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Elevation of Ca 19-9

72-year-old female with elevated levels of the tumour marker CA 19-9 but none of the diagnostic tests showed any tumour finding. The levels of CA 19-9 remained in the pathologic range, although with decreasing values. Currently, the patient is not reporting any significant symptoms.

Chronic Glomerulonephritis with immune complexes

42-year-old female with chronic renal insufficiency secondary to immune complex mediated glomerulonephropathy, hypertension, Type 2 diabetes mellitus, and hyperlipidemia. The recommended solution for her is kidney transplant.

IgG Multiple Myeloma

57-year-old male who was found to have back pain and hyperglobulinemia approximately. Marrow biopsy was consistent with IgG myeloma. He was treated with steroids and local radiotherapy with improvement in symptoms and a modest reduction in the M-component. He received melphalan-based autologous stem cell transplantation, which was complicated by reversible respiratory failure. Unfortunately, he relapsed and was treated with bortezomib and steroids for 6 cycles followed by thalidomide. The disease has responded to therapy.

Hypertensive Patient with mostly uncontrolled Blood Pressure

A known hypertensive female patient whose blood pressure is mostly uncontrolled. The expert recommends to focus on appropriate treatment which should include fixed combination of Angiotensin Receptor Blocker and diuretics together with 24 hour blood pressure monitoring. The expert emphasize that frequent changes, discontinuations of drugs or big intervals between one dose to another can be responsible for hypertensive crisis.

Vitamin D Abnormality / Parathyroid Hormone Abnormality

51-year-old female with vitamin D deficiency among other medical problems: high blood pressure, episodes of transient syncope, and sleep apnea. In the expert's opinion frequent changes and discontinuations of drugs as well as big intervals between one dose to another, can be responsible for hypertensive crisis. Therefore the expert recommends to stop too frequent investigations , and instead focus on appropriate treatment, that should be combination of Angiotensin Receptor Blocker and diuretics.

Multirelapse Squamed Carcinoma of the Skin

75-year-old male with a cutaneous squamous cell carcinoma resected from the right eyebrow in 2003. In 2006, the patient underwent resection of an ipsilateral squamous cell carcinoma in the parotid bed that was presumably a nodal metastasis. He then experienced local relapse treated with resection and adjuvant radiotherapy. There was recurrent disease involving the right cheek excised in 2008. In 2009, another recurrence led to resection with orbital exenteration. Pathology showed squamous cell carcinoma, with perineural invasion, and extension into the orbital muscles.

End Stage Renal Disease

54-year-old obese male with end stage renal disease due to membranous nephropathy, has received 2 renal transplants in the past and is highly sensitized. He underwent coronary angiography for vessel CAD, and PTCAs and stanting were performed. His current treatment consists of multiple medications including mycophylate according to the instructions of his transplant nephrologist. His cardiologists sees no contraindication to transplantation.

Psychomotor retardation due to spinal amyotrophy

10 months old, female. After normal birth (at the 40th week of pregnancy) and neonatal period, started to suffer from gastroesophageal reflux and recurrent respiratory infections, at times with broncospasm. In addition, psychomotor retardation was found and the young patient was assessed by a neurologist. The tests run (EMG and genetics for SMA) pointed to the diagnosis of Spinal Amyotrophy.
After hospitalization due to catarrhal bronchitis, the patient was discharged in good general conditions with recomendations for respiratory physiotherapy and neurological rehabilitation.

Neuroroendocrine neoplasia with hepatic secondary lesions

39-year old male was diagnosed with metastases of Neuroendocrine tumor to the liver, presumably from pancreatic origin, suffered from significant weight loss. The administered treatments include Chemotherapy, Roferon A, Statins and Dietary supplements.

Cancer of Colon with Metastases

70-year-old-male was diagnosed with colon cancer. After undergoing a right hemicolectomy, hepatic lesions were revealed. Three months after starting chemotherapy a CT revealed recurrent hepatic disease and celiac lymphadenopathy. He underwent directed therapy with radiofrequency ablation and stereotactic radiation, but unfortunately a repeat CT showed progressive disease in the liver and new pulmonary disease. Upon surgical exploration, his liver disease was deemed too extensive for surgical resection.

Hepatic metastases from prostatic adenocarcinoma

A 66 year old man that was diagnosed with prostate cancer underwent radical prostatectomy 2 years ago. Pathology result of the surgical specimen revealed poorly differentiated prostate carcinoma with positive surgical margins. He was treated with antiandrogens and adjuvant radiation therapy. Since the beginning of the last year and under hormonal monotherapy with Casodex his PSA levels doubled. PET CT of the abdomen and the pelvis revealed hepatic lesion.

Multiple myeloma with renal involvement, bone lesions and Neuropathy

71-year-old-male had been diagnosed as having multiple myeloma (MM), apparently of the IgA-Lambda type, with renal involvement. The disease course is characterized by "ups and downs responding to anti-MM therapy. During the disease course, several problems and complications developed: Renal failure, Bone lesions and Neuropathy.