Neuroendocrine neoplasms (NENs) constitute a heterogenous group of tumors originating from neuroendocrine cells scattered throughout the body. Peptide Receptor Radionuclide Therapy (PRRT) is a treatment of choice of unresectable metastasized progressive and well-differentiated NENs. The aim of the study was to assess early bone marrow and kidney injury after administration of Lutetium-177 or Lutetium-177 combined with Yttrium-90. Thirty-one patients received treatment with [177Lu]Lu-DOTATATE with the activity of 7.4 GBq. Eleven patients received tandem treatment with [90Y]Y-DOTATATE with the activity of 1.85 GBq + [177Lu]Lu-DOTATATE with the activity of 1.85 GBq. After PRRT a significant decrease in leukocyte, neutrophil, and lymphocyte counts was noted. Tandem treatment demonstrated a more marked decrease in white blood cell count compared to Lutetium-177 therapy only. Conversely, no significant influence on glomerular filtration was found in this assessment. However, PRRT triggered acute renal tubule dysfunction, regardless of the treatment type. Regarding the acute complications, PRRT appeared to be a safe modality in the treatment of patients with NEN.
Non-tuberculous mycobacterial lung disease (NTMLD) in patients with chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertensionMikobakterioza płuc u chorych na nadciśnienie płucne zakrzepowo-zatorowe i idiopatyczne tętnicze nadciśnienie płucneThe authors declare no financial disclosure Abstract Introduction: Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD yet. The aim of the study was to analyse the clinical course and predisposing factors of NTMLD recognised in our centre between 2002 and 2012 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). Material and methods: Thirteen patients (10 -CTEPH, 3 -IPAH) entered the study. PH was recognised during right heart catheterisation. Median value of mean pulmonary artery pressure (mPAP) was 49 mm Hg (39-65 mm Hg). NTMLD was diagnosed according to ATS guidelines (2007). Results: M. kansasii was the most frequent pathogen. Most patients complained of the exaggeration of dyspnoea and productive cough. Computed tomography of the chest with angiography revealed infiltrations with cavitation in seven patients and cavities surrounded by micronodules in six patients. In all CTEPH patients, NTMLD developed in the hypoperfused lung areas. No parenchymal abnormalities preceded the development of NTMLD. After diagnosis all of the patients received antituberculous treatment; in 12/13 improvement was achieved. By the end of March 2014 seven patients died due to right heart insufficiency, no deaths due to NTMLD were noted. Conclusions: NTMLD should be suspected in patients with CTEPH or IPAH, presenting with productive cough and a new pulmonary infiltrate with cavitation. In patients with CTEPH, special attention should be paid to a new cavitary lesions without accompanying thrombus in the artery supplying the area. High mPAP (CTEPH/IPAH) and hypoperfusion (CTEPH) are predisposing to NTMLD.
Introduction: The risk of developing anemia in diabetic patients is nearly 3-times higher than in non-diabetic patients. Aim: The aim was to assess factors that may affect both the erythrocyte count (RBC) and hemoglobin concentration (HGB) in type 2 diabetes patients. Material and methods: In type 2 diabetes patients (N = 80) and in control subjects with normal carbohydrate metabolism (N = 40) RBC and HGB were determined in whole blood collected in the EDTA-K3 tube. Results: The degree of metabolic compensation of diabetes, measured by the percentage of HbA1c, did not significantly affect RBC and HGB. In diabetic women, unlike men, there was no relationship between RBC and HGB and kidney function, measured with eGFR. Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers did not significantly affect RBC and HGB in these patients. Multivariate linear regression analysis showed that in type 2 diabetes women variables that affect the RBC included: systolic BP, arrhythmias, taking fibrates. In the multivariate linear regression model variables that influence the HGB in type 2 diabetes women included systolic BP and fibrate treatment. In type 2 diabetes men a statistically significant model of multivariate linear regression for RBC was not obtained. In the multivariate linear regression model the variables that influence the HGB in type 2 diabetes men included: white blood cell count, age, obesity, and taking statins. Conclusions: In women with type 2 diabetes, the RBC is influenced by other factors (systolic BP, cardiac arrhythmias, fibrates and calcium antagonists) than in men (obesity and the use of oral antidiabetic agents). In type 2 diabetes women also other factors influence HGB (systolic BP, cardiac arrhythmias presence, fibrates, calcium antagonists and ACE inhibitors) than in type 2 diabetes men (hypertension, obesity, leukocyte count, age, proton pump inhibitors and statins medication).
Nontuberculous mycobacteria (NTM) are a group of bacteria that may cause human disease mycobacteriosis, but do not cause tuberculosis or leprosy. NTM are acquired through environmental exposure to water, aerosols, soil, dust and are transfered to human through inhalation, ingestion, and skin lesions, due to injuries, surgical procedures, or intravenous catheters. People with suppressed immune response, with pre-existing lung damage in the course of various lung diseases are most likely to be affected. There is no evidence of person-to-person spread of these diseases. A variety of manifestations of NTM infection have been described, but the lungs remain the most commonly involved site. Molecular methods allow the quicker differentiation of NTM from TB isolates and help to identify new NTM species. The purpose of this article is to review the common clinical manifestations of NTM lung disease, the conditions associated with NTM lung disease, diagnostic criteria and treatment of the most frequent species of NTM.
Exudative pericarditis is a disease of varied aetiology requiring inclusion of both infectious and non-infectious causes in its differential diagnosis. The possible diagnoses include adult-onset Still’s disease (AOSD), a rare systemic inflammatory disease of unknown aetiology. AOSD typically develops in patients between 16 and 35 years of age and is characterised by fever, arthralgia, transient salmon-coloured rash and other abnormalities including pharyngitis, serositis (particularly pleuritis and pericarditis) and laboratory abnormalities, such as elevated white blood cell count and elevated markers of inflammation. We report two cases of AOSD with recurrent exudative pericarditis.
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