Correlation between karyotype and quantitative immunophenotype in acute myelogenous leukemia with t(8;21).

Acute myelogenous leukemia with t(8;21) is a distinct clinicopathologic entity in which the malignant myeloblasts display a characteristic pattern of surface antigen expression. Quantitative analysis of surface marker expression in patients with this chromosomal abnormality compared to acute myelogenous leukemia patients with a different karyotype has not been reported. From 305 consecutive newly diagnosed acute myelogenous leukemia patients underwent immunophenotyping and cytogenetic analysis at our center; 16 patients (5.2%) had a t(8;21). Fluorescence intensity values were obtained, using a set of reference microbeads, by conversion of mean channel fluorescence to molecular equivalent of soluble fluorochrome. Patients with t(8;21) displayed higher levels of CD34, HLA-DR and MPO expression (P < 0.001 for each) and lower levels of CD13 (P = 0.03) and CD33 (P = 0.02) expression. In order to study the sensitivity, specificity and predictive value of these markers, molecular equivalent of soluble fluorochrome thresholds were statistically determined. The statistically established threshold for each of the individual markers (CD34 > 60.5 x 10(3), HLA-DR > 176.1 x 10(3), MPO > 735.1 x 10(3), CD13 < 24.3 x 10(3) and CD33 < 17.3 x 10(3)) had a sensitivity of 100%, a specificity of 62-92% and a positive predictive value of 7-45%. In multivariate analysis, two quantitative patterns (CD34 > 60.5 x 10(3) and MPO > 176.1 x 10(3); CD33 < 17.3 x 10(3) and MPO > 176.1 x 10(3)) had a sensitivity, specificity and positive predictive value of 100%. These aberrant phenotypic patterns might help identify patients with t(8;21) at diagnosis and could be useful in minimal residual disease monitoring.     

Acute ethanol administration selectively alters localized cerebral glucose metabolism

The effects of acute ethanol administration on glucose utilization in the CNS of rat were studied using the 2-deoxyglucose technique. Cerebral glucose utilization was determined for 53 brain regions at peak and descending blood ethanol concentrations averaging 14, 26 and 66 mM. Decreased glucose utilization was the predominant finding and was observed in 20% of the regions evaluated, with median raphe, vestibular nucleus, cerebellar vermis, and various structures associated with the auditory system showing the greatest reductions. The only structures that showed increased glucose utilization were the dentate region of the hippocampus and the superior olive, and this was only apparent at a blood ethanol concentration of 14 mM.     

Acute presentation of meningioma due to haemorrhage following a motor vehicle accident.

Only three previous cases have been reported in which trauma has precipitated haemorrhage from a meningioma. This case is unique due to its occurrence after a minor motor vehicle accident. Our patient presented with transient weakness and sensory loss of the right lower leg following a motor vehicle accident and the subsequent occurrence of focal seizures prompted a computed tomography scan of the head which revealed a large parasagittal meningioma with intratumoural haemorrhage. The tumour was successfully removed with complete recovery. The literature related to haemorrhage from meningiomas following trauma is reviewed.     

Patient-administered anxiolysis--a pilot study

The feasibility of self-premedication with intravenous diazepam was examined in an open study of 50 preoperative patients. Using a Bard 'Harvard PCA' patient-controlled analgesia system, patients were instructed to deliver the drug in a dose sufficient to remove their anxiety for the scheduled surgical procedure. Aliquots of diazepam 2 mg were delivered on demand up to a total dose of 20 mg over a 30 minute premedication period. The mean dose administered was 8.1 mg (range 0-16 mg) producing a highly significant reduction in both patient- and anaesthetist-assessed anxiety rating. Neither the patient's sex nor the nature of the surgical procedure influenced the dose administered. Although poor, the best predictor of self-premedicating dose was patient's own preoperative anxiety rating with the anaesthetist's assessment of patient anxiety not correlating with the dose administered. No patient was considered excessively sedated by the premedication. Patient-administered anxiolysis is suggested as a useful research tool in the examination of anxiety and of value in premedicating patients with high preoperative anxiety levels.     

A pilot study of a computerized assessment (AGE-PC) for the elderly in general practice

A pilot project was undertaken in Liverpool UK, to investigatewhether data useful for both general practice and public healthpurposes could be collected by primary care personnel usinga computerized semi-structured interview (AGE-PC) for assessmentof patients aged 75 and over. A high degree of variation betweenpractices was found in the proportion of elderly assessed withAGE-PC largely related to motivation to undertake assessmentsand methods employed to approach patients. Considerable differencesbetween and within practices were evident in staff attitudesto the need for detailed formal assessments and the use of computers.Several aspects of the AGE-PC package itself were identifiedas requiring modification including streamlining data transfermethods, adding facilities for analysis and giving users a degreeof choice over content of the assessment. This technique doesoffer a potentially efficient means of collecting very detailedstandardized data for intra- or inter-practice analysis whileat the same time generating a comprehensive report for individualpatients. However, in the context of the over-75 assessmentsit was too time-consuming. Possible future strategies are discussedsuch as using an initial screening stage with a self-reportquestionnaire to reduce numbers needing full assessment andthe use of the package for the community care assessments. Thepilot project highlighted some of the potential advantages anddisadvantages of collecting data from primary health care forpublic health purposes. One of the most salient lessons learntwas the importance of involving the different team members inthe planning process so that there is agreement on: the essentialdata items required by both parties, the use of a uniform methodof approaching and sampling patients for assessments, the importanceof accuracy and obtaining a high response rate, and finallythat the whole procedure must be easy and not involve too muchtime or effort on the part of the overloaded primary care staff.