Журнал клинических случаев

??????? 90 ??? ? ??????????? ????????? ???? ????????? ? ????????? ????????? ????????? ?????????? ?????? ? ??????? ?? ??????????????? ?????? ? ??????? ???? ???, ???????? ?? ???????????? ????? ?????????????????, ???????????? ? ????????????. ??????????????? ???????????? ??????? ?????? ?? ???????????.

? ?????????? ???? ???????????? ????? ?????? ??????? ????????????? ??????? ? ?????????? ????????. ??? ?????? ???????? ?????? ??????? NK/T-????????? ??????? ? ?????????? ???????? . NK ? T-?????? ????? ????? ????????? ? ????????????? ???????? ????? T, ????? ??? CD2 ? CD7, ?? NK-?????? ?????? ?????????????? CD3 ? ????????????? ?????????????????? CD3, ? ????? CD16, CD56 ? CD57. ?????? NK/T-????????? ??????? ???????????? EBV, ? ????????????? ???????????? in situ ????????? ??????????????? ???????????. ??????? ??????? ??? EBV ? ?????? ???????????? ??????????? ? ?????????????, ? ???????? ?????????? ??? EBV ? ?????? ??????? ??? ?????? ???????????????? ?????? ? ????????? ????????. ??-????????, ??? ?????? ????? ????? ?????????? ???????? ? ????????? ????????????? ????????, ? ????? ?????? ????? ????????????????? ????????, ???? ???????????? ????? ??????????????? ???????????????? ????????.

?????????? ?????????? ?????????? ??????? (SCAD) ???????? ?????? ??????? ??? ????? ???????? ??????? ??????????? ???????? . ??? ????? ???????? ??????? ????????? ??? ???????? ????? ?????????????, ???????? ?????? ? ????????? ??? ?????? ???????????? ???????, ? ????? ??????? ????????? ? ??????? ?????? ???????????????????? ???????????. ?????????, ??????????? SCAD ? ?????????????, ????????? ?? ???????. ????????? ?????????????????? ??????? SCAD ? ???????? ????????????? ????????????? ???????? ??????? (????) ????? ??????? ???? ?? ????????????? ???????? ? ?????????? ??? ???????? ???????. ?? ??? ??? ??? ?????? SCAD ? ???????? ????????????? ???????? ??????? ???????? ????????????? ? ??????? ??????????????? ???????. ? ????????? ????????? ?? ???????? ? ?????? SCAD ? ????? ???????? ?????????? ???????, ????????? ? ???????? ???????? ??? ??????? ???????? ST ? ?????? ??????? ???????, ????????? ? ?????? ?????????????? ???????? ??????? ? ??????? ???????????? ?????????, ??????? ???? ??????? ???????? ????????????? ? ??????????? ?????????? ??????. ?? ????????? ??????? ????????? ? ????? ? ??????? ????? ??????? ??? ???????? ?????????. ????????? ??? ????????, ??? ?????? ?????? SC.

????? ????? ???????? ?????? ?????? ??????????? ??? ??????????? ????????????, ????????????? ??????? ?????? ???? ????????? ????????? ??-?? ????? ???????? ???????????? , ?????????? ? ???? ????????. ??????????? (??) ?????? ???????????????? ??? ??????????? ??????????? ?????? ?? ?????? ?????? ???????????? ? ?????? ??????? ?????????????? ????????????? ???????? (ß-???), ?????? ??????? ??????????. ??? ?????? 39-?????? ??????? ? 6,5-????????? ??????? ?????????????. ??????? ??? ?????????? ? ????? ??????????? ??-?? ??????? ???????? ???????????? ???????????? ? ??????? ????, ??????????????? ??????????? ß-??? ? ?????, ???????????? ???????????? ? ?????????????? ?????? . ????????? ????????? ???? ??????????????? ????????? ? ????? ???????? ?? ?????? ????? ????????????, ?? ??????? ??????????????? ??????? ?? ? ???????????? ?????. ??????? ???? ???????? ????? 3 ??? (?? 62,5 ?? ??????, ???????????), ??????????? ?? 1, 3 ? 5 ????, ? ?????????????? ??????????? (1 ?) ????? ???? ? ???????? ???????????? ???????. ????????? ?????? ß-??? ???? ???????????????? ?? ?????? 211 ???/??, ? ??????? ??????? ????????? ? ??? ??????????? ???????? ?????? ß-??? ?? 77,5% ? ?????????? ????????????, ????? ??? ?????? ?????????? ??????? ß-??? ???????? 0 ???/??. ??????????????? ??????? ??????? ????????? ??????? ????????????, ??? ????? ??????? ??????, ??????? ????? ???????????? ????? ?????????? ?????????.

?????????? — ??????, ?????????? ?? ???????, ??????? ? ??????? ?????? ??? ????????????? ? ???????? ???????????
????????? ???????? ? ????????? ? ?????????????? (??? ???? ???????????). ? ???????????????? ? ??????? ??????????????? ???????? ????????
????????? ????????? , ????????? ??????????, ????????????, ???????, ??????????, ??????????? ? ????????. ???
????? ? ?????????? ??????, ??????? ?????? ? ??????? ??????? ????? ???????????? ?????? ?????? ??????????? ??-??
???? ? ????? ? 35-??????? ??????? ??? ??????? ??????? ?????????. ??????? ???????? ? ?????? ????????? ????????????
????????? ????? ??????????? ?????? ???????????. ????? ???? ???????????? ???????????? ?? ???? ?????????, ?????
?????????? ????????????? ? ????????? ? ??????? ???????????, ?? ? ???? ?????????? ?????? ??????? ?? ???????? ???????
?????? ????????, ????? ???????????. ???? ?????????? ?????? ??????? ????? ????? ????????????? ??????????? ???????????
? ????????? ??????????????? ?????????. ????????????? ???? ????????? ??????????????? ???????? ????????
????????????? ??????????? ???????? ?? ?????? ?????? ?????????? ?? ?????????, ???????? ? ???????. ????????????? ????????,
????????? ?????????????, ?? ???????? ???????????????? ??????????, ?? ??? ??-???????? ???????? ???????????? ?????????????????? ? ??????????.

?????? ????????? ?????????? ??????????????? ??????????????? ??????????? ???????. ?? ????????????? ???????? ????????? ??????????? ??????????? , ???????? ????? ?????? ???????. ???????????? ? ??????????? ?????????????????? ??????? ?????????? ????????? ???????. ?? ???????????? ?????? ??????? ????????? ???????????? ????????? , ??????? ??????? ????? 3 ???? ????? ??????????????? ????????? ?????? ?????????.

??????????????? ?????? — ??? ??????? ????? ????????????? ??????? ?? ????? ?????????? ?????? ??????????. ?? ????? ?????
??????????, ???????????? ???????????????????? ???????????, ???????, ???? ?? ??????????? ????????, ????? ???????? ? ????????????? ????????
?, ????? ???????, ? ?????????? ??????? ??????????? ????????????. ??? ??????? ????????? ? ??? ? ?????????? ??????? ??????? ,
???????????? ??????? ???? ? ? 2009 ???? ? ???? ??? ????????? ?????? ???????????, ?? ???????? ?? ???????? ?????????. ?
?????? ?????? ????? ?????? ????? ??????? ??????????? ? ?????????????????, ? ?? ????? ??? ??????????? ???????
???????? ????? ???????? ??????? ????????????????????? ??????????? ? ??????????????? ????????? ?????????????????? ???????.
? ????? ?????? ??? ????? ?????? ????? ??????? ??????????? ? ????????????, ??? ? ??????, ?? ???????????????
???????????? ??? ??????????????? ????? ???????? ??????? 80% ?????????????? ??????. ????????????????????? ????????
CD23(+) ? CD56(+), ? ???????????????? ???????? CD23(+), CD56(+) ? CD138(+). ????????????
???????? ??????? t(4;14) ? 5% ????????????? ??????. ?? ????????? ?????????????? ????????????
??? ????????? ??????? ??????????????? ???????, ? ???????? ???? ????????? ????? ???????, ??????????
???????????, ?????????? ? ?????????????. ??? ?????????? ????? ?????? ? ????? ? ??????? ??????
????? ?????? ???????. ??????? ???????? ????? ???????? ????? ?? ?????? ?????, ??????? ??????? ??????????? ??? ??????????
??????????? ????????. ???????? ???????????? ?????????? ???????????, ???????
??????????? ??? ????? ?????? ????????????????? ????????????, ????????? ??? ?????????? ? ???????????? ????????, ??? ?????????? ??????????? ???????? ?, ????? ???????, ???????? ??????? ?
????????? ????? ??????? ????????.

Keratosis Follicularis Spinulosa Decalvans (KFSD) is an X-linked
genodermatosis characterized by scarring alopecia and follicular
hyperkeratosis. This condition mainly affects males with females being
carriers and will have milder symptoms. We present a family of two
siblings of KFSD, boy had nine years and girl had five years old. This
genodermatosis often starts at infancy or early childhood. Keratosis
pilaris atrophicans (KPA) is the umbrella term for a group of three rare
and distinct clinical entities representing the scarring types of keratosis
pilaris.

Transformation of follicular lymphoma (FL) to Diffuse Large B-Cell Lymphoma (DLBCL) occurs commonly is and associated with a rapidly progressive clinical course that is refractory to treatment and a short survival. The clinical presentation of this transformed disease is variable. We here report a 65 years old man with an atypical presentation of transformed FL. He initially presented with symptoms and clinical signs consistent with Multiple myeloma. His bone marrow biopsy result revealed plasma cell infiltration (CD 138+, CD56-) throughout the marrow. He had a rapid progressive worsening of his condition; he developed liver and renal failure. His imaging studies revealed diffuse lymphadenopathy, an excisional lymph node biopsy done showed FL which had transformed into DLBCL with prominent plasma cell differentiation. He was treated with of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) with overall good response but has currently relapsed.

Background: The tyrosine kinase inhibitor, a new treatment option in hepatic carcinoma, may associate thyroid dysfunction like spontaneously remitting thyrotoxicosis followed by hypothyroidism. Case report: A 66-year Caucasian female was first diagnosed and operated for a moderately differentiated rectal adenocarcinoma of 5 centimeters. Immunohistochemistry showed positive VEGF receptor 2 (Flk-1, KDR), VEGF receptor 1(Flt-1), and a Ki67 of 30%. 4 years later a hepatic adenocarcinoma (clear cells variant) was diagnosed. After surgery, daily 400 mg of sorafenib was introduced. Three months later mild symptomatic thyrotoxicosis was seen: palpitations, fatigue, and mild bilateral pedal clonus. Thyroid-stimulating hormone (TSH) was suppressed (0.044 μIU/mL, normal levels between 0.4 and 4.5 μIU/mL), and free levothyroxine (fT4) elevated. The TSH receptor antibody, the antithyreoglobulin and antithyreoperoxidase antibodies were negative. Thyroid ultrasound pointed hypoechogenic, inhomogeneous aspects. She received beta-blocker and within two months thyrotoxicosis remitted but TSH progressively increased suggesting hypothyroidism with level less 5 μIU/mL so no replacement levothyroxine therapy was added yet. Discussions: The exact mechanism of the tyrosine kinase inhibitors-related thyroid malfunction is not fully understood. Non-autoimmune destructive thyroiditis of unknown trigger causes thyrotoxicosis and later hypothyroidism as seen in our case. The clinical features vary from one person to another. The hormone replacement is rarely necessary. The baseline cancer seems irrelevant for thyroid toxicity. In our unusual case the patient had a history of two metachronous cancers. The thyroid follow up is essential during each patient therapy yet a specific pattern of follow-up is not precisely designed. Conclusion: The tyrosine kinase inhibitor-induced thyroid dysfunction includes both thyrotoxicosis and hypothyroidism. We emphasize the idea of periodic endocrine evaluation in oncologic patient treated with this class of drugs.

Objective: We report a case of pulmonary cement embolism following percutaneous vertebroplasty performed for osteoporotic vertebral compression fracture. Summary of background data: Asymptomatic pulmonary cement embolism, more than symptomatic pulmonary cement embolism, are not so rare from 2.1% to 26%. Methods: The fifth day after surgery, an angioscan was performed because of respiratory failure. It showed a pulmonary cement emboly in the apical segment, medium lobe and ventro-basal segment of the right lung. Results: Symptomatic treatment with oxygen and curative anticoagulation allowed a complete respiratory function recovering. Conclusions: So as to better diagnose this complication, a careful analysis of the post-operativ pulmonary X-ray and regular follow-up are necessary. The main interest of this case report is the knowledge of chest X-ray as a screening test for pulmonary cement embolism.

Introduction: Vitamin D receptor (VDR) plays a key role in the metabolism and differentiation of keratinocytes; thus, associations between VDR polymorphisms with Psoriasis vulgaris (PsV) onset have been sought for many years. The results of these studies have not been conclusive. To date there are no studies in Mexico regarding the association between these polymorphisms and the clinical manifestations of PsV. Objective: The aim of this study was to determine the association between polymorphisms in the VDR gene (FokI, BsmI, ApaI and TaqI) and the clinical manifestations of PsV in a group of Mexican patients. Methods: The study group consisted of 52 patients from north (NPsV n=24) and western (OPsV n=28) regions of the country diagnosed with PsV. This group of patients were compared with healthy donors from the western (POc n=50) and northern (PN n=50) regions. RFLPs were identified to determine allelic and genotypic frequencies for all the groups. Hardy-Weinberg equilibrium (HWE) as well as haplotype distributions were estimated. Statistical tests were X2 and Fisher’s exact test. Haplotype distribution was carried out with SNPstats software. Results: There was no significant difference when the genotypic frequencies between patients and controls are compared; however, there is an association between the TT(ff) genotype of FokI polymorphism and clinical manifestations. The most frequently observed haplotypes of polymorphisms (FokI, BsmI, ApaI and TaqI) have significantly different distributions (p>0.0001) between patients with PsV and controls. Conclusions: Our results show that the polymorphisms FokI, ApaI, BsmI and TaqI in the VDR gene are not associated with the risk of presenting PsV in Mexican population, but the TT(ff) genotype of the FokI polymorphism is significantly more common in patients with late onset of PsV (after age 40) and those without nail affection. More studies including a greater number of samples and other polymorphisms must be analyzed.

A 51-year old women suffering from depression with psychotic symptoms and a history of meningitis and epilepsia since childhood was treated paroxetine, olanzapine and lamotrigine for years.