Internal medicine
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Case Reports
Spontaneous resolution of an acute spontaneous spinal epidural hematoma without neurological deficits.
A 46-year-old woman presented with sudden severe pain in the interscapular region. Physical examination, including detailed neurological evaluation, did not disclose any abnormalities. ⋯ To our knowledge, this report documents the first case of a spontaneous spinal spidural hematoma without neurological deficits. Spinal epidural hematoma may be more common than previously thought because some cases have probably been misdiagnosed as transient back pain of unknown etiology.
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Case Reports
Development of hypercalcemic crisis in a Graves' hyperthyroid patient associated with central diabetes insipidus.
A 26-year-old man with Graves' hyperthyroidism associated with central diabetes insipidus (DI), initially showed hypercalcemic crisis. Initially, very low serum levels of intact parathyroid hormone (PTH) and 1,25-dihydroxy vitamin D3 and a moderate rise of serum C-terminal PTH related protein (C-PTHrP) were observed which strongly suggested a humoral hypercalcemia of malignancy due to PTHrP. ⋯ Mild hyperprolactinemia, no responses of growth hormone (GH) to insulin-induced hypoglycemia despite a normal growth hormone releasing hormone (GRH) test and mild thickening of the pituitary stalk on magnetic resonance imaging were observed. Thus, an autoimmune nature of his central DI is considered; it is noteworthy that the serum C-PTHrP level may be elevated by renal failure in patients with hypercalcemia due to causes other than PTHrP.
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The bronchoscopic findings of arteriovenous malformation of the bronchial artery are compared with findings on angiography and pathology. A non-pulsatile protrusion with engorged vessels on its glossy and uneven surface was seen at the distal portion of the right anterior segmental bronchus. ⋯ Histologically, a glossy, uneven surface and engorged vessels represented normal mucosa overlaying an extramuscular tortuous artery and proliferation of submucosal tiny vessels, respectively. These bronchoscopic findings were important clues for diagnosis.
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Sjögren's syndrome (Sjs) can cause many organic changes, but is rarely accompanied by pleuritis. We report here a 62-year-old patient with subclinical Sjs who developed unilateral pleuritis with moderate effusion. He was diagnosed to have subclinical Sjs based on the positivity of anti SS-A/SS-B antibodies and the biopsy findings of minor salivary glands which revealed lymphocyte infiltration around the duct. ⋯ We conclude that the pleuritis was caused by Sjs. In patients with Sjs, activated polyclonal B lymphocytes and autoantibodies are considered to cause systemic tissue damage. This case indicates that these factors can cause pleuritis in Sjs patients.