Preliminary laboratory based diagnostic criteria for immune thrombocytopenic purpura: evaluation by multi-center prospective study

BACKGROUND: We proposed diagnostic criteria for immune thrombocytopenic purpura (ITP) by modifying the existing guidelines for diagnosis of ITP and by incorporating laboratory tests found useful for predicting its diagnosis, for example erythrocyte count, leukocyte count, anti-GPIIb/IIIa antibody-producing B cells, platelet-associated anti-GPIIb/IIIa antibodies, percentage of reticulated platelets, and plasma thrombopoietin. OBJECTIVE AND METHODS: To validate our criteria, we conducted a multi-center prospective study involving 112 patients with thrombocytopenia and a morphologically normal peripheral blood film at the first visit. Each patient underwent a physical examination, routine laboratory tests, and specialized tests for the anti-GPIIb/IIIa antibody response and platelet turnover. RESULTS: Ninety-one patients (81%) satisfied the proposed criteria at first visit. Clinical diagnosis was made by skilled hematologists > 6 months after the first visit; ITP was diagnosed in 88 patients and non-ITP disorders in 24. The proposed criteria had 98% sensitivity, 79% specificity, a 95% positive predictive value, and a 90% negative predictive value. A relatively low specificity appears to be attributed to a few patients who had both ITP and aplastic anemia or myelodysplastic syndrome. CONCLUSIONS: Our preliminary diagnostic criteria based on ITP-associated laboratory findings were useful for the differential diagnosis of ITP, but additional evaluations and modifications will be necessary to develop criteria that can be used routinely.     

Clinical features of hepatocellular carcinoma that occur after sustained virological response to interferon for chronic hepatitis C

Background and Aim: This study investigated the clinical features of hepatocellular carcinoma in patients with sustained virological response to interferon for hepatitis C viral (HCV) infection. Methods: A total of 7715 patients with HCV infection were treated with interferon and followed up for more than 1 year after withdrawal of interferon in 64 Japanese hospitals and clinics between July 1988 and August 2001. Sustained virological response was obtained in 2515 (32.6%) patients. Of these 2515 patients, clinical data were collected for 38 patients in whom hepatocellular carcinoma developed. Sustained virological response was defined as HCV RNA negativity more than 6 months after the termination of interferon. Results: All patients were HCV RNA negative at the time of diagnosis of hepatocellular carcinoma. The median period until the detection of hepatocellular carcinoma was 4.7 years (range 1.4–9.0 years). There were significant improvements in hepatic function including serum albumin, aspartate aminotransferase, alanine aminotransferase, indocyanine green test, platelet count and histological activity grade in comparison with those before interferon therapy and at the onset of hepatocellular carcinoma. The maximum tumor size in patients without medical follow‐up for 1 year or more (median: 60 mm) was significantly larger than in patients who were periodically followed up for 6 months or less (median: 25 mm) (P = 0.002). Conclusions: The present findings emphasize the importance of regular medical follow up of patients with HCV infection, as even patients showing a sustained virological response to interferon and in whom hepatic function has improved have the potential to develop hepatocellular carcinoma.     

Complete response, as determined by prostate-specific antigen level, to chlormadinone acetate withdrawal persisting longer than 2 years in patients with advanced prostate cancer: Two case reports

Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer. However, responses to AWS are usually of limited duration, and a complete response (CR) is extremely rare. We present two patients who exhibited a chemical CR for more than 2 years after the discontinuation of steroidal antiandrogen chlormadinone acetate use. Whether patients who respond to antiandrogen withdrawal include a group of patients with a better prognosis remains uncertain. However, considering that the usual survival period of patients with hormone-resistant prostate cancer is approximately 12 months, both of the patients reported here, who are present in excellent physical condition, exhibiting an improved quality of life, and attending their hospital as outpatients, obviously acquired a prolonged survival because of AWS.     

Effect of total flow rate on the concentration of degradation products generated by reaction between sevoflurane and soda lime

We have compared concentrations of degradation products in thecircle system during sevoflurane anaesthesia at different freshgas flows. Twenty-four patients underwent sevoflurane anaesthesiawith fresh gas flows of 1 litre min^–1 (1L group), 3 litremin^–1 (3L group), or 6 litre min^–1 (6L group) (n= 8 in each group). During anaesthesia, the concentrations ofdegradation products were measured every hour, and the temperatureof soda lime, end-tidal carbon dioxide concentration, inspiredand end-tidal sevoflurane concentrations, and carbon dioxideelimination were measured. CF₂=C(CF₃)—0—CH₂F (compoundA) was the only degradation product detected. The mean maximumconcentration of compound A was 19.7 (SD 4.3) ppm in the 1 Lgroup, 8.1 (2.7) ppm in the 3L group and 2.1 (1.0) ppm in the6L group (P > 0.05). The maximum temperature of soda limewas 44.6 (1.5) °C in the 1 L group, 37.0 (4.4) °C inthe 3L group and 29.1 (5.1) °C in the 6L group (P > 0.05).There were no significant differences in end-tidal sevofluraneconcentration or mean carbon dioxide elimination between thegroups. Only compound A was detected following anaesthesia,with higher concentrations observed at lower flow rates.     

An Autopsy Case of Tracheal Agenesis with Broncho-esophageal Fistula

Abstract True incidence of this malformation is probably greater than that reported since the definitive diagnosis has been made at autopsy in most cases. Various hypotheses on the pathogenesis of tracheal agenesis have been proposed but they are still controversial.
In this report, we present a case of tracheal agenesis with a broncho-esophageal fistula and discuss the formal genesis.     

多激素分泌性垂体泌乳素腺瘤的激素分泌谱及克隆分析

目的 对多激素分泌性垂体泌乳素腺瘤的克隆状态以及激素分泌谱进行分析。方法 对26例女性垂体泌乳素腺瘤患者（单激素分泌性PRL腺瘤7例，多激素分泌性PRL腺瘤19例）进行肿瘤标本的免疫组化分析，并且提取DNA行HUMARA分析。结果免疫组化分析提示本组多激素分泌性垂体PRL腺瘤具有10种不同的激素分泌谱，现代分子生物学HUMARA克隆分析提示11／13例（85％）多激素分泌性垂体PRL腺瘤为单克隆起源。结论 结果提示垂体泌乳素腺瘤除了分泌泌乳素外，还可以分泌多种垂体激素，而且绝大多数多激素分泌性垂体腺瘤的起源是单克隆性的。     

~(123)I-MIBG心肌显像预测依那普利对扩张型心肌病患者治疗效果的临床价值

目的探讨123I-MIBG心肌显像在治疗前预测依那普利对扩张型心肌病(DCM)患者治疗效果的临床价值。方法对24例DCM患者于依那普利治疗前行早期(20min)及延迟(3h)123I-MIBG心肌显像,采用心/上纵隔(H/M)比和心脏放射性洗脱率(WR)作为相对半定量计数分析,与超声心功能参数进行对比。根据123I-MI-BG心肌显像延迟相的H/M分为3组延迟H/M≥1.7为组Ⅰ,1.5<延迟H/M<1.7为组Ⅱ,延迟H/M≤1.5为组Ⅲ。组Ⅰ和组Ⅱ在平均治疗4.5个月后重复以上检查。结果治疗前3组间超声心功能参数比较均无统计学差异。治疗后组Ⅰ的左室射血分数(LVEF)和左室收缩末径(LVDs)明显改善,早期H/M和延迟H/M均明显改善(P<0.05),而WR无明显变化。治疗后组Ⅱ的延迟H/M明显改善(P<0.05),而早期H/M和WR均无明显变化,心功能参数也无改善。组Ⅰ和组Ⅱ患者均能耐受依那普利治疗,而组Ⅲ患者均不能耐受依那普利治疗。结论123I-MIBG心肌显像在治疗前预测依那普利对DCM患者的治疗效果方面有一定价值。     

Oxygen uptake and carbon dioxide elimination during controlled hypotension induced by prostaglandin E1 or nitroglycerin

To compare the effects of prostaglandin E₁ (PGE₁) with thoseof nitroglycerin (NTG) on whole body metabolism (oxygen uptake(Vo₂) and carbon dioxide elimination (VCO₂)) during inducedhypotension, we have studied 16 patients undergoing electivesurgery (radical mastectomy or tympanoplasty). The patientswere allocated randomly in a non-blinded manner to two groups.Baseline characteristics were similar in the two groups. Arterialpressure was controlled at about 70% of the baseline value usingPGE₁ or NTG. VO₂, VCO₂, gas exchange ratio (RQ) and deadspaceventilation ratio (VD/VT) were measured continuously with massspectrometry. The values for all variables were measured for10 min at five times (1 = start of surgery (baseline value);2 = start of drug infusion; 3 = 60 min after start of drug infusion;4 = drug infusion stopped; 5 = surgery finished). VO₂, VCO₂,RQ and VD/VT values were relatively constant in both groupsduring surgery. The balance between oxygen supply and oxygendemand was maintained during induced hypotension with PGE₁ orNTG. (Br. J. Anaesth. 1994; 72: 439–442)