Anna Grzywa-Celińska

A comparative analytical assessment of iodides in healthy and pathological human thyroids based on IC-PAD method preceded by microwave digestion

The aim of the study was to examine correlations between the content of iodides in 66 nodular goiters and 100 healthy human thyroid tissues (50- frozen and 50 formalin-fixed). A fast, accurate and precise ion chromatography method on IonPac AS11 chromatographic column (Dionex, USA) with a pulsed amperometric detection (IC-PAD) followed by alkaline digestion with tetramethylammonium hydroxide (TMAH) in a closed system and with the assistance of microwaves was developed and used for the comparative analysis of two types of human thyroid samples. Statistical analysis revealed over eightfold reduction of iodine concentration in the pathological tissues (the mean value was 77.13±14.02 ppm) in comparison with the control group (622.62±187.11 ppm for frozen samples and 601.49±192.11 ppm for formalin-fixed ones). A good correspondence (for 10 additional determinations) between the certified (3.38±0.02 ppm with variation coefficient (V.C.) of 0.59% for Standard Reference Material (SRM) NIST 1549-non-fat milk powder) and the measured iodine concentrations (3.52±0.29 ppm; V.C.=10%) was achieved. It was pointed out that the way of tissue preservation (either in formalin or by freezing) had no significant effect on the iodine determination result (α=0.1). Significantly lower iodide content was found in nodular goiter thyroid samples. The applied conditions of digestion, reinforced by the action of microwaves, brought about a decidedly shorter (less than 20 min) sample preparation time. Suitability of the developed IC method was supported by validation results.

Pulmonary actinomycosis – the great imitator

Pulmonary localisation represents only 15% of all cases of actinomycosis. The clinical symptoms and radiological changes of this disease are non-specific and sometimes it can be misdiagnosed, usually as tuberculosis, lung cancer or lung abscess. In the reported case, what might look like the lung cancer, finally turned out to be actinomycosis. The interesting case is presented of lung actinomycosis in a 77-year-old farmer, admitted to the Department of Pneumonology, Oncology and Allegology in Lublin due to a massive haemoptysis. CT scan of the chest showed, apart from other changes, the spicular consolidation in the right lung which aroused oncology vigilance. The diagnostic path, which was a real medical challenge, led to the diagnosis of actinomycosis. The process of diagnosis and consequent treatment, which led to the complete regression of clinical and radiological changes, is presented.

‘TB or not TB?’ Problems of differential diagnosis of cutaneous mycobacteriosis and tuberculosis – A Case Study and interdisciplinary discussion

The diagnosis of cutaneous tuberculosis poses a serious challenge due to many skin diseases of different etiology resembling the lesions caused by the TB (tuberculosis) bacillus, and difficulties in confirming the disease. The presented case concerns skin lesions in a hobby aquarist stung in the finger of the left hand by a fish. The resulting inflammatory infiltration was to be cutaneous tuberculosis or mycobacteriosis caused by MOTT (Mycobacterium other than tuberculosis). Laboratory, pathomorphologic, genetic and microbiologic tests of samples obtained from the patient, fish and water in the aquarium gave ambiguous results. A multidisciplinary discussion is presented on the difficulties in the differential diagnosis, problems with a clear interpretation of the results of various conducted tests, and possible ways of transmission of the infection, relevant to the described example.

Acute urticaria: an extremely rare adverse effect of levonorgestrel-releasing intrauterine system as a possible manifestation of progestogen hypersensitivity syndrome

Address for correspondence: Justyna Emeryk-Maksymiuk, MD, PhD, Chair of Internal Medicine and Department of Internal Medicine in Nursing, Medical University of Lublin, 8 Jaczewskiego St, 20-954 Lublin, Poland, phone: +48 81 724 47 02, e-mail: justynaemeryk@poczta.onet.pl Received: 6.03.2017, accepted: 9.07.2017. Acute urticaria: an extremely rare adverse effect of levonorgestrel-releasing intrauterine system as a possible manifestation of progestogen hypersensitivity syndrome

Three interesting cases of syndrome of inappropriate antidiuretic hormone secretion

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an etiologically-diverse pathological condition resulting from the elevation in both ectopic and autonomic secretion of the antidiuretic hormone (ADH) by neoplastic tissue; excessive stimulation of the hypothalamic-pituitary axis, e.g. in pulmonary diseases, central nervous system (CNS) abnormalities, endocrine glands dysfunction or due to the use of some medications; intensification of renal ADH action by certain medications and action of substances chemically-related to vasopressin. The clinical characteristics of the syndrome are comprised of the presence of inadequately concentrated urine, hyponatremia, and hypo-osmolal blood serum, as well as weight gain. To show the variety of its causes and courses the article presents three cases of patients diagnosed with SIADH in the Department of Internal Medicine. In each of them the syndrome of inappropriate antidiuretic hormone secretion manifested in clinical laboratory tests in the form of hyponatremia.