Acute myelogenous leukemia patients are at low risk for invasive fungal infections after high-dose cytarabine consolidations and thus do not require prophylaxis

We evaluated the frequency of invasive fungal infections (IFI), the frequency of empirical antifungal use (EAFU), and the efficacy of fluconazole prophylaxis on IFI and EAFU after high-dose cytarabine (HiDAC) consolidations. Twenty-seven acute myelogenous leukemia patients in their first complete remission received 76 cycles of HiDAC (median cycle: n = 3). Fluconazole prophylaxis was administered following 44 cycles (fluconazole group) and not given in 32 cycles (control group). IFI (2 episodes) + EAFU (11 episodes) was observed in 13 of 76 cycles (17%); there was no difference between the fluconazole group and the control group (p = 0.469). Neutropenia duration was <13 days in 89% of the 76 cycles and was similar in the fluconazole and control groups (p = 0.845). Neutropenic fever was observed in 34 of the 76 cycles (45%) and was similar in the fluconazole group and the control group (p = 0.43). Although HiDAC cycle 1 was associated with a shorter neutropenia duration, there was no association between HiDAC cycle numbers and neutropenic fever or IFI + EAFU. HiDAC consolidations resulted in a high rate of neutropenic fever, the lack of an appreciable benefit from EAFU, and rare IFI. Most likely because of the low incidence of IFI, use of fluconazole or another antifungal is not warranted in this setting.     

Plasma plasminogen activator inhibitor 1 (PAI-1) and P-selectin levels in urgent hypertension: effect of single dose captopril and nifedipine on fibrinolytic activity

In this study, we primarily aimed to identify the acute effects of hypertension on fibrinolytic function in previously untreated urgent hypertensive patients and to evaluate the influence of two commonly used, short-acting, anti-hypertensive agents, captopril and nifedipine, in these patients. Patient groups were selected homogeneously, i.e., only previously untreated patients amidst an urgent hypertensive episode and having no co-morbid disease were included-and randomly assigned to receive either captopril or nifedipine for immediate management. These two treatment groups were matched for age, gender, and mean arterial blood pressure. Study results demonstrated that lowering blood pressure with either agent improved fibrinolytic function; however, in those patients given captopril, this beneficial effect was more prominent, providing evidence supporting the preferential use of short-acting, angiotensin-converting enzyme (ACE) inhibitors in this setting.     

Plasmablastic lymphoma: CNS involvement, coexistence of other malignancies, possible viral etiology, and dismal outcome

The clinical and pathological findings of plasmablastic lymphoma (PBL) have been described in the literature but the etiology is not well established, and treatment options are poorly defined. We reviewed patients with PBL in our institution to characterize the clinicopathologic features in our patient population. In this retrospective analysis from a single academic institution, five patients with PBL were identified and analyzed. Human immunodeficiency virus and human herpesvirus 8 (HHV-8) were identified in 40% (two out of five) and 80% (four out of five) of these patients, respectively. Central nervous system (CNS) involvement was identified in four out of five (80%) patients. Interestingly, three out of five patients had a concurrent or preceding second primary malignancy including small lymphocytic lymphoma, endometrial cancer, and nonsmall cell lung cancer. Most of the patients had advanced disease and a poor performance status at diagnosis. Only two of the patients received systemic chemotherapy with an initial partial response. All five patients died; the median overall survival was 1 month. Our experience in patients with PBL indicates that CNS involvement is more common than reported in the literature. Coexistence of a second primary malignancy may be frequent, and prognosis remains dismal with standard lymphoma therapy. Lastly, the role of HHV-8 in the etiopathogenesis needs further trials.     

Changes in vascular endothelial growth factor, angiopoietins, and Tie-2 levels with G-CSF stimulation in healthy donors

The roles of vascular endothelial growth factor (VEGF), Tie-2, and angiopoietins in the mobilization of the hematopoietic stem cells (HSCs) in humans are not yet clearly understood. In order to elucidate mechanisms of HSC mobilization from their niches, we aimed to investigate the effects of mobilization with granulocyte colony-stimulating factor to the levels of VEGF, Tie-2, and angiopoietins 1 and 2 in the allogeneic HSC transplantation donors. Soluble VEGF, Tie-2, angiopoietin 1 and angiopoietin 2 levels were studied in 20 healthy allogeneic HSC transplantation donors before (from peripheral blood) and 5 days after mobilization (from apheresis material). Mean VEGF level in the postmobilization apheresis sample was significantly higher compared to baseline premobilization peripheral blood (t test, p < 0.001). In contrast, mean Tie-2 level in the postmobilization aphaeresis sample was significantly lower compared to baseline premobilization peripheral blood (t test, p = 0.01). Angiopoietin 1 and angiopoietin 2 levels did not differ between baseline and postmobilization samples. A significant rise in VEGF level after mobilization suggests stimulation of the angiogenesis. A significant fall in Tie-2 level suggests suppression of the angiopoietin 1/Tie-2 signaling, leading to release of HSC from the hematopoietic niches and mobilization to the peripheral blood.     

Mandible fractures during epileptic seizure: two case reports

Epilepsy is a neurological disorder characterized by repeated unprovoked seizures. It is well known that epileptic seizures may cause fractures and dislocations. Many antiepileptic drugs increase the risk of osteoporosis and bone fractures. For this reason, minimal traumas may result in fractures during an epileptic seizure. However, mandible fracture cases have rarely been reported. To the authors’ knowledge, there is nothing published on subcondylar fracture of the mandible as a result of an epileptic seizure, probably because of their very low incidence.     

Thrombopoietin and thrombospondin in renal allograft recipients.

Recipients of renal transplants appear to be at increased risk of thromboembolic events. Despite accumulating evidence for the hyperreactivity of platelets, the primary regulator of thrombopoiesis, thrombopoietin (TPO), has not yet been studied in renal transplant recipients. Thus, the aim of the present study was to quantify the levels of TPO and to assess its contribution to increased platelet reactivity in recipients of renal allografts. Serum concentrations of thrombospondin (TSP) were also determined in patients undergoing renal transplants in order to evaluate the role of this multifunctional protein in platelet hyperaggregability. Serum levels of TPO were significantly lower in renal transplant recipients (n = 27) than in healthy controls (30.8+/-20.6 pg/ml versus 129.9+/-113.6 pg/ml, P = 0.001). Serum concentrations of TPO were correlated neither with serum levels of creatinine nor duration of transplantation. However, levels of TPO were negatively correlated with platelet counts (r = -0.50, P = 0.007) in recipients of renal transplants. Plasma levels of TSP were higher in renal transplant patients than in the control group (104.5+/-54.7 ng/ml versus 63.4+/-41.5 ng/ml, P = 0.003). No significant correlation was found between levels of TPO and TSP. We conclude that, rather than the allograft function, the platelet mass determines the levels of TPO in recipients of renal transplants. Despite the low serum levels of TPO, and increased concentrations of TSP, TPO might still play a role in the hyperaggregability of platelets in patients undergoing renal transplants.     

Protein Z Levels in Haemodialysis Patients

Protein Z (PZ) is a vitamin K-dependent protein isolated from human and bovine plasmas. Although the exact role of PZ in the haemostatic system is presently unknown, it is suggested that PZ deficiency may cause bleeding tendency. Haemostatic alterations in end-stage renal failure (ESRF) are certainly complex and involve several abnormalities in the coagulation and fibrinolytic system. In order to elucidate the detail of the haemostasis in ESRF, we aimed to investigate PZ activity in haemodialysis patients.Therefore, we compared plasma PZ levels in 10 haemodialysis patients (6M, 4 F, mean age 36±11) and 10 healthy normal controls (5 M, 5 F, mean age 34±8) in this study. We found mean plasma PZ levels in haemodialysis patients and healthy controls 6.95±2.93 µg/ml and 3.06±0.81 µg/ml, respectively (p<0.005). Increased level of PZ which influences the action of thrombin on its protein substrates and inhibitors may contribute to the haemostatis alterations in ESRF patients, in addition to other well known abnormalities in the coagulation and fibrinolytic system.     

Lack of relation between serum parathyroid hormone levels and erythrocyte osmotic fragility in pediatric patients on peritoneal dialysis

Secondary hyperparathyroidism and anemia are the hallmarks in uremic patients. It is suggested that parathyroid hormone increases erythrocyte osmotic fragility and induces hemolysis. The present study was undertaken to examine the possible relationship between erythrocyte osmotic fragility and secondary hyperparathyroidism in 20 pediatric patients on maintenance peritoneal dialysis. We found that erythrocyte osmotic fragility in these patients was normal. No correlation between erythrocyte osmotic fragility and hematochemical changes associated with secondary hyperparathyroidism was found. We conclude that erythrocyte osmotic fragility was normal in pediatric patients on peritoneal dialysis and excess parathyroid hormone levels do not affect erythrocyte osmotic fragility and do not cause anemia.