Paraneoplastic Raynaud's phenomenon in a breast cancer survivor.
ABSTRACT A 35-year-old woman with a history of breast cancer, treated 3 years ago with surgery, radiation, and chemotherapy presented with a rapid onset of severe Raynaud's phenomenon. On physical examination, she had digital ulcers and splinter hemorrhages; there were no signs of an underlying rheumatic condition. Laboratory evaluation revealed anemia, the presence of antinuclear antibody and slight depression in her serum complement C3 level. The remainder of her serologic evaluation, including extractable nuclear antigens, anti-double-stranded DNA antibody, antiphospholipid antibodies, rheumatoid factor, anti-neutrophil cytoplasmic antibodies, cryoglobulins, and cold agglutins, were negative. Within weeks of her presentation, she developed acute renal failure and bilateral lower extremity edema. A computed tomography scan of her abdomen and pelvis showed bulky lymphadenopathy and hydronephrosis; a pelvic lymph node biopsy revealed metastatic breast cancer. She was initially managed with passive rewarming strategies, topical antibiotics, vasodilator and anti-platelet therapy, but had a negligible response. However, once she was started on chemotherapy for her recurrent malignancy, there was a significant improvement in her Raynaud's symptoms and resolution of her digital ulcers.
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ABSTRACT: A distributed algorithm to reconfigure a unidirectional optical-bus local-area network following topological changes, giving protection against any kind and number of faults, is presented. A sequence of operations is introduced based on which a system configuration is established, allowing information exchange between live stations. The faulty element is detected and isolated from the network, and the live nodes assume operation even with reduced performance. As soon as the faulty element has been repaired, the algorithm returns it to the network. The proposed implementation of the algorithm strictly takes into account the layer approach of the International Standardization Organization (ISO) for Open Systems Interconnection (OSI)Computers and Communications, 1989. Conference Proceedings., Eighth Annual International Phoenix Conference on; 04/1989