Request For Assistance - Soviet Georgia
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Organization: Children hospital N3
Reply-To: maia@children.kheta.ge
From: maia@children.kheta.ge (Maia Kherkheulidze)
Date: Fri, 24 Apr 1998 11:36:22 +0400 (MSD)
X-Mailer: dMail [Demos Mail for Windows v1.2 Professional]
Subject: Patient
Lines: 88
Patient - Mdzinarishvili Zurab
Age - 4 years and 10 months
Sex - male
Lives in Tbilisi, Georgia
Disease began in December 1997 with cough, general weakness,
fever, respiratory disorders. Initially was diagnosed and treated as
pneumonia.
Several studies were performed and lymposarcoma was suspected.
The first CT study, performed on 16.02.98 revealed on I-II lumbar vertebras
level on small intestine
mesentery projection lymphatic nodes of 0,3-0,5 cm size. On the same level
in front of the inferior
vena cava was seen a tissular area with distinct, rough, polycycle surface,
of 2 cm size, which was
considered a conglomerate of limphatic nodes.
The second CT study was conducted on 21.03.98. It revealed on I-II lumbar
vertebras level a tissular
structure with round, rough form and distinct outlines. It occupies
projection field of rostral offshot pancreas
(The Structure was considered a conglomerate of lymphatic nodes).
The lymphatic nodes of 0,6 cm size were seen on projection of small
intestine mesentery
(Positive dynamics comparing to the previous study).
General blood Test:
Date: 12.02 19.02 23.02
02.03 06.03 16.03 20.03 27.03
Hemoglobin g\l 100 126 116
120 120 133 126 130
Erythrocyte 3,6 4,0 3,7
4,1 4,3 4,3 4,1
4,5
Color factor - 0,94 0,95
0,88 0,84 0,93 0,93
0,87
Thrombocytes per 1000 - 40 60
60 50 50 50 50
Leukocytes 24,0 11,6 11,8
6,5 7,2 7,7 10,0 13,7
Mielocytes % - 0,5 -
- - -
- -
Metamyelocytes % - - -
- - - -
-
Neutrophils-"bends"% 2 3,5 -
- - - 1
-
Neutrophils-"segs" % 14 13 12
30 31 30 24 23
Eosinophils % 71 48 45
25 28 27 30
30
Basophils % - - -
- - -
- -
Lymphocytes % 10 30,5 32
26 37 37 35
41
Monocytes % 3 4,5 11
5 4 5 9
5
ESR 38 32 31
26 21 20 18
8
Results of the serological study on yersinial infection and tuberculosis
was negative.
Biochemical blood test:
AST - 17 units \ liter, ALT - 18 units \ liter, Sialus acid -
150, "O"-strephtolisine - 125,
"C"-reactive protein - (---), rhevmatoid factor - (---)
Study medulla marrow:
Mieloblastus - 0,25%
Promielocytes - 0,25%
Mielocytes - 5,25%
Metamielocytes - 3,25%
Lymphocytes - 20,75%
Monocytes - 0,5%
Plasma cells - 0,25%
Neutrophils-"bends" - 5,0%
Neutrophils-"segs" - 15,25%
Eosinophils:
Promielocytes - 0,25%
Mielocytes - 5,25%
Metamielocytes -1,25%
Neutrophils-"bends" - 2,25%
Neutrophils-"segs" - 34,0%
General urine test and urine test on bilirubin without changing.
Apart from this in the research institute of Parasitology laboratory
studies on helminthosis were conducted.
Negative answers were received on all events.Specialist from the research
institute of Parasitology
suspected Fascioliasis, unfortunately they an were unable to conduct
specific study.
>From their point of view the disease is in the incubation stage which
will finish at the end of April.
At present the patient's condition is unsatisfactory. Respiratory disorders
still occur (cough, weakness).
High eosinophilys, changes on CT are unexplained.
We would request:
Your opinion on the diagnosis
Looking forward for your reply.
Thank you in advance.
Sincerely yours,
Ivane Chkhaidze MD
Deputy director
Michael Guramishvili Pediatric Clinic
Tbilisi, Georgia
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