Plateletpheresis in the management of thrombocytosis

Acute thrombotic and hemorrhagic manifestations of thrombocytosis associated with myeloproliferative disorders may be life threatening. Conventional therapy with radioisotopes and/or cytotoxic drugs may require weeks for effective control of platelet counts. In five patients, plateletpheresis by discontinuous-flow (Haemonetics) or continuous-flow (Aminco Celltrifuge) centrifugation was used as a means of reducing platelet counts acutely. With each procedure, approximately 2-9 X 10(12) platelets were removed, resulting in decrements in platelet counts and relief of symptoms. Plateletpheresis is a useful and safe acute means of controlling platelet counts in myeloproliferative disorders.     

Colonic and jejunal motor disturbances after colonic antigen challenge of sensitized rat

BACKGROUND & AIMS: Inflammation in the colon may alter motility in the proximal gut and potentiate clinical symptoms. The aim of this study was to characterize the effect of colonic anaphylaxis on local (colonic) and remote (small intestinal) motility and identify the mechanism and mediators involved. METHODS: Rats were sensitized by intraperitoneal injection of 10 microg egg albumin and surgically prepared with electrodes in jejunum and colon and a colostomy tube. Colonic and jejunal myoelectric activity were recorded in fasted animals before and after colonic antigen challenge without and then after pretreatment with specific antagonists. RESULTS: Colonic antigen challenge of sensitized rats was associated with significant (1) increase in colonic myoelectric spike activity, (2) disruption of fasting jejunal motility and initiation of aborally propagating spike complexes, and (3) increase in plasma rat mast cell protease II levels with a decrease in granulated mast cells in colon but not jejunum. The myoelectric disturbance in both colon and jejunum was inhibited significantly by pretreatment with atropine and hexamethonium, doxantrazole, cyclooxygenase, and lipoxygenase inhibitors. Methysergide inhibited only the jejunal disturbance. CONCLUSIONS: Colonic antigen challenge of sensitized animals results in local mast cell activation and the release of mediators that modulate neural pathways to initiate both a local colonic and a remote jejunal myoelectric disturbance. (Gastroenterology 1997 Jun;112(6):1996-2005)     

Epstein-Barr virus and childhood Hodgkin's disease in Honduras and the United States

In industrialized populations, Hodgkin's disease (HD) has an initial peak in young adulthood, whereas in economically developing populations the initial peak occurs in childhood. This pattern resembles that of infection with poliovirus and suggests an infectious cofactor in the etiology. Serologic studies have linked Epstein-Barr virus (EBV) to young adult and adult HD, and viral nucleic acids and antigens have been detected in a subset of Hodgkin's tumor specimens. To investigate the association of childhood HD with EBV we studied tumor specimens from 11 children treated in Honduras and 25 children treated in the United States using in situ hybridization and antigen detection techniques. Among the patients from Honduras, tumor specimens from all cases were EBV positive. Among the patients from the United States, tumor specimens from six of seven patients with mixed cellularity histology, 2 of 15 with nodular sclerosis histology, and neither of two patients with lymphocyte-predominant histologies were EBV positive. These findings support the hypothesis that EBV contributes to the pathogenesis of HD in children, particularly in mixed cellularity HD, and raises the possibility that there are important geographic, racial, or ethnic factors in the EBV association with HD.     

Acute leukemia in idiopathic sideroblastic anemia: response to combination chemotherapy

Three patients with idiopathic sideroblastic anemia of variable duration developed acute leukemia. In two the leukemia was morphologically and histochemically myeloblastic, in one lymphoblastic. With combination chemotherapy remission was achieved in all three. The remission inductions were complicated by long periods of bone marrow suppression and the duration of remissions was brief (3, 2 and 3 months). Survival after diagnosis was 13, 10 and 9 mo, respectively. The ring sideroblast abnormality persisted during the leukemic and remission phases and transfusion requirements remained unaltered in the two patients with transfusion dependent anemia throughout their courses.     

Characterization of a suppressor T-cell chronic lymphocytic leukemia with ADCC but not NK activity

A patient with T-cell chronic lymphocytic leukemia (T-CLL) is reported whose cells demonstrate in vitro suppression of normal lymphocyte mitogen stimulation. The patient, who remains in Rai's clinical stage 0 on no therapy after more than 24 mo of observation, has shown a less aggressive clinical course than is usually attributed to T-CLL. His peripheral blood lymphocytes (PBL) were characterized by functional assays as well as surface markers. Over 90% of the patient's PBL formed rosettes with sheep erythrocytes and were lysed by two T-cell-specific antisera plus complement, while less than 1% bore surface immunoglobulins, and only 3% had complement receptors. In addition, 45% of the PBL demonstrated Ia-like antigens, more than 50% expressed a receptor for the Fc portion of IgG(T gamma), and most of the sheep erythrocyte rosettes were inhibited by theophylline. The patient's cells failed to respond to several mitogens and they caused marked suppression of lymphoproliferative responses to normal PBL to phytohemagglutinin (PHA) and concanavalin A (Con-A). The patient's lymphocytes also exhibited antibody-dependent cytotoxic activity (ADCC) against antibody-coated nucleated target cells, but lacked demonstrable natural killer (NK) activity. This patient's T-CLL cells appear to represent the clonal expansion of a subset of T cells with a previously undescribed pattern of suppressor and cytotoxic activities.     

The tall girl. Prediction of mature height and management

The arrest of excessive tallness in girls with hormonal therapy has been reported to be useful, but lack of accuracy in the prediction of ultimate stature based on the tables of Bayley and Pinneau (1952) has allowed only a rough evaluation of its benefits. A series of 40 tall girls were treated with oestrogens and mature stature was evaluated by the method of Tanner et al. (1975). Results were compared with those obtained in a previous study made in 1966 where Bayley and Pinneau tables were used.     

Weight gain after laparoscopic cholecystectomy

Introduction Laparoscopic cholecystectomy (LC) relieves symptomatic cholelithiasis (SC) but may facilitate postoperative gluttony. Aim To examine changes in body mass index (BMI) and general health of a cohort of patients three years after uncomplicated LC for SC. Methods Patients were studied three years after uncomplicated LC and compared to age- and gender-matched controls who had undergone non-biliary surgery.Results Forty-two patients and 42 controls were studied. The mean age of the patients was 55 years (range 29–82) versus 54 years (25–82) for controls. Patients undergoing LC increased their mean BMI by 1.8kg/m2. Females were particularly likely to gain weight (mean change in BMI=+2.1), with no significant difference being found between premenopausal and postmenopausal women. Of the 24 LC patients who claimed to continue their low fat diet, the mean BMI changed from 27.6 to 29.6kg/m2. The mean BMI of the 17 people who claimed regular exercise changed less markedly (+1.4) than those who admitted infrequent exercise (+2.1). Conclusion Selection for LC may identify patients at risk of continuing or resumed aetiological contributors to obesity. Follow-up long after the surgery may therefore be necessary to facilitate additional healthcare interventions.     

单臂多功能外固定架治疗开放性胫腓骨骨折122例

1临床资料1997-07/2004-06开放性胫腓骨骨折122(男84,女38)例,年龄16～61(平均32)岁.骨折部位,胫腓骨中上段40例,中段32例,中下段50例,局部皮肤软组织损伤按Gustilo分型:Ⅰ型12例,Ⅱ型41例和Ⅲ型69例.46例在处理骨折的同时Ⅰ期缝合伤口,其中4例出现局部皮肤坏死,后用游离植皮术使创面愈合.     

MR imaging of the calvarium: pictorial essay

Summary Magnetic resonance is unique in its ability to directly image the bone marrow. Thus, primary or secondary processes involving the bone marrow of the calvarium can be well visualized. In cases of superficial lesions, magnetic resonance demonstrates calvarial and bone marrow invasion. This is particularly important in cases where surgical preservation of the inner table in contemplated. Both erosion and involvement of the calvarium by intracranial processes can also be well visualized. Because of the ability of magnetic resonance to image in multiple orthogonal planes, it is particularly useful for precise delineation of the extent of lesions. Its ability to also image in oblique planes may aid in better demonstration of pathology. Use of both T1 and T2 weighted imaging sequences may also be of help in determination of the tissue type.

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Imagerie de la calvaria en IRM : essai préliminaire

Résumé L'IRM est la seule technique permettant de mettre directement en évidence l'os spongieux. Ainsi, les affections primaires ou secondaires primitives de l'os spongieux de la voûte du crâne peuvent être parfaitement visualisées. En cas de lésion superficielle, l'IRM montre l'invasion corticale et spongieuse de la calvaria. Ceci est particulièrement important lorsque on cherche à préserver la table interne de la voûte. L'érosion, aussi bien que l'envahissement de la calvaria par les processus intracrâniens, peuvent également être bien mises en évidence. La capacité de l'IRM de permettre des études dans plusieurs plans orthogonaux la rend particulièrement utile à la définition précise des limites de l'extension de ces affections. La possibilité d'obtenir également des images obliques améliore la mise en évidence de ces maladies. L'utilisation de séquences en T1 et T2 permet d'aborder les diagnostics tissulaires.