METFORMIN POISONING AND METFORMIN ASSOCIATED LACTACIDOSIS

Svrha ovog rada je prikaz neobičnog slučaja otrovanja metforminom s razvojem laktacidoze, koji je uspješno liječen u hitnom prijmu. Dijabetičar u dobi od 65 godina koji je u terapiji imao metformin dovezen je u noćnim satima u hitni prijam zbog traume glave. Nađene su niske vrijednosti glukoze u kapilarnoj krvi, koje su se normalizirale nakon primjene glukoze intravenski. Nakon udarca u glavu zaostao je nejasan kvalitativni poremećaj svijesti, a u acidobaznom statusu smo našli tešku acidozu s proširenim anionskim zjapom i povišenim laktatima. Na agresivne potporne mjere došlo je do stabilizacije acidobaznog statusa, a nakon dugotrajne opservacije pacijent je otpušten iz hitnog prijma. Ovakvo otrovanje metforminom je neobična i atipična klinička prezentacija koja je mogla lako završiti smrtnim ishodom. U prikazu slučaja dajemo recentne preporuke o prepoznavanju, obradi i liječenju ovog za život opasnog stanja.The objective of this case report is to present a patient with metformin poisoning, and to highlight treatment and potential pitfalls. A 65-year-old patient was admitted to Emergency Department (ED) with head injury. He was hypoglycemic and received IV glucose, but altered consciousness persisted. His arterial blood gas analysis showed deep acidemia with high lactate levels. After aggressive treatment, his pH improved, and after prolonged 36-hour observation in ED, lactate levels dropped to normal, he was feeling better and was discharged home. This was an unusual presentation of metformin toxicity, which is usually life threatening, therefore we try to point out how to manage and recognize patients like this one in ED

Value of Fine-Needle Aspiration Cytology in Diagnosis of Hodgkin’s Lymphoma and Anaplastic Large Cell Lymphoma: One Centre Experience

The aim of the study was to determine the value and limitations of cytology in diagnosis of Hodgkin’s lymphoma (HL) and anaplastic large cell lymphoma (ALCL) as well as differentiation between these two entities. We analysed the FNA cytodiagnoses and histopathological reports, as well as treatment and survival in 89 newly diagnosed consecutive patients with these lymphomas treated in our clinical department. These patients (40 male, 49 female; age range 16–93 years; 44 in clinical stages I–II; 38 with B symptoms) were diagnosed and treated during a period of 64 months (1.1. 2004–1.5.2009). The FNA cytodiagnoses were available in 86 patients and the pathohistological diagnoses were available in 84 patients. Cytology revealed 65 classic HL, 18 ALCL and three patients in which diagnosis was not informative. Among 65 FNA cytodiagnoses of HL, comparison with histopathology was made in 61 cases and the histopathological diagnoses were as follows: 56 (91.8%) HL; three ALCL; one diffuse large B cell lymphoma and one marginal zone B cell lymphoma. In the group of 18 FNA cytodiagnoses of ALCL eight patients (53.3%) had definitive diagnosis of ALCL (either as T-cell or O type), five (33.3%) of HL and in three cases a histopathological diagnosis could not be made. These results confirm the value of FNA in diagnostic procedure in patients with HL and ALCL, especially in HL group of patients. Since we have an almost uniform group of patients according to therapeutic approach, we did univariate analyses and found out that patients with FNA cytodiagnoses of HL, younger than 55 years, with early stage of the disease and without B symptoms had significantly longer overall survival (OS). FNA cytodiagnosis has clinical relevance in differentiation between HL and ALCL

METFORMIN POISONING AND METFORMIN ASSOCIATED LACTACIDOSIS

Svrha ovog rada je prikaz neobičnog slučaja otrovanja metforminom s razvojem laktacidoze, koji je uspješno liječen u hitnom prijmu. Dijabetičar u dobi od 65 godina koji je u terapiji imao metformin dovezen je u noćnim satima u hitni prijam zbog traume glave. Nađene su niske vrijednosti glukoze u kapilarnoj krvi, koje su se normalizirale nakon primjene glukoze intravenski. Nakon udarca u glavu zaostao je nejasan kvalitativni poremećaj svijesti, a u acidobaznom statusu smo našli tešku acidozu s proširenim anionskim zjapom i povišenim laktatima. Na agresivne potporne mjere došlo je do stabilizacije acidobaznog statusa, a nakon dugotrajne opservacije pacijent je otpušten iz hitnog prijma. Ovakvo otrovanje metforminom je neobična i atipična klinička prezentacija koja je mogla lako završiti smrtnim ishodom. U prikazu slučaja dajemo recentne preporuke o prepoznavanju, obradi i liječenju ovog za život opasnog stanja.The objective of this case report is to present a patient with metformin poisoning, and to highlight treatment and potential pitfalls. A 65-year-old patient was admitted to Emergency Department (ED) with head injury. He was hypoglycemic and received IV glucose, but altered consciousness persisted. His arterial blood gas analysis showed deep acidemia with high lactate levels. After aggressive treatment, his pH improved, and after prolonged 36-hour observation in ED, lactate levels dropped to normal, he was feeling better and was discharged home. This was an unusual presentation of metformin toxicity, which is usually life threatening, therefore we try to point out how to manage and recognize patients like this one in ED

Value of fine-needle aspiration cytology in diagnosis of Hodgkin's lymphoma and anaplastic large cell lymphoma: one centre experience [Važnost citološke aspiracijske punkcije tankom iglom u dijagnostici Hogkinovog limfoma i anaplastičnog velikostaničnog limfoma: iskustvo jednog kliničkog centra]

The aim of the study was to determine the value and limitations of cytology in diagnosis of Hodgkin’s lymphoma (HL) and anaplastic large cell lymphoma (ALCL) as well as differentiation between these two entities. We analysed the FNA cytodiagnoses and histopathological reports, as well as treatment and survival in 89 newly diagnosed consecutive patients with these lymphomas treated in our clinical department. These patients (40 male, 49 female; age range 16–93 years; 44 in clinical stages I–II; 38 with B symptoms) were diagnosed and treated during a period of 64 months (1.1. 2004–1.5.2009). The FNA cytodiagnoses were available in 86 patients and the pathohistological diagnoses were available in 84 patients. Cytology revealed 65 classic HL, 18 ALCL and three patients in which diagnosis was not informative. Among 65 FNA cytodiagnoses of HL, comparison with histopathology was made in 61 cases and the histopathological diagnoses were as follows: 56 (91.8%) HL; three ALCL; one diffuse large B cell lymphoma and one marginal zone B cell lymphoma. In the group of 18 FNA cytodiagnoses of ALCL eight patients (53.3%) had definitive diagnosis of ALCL (either as T-cell or O type), five (33.3%) of HL and in three cases a histopathological diagnosis could not be made. These results confirm the value of FNA in diagnostic procedure in patients with HL and ALCL, especially in HL group of patients. Since we have an almost uniform group of patients according to therapeutic approach, we did univariate analyses and found out that patients with FNA cytodiagnoses of HL, younger than 55 years, with early stage of the disease and without B symptoms had significantly longer overall survival (OS). FNA cytodiagnosis has clinical relevance in differentiation between HL and ALCL

Fractional crystallization-induced variations in sulfides from the Noril’sk-Talnakh mining district (polar Siberia, Russia)

The distribution of platinum-group elements (PGE) within zoned magmatic ore bodies has been extensively studied and appears to be controlled by the partitioning behavior of the PGE during fractional crystallization of magmatic sulfide liquids. However, other chalcophile elements, especially TABS (Te, As, Bi, Sb, and Sn) have been neglected despite their critical role in forming platinum-group minerals (PGM). TABS are volatile trace elements that are considered to be mobile so investigating their primary distribution may be challenging in magmatic ore bodies that have been somewhat altered. Magmatic sulfide ore bodies from the Noril’sk-Talnakh mining district (polar Siberia, Russia) offer an exceptional opportunity to investigate the behavior of TABS during fractional crystallization of sulfide liquids and PGM formation as the primary features of the ore bodies have been relatively well preserved. In this study, new petrographic (2D and 3D) and whole-rock geochemical data from Cu-poor to Cu-rich sulfide ores of the Noril’sk-Talnakh mining district are integrated with published data to consider the role of fractional crystallization in generating mineralogical and geochemical variations across the different ore types (disseminated to massive). Despite textural variations in Cu-rich massive sulfides (lenses, veins, and breccias), these sulfides have similar chemical compositions, which suggests that Cu-rich veins and breccias formed from fractionated sulfide liquids that were injected into the surrounding rocks. Numerical modeling using the median disseminated sulfide composition as the initial sulfide liquid composition and recent DMSS/liq and DISS/liq predicts the compositional variations observed in the massive sulfides, especially in terms of Pt, Pd, and TABS. Therefore, distribution of these elements in the massive sulfides was likely controlled by their partitioning behavior during sulfide liquid fractional crystallization, prior to PGM formation. Our observations indicate that in the Cu-poor massive sulfides the PGM formed as the result of exsolution from sulfide minerals whereas in the Cu-rich massive sulfides the PGM formed by crystallization from late-stage fractionated sulfide liquids. We suggest that the significant amount of Sn-bearing PGM may be related to crustal contamination from granodiorite, whereas As, Bi, Te, and Sb were likely added to the magma along with S from sedimentary rocks. Large PGM that are scarce and randomly distributed may account for most of the whole-rock Pt budget. Based on our results, we propose a holistic genetic model for the formation of the magmatic sulfide ore bodies of the Noril’sk-Talnakh mining district

Processes controlling the distribution of Te, As, Bi, Sb, and Sn, and the formation of platinum-group minerals in sulphide ores in the Noril’sk mining district (Russia)

The distribution of TABS (Te, As, Bi, Sb, and Sn) in magmatic sulphide ore deposits have been neglected despite their critical role in forming platinum-group minerals (PGM). Investigating the primary processes controlling the TABS distribution is a challenge as TABS are generally volatile, present at low levels, and mobile with alteration. Magmatic sulphide ore bodies in the Noril’sk mining district (Siberia, Russia) offer an exceptional opportunity to investigate the behaviour of TABS during fractional crystallisation of sulphide liquids and PGM formation as the primary features of the ore bodies have been relatively well preserved. We show that the distribution of Pt, Pd, and TABS is controlled by their partitioning behaviour during sulphide liquid fractional crystallisation, prior to PGM formation. In Cu-poor massive sulphides the PGM formed as the result of exsolution from sulphide minerals, whereas in Cu-rich massive sulphides the PGM formed by crystallisation from late-stage fractionated liquids