[Severe idiopathic hyponatremia caused by ADH inappropriate secretion in the elderly].

We report on seven elderly patients with severe hyponatremia (plasma sodium < 125 meq/l). All were symptomatic for central nervous system disturbances, weakness, nausea/vomiting and met clinical and laboratory criteria for the diagnosis of inappropriate secretion of antidiuretic hormone (SIADH). Investigations performed to determine the etiology of the syndrome gave negative results, so that the form was considered to be idiopathic.

[Carbamazepine-induced agranulocytosis. Apropos of 2 cases].

Carbamazepine-induced agranulocytosis (CIA) is a rare event. We report on two cases, highlighting the wide variability of the bone marrow, which may show pseudohypercellularity with disappearance of neutrophils and excess of immature cells (myeloblasts and promyelocytes), thus mimicking the features of acute myeloid leukemia. Although its pathogenesis is still unclear, CIA must be considered as an idiosyncratic hemopathy and moreover it appears to be an unpredictable complication among patients taking the drug.

[2 cases of acute cholestasis caused by ticlopidine].

We report the case of two patients suffered from cholestatic jaundice occurred 3-4 weeks after starting ticlopidine therapy. In both cases the diagnosis was made by ruling out any other known cause of acute hepatitis or cholestasis. One patient underwent liver biopsy, which showed a typical intralobular cholestatic pattern and a slight lymphocytic infiltration of the portal tracts.

[Primary thrombocythemia in a female carrier of IgA deficiency].

We describe a case of essential thrombocythemia observed in a 67-year-old woman with severe IgA-deficiency. The the best of our knowledge, this is the first report concerning the onset of a chronic myeloproliferative disease (CMPD) in a patient affected with primary immunodeficiency, in particular IgA-defect. The association may be merely coincidental; otherwise hemopoietic growth factors acting on myeloid progenitor cells could play a role in this relationship.

[Myocardial infarction caused by accidental electrocution. Apropos of a case with an 8-year follow-up].

We report on a case of non-fatal myocardial infarction (MI) after electrocution. The diagnosis was made on the basis of electrocardiographic and enzymatic changes and was supported by the results of two-dimensional echocardiogram and radio-nuclide scans, showing segmental hypoperfusion and wall motion abnormalities. The patient was followed for over 8 years, evaluating the evolution of cardiac damage with the above tests.

[Immune hemolytic anemia and acute kidney failure due to rifampicin].

A case is reported of hemolytic anemia following rifampicin administration and complicated by acute renal failure. Furthermore clotting analyses suggested a slight disseminated intravascular coagulation, very likely activated by hemolysis products. Both hemolysis and renal function impairment subsided spontaneously, after the sole withdrawal of rifampin.

[Sarcomatous degeneration in Paget disease of bone. Apropos of a clinical case].

Sarcomatous degeneration is the most dreaded complication of Paget's disease of bone: this case report offers an opportunity for underlining the difficulties of differential diagnosis in a case of pulmonary metastatization in the presence of osteitis deformans. Immunohistochemical assay applied to the cytology of pulmonary needle-aspiration and surgical biopsy targeted to the suspected neoplastic lesion allowed correct diagnosis. This case confirms the very poor prognosis of this kind of neoplasm: the rapidity of the fatal outcome was not significantly influenced even by the most aggressive polychemotherapy.

[The emergency treatment of supraventricular tachyarrhythmias: the efficacy and safety of intravenous propafenone].

One hundred patients, admitted to the Emergency Unit for paroxysmal supraventricular tachycardia (SVT) with 1:1 AV conduction, atrial fibrillation (af) and flutter (AF) of recent onset (less than 72 hours) were treated with intravenous propafenone (P). The drug was administered at the dose of 70 mg over 5 min, repeated after 10 min if sinus rhythm (SR) was not restored and eventually followed by continuous infusion (0.35-0.

[Severe ventricular arrhythmia secondary to indapamide-induced hypopotassemia].

We report on two patients, treated with indapamide for mild hypertension, who developed life-threatening ventricular arrhythmias. The former showed severe hypokalemia, QT interval prolongation and "torsade de pointes": the latter, who suffered from ischemic heart disease, had slightly decreased serum potassium and ventricular fibrillation. In both cases no other cause accounting for hypokalemia and ventricular arrhythmia was found.

Cold agglutinin hemolytic anemia in a patient with adult-onset Still's disease.

We report on a patient with adult Still's disease who developed, at the onset of her illness, an autoimmune hemolytic anemia (AHA) due to cold agglutinin (CA). Hemolysis spontaneously subsided and CA disappeared before starting therapy with aspirin and prednisone. The occurrence of AHA in patients affected with collagen diseases is currently explained by a loss of tolerance, leading to the emergence of multiple autoreactive clones.

[Acute hybrid leukemia. Review of the literature and presentation of a case].

In the last years, the development of immunophenotypic and molecular analyses allowed to recognize several cases of hybrid acute leukemia (AL), whose blast cell display both lymphoid and myeloid features. Hybrid, or mixed-lineage, AL seems to have distinct clinical manifestations and hematological findings, and is mainly characterized by resistance to chemotherapy and poor prognosis. We report on a patient with AL, which showed a very rapid switch from the lymphoblastic phenotype exhibited at presentation to a myelomonoblastic one, appeared at first relapse, and lastly progressed to an undifferentiated leukemia in the terminal phase.

[Myocardial infarct following a negative maximal exercise test: apropos of a case].

A 63-year-old patient, with effort angina diagnosed 3 months previously, suffered a myocardial infarction 6 minutes after a maximal exercise stress test which had given a normal result. Intravenous streptokinase, nitrates and calcium-antagonist treatment were performed immediately, but they failed to achieve myocardial re-perfusion. The patient refused coronary arteriography, but one year later underwent a further maximal exercise test, which gave a completely negative result.

[Polycythemia vera and hemoregulator hormones. Considerations on an unusual clinical case].

The case is reported of a patient with polycythemia vera, who developed an anterior panhypopituitarism, due to an adenoma, some years later. The endocrine deficiency caused the return of the hemoglobin count and global red cell volume to the normal range. The finding suggests that in polycythemia vera the neoplastic growth is still partially responsive to normal hemoregulator factors.

Adrenal failure due to bilateral metastases as the sole manifestation of relapsing lung carcinoma. Report of two cases.

We describe two patients with lung carcinoma in whom adrenal glands were the sole site of tumor relapse, revealed by the appearance of Addison's disease. Both patients showed bilateral adrenal masses on US and/or CAT scans and received hormone replacement therapy, with rapid improvement of their general conditions. One of them, with small-cell carcinoma, could also be treated with further chemotherapy and achieved a second remission.

A case of Waldenström macroglobulinemia terminating in acute lymphoblastic leukemia.

A case of acute lymphoblastic leukemia occurring in a patient with Waldenström macroglobulinemia more than 6 years after the onset of the disease is reported. At the time of acute transformation, bone marrow and peripheral blood lymphoid populations were almost entirely represented by lymphoblasts; the serum monoclonal peak had disappeared and no cells bearing surface or intracytoplasmic immunoglobulins were found. This observation suggests that the blast crisis might be derived from a dedifferentiative process within the lymphatic clone of the chronic phase.

[Juvenile myocardial infarct. A description of 2 cases occurring before 20 years of age and a review of the literature].

Authors report two cases of myocardial infarction occurred before the age of twenty: the former in a man without risk factors, who had 12 years later a cerebral embolic stroke, caused by a left-ventricular thrombus; the latter in a young woman who was taking oral contraceptives. The review of the literature shows that the prevalence of myocardial infarction in juvenile age is not negligible. Especially in those cases occurred before the age of 35, risk factors, clinical features, coronary angiographic findings and possible pathogenetic mechanisms are quite different from those generally observed in elderly patients.

[Plasma cell leukemia originating with pleural effusion].

A case of plasma cell leukemia, secreting light kappa chains, is reported. It arose in a 62 year old man and was diagnosed on the basis of a bilateral pleural effusion, which showed many plasma cells and plasmoblasts. The patient also presented multiple osteolytic lesions, no adenopathies, or signs of hepatic or splenic infiltration.

Measurement of glomerular filtration rate by impulse synthesis: clinical validation and optimization.

Impulse synthesis is a technique which relies upon the logic of continuous infusion but extracts the clearance value from single-injection data by shifting and adding them until an asymptotic value is attained. This study has been aimed at validating and optimizing clinically the measurement of glomerular filtration rate by impulse synthesis. A single intravenous injection of 51Cr-EDTA has been made in 32 patients and plasma activity monitored over the next 6 h.