[Therapy of status asthmaticus].
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Biomedical subjects
Publications and source records attributed to M Koller.
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Adenoid cystic carcinoma of the breast is a rare neoplasm that usually has a benign biological behavior. A patient who was operated upon for removal of this tumor developed metastases to the lungs and brain 12 years after mastectomy. This is probably the first report in the literature of brain metastasis from adenoid cystic carcinoma of the breast. Radiological and histological evidence of both primary breast tumor and the metastasis to the brain are presented.
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Case reports on two patients with metastatic pulmonary calcification are presented. Both suffered from long standing chronic renal failure and received immunosuppressive therapy for a (non-functioning) renal transplant. Laboratory tests disclosed hyperphosphatemia and secondary hyperparathyroidism. In the first patient, who presented with "pulmonary edema", the course was rapidly fatal. Diffuse pulmonary calcification was diagnosed only post mortem. Transbronchial biopsy was diagnostic for calcification in the second patient, who had exertional dyspnea and bilateral, asymmetric, interstitial infiltrations on chest X-ray. In patients with chronic renal failure, metastatic calcifications are due not only to disturbances of calcium-phosphate homeostasis but also to other, mostly unknown factors. Diagnostic procedures include biopsy and 99m-technetium-diphosphonate scintigraphy. Prophylaxis of pulmonary calcifications through normalization of serum phosphate and, if indicated, subtotal parathyroidectomy is of the utmost importance as regression of established calcifications rarely occurs.
Since automated multichannel analyzers have been introduced in the clinical laboratory the diagnosis of hypercalcemia is frequently accidental. The clinical significance of asymptomatic hypercalcemia is discussed on the basis of the differential diagnosis of hypercalcemia. In no disease, and especially not in malignancy and primary hyperparathyroidism, which are the two most frequent causes, is asymptomatic hypercalcemia clinically relevant, and further diagnostic tests should be avoided. Up to now it has not been demonstrated that patients with asymptomatic hyperparathyroidism benefit from surgery. Instead of routine estimations of serum calcium concentration, the aim should be to detect symptomatic hypercalcemia on the basis of a thorough knowledge of the hypercalcemia syndrome with all its variants.
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