Patients with Takayasu arteritis have a high rate of atherosclerotic plaques, at least as frequent as that observed among patients with SLE.

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Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.

A 53-year-old man presented to our clinic with a 4month history of loss of appetite and marked bodyweight loss (from 74 to 55 kg), and 1-month duration of progressively worsening exertional dyspnea. Pertinent abdominal sonography disclosed pancreatic head tumor with peripancreatic lymphadenopathy and a cardiac mass lesion. He was a heavy smoker but had no history of major systemic illness, including coronary arterial diseases. Upon admission, physical examination, chest film and serum biochemistry were unremarkable, except alkaline phosphatase 419 IU/L (upper limit of normal [ULN] <237) and g-glutamyl transpeptidase 246 U/L (ULN <30). The serum CA 19.9 level was 60 IU/mL. An electrocardiogram showed old inferior wall myocardial infarction, a first-degree atrioventricular block and a left anterior bundle branch block. Echocardiography showed a mass lesion (measuring 6.3 ¥ 5.4 cm) involving the right atrium (RA), the right REFERENCES1 Lam KY, Dickens P, Chan ACL. Tumors of the heart. a 20year experience with a review of 12,485 consecutive autopsies. Arch. Pathol. Lab. Med. 1993; 117: 1027-31. 2 Bowman AR, Siegel RJ, Blanche C et al. Metastatic pancreatic adenocarcinoma to the heart diagnosed antemortem. J. Am. Soc. Echocardiogr. 2000; 13: 415-16. 3 Labib SB, Schick EC Jr, Isner JM. Obstruction of right ventricular outflow tract caused by intracavitary metastatic disease: analysis of 14 cases. J. Am. Coll. Cardiol. 1992; 19: 1664-8. 4 Faivre S, Raymond E, Woynarowski JM et al. Supraadditive effect of 2¢,2¢-difluorodeoxycytidine (gemcitabine) in combination with oxaliplatin in human cancer cell lines. Cancer Chemother. Pharmacol. 1999; 44: 117-23. 5 Louvet C, Andre T, Hammel P et al. Phase II trial of bimonthly leucovorin, 5-fluorouracil and gemcitabine for advanced pancreatic adenocarcinoma (FOLFUGEM).

Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.