Internal medicine
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We report an autopsied case of a 74-year-old man with primary pulmonary squamous cell carcinoma (SCC) associated with leukocytosis, hypercalcemia, phagocytosis in the bone marrow, reactive lymphadenopathy and mesangial cell proliferation in the glomerulus. Laboratory examination revealed increased serum levels of parathyroid hormone-related peptide (PTH-rP), granulocyte colony stimulating factor (G-CSF), interleukin-6 (IL-6) and soluble interleukin 2 receptor (s-IL2R). ⋯ Thus, pulmonary SCC seemed to produce both G-CSF and PTH-rP, causing leukocytosis, hypercalcemia, and IL-6 production from the bone. IL-6 also might have stimulated the proliferation of SCC and glomerular mesangial cells, and induced phagocytosis, reactive lymphadenopathy and hepatosplenomegaly by interacting with the mononuclear phagocytic system.
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Comparative Study
Barrett's esophagus and severe reflux esophagitis share common pathophysiological characteristics among Chinese in Taiwan.
The pathophysiological data on Barrett's esophagus are scant in Asia, so the purpose of this study was to compare and analyze the pathophysiological characteristics of Barrett's esophagus and reflux esophagitis among Chinese in Taiwan. ⋯ We concluded that Barrett's esophagus had significantly stronger acid reflux, lower LES pressure, and weaker distal esophageal peristalsis compared to mild esophagitis. Barrett's esophagus and severe reflux esophagitis share common pathophysiological characteristics among Chinese in Taiwan.
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We present a 21-year-old woman with an oculogyric crisis following the administration of clebopride. Based on the temporal relationship of the administration of clebopride to the occurrence of the event and the absence of other possible etiologies, clebopride is implicated as the cause of this acute oculogyric crisis, despite the fact that a cause-and-effect relationship cannot be confirmed.
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Comparative Study
Natural human interferon beta plus ribavirin combination therapy in Japanese patients infected with hepatitis C virus and a high viral load.
The aim of this pilot study was to determine the safety and efficacy of natural human interferon beta (nIFNbeta) plus ribavirin (RBV) in patients with chronic hepatitis C who did not respond to pegylated interferon alpha (PEG-IFN), with special emphasis on the incidence of mental disorders or refusal for fear of adverse effects. ⋯ nIFNbeta-RBV therapy offers sufficient safety and efficacy for patients with mental disorders, and thus could represent an excellent second-line therapy for subpopulations that are not suitable for PEG-IFN-RBV.
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Case Reports
An unusual case of acute brucellosis presenting with Coombs-positive autoimmune hemolytic anemia.
Brucellosis can mimic several primary hematological diseases. Mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia, thrombocytopenia, and hemolysis are less frequently seen. To our knowledge, brucellosis has not previously been described in association with Coombs-positive autoimmune hemolytic anemia. ⋯ The patient responded well to short-term pulse corticosteroid therapy followed by antibrucellosis treatment. We suggest that Brucella infection may be the probable cause of the immune hemolytic anemia in this patient. Therefore, the differential diagnosis of Coombs-positive autoimmune hemolytic anemia should include brucellosis, especially in areas where the disease is endemic.