Biomedical subjects
Publications and source records attributed to A Moragas.
A case of gastric lymphoplasmocytoid lymphoma with alpha heavy chains in the serum is reported. The patient was a 20-year-old female who had a gastric lymphomatous ulcer and who died of acute bleeding, with no clinical or radiological signs of small intestine involvement. This seems to be the first reported case of gastrin alpha heavy chain disease.
We report on two outbreaks of Mycobacterium chelonei subsp. abscessus cutaneous infections, which occurred between June 1974 and April 1975 in a series of 24 patients (15 studied bacteriologically) subjected to venous stripping for varicose veins. The source of infection was the aqueous solution of merbromin used in presurgical care.
The first case of gamma-heavy chain disease described in Spain is here reported. The patient, a 36-year-old woman, presented fever, enlarged regional lymph nodes, and hepatosplenomegaly, without bone marrow abnormalities but with lymphopenia. Serum electrophoresis did not disclose any M-component. The abnormal gamma-chain protein had a alpha2-globulin mobility and was immunochemically related to the Fc fragment. It belonged to the IgG 4 subclass, its molecular weight was about 60,000. Proteinuria was minimal but the electrophoresis of concentrated urine showed a homogeneous peak of alpha2-globulin mobility constituted by the gamma-chain fragment. Biopsy of an axillary lymph node disclosed features of immunoblastic sarcoma. The course was malignant, resulting in death in 8 months.
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Two patients with alpha heavy chain disease are described. In the first patient, treatment with cyclophosphamide, prednisone and doxycycline was associated with a 28 month-long remission and the disappearance of the paraprotein and lymphoplasmocytic infiltration of the intestine. Shortly afterwards, a retroperitoneal immunoblastic lymphoma was found associated with an immunoglobulin G-kappa-paraproteinemia, and gamma heavy and kappa-light chains in the urine; the intestinal biopsy specimen was normal. In the other patient, the alpha chain only appeared two years after the malabsorption syndrome. The fact that in the first, apparently cured patient, a tumor of different anatomic site and secretory capacity appeared, suggests the existence of a B-cell neoplasia of different clone from that which gave rise tothe original disease. In the second patient, it is probable that only the increase in the mass of neoplastic cells led to the detection of the protein abnormality, or alternatively the antigenic-oncogenic stimulus led to the abnormal secretion only after two years.
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Hepatic lesions were studied for the first time in 13 cases of boutonneuse fever (Mediterranean exanthematous fever). The glutamic-oxalacetic transaminases were raised in eight patients, the glutamic-pyruvic transaminases showed an increase in 10 patients, alkaline phosphatases in seven of the 10 patients investigated, and conjugate bilirubin showed moderate increases in three patients. Five patients were studied histologically; this study showed lesions of a granulomatous type, similar to those described in Q fever, in three patients, fatty degeneration with marked alcoholism in another patient, and a normal liver in the last patient. Two of the three patients with granulomatous lesions showed a moderate increase in alkaline phosphatases. After this report boutonneuse fever must be included among the infectious conditions that can produce granulomas within the liver.
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