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P0489 TAKAYASU DISEASE: A RARE CAUSE OF HYPERTENSION
S162
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P0488 MULTIPLE TUMORS ASSOCIATED WITH ANAPLASIC LARGE CELL LYMPHOMA: WHAT DO WE KNOW ABOUT CARCINOGENESIS?
Ana María Arnáiz-García, Mariana Carrillo-Rivas, Javier Arnáiz-García, Miguel Angel Núñez-Viejo, Maria Elena Arnáiz-García, Victoria Pardo-Gutiérrez. University Hospital Marqués De Valdecilla Introduction: Anaplastic large cell lymphoma (ALCL) represents only about 2% of all non-Hodgkin’s lymphoma in adults, but is still the second most common T-cell lymphoma. The median age of patients with primary systemic ALCL is 34, with a male predominance.There is a bimodal age distribution, with peaks in childhood/young adulthood, and again in late adulthood.Association with synchronic tumors as gastrointestinal stromal tumors and cutaneous tumours is not well known. Case: A woman of 85 year-old with antecedents of Bowen’s disease, and non-metastatic breast cancer 10 years ago was admited to our hospital with a picture of dysphagia, fever and constitutional syndrome in last 10 months. Physical examination showed right mastectomy and adenopathies in both axillas. Laboratory findings showed anemia of chronic disease, thrombocytopenia, hypercalcemia and increased levels of erythrocyte sedimentation rate and lactate dehydrogenase. Rest of chemical parameters, including liver and renal function tests, PTH and vitamin D metabolites were normal. Upper endoscopic study and bone scan were also completely normal. Body TC scan was performed with the result of multiple masses involving mediastinum, retroperitoneum, axillary and inguinal lymphadenopathies, solitary pulmonary node and adrenal mass. With the suspect of tumoral hypercalcemia secondary to lymphoma, symptomatic treatment with saline hydratation, bisphoponates, glucocorticoids and packed red cells and platelets transfusions was administred. Dued to the characteristics of the patient,non agressive diagnostic procedures were performed. She developed an unfavourable evolution and died 10 days after admission. Necropsic study revealed ALCL with negative inmunophenotype to Ki/CD30/Epstein-Barr virus. ALCL was found to be involving the central nervous system, bones, lungs, liver, spleen and forming masses and lymphadenopathies that were cause of compression of different organs like the digestive tract. There were also found a gastric stromal tumor (GIST), an adrenocortical carcinoma and a condroid hamartoma in the left lung. Discussion & conclusion: ALCL is a lymphoid neoplasm of T or null origin.The majority of patients with primary systemic ALCL present with painless adenopathy and are found to have widespread disease on staging. B symptoms are not uncommon. Extranodal disease, most commonly cutaneous involvement, is less frequent. No references in the literature about ALCL and synchronic tumors has been found.We suppose that clonal nature of tumors is a critical feature of the somatic mutation/clonal evolution theory of human carcinogenesis,so that further researches in this way are needed to get an early diagnosis and improve the prognosis of these patients.
P0489 TAKAYASU DISEASE: A RARE CAUSE OF HYPERTENSION
G. Benites, P. Mendes, A. Sousa, A. Silva, L. Monjardino, A. Rego. Hseah-epe Introduction: Takayasu arteritis is a chronic vasculitis of unknown etiology. Women are affected in 80 to 90 percent of cases, with an age of onset that is usually between 10 and 40 years. It has a worldwide distribution, with the greatest prevalence in Asians. The incidence is 1 to 3 new cases per year per million population in the United States and Europe. Objectives: The authors present a clinical case report of a 26 year old caucasian woman, with a history of symptomatic hypertension wich motivated many attends at the emergency of the local hospital.Detailed study of secundary hypertension is mandatory. Materials & methods: Previous personal and familiar history: tobacco addiction (20 cigarrets a day for 10 years), mother died at the age of 40 because of a stroke. The patient was admitted at the Internal Medicine ward for hypertension control and ethylogical study. Physical examination showed no abnormalities. Moderate renal insufficiency (creatinine clearance 60 ml/min) and non specific repolarization changes were found at the electrocardiogram. Blood pressure was successfully controlled with amlodipine 5 mg daily. She was discharged and followed up regularly at the internal medicine clinics. Results: Two years later she was complaining about a headache and visual changes; blood pressure was unmeasurable on her left arm, no pulses were palpable at the left radial, braquial and carotid arteries. She was immediately submitted to aortic arch angiography, which showed complete occlusion of
the left carotid, subclavian, braquial and renal arteries. Soon she went under vascular surgery with carotid and subclavian bypasses. At this time treatment was started with oral prednisolone and cyclophosphamide. She became clinically stable. However a second angiography performed one year later revealed partial stenosis of the bypasses. The electrocardiogram showed Q waves at the inferior territory. She is now having an active life, without symptoms, under mycophenolate mofetil 2 g daily, amlodipine and ticlopidine 500mg daily. Discussion & conclusion: Hypertension at 26 years old, should raise a suspicion of a rare cause when the study of secundary hypertension results negative. Keywords: Takayasu disease, Hypertension
P0490 THE ROLE OF GLUTATHIONE S- TRANSFERASE M1 AND T1 GENE POLYMORPHISMS AND OXIDATIVE STRESS- RELATED PARAMETERS IN EGYPTIAN PATIENTS WITH ESSENTIAL HYPERTENSION
Sahar Bessa. Faculty of Medicine, Tanta University Introduction: Essential hypertension is a complex, multifactorial, polygenic disease in which the underlying genetic components remain unknown. Oxidative stress is implicated in the pathogenesis of cardiovascular diseases, including hypertension. Glutathione S-transferase (GST) is a family of enzymes involved in detoxification of reactive oxygen species and limiting oxidative damage to tissues. Objectives: This study aimed to investigate GSTM1 and GSTT1 gene polymorphisms in Egyptian patients with essential hypertension and to evaluate their relationship with oxidative stress-related parameters Materials & methods: The study included 40 newly-diagnosed, untreated, essential hypertensive patients and 40 normotensive subjects.Lipid peroxidation endproduct; malondialdehyde (MDA) and nitrate/nitrite levels were measured in plasma. Reduced glutathione (GSH) level and activities of antioxidant enzymes;catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and glutathione S-transferase (GST) were determined in erythrocytes. Genotyping for GSTM1 and GSTT1 was performed using a multiplex polymerase chain reaction. Results: The frequency of GSTM1+ve/GSTT1+ve in hypertensives (5%) was significantly lower than in normotensives (37.5%)However, the frequency of GSTM1–ve/GSTT1–ve was significantly elevated in hypertensives (35%) as compared to normotensives (7.5%). Plasma MDA level was higher and nitrate/nitrite level was lower in hypertensives than in normotensives. Erythrocyte GSH level and activities of antioxidant enzymes; CAT, SOD, GSH-Px, and GST of hypertensives were lower than in normotensives. Moreover,GST activity was significantly lower in subjects with GSTM1–ve/GSTT1–ve than in those with GSTM1+ve/GSTT1+ve. In hypertensive patients, both systolic and diastolic blood pressures were negatively correlated with erythrocyte activities of CAT, GSH-Px, and GST. Discussion & conclusion: GSTM1–ve/GSTT1–ve (null genotype) might be considered as a potential genetic factor to predict the development of essential hypertension and permit early therapeutic intervention. Future polymorphic studies to identify other candidate antioxidant genes that are altered in essential hypertension are warranted. In addition, the significant association between blood pressure and oxidative stress-related parameters indicates that oxidative stress may have a pathogenic role in the development of essential hypertension. Thus, antioxidant therapy may potentially become an important adjunct in the management of hypertension to prevent progressive deterioration and target organ damage.
P0491 REPEATED MULTIPLE AND BILATERAL COUGH-INDUCED RIB FRACTURES: CASE REPORT AND REVIEW LITERATURE
Sofia Florindo Galego, Manuel De Sousa, João João Mendes, Nélia Marques, Tânia Rodrigues, Francisco Ferreira, Elsa Lamothe, Alexandrina Quintino. Hospital De Santa Marta Introduction: Cough is usually self-limited and uncomplicated but severe acute and paroxysmal coughs can be associated with many complications and infrequently causes bilateral rib fractures more common in woman than in men. Objectives: The cough-induced rib fracture mechanism is reviewed, as well as the diagnostic, complications and treatment of the injury. Discussion & conclusion: We report an unusual case of repeated multiple bilateral rib fracture, hemothorax and chest wall hematoma induced by several
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P0488 MULTIPLE TUMORS ASSOCIATED WITH ANAPLASIC LARGE CELL LYMPHOMA: WHAT DO WE KNOW ABOUT CARCINOGENESIS?
Ana María Arnáiz-García, Mariana Carrillo-Rivas, Javier Arnáiz-García, Miguel Angel Núñez-Viejo, Maria Elena Arnáiz-García, Victoria Pardo-Gutiérrez. University Hospital Marqués De Valdecilla Introduction: Anaplastic large cell lymphoma (ALCL) represents only about 2% of all non-Hodgkin’s lymphoma in adults, but is still the second most common T-cell lymphoma. The median age of patients with primary systemic ALCL is 34, with a male predominance.There is a bimodal age distribution, with peaks in childhood/young adulthood, and again in late adulthood.Association with synchronic tumors as gastrointestinal stromal tumors and cutaneous tumours is not well known. Case: A woman of 85 year-old with antecedents of Bowen’s disease, and non-metastatic breast cancer 10 years ago was admited to our hospital with a picture of dysphagia, fever and constitutional syndrome in last 10 months. Physical examination showed right mastectomy and adenopathies in both axillas. Laboratory findings showed anemia of chronic disease, thrombocytopenia, hypercalcemia and increased levels of erythrocyte sedimentation rate and lactate dehydrogenase. Rest of chemical parameters, including liver and renal function tests, PTH and vitamin D metabolites were normal. Upper endoscopic study and bone scan were also completely normal. Body TC scan was performed with the result of multiple masses involving mediastinum, retroperitoneum, axillary and inguinal lymphadenopathies, solitary pulmonary node and adrenal mass. With the suspect of tumoral hypercalcemia secondary to lymphoma, symptomatic treatment with saline hydratation, bisphoponates, glucocorticoids and packed red cells and platelets transfusions was administred. Dued to the characteristics of the patient,non agressive diagnostic procedures were performed. She developed an unfavourable evolution and died 10 days after admission. Necropsic study revealed ALCL with negative inmunophenotype to Ki/CD30/Epstein-Barr virus. ALCL was found to be involving the central nervous system, bones, lungs, liver, spleen and forming masses and lymphadenopathies that were cause of compression of different organs like the digestive tract. There were also found a gastric stromal tumor (GIST), an adrenocortical carcinoma and a condroid hamartoma in the left lung. Discussion & conclusion: ALCL is a lymphoid neoplasm of T or null origin.The majority of patients with primary systemic ALCL present with painless adenopathy and are found to have widespread disease on staging. B symptoms are not uncommon. Extranodal disease, most commonly cutaneous involvement, is less frequent. No references in the literature about ALCL and synchronic tumors has been found.We suppose that clonal nature of tumors is a critical feature of the somatic mutation/clonal evolution theory of human carcinogenesis,so that further researches in this way are needed to get an early diagnosis and improve the prognosis of these patients.
P0489 TAKAYASU DISEASE: A RARE CAUSE OF HYPERTENSION
G. Benites, P. Mendes, A. Sousa, A. Silva, L. Monjardino, A. Rego. Hseah-epe Introduction: Takayasu arteritis is a chronic vasculitis of unknown etiology. Women are affected in 80 to 90 percent of cases, with an age of onset that is usually between 10 and 40 years. It has a worldwide distribution, with the greatest prevalence in Asians. The incidence is 1 to 3 new cases per year per million population in the United States and Europe. Objectives: The authors present a clinical case report of a 26 year old caucasian woman, with a history of symptomatic hypertension wich motivated many attends at the emergency of the local hospital.Detailed study of secundary hypertension is mandatory. Materials & methods: Previous personal and familiar history: tobacco addiction (20 cigarrets a day for 10 years), mother died at the age of 40 because of a stroke. The patient was admitted at the Internal Medicine ward for hypertension control and ethylogical study. Physical examination showed no abnormalities. Moderate renal insufficiency (creatinine clearance 60 ml/min) and non specific repolarization changes were found at the electrocardiogram. Blood pressure was successfully controlled with amlodipine 5 mg daily. She was discharged and followed up regularly at the internal medicine clinics. Results: Two years later she was complaining about a headache and visual changes; blood pressure was unmeasurable on her left arm, no pulses were palpable at the left radial, braquial and carotid arteries. She was immediately submitted to aortic arch angiography, which showed complete occlusion of
the left carotid, subclavian, braquial and renal arteries. Soon she went under vascular surgery with carotid and subclavian bypasses. At this time treatment was started with oral prednisolone and cyclophosphamide. She became clinically stable. However a second angiography performed one year later revealed partial stenosis of the bypasses. The electrocardiogram showed Q waves at the inferior territory. She is now having an active life, without symptoms, under mycophenolate mofetil 2 g daily, amlodipine and ticlopidine 500mg daily. Discussion & conclusion: Hypertension at 26 years old, should raise a suspicion of a rare cause when the study of secundary hypertension results negative. Keywords: Takayasu disease, Hypertension
P0490 THE ROLE OF GLUTATHIONE S- TRANSFERASE M1 AND T1 GENE POLYMORPHISMS AND OXIDATIVE STRESS- RELATED PARAMETERS IN EGYPTIAN PATIENTS WITH ESSENTIAL HYPERTENSION
Sahar Bessa. Faculty of Medicine, Tanta University Introduction: Essential hypertension is a complex, multifactorial, polygenic disease in which the underlying genetic components remain unknown. Oxidative stress is implicated in the pathogenesis of cardiovascular diseases, including hypertension. Glutathione S-transferase (GST) is a family of enzymes involved in detoxification of reactive oxygen species and limiting oxidative damage to tissues. Objectives: This study aimed to investigate GSTM1 and GSTT1 gene polymorphisms in Egyptian patients with essential hypertension and to evaluate their relationship with oxidative stress-related parameters Materials & methods: The study included 40 newly-diagnosed, untreated, essential hypertensive patients and 40 normotensive subjects.Lipid peroxidation endproduct; malondialdehyde (MDA) and nitrate/nitrite levels were measured in plasma. Reduced glutathione (GSH) level and activities of antioxidant enzymes;catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and glutathione S-transferase (GST) were determined in erythrocytes. Genotyping for GSTM1 and GSTT1 was performed using a multiplex polymerase chain reaction. Results: The frequency of GSTM1+ve/GSTT1+ve in hypertensives (5%) was significantly lower than in normotensives (37.5%)However, the frequency of GSTM1–ve/GSTT1–ve was significantly elevated in hypertensives (35%) as compared to normotensives (7.5%). Plasma MDA level was higher and nitrate/nitrite level was lower in hypertensives than in normotensives. Erythrocyte GSH level and activities of antioxidant enzymes; CAT, SOD, GSH-Px, and GST of hypertensives were lower than in normotensives. Moreover,GST activity was significantly lower in subjects with GSTM1–ve/GSTT1–ve than in those with GSTM1+ve/GSTT1+ve. In hypertensive patients, both systolic and diastolic blood pressures were negatively correlated with erythrocyte activities of CAT, GSH-Px, and GST. Discussion & conclusion: GSTM1–ve/GSTT1–ve (null genotype) might be considered as a potential genetic factor to predict the development of essential hypertension and permit early therapeutic intervention. Future polymorphic studies to identify other candidate antioxidant genes that are altered in essential hypertension are warranted. In addition, the significant association between blood pressure and oxidative stress-related parameters indicates that oxidative stress may have a pathogenic role in the development of essential hypertension. Thus, antioxidant therapy may potentially become an important adjunct in the management of hypertension to prevent progressive deterioration and target organ damage.
P0491 REPEATED MULTIPLE AND BILATERAL COUGH-INDUCED RIB FRACTURES: CASE REPORT AND REVIEW LITERATURE
Sofia Florindo Galego, Manuel De Sousa, João João Mendes, Nélia Marques, Tânia Rodrigues, Francisco Ferreira, Elsa Lamothe, Alexandrina Quintino. Hospital De Santa Marta Introduction: Cough is usually self-limited and uncomplicated but severe acute and paroxysmal coughs can be associated with many complications and infrequently causes bilateral rib fractures more common in woman than in men. Objectives: The cough-induced rib fracture mechanism is reviewed, as well as the diagnostic, complications and treatment of the injury. Discussion & conclusion: We report an unusual case of repeated multiple bilateral rib fracture, hemothorax and chest wall hematoma induced by several