Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.

Tyrimo objektas. Celiakija yra labai dažna virškinimo trakto liga. Jos paplitimas Europoje ir Šiaurės Amerikoje 1 iš 100-300 suaugusių ir vaikų. Lietuvoje duomenų apie celiakijos paplitimą nėra, ši liga diagnozuojama tik pavieniais atvejais [29]. Sergantieji imumoglobulino A (IgA) deficitu 10 kartų dažniau serga celiakija negu sveikieji. Viršutinių kvėpavimo takų ir virškinimo trakto infekcijos, autoimuninės ligos ir onkologiniai susirgimai taip pat dažnesni sergantiesiems IgA deficitu [143, 163-168]. Lietuvoje duomenų apie IgA deficito paplitimą nėra [29]. Darbo tikslas. Nustatyti Vilniaus miesto 11-13 m. vaikų celiakijos ir IgA deficito paplitimą. Tyrimo medžiaga ir metodai. Gavus Lietuvos bioetikos komiteto leidimą nuo 2009 metų sausio mėnesio iki 2010 metų kovo mėnesio ištirta 1000 vaikų nuo 11 iki 13 metų amžiaus, kurie mokėsi šešiose lietuviškose Vilniaus miesto mokyklose. Mokyklos pasirinktos atsitiktiniu atrankos būdu. Jose buvo išdalintos asmens informavimo formos (tėvams priedas nr. 1 ir vaikams priedas nr. 2), kuriose buvo aprašytas biomedicininis tyrimas, jo eiga ir nauda. Vaikams, kurių tėvai sutiko atlikti celiakijos tyrimą, buvo nustatomi audinių transgliutaminazės IgA klasės (aTG IgA) antikūnai ir bendras IgA kiekis kapiliarinio kraujo laše. Tyrimo metu buvo naudojami Biocard TM celiakijos testai (Ani Biotech OY, Suomija). Tyrimo atsakymas buvo gaunamas ir įvertinamas po 5 min. Nustačius aTG IgA klasės antikūnus, vaikai buvo nukreipti į Vilniaus universitetinę... [toliau žr. visą tekstą] / Object. Coeliac disease is one of the most prevalent gastrointestinal disorder. It‘s prevalence in Europe and North America is 1 of 150-300 adults and children. In Lithuania there are no data on prevalence of coeliac disease but it‘s seems that there is hypodiagnosis [29]. IgA-deficient individuals have a tenfold risk for coeliac disease compared with the general population. Patients with IgA deficiency have a tendency to develop recurrent sinopulmonary and gastrointestinal infections, allergies, autoimmune diseases and malignancies [148-154]. There are no data on the prevalence of IgA deficiency in Lithuania [29]. The aim. To determine the prevalence of coeliac disease and IgA deficiency among 11-13 years children in Vilnius. Material and methods. From January 2009 to March 2010 we investigated 1000 children (11-13 years of age) for coeliac disease and immunoglobulin A (IgA) deficiency from six Vilnius secondary schools. We examined capillary blood for tissue transglutaminase IgA class antibodies (tTG IgA) and total IgA with Biocard TM test (Ani Biotech OY, Finland) for children whose parents agreed to do this test. The results were evaluated after 5 min. Children with positive test results (tTG IgA positive or total IgA deficiency) underwent small bowel endoscopy with biopsies at Vilnius University Children Hospital to confirm or deny the diagnosis of coeliac disease. We get permission for this study from Lithuanian Bioethics Committee. Results. Two of 1000 children were... [to full text]

A Imunodeficiência Comum Variável (ICV) e a Deficiência Seletiva de Imunoglobulina A (DIgA) são as imunodeficiências primárias humorais de maior freqüência na população mundial. Ambas as doenças são caracterizadas pela ausência ou redução significativa de imunoglobulinas no soro. Embora diversas anormalidades imunológicas tenham sido associadas a estas doenças, nenhuma hipótese unificadora a respeito das bases moleculares das mesmas foi proposta até o presente momento, sendo que o único defeito comum a todos os pacientes é a falha na diferenciação de células B em plasmócitos e conseqüente secreção de anticorpos. Devido à alta incidência de auto-imunidade e alergia em pacientes com ICV e DIgA, no presente trabalho, visamos analisar por citometria de fluxo a população de linfócitos CD4+ com potencial regulador nesses pacientes, para avaliar se possíveis defeitos quantitativos ou funcionais nesta população reguladora poderiam explicar a alta incidência de doenças auto-imunes ou alérgicas associadas a estas imunodeficiências. / Common Variable Immunodeficiency (CVID) and Selective Immunoglobulin A deficiency (IgAD) are the humoral primary immunodeficiencies with the highest incidence in the population. Both diseases are characterized by the absence or significant reduction of serum immunoglobulins. Although several immunological abnormalities have been associated with these diseases, no unifying hypothesis regarding the molecular basis of CVID and IgAD have been proposed to date, and the only defect common to all patients is the failure in differentiation of B cells into plasma cells and consequent secretion of antibodies. Due to the high incidence of autoimmunity and allergy in patients with CVID and IgAD, in the present work we analyzed by flow cytometry the population of CD4+ lymphocytes with regulatory potential in these patients to assess whether possible quantitative or functional defects in this regulatory population could explain the high incidence of autoimmune diseases or allergic reactions associated with these immunodeficiencies.

A Imunodeficiência Comum Variável (ICV) e a Deficiência Seletiva de Imunoglobulina A (DIgA) são as imunodeficiências primárias humorais de maior freqüência na população mundial. Ambas as doenças são caracterizadas pela ausência ou redução significativa de imunoglobulinas no soro. Embora diversas anormalidades imunológicas tenham sido associadas a estas doenças, nenhuma hipótese unificadora a respeito das bases moleculares das mesmas foi proposta até o presente momento, sendo que o único defeito comum a todos os pacientes é a falha na diferenciação de células B em plasmócitos e conseqüente secreção de anticorpos. Devido à alta incidência de auto-imunidade e alergia em pacientes com ICV e DIgA, no presente trabalho, visamos analisar por citometria de fluxo a população de linfócitos CD4+ com potencial regulador nesses pacientes, para avaliar se possíveis defeitos quantitativos ou funcionais nesta população reguladora poderiam explicar a alta incidência de doenças auto-imunes ou alérgicas associadas a estas imunodeficiências. / Common Variable Immunodeficiency (CVID) and Selective Immunoglobulin A deficiency (IgAD) are the humoral primary immunodeficiencies with the highest incidence in the population. Both diseases are characterized by the absence or significant reduction of serum immunoglobulins. Although several immunological abnormalities have been associated with these diseases, no unifying hypothesis regarding the molecular basis of CVID and IgAD have been proposed to date, and the only defect common to all patients is the failure in differentiation of B cells into plasma cells and consequent secretion of antibodies. Due to the high incidence of autoimmunity and allergy in patients with CVID and IgAD, in the present work we analyzed by flow cytometry the population of CD4+ lymphocytes with regulatory potential in these patients to assess whether possible quantitative or functional defects in this regulatory population could explain the high incidence of autoimmune diseases or allergic reactions associated with these immunodeficiencies.