Life threatening hypophosphataemia in a patient with Philadelphia chromosome-positive chronic myelogenous leukaemia in acute blastic crisis.

Life-threatening hypophosphataemia developed in a 47 year old woman with blastic crisis of chronic myelogenous leukaemia. The patient''s hospitalization was characterized by reciprocal relationship between her white cell count and the serum phosphorus levels. The patient did not demonstrate any of the usual causes of profound hypophosphataemia. The postulated mechanism of this patient''s hypophosphataemia is uptake by the rapidly dividing leukaemic cells. To the best of our knowledge this is the first case in the English literature of hypophosphataemia associated with blast crisis of Philadelphia chromosome-positive chronic myelogenous leukaemia.     

Aspergillosis in a patient with acute lymphoblastic leukaemia

A case is described of a 3-year-old boy with acute lymphoblastic leukaemia (ALL) who presented initially with aspergillosis of the nasopharynx. Fungal infection with Aspergillus species is not uncommon in immunosuppressed children, but this case is noteworth in that the disease presented at the onset of therapy rather than during the phase of treatment, with maximum immunosuppression following chemotherapy. This type of infection is usually associated with the treatment of acute non-lymphoblastic leukaemias (AML) rather than ALL, and prolonged periods of neutropenia which results from aggressive treatment. This patient responded rapidly to treatment with amphotericin B, coincident with resolution of his neutropenia as the underlying disease was treated, eventually eradicating the fungus.     

VP 16-213 in acute myelogenous leukaemia

The use of the epipodophyllotoxin VP 16-213 is described in twenty patients with acute myelogenous leukaemia resistant to other chemotherapy. The drug was usually given in 5-day courses of 50 mg/m² daily and occasionally in 24-hr infusions of 250 mg/m², on the basis of its phase-activity.     

Long survival in acute myelogenous leukaemia: an international collaborative study

A group of 82 adult patients with acute myelogenous leukaemia had survived in continuous first remission for more than three years was studied. These long-surviving patients were being treated at 12 referral centres in Europe and the USA, and they were compared with other patients with acute myelogenous leukaemia from 10 of these centres. There was no clear difference in the amount of induction chemotherapy or the time taken to achieve remission. Immunotherapy was not found to improve chances of long-term survival. The 82 patients were also compared with a group of 115 patients who had no appreciable difference in the number of blood or marrow myeloblasts between these two groups at presentation, but the long survivors had significantly higher initial platelet counts and were slightly younger. The long survivors also tended to have a lower total white cell count at presentation and lower granulocyte counts; there was no obvious explanation for these differences. Eight of the 82 patients relapsed from three to four years after remission and two (of 69 patients) after four to five year. Thereafter relapse was rare, and it seems likely that some of the 40 patients who have survived for five years or more are cured.     

Atypical chronic myeloid leukaemia with trisomy 13: a case report

ATYPICAL chronic myeloid leukaemia (aCML), which shows both myeloproliferative and myelodysplastic features, is a type of myeloproliferative/myelodysplastic disease as defined by the World Health Organisation (WHO) classification of the myeloid neoplasms.1 Because of the presence of     

Granulocytic sarcoma with spinal cord compression in chronic myelogenous leukemia: a case report

We report on a 19-year-old man with a spinal cord compression secondary to granulocytic sarcoma (GS) as the initial presentation of a chronic myelogenous leukemia (CML). Blastic crisis developed two months later. According to our case report and to the literature, the diagnosis of GS could predict a rapid progression to blastic phase.     

Legg-Calve-Perthes' disease associated with chronic myeloid leukaemia in a child: case report

Chronic myeloid leukaemia was discovered in a female child aged 12 years, whose presenting signs and symptoms were those of Legg-Calve-Perthes' disease in the left hip. The chronic myeloid leukaemia responded dramatically to myeleran therapy, whilst the Legg-Calve-Perthes' disease was treated by bed rest in hospital followed by weight-relieving paten-ended calliper. A rare case of CML in a female child who has 'Legg-Calve-Perthes' disease of the left hip in association is described.     

Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis complicating acute cholecystitis: a case report

Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder. In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.     

Mediastinal lymphadenopathy in a patient with previously treated T-cell acute lymphoblastic leukaemia

Mediastinal lymphadenopathy in a patient with previously treated T-cell acute lymphoblastic leukaemia is a diagnostic problem. The differential diagnosis in an adult is sarcoidosis, metastases, lymphoma or, rarely, tuberculosis. Mediastinal lymph node involvement is uncommon in tuberculosis. In view of its relative rarity but good prognosis, it is important to distinguish tuberculous mediastinal lymphadenitis in adults from other causes of mediastinal masses.     

Hairy cell leukaemia with advanced treatment - a case report

A case of hairy cell leukaemia (HCL), a rare leukaemia, is reported here. The patient was presented with high grade continuous fever with left upper abdominal discomfort for 6 days. He was moderately anaemic, had no peripheral lymphadenopathy with mild hepatosplenomegaly. He was anaemic (Hb-7.8 gm/dl), total leukocyte count was 20 x 109/L. Peripheral blood film showed lymphocytosis (92%) with neutropenia (8%) and absolute neutophil count (ANC) was 1 x 109/L. On review, 88% of the peripheral cells had peripheral hairy projections resembling hairy cell (HC). Bone marrow examination was consistent with HCL (morrow hairy cell = 52%) including marker studies. Tartrate resistant acid phosphatase test (TRAP) was also positive. He had opportunistic mycobecterial infection giving a positive bronchial lavage for acid fast bacilli. After controlling the infection he was advised a single dose chemotherapy of 2-chlorodeoxyadenosine (2-CDA). After that he was in partial remission and after 25 months clinical and pathological relapses occurred and a second dose of 2-CDA was given and the patient went into complete remission.     

Recurrent chylothorax in a patient with non-Hodgkins lymphoma: case report

Spontaneous chylothorax could arise as a complication of Iymphoma. There are no reports on the frequency of it's occurrence. It is associated with a high mortality rate. This is mainly due to severe nutritional deficiencies and wasting. This case describes a patient with non-Hodgkins Iymphoma who developed recurrent bilateral chylothorax requiring repeated pleural aspirations and eventually talc pleurodesis which failed.     

Liver transplantation in a patient with situs inversus: a case report

Situs inversus （SI） is a congenital anomaly characterized by the mirror-image orientation of the inner organs. The estimated incidence of SI is 1/15 000 to 1/10 000 live births. The disease is often complicated with biliary atresia, polysplenia, intestinal nonrotation, preduodenal portal vein, aberrant hepatic artery, or absence of the suprarenal inferior vena cava. In 2004, we performed a liver transplantation on a patient with SI complicated with hepatolithiasis, end-stage liver cirrhosis and liver failure, because of the unavailability of donor organs, the operation became more complicated and difficult.     

Polycystic kidney disease in a patient with achondroplasia: case report

Autosomal dominant polycystic kidney disease is a multisystem disease involving many organs. An association with other diseases such as tuberous sclerosis, von Hippel-Lindau disease and Marfan syndrome have been previously described. We describe a 35 year old female with achondroplasia who developed polycystic kidney disease involving both kidneys and progressing to end-stage renal disease. To the best of our knowledge this is the first such case described in the literature. We also delve, briefly, into the possibility of the genes and chromosomes involved in Marfan syndrome, polycystic kidney disease, tuberous sclerosis and achondroplasia playing a role in the co-occurrence of these entities.     

Cervicothoracic arachnoid cyst in a patient with neurofibromatosis: case report

Intradural cervicothoracic arachnoid cysts are not common. They may be congenital, or secondary to trauma, surgery, haemorrhage, or inflammation. This is a report of a 39-year-old man who presented with cutaneous neurofibromatosis and cervicothoracic arachnoid cyst causing gradual quadriparesis. Magnetic resonance imaging showed an intradural extramedullary anterior cystic lesion at C5-T2 level. Laminectomy and mersupialisation of the cyst was performed. Histology confirmed the diagnosis of arachnoid cyst. The patient recovered without neurological deficit.