When dealing with giant lipomas, liposarcomas should always be included in the differential diagnosis.

Background: Brain natriuretic peptide (BNP) is a cardiac hormone secreted from the ventricular myocardium as a response to ventricular volume expansion and pressure overload. Rheumatic heart disease (RHD) is still an important cause of heart failure in developing countries. Aims: To measure BNP levels in patients with RHD and to determine whether BNP concentrations correlate with clinical and echocardiographic findings. Methods: Eighty-eight patients with rheumatic valve disease and 24 age-and sex-matched healthy subjects were entered in the study. BNP was measured using the Triage B-Type Natriuretic Peptide test (Biosite Diagnostics, San Diego, CA). Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure. Results: The plasma concentrations of BNP were significantly higher in patients with rheumatic heart disease than in control subjects (232 F 294 vs. 14 F 12 pg/ml, p < 0.0001). The plasma BNP level was significantly higher in NYHA class III + IV than in class II (463 F 399 vs. 192 F 243 pg/ml, p < 0.0001) and in NYHA class II than in class I (192 F 243 vs. 112 F 135 pg/ml, p < 0.001). The independent determinants of higher BNP levels were NYHA functional class and systolic pulmonary artery pressure in multivariate analysis. Conclusion: We found increased plasma BNP levels in patients with rheumatic heart disease compared with healthy subjects.

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Serum sickness and serum sickness-like reactions are the type III hypersensitivity reactions that occur in the presence of culprit agents which can be an exogenous protein, drug, bacteria, virus. Clinical symptoms usually begin in 6-21 days after exposure to antigenic stimulation. Typical clinical findings are characterised as fever (10-20%), erythematous rash (95%), polyarthritis and / or polyarthralgia (10-50%), and lymphadenopathy (10-20%). There are no specific laboratory findings and diagnostic criteria for serum sickness-like reaction. Laboratory findings usually include leukocytosis, mildly increased erythrocyte sedimentation rate, and rarely proteinuria and hematuria. Even though there are no diagnostic criteria for serum sicknesslike reaction, it can be diagnosed with the presence of fever, rash, arthritis-arthralgia, lymphadenopathy, myalgia which occurs in 1-2 weeks after exposure to an agent that can trigger the disease. Recommended or achieved a consensus for the treatment of the serum sickness-like reaction doesn't occur and the information about this subject in the literature is limited by the authors' case reports who share their experiences.