- Email: [email protected]
Indomethacin-associated acute renal failure
lndomethacln
Proteinuria
Ectopic ACTH Uterine cervix Small cell carcinoma Cervical carcinoma
Platelet aggregation
Corticosteroid therapy
Rheumatoid factor
Monoclonal IgA
Described are the clinical and laboratory features of a patient with an idiopathic hyperviscosity syndrome attributable to large amounts of intermediate-sedimenting (-14s) immunoglobulin-anti-immuncglobulin immune complexes. The immunoglobulinwith rheumatoid factor activity was isolated and identified as a monomeric (7s) monoclonal IgAK protein; the immune complexes consisted of this IgA protein plus polyclonal IgG. No high molecular weight (>22S) serum proteins were evident by ultracentrifugation or gel filtration analyses, and the viscous nature of the intermediate-sedimenting immune complexes was demonstrated in vitro. The serum concentrations of the monoclonal IgA protein and the IgA-IgG immune complexes were reduced by plasmaphereses and cyclophosphamide therapy. This resporise was associated with decreased serum viscosity and marked clinical improvement.
Kosaka M. Solomon A: Hyperviscosity syndrome associated with an idiopathic monoclonal IgA-rheumatoid factor. Am J Med 1980; 69: 145-154.
Hyperviscosity syndrome
A 79 year old white woman presented with a severe bleeding disorder. Evaluation revealed a prothrombin time of 27.6 seconds (control, 11 seconds) and an activated partial thromboplastin time of 61 seconds. Specific clotting factor assays showed an isolated deficiency of factor X ranging from 7 to 12 per cent on three determinations. Platelet aggregation and bleeding time were also abnormal in response to epinephrine and collagen. Factor X levels and platelet aggregation returned to normal and bleeding stopped after institution of corticosteroid therapy.
Edgin RA, Metz EN, Fromkes JJ, Beman FM: Acquired factor X deficiency with associated defects in platelet aggregation: a response to corticosteroid therapy. Am J Med 1980;69: 137-139.
Factor X deficiency
Continued on puge A54
In a 28 year old woman Cushing’s syndrome developed from a small cell carcinoma of the uterine cervix. Ectopic ACTH production was demonstrated clinically and by immunohistochemical studies. Two previously reported cases are discussed and compared to the present case. It is suggested that some small cell carcinomas of the cervix may be biologically different from keratinizing and large cell nonkeratinizing carcinomas and that they may represent an example of tumors arising from the APUD series. It is further proposed that ectopic hormone production,the production of abnormal peptides or of vasoactive amines, may be more common in small cell carcinoma of the cervix than is currently recognized. In tumors of this type, these may serve as tumor markers and should be actively sought.
Lojek MA, Fer MF, Kasselberg AG, Glick AD, Burnett LS, Julian CG. Greco FA, Oldham RK: Cushing’s syndrome with small cell carcinoma of the uterine cervix. Am J Med 1980; 69: 140-144.
Oat cell carcinoma
Ectopic hormone
A 61 year old man experienced oliguric acute renal failure during therapy with indomethacin. Proteinuria (5.1 g/24 hours) and hypertension, which accompanied renal insufficiency, cleared with recovery of function. These features may suggest drug-associated acute kidney failure.
Gary NE, Dodelson R, Eisinger RP: Indomethacin-associated acute renal failure. Am J Med 1980; 69: 135-136.
Acute renal failure
Proteinuria
Ectopic ACTH Uterine cervix Small cell carcinoma Cervical carcinoma
Platelet aggregation
Corticosteroid therapy
Rheumatoid factor
Monoclonal IgA
Described are the clinical and laboratory features of a patient with an idiopathic hyperviscosity syndrome attributable to large amounts of intermediate-sedimenting (-14s) immunoglobulin-anti-immuncglobulin immune complexes. The immunoglobulinwith rheumatoid factor activity was isolated and identified as a monomeric (7s) monoclonal IgAK protein; the immune complexes consisted of this IgA protein plus polyclonal IgG. No high molecular weight (>22S) serum proteins were evident by ultracentrifugation or gel filtration analyses, and the viscous nature of the intermediate-sedimenting immune complexes was demonstrated in vitro. The serum concentrations of the monoclonal IgA protein and the IgA-IgG immune complexes were reduced by plasmaphereses and cyclophosphamide therapy. This resporise was associated with decreased serum viscosity and marked clinical improvement.
Kosaka M. Solomon A: Hyperviscosity syndrome associated with an idiopathic monoclonal IgA-rheumatoid factor. Am J Med 1980; 69: 145-154.
Hyperviscosity syndrome
A 79 year old white woman presented with a severe bleeding disorder. Evaluation revealed a prothrombin time of 27.6 seconds (control, 11 seconds) and an activated partial thromboplastin time of 61 seconds. Specific clotting factor assays showed an isolated deficiency of factor X ranging from 7 to 12 per cent on three determinations. Platelet aggregation and bleeding time were also abnormal in response to epinephrine and collagen. Factor X levels and platelet aggregation returned to normal and bleeding stopped after institution of corticosteroid therapy.
Edgin RA, Metz EN, Fromkes JJ, Beman FM: Acquired factor X deficiency with associated defects in platelet aggregation: a response to corticosteroid therapy. Am J Med 1980;69: 137-139.
Factor X deficiency
Continued on puge A54
In a 28 year old woman Cushing’s syndrome developed from a small cell carcinoma of the uterine cervix. Ectopic ACTH production was demonstrated clinically and by immunohistochemical studies. Two previously reported cases are discussed and compared to the present case. It is suggested that some small cell carcinomas of the cervix may be biologically different from keratinizing and large cell nonkeratinizing carcinomas and that they may represent an example of tumors arising from the APUD series. It is further proposed that ectopic hormone production,the production of abnormal peptides or of vasoactive amines, may be more common in small cell carcinoma of the cervix than is currently recognized. In tumors of this type, these may serve as tumor markers and should be actively sought.
Lojek MA, Fer MF, Kasselberg AG, Glick AD, Burnett LS, Julian CG. Greco FA, Oldham RK: Cushing’s syndrome with small cell carcinoma of the uterine cervix. Am J Med 1980; 69: 140-144.
Oat cell carcinoma
Ectopic hormone
A 61 year old man experienced oliguric acute renal failure during therapy with indomethacin. Proteinuria (5.1 g/24 hours) and hypertension, which accompanied renal insufficiency, cleared with recovery of function. These features may suggest drug-associated acute kidney failure.
Gary NE, Dodelson R, Eisinger RP: Indomethacin-associated acute renal failure. Am J Med 1980; 69: 135-136.
Acute renal failure