The Netherlands journal of medicine
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In up to 20% of patients with renal cell cancer (RCC) an inflammatory response consisting of low-grade fever, weight loss and an elevated ESR and CRP may occur with modest granulocytosis and thrombocytosis. Clinical and experimental data suggest a pathogenic role for tumour-derived cytokine production, especially interleukin-6. ⋯ We have provided direct evidence for the production of pro-inflammatory cytokines by renal cancer cells in a patient with RCC and a profound inflammatory response, with a central role of IL-6, probably due to a gain of chromosome 7. The extreme granulocytosis and thrombocytosis may have resulted from the secondary systemic production of G-CSF and TPO.
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A strong epidemiological association has been revealed between air pollution and the occurrence of cardiovascular disease (CVD). Deleterious consequences of such pollution, including myocardial infarction and coronary ischaemia, have occurred after both acute as well as chronic exposure to air pollution. ⋯ Nevertheless, for the high cardiovascular risk population, air pollution might have direct clinical relevance. In the future, more knowledge is required about the absolute risk of air pollution in specific high-risk populations and the pathophysiological mechanisms behind this relationship.
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The extent of reversibility of loss of bone mass density (BMD) in hyperthyroid patients after treatment is not clear. ⋯ The decline in BMD in hyperthyroid patients measured by DXA seems to be reversible after treatment of hyperthyroidism, whereas a change in the QUS parameters, probably also an indicator of bone elasticity and architecture, could not be found.
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Epiglottitis is an acute disease, which was predominantly caused by Haemophilus influenzae type b in the pre-vaccination era. In the vaccination era, with waning vigilance, adults remain at risk for acute epiglottitis according to recent Dutch incidence rates. There is more diversity in the cause of epiglottitis in adults. ⋯ Fibreoptic nasal intubation should preferentially be attempted with the possibility of immediate surgical airway on hand. Timely diagnosis and treatment usually results in a complete recovery. In adults, severe acute epiglottitis and stridor can justify early intubation.
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In this study we describe the clinical presentation and electrolyte disturbances of thyrotoxic periodic paralysis (TPP) in patients admitted to the Department of Medicine at Hamad General Hospital. ⋯ The causes of hypokalaemia and lower-extremity paralysis are numerous; TPP should be taken into consideration in the differential diagnosis of all acute episodes of motor paralysis, especially in young Asian male patients.