopenia, with frequent blood transfusions) didn’t allow systemic therapy or radiotherapy. Palliative measures were instituted. This case shows a very rare clinical manifestation of colon cancer in which microangiopathic hemolytic anemia and thrombocytopenia were present, secondary to bone marrow metastasis, in the absence of liver dissemination.
Hematology
S113
giving rise to thought of multiple myeloma.Lambda monoclonal gammapathy in the serum immunofixation electrophoresis, lambda light chain band in the urine immunofixation electrophoresis were found. Bone marrow biopsy was performed to confirm the diagnosis of multiple myeloma. %55 atypic plasma cells were found in the BM biopsy. Also the right pleural effusion was aspirated. Pleural effusion protein level was detected high (114 gr/L). Pleural immunofixation electrophoresis was compatible with IgG lambda paraproteinemia. Pleural effusion IgG level was 106 gr/L, meaning, pleural involvement of multiple myeloma. We diagnosed the myelomatous involvement with IgG monoclonal gammapathy in the electrophoresis. Discussion & conclusion: Pleural myelomatotic involvement is diagnosed by one of the three criterias. The first criteria is the monoclonal gammapathy shown by electrophoresis of the pleural fluid. The second criteria is the atypic plasmacytes depicted in the pleural fluid cytology. The third one is pleural biopsy demonstrating histological myelomatous involvement. Myelomatous pleural effusion is seen very rarely. We diagnosed multiple myeloma in a patient applying to our clinic with pleural effusion and no significant diagnosis before. We chose this patient as a case report. Because myelomatous pleural involvement of multiple myeloma is seen occasionally. Our patient had rightsided pleural effusion with IgG lambda monoclonal gammapathy despite the the fact that left-sided effusions and IgA-type myelomatous involvement are the most commonly seen ones. Keywords: Multiple Myeloma, Pleural effusion
P0327 PURIFICATION AND PARTIAL CHARACTERIZATION OF PROCOAGULANT FACTOR (FACTOR V ACTIVATOR FROM IRANIAN VIPERA LEBETINA)
Zohreh Amoozgari 1 , Abbas Zare 2 , Mozhgan Noor Behbahani 1 . 1 Dept. of Biochemistry, Faculty of Medicine, Ahwaz Jundishapour University of Medical Sciences, Iran; 2 Razi, Vaccine Serum Institute, Tehran, Iran Introduction: The Venom of many viperidae snakes appeared to contain proteins that affect blood coagulation. Vipera lebetina is one of the poisonous snakes of Iran. Its venom has been found to have potent effects on coagulation, through both pro and anticoagulant mechanisms of blood coagulation. Factor V is a single chain glycoprotein which plays an important role in procoagulant and anticoagulant pathways. Thrombin activates factor V in to factor Va. Factor V can also be activated by a wide variety of snake venoms. Material and methods: Our studies of the Iranian vipera lebetina venom have demonstrated the existence of both coagulant and anticoagulant effects of heamostasis system. Further analysis by purified systems, it was demonstrated that this venom contain factor V activation activity. The factor V activator present in the venom was sepatrated by gel filtration on sephadex G-100 followsd by ion exchange chromatography on DEAE cellulose and affinity chromatography on heparin agarose Results and conclusion: It was shown that a single protein band in sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) under nonreducing conditions. The molecular weight was estimated to be 29KDa by SDS PAGE. This compound activated factor V to VA in the presence of calcium ions. It had arginine esterase activity toward substrate BAEE (Benzoyl arginine ethylester). It also had weak amidase activity on S-2222 (benzoyl Arg nitroanilide). Keywords: Factor V activity, coagulant and anticoagulant, snake venom vipera lebetina.
P0326 PLEURAL INVOLVEMENT OF MULTIPLE MYELOMA WITH ELEVATED IMMUNOGLOBULIN G: A CASE REPORT 1
1
1
P0328 2
Engin Sennaroglu , Sibel Ureyen , Narin Imga , Cagin Mustafa Ureyen , Fatih Yildiz 1 , Cumali Efe 1 , Hasan Tunca 1 . 1 Ankara Numune Education and Research Hospital Department of 4 Internal Medicine; 2 Ankara Numune Education and Research Hospital Department of Cardiology Introduction: Multiple myeloma is the malign proliferation of plasma cells leading to bone pain, pathological bone fractures, renal failure, infections, anemia, hypercalcemia, coagulation disorders and hyperviscosity syndrome. A 44 years old male patient was admitted to our clinic for management of high fever, epistaxis, hematuria and one month lasting unilateral pleural effusion.The findings of the patient were elevated erythrocyte sedimentation rate, anemia, rouleau formation in peripheral smear, hypercalcemia, elevated total protein level, hypoalbuminemia, hematuria, low serum immunoglobulin levels, elevated serum BUN and creatinine levels, lytic lesion on the 6th thoracal vertebra and monoclonal gammapathy in serum protein electrophoresis,
SAME PRESENTATION, DIFFERENT DISEASES
Teresa Amaral, Ana Gonçalves, Victor Ramalhinho. Centro Hospitalar Lisbo Norte, Hospital De Santa Maria Introduction: Although we always learn that the different symptoms in the same patient should be connected to one single disease, sometimes patients get to surprise us, and they actually have more than one medical condition. Here we present a clinical case in which a common disease can easily be mistaken with another common disease, if we don’t think outside the box. B.E.L. male Caucasian, 76 years old presents to the emergency department with non-specific complains of asthenia and anorexia for the last two weeks. The patient also referred diffuse bone and joint pain. It was not possible to determine the exact time when these symptoms began. He has a personal medical history of prostatic cancer operated 9 years ago, under hormonotherapy, arterial hypertension, chronic anaemia, renal insufficiency grade 1 and obesity.
P0325 CANCER:EASY TO SEE BUT HARD TO FIND
Monica Levy, Paula Augusto, Raquel Nazareth, João Pacheco Pereira, Francisco Da Silva, José Pimenta Da Graça. Hospital Egas Moniz Approximately 20 percent (%) of patients have distant metastatic disease at the time of presentation. The incidence of bone metastases in colorectal cancer is small, generally less than 10%. A 63 years old man, resident in Mozambique, was hospitalized with rectal bleeding, fatigue, weight loss of 10kg over the previous 3 months. He had a recent history of malaria treated with Artesiance and back pain medicated with diclofenac and prednisone. Physical examination showed a blood pressure of 150/84 mmHg, pallor, pethequiae in the lower legs, sub-icteric sclera. The results of laboratory studies were as follows: hemoglobin, 7.3 g/dL, white blood cells, 6.8×109 /L; with normal differential count, platelets, 17×109 /L, mean corpuscular volume, 85,7fL, LDH, 5.253UI/L, total bilirrubin, 1.46mg/dL (unconjugated bilirrubin elevated); thick blood smear for plasmodium was negative, alanine aminotransferases, 79UI/L; negative serology to HIV1. Peripheral blood smear showed schistocytes, suggesting hemolytic anemia. Direct and indirect Coombs test and anti-platelets antibodies were negatives. Abdominal ultra-sound revealed:”enlarged spleen (∼14cm), normal liver”. Lumbar and sacral spine CT showed: “diffuse infiltration of lumbar and sacral vertebraes by lytic lesions, pathological fracture of L4”. The bone marrow aspirate and biopsy histology was compatible with colon adenocarcinoma metastasis, Ck20+; CK7-;PSA-. Thoracic, abdominal and pelvic CT identified “exuberant thining of the rectosigmoidal transition, suggesting stenosant lesion”. The patient clinical condition (anemia, thrombocytopenia, with frequent blood transfusions) didn’t allow systemic therapy or radiotherapy. Palliative measures were instituted. This case shows a very rare clinical manifestation of colon cancer in which microangiopathic hemolytic anemia and thrombocytopenia were present, secondary to bone marrow metastasis, in the absence of liver dissemination.
Hematology
S113
giving rise to thought of multiple myeloma.Lambda monoclonal gammapathy in the serum immunofixation electrophoresis, lambda light chain band in the urine immunofixation electrophoresis were found. Bone marrow biopsy was performed to confirm the diagnosis of multiple myeloma. %55 atypic plasma cells were found in the BM biopsy. Also the right pleural effusion was aspirated. Pleural effusion protein level was detected high (114 gr/L). Pleural immunofixation electrophoresis was compatible with IgG lambda paraproteinemia. Pleural effusion IgG level was 106 gr/L, meaning, pleural involvement of multiple myeloma. We diagnosed the myelomatous involvement with IgG monoclonal gammapathy in the electrophoresis. Discussion & conclusion: Pleural myelomatotic involvement is diagnosed by one of the three criterias. The first criteria is the monoclonal gammapathy shown by electrophoresis of the pleural fluid. The second criteria is the atypic plasmacytes depicted in the pleural fluid cytology. The third one is pleural biopsy demonstrating histological myelomatous involvement. Myelomatous pleural effusion is seen very rarely. We diagnosed multiple myeloma in a patient applying to our clinic with pleural effusion and no significant diagnosis before. We chose this patient as a case report. Because myelomatous pleural involvement of multiple myeloma is seen occasionally. Our patient had rightsided pleural effusion with IgG lambda monoclonal gammapathy despite the the fact that left-sided effusions and IgA-type myelomatous involvement are the most commonly seen ones. Keywords: Multiple Myeloma, Pleural effusion
P0327 PURIFICATION AND PARTIAL CHARACTERIZATION OF PROCOAGULANT FACTOR (FACTOR V ACTIVATOR FROM IRANIAN VIPERA LEBETINA)
Zohreh Amoozgari 1 , Abbas Zare 2 , Mozhgan Noor Behbahani 1 . 1 Dept. of Biochemistry, Faculty of Medicine, Ahwaz Jundishapour University of Medical Sciences, Iran; 2 Razi, Vaccine Serum Institute, Tehran, Iran Introduction: The Venom of many viperidae snakes appeared to contain proteins that affect blood coagulation. Vipera lebetina is one of the poisonous snakes of Iran. Its venom has been found to have potent effects on coagulation, through both pro and anticoagulant mechanisms of blood coagulation. Factor V is a single chain glycoprotein which plays an important role in procoagulant and anticoagulant pathways. Thrombin activates factor V in to factor Va. Factor V can also be activated by a wide variety of snake venoms. Material and methods: Our studies of the Iranian vipera lebetina venom have demonstrated the existence of both coagulant and anticoagulant effects of heamostasis system. Further analysis by purified systems, it was demonstrated that this venom contain factor V activation activity. The factor V activator present in the venom was sepatrated by gel filtration on sephadex G-100 followsd by ion exchange chromatography on DEAE cellulose and affinity chromatography on heparin agarose Results and conclusion: It was shown that a single protein band in sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) under nonreducing conditions. The molecular weight was estimated to be 29KDa by SDS PAGE. This compound activated factor V to VA in the presence of calcium ions. It had arginine esterase activity toward substrate BAEE (Benzoyl arginine ethylester). It also had weak amidase activity on S-2222 (benzoyl Arg nitroanilide). Keywords: Factor V activity, coagulant and anticoagulant, snake venom vipera lebetina.
P0326 PLEURAL INVOLVEMENT OF MULTIPLE MYELOMA WITH ELEVATED IMMUNOGLOBULIN G: A CASE REPORT 1
1
1
P0328 2
Engin Sennaroglu , Sibel Ureyen , Narin Imga , Cagin Mustafa Ureyen , Fatih Yildiz 1 , Cumali Efe 1 , Hasan Tunca 1 . 1 Ankara Numune Education and Research Hospital Department of 4 Internal Medicine; 2 Ankara Numune Education and Research Hospital Department of Cardiology Introduction: Multiple myeloma is the malign proliferation of plasma cells leading to bone pain, pathological bone fractures, renal failure, infections, anemia, hypercalcemia, coagulation disorders and hyperviscosity syndrome. A 44 years old male patient was admitted to our clinic for management of high fever, epistaxis, hematuria and one month lasting unilateral pleural effusion.The findings of the patient were elevated erythrocyte sedimentation rate, anemia, rouleau formation in peripheral smear, hypercalcemia, elevated total protein level, hypoalbuminemia, hematuria, low serum immunoglobulin levels, elevated serum BUN and creatinine levels, lytic lesion on the 6th thoracal vertebra and monoclonal gammapathy in serum protein electrophoresis,
SAME PRESENTATION, DIFFERENT DISEASES
Teresa Amaral, Ana Gonçalves, Victor Ramalhinho. Centro Hospitalar Lisbo Norte, Hospital De Santa Maria Introduction: Although we always learn that the different symptoms in the same patient should be connected to one single disease, sometimes patients get to surprise us, and they actually have more than one medical condition. Here we present a clinical case in which a common disease can easily be mistaken with another common disease, if we don’t think outside the box. B.E.L. male Caucasian, 76 years old presents to the emergency department with non-specific complains of asthenia and anorexia for the last two weeks. The patient also referred diffuse bone and joint pain. It was not possible to determine the exact time when these symptoms began. He has a personal medical history of prostatic cancer operated 9 years ago, under hormonotherapy, arterial hypertension, chronic anaemia, renal insufficiency grade 1 and obesity.