高白细胞急性白血病44例分析

目的：探讨高白细胞急性白血病临床特征、早期并发症及其处理。方法：选择1990年至1996年我院住院治疗高白细胞急性白血病44例。结果：36例（81．6％）有髓外白血病表现。6例于确诊2周内死亡。19例（43．2％）获得完全缓解。中位生存期为4个月。较对照组有统计学差异。11例使用白细胞分离术患者5例出现白细胞反跳。口服羟基脲2～4g／d，白细胞24h内降低47．1％，同时给予水化治疗、碱化尿液和别嘌呤醇治疗，无肾功能损伤发生。结论：高白细胞急性白血病患者早期死亡率高，临床缓解率低，预后差。早期积极治疗可降低死亡率。     

Leukocytosis and blood eosinophilia in a polyparasitised population in north-eastern Brazil

It has long been known that leukocytosis and blood eosinophilia are common in the tropical environment, but data derived from population-based studies are scarce. A study was undertaken in a fishing village in north-east Brazil where both intestinal helminthiases and parasitic skin diseases are common. Of 409 individuals studied, 128 (31.3%) were infected with one intestinal helminth or ectoparasite species, 93 (22.7%) with two, 61 (14.9%) with three, 25 (6.1%) with four and 11 (2.7%) with more than four species; no parasites were found in 91 (22.2%) individuals. Leukocyte counts ranged between 3,300 cells/microl and 16,100 cells/microl (median, 7,200 cells/microl) and eosinophil counts between 40 cells/microl and 5,460 cells/microl (median, 455 cells/microl). Eosinophilia (>500/microl) was detected in 44.7% of the individuals, and hypereosinophilia (>1,000/microl) in 12.9%. Thirty-six (8.8%) individuals showed leukocytosis. While 75% of individuals with normal eosinophil counts were considered parasite-free, only 14% with eosinophilia and 11% with hypereosinophilia did not have enteroparasites or ectoparasites. Multivariate regression showed that the probability of eosinophilia and hypereosinophilia, but not of leukocytosis, increased with the number of parasite species present. The data show that eosinophilia occurs in almost one-half of the individuals from a resource-poor setting and that it is significantly associated with the presence of intestinal helminths, but not with the presence of ectoparasites.     

血白细胞计数在颅脑外伤患者中的临床评估研究

目的：验证颅脑外伤伤情程度和白细胞计数，尤其是中性粒细胞计数之间的关系。方法：回顾性分析1997－2000年间急诊收入我院的颅脑外伤患者，入院时均做末梢血白细胞计数检查，并排除可能影响白细胞计数的其他因素。结果：重度脑外伤组白细胞计数和中性粒细胞计数明显高于中度和轻度脑外伤组，瞳孔光以应丧失组白细胞计数明显高于瞳孔光反应灵和灵敏组，差别有显著意义，结论：白细胞计数和中性粒细胞计数可作为判断颅脑外伤严重程度的一项空观独立的指标。     

Renal Pelvic Carcinoma Producing Granulocyte Colony-Stimulating Factor: Report of a Case

A 69-year-old man was admitted to our hospital because of anorexia and weight loss. Abdominal computed tomography showed an irregularly contoured mass in his left renal pelvis. The patient had a remarkable degree of leukocytosis with no obvious focus of infection. An enzyme immunoassay of the serum revealed a remarkably high concentration of granulocyte colony-stimulating factor (G-CSF). The patient died 6 weeks after admission without a resection of the renal pelvic tumor. At autopsy, the tumor involved the pancreas, stomach, and descending colon. The histopathologic diagnosis was squamous cell carcinoma with sarcomatous change. Immunohistochemical staining using anti-G-CSF antibody demonstrated immunoreactivity in the cancer cells. To our knowledge, this is the first case of renal pelvic carcinoma proven to produce G-CSF reported in English. Received: March 21, 2000 / Accepted: September 26, 2000     

Esophageal carcinoma with humoral hypercalcemia and leukocytosis successfully treated by a two-stage operation: report of a case

We herein report a patient demonstrating esophageal carcinoma with humoral hypercalcemia and leukocytosis. A 56-year-old Japanese man complained of a 2-month history of pyrexia. The radiological and endoscopic findings showed advanced esophageal carcinoma with a giant intraabdominal lymph node metastasis. Preoperative examination suggested that the tumor, consisting of squamous cell carcinoma, produced both parathyroid hormone-related protein and granulocyte colony-stimulating factor. We first performed an extirpation of the giant metastatic tumor to reduce the degree of humoral secretion and to improve his general condition. Thereafter, the hypercalcemia, leukocytosis, and other associated symptoms all improved. As a result, we were then able to safely perform an esophagectomy 2 months later. The patient has been doing well during the 10-month follow-up period, and is presently alive more than 1 year since hypercalcemia and leukocytosis were first observed. This is the first report of esophageal carcinoma with humoral hypercalcemia and leukocytosis that was successfully treated by an operation.     

Pretreatment leukocytosis is an indicator of poor prognosis in patients with cervical cancer

Objectives

The aim of this study was to investigate the prognostic value of pretreatment leukocytosis in patients with cervical cancer in relation to well-established conventional risk factors.

Methods

The baseline characteristics and outcome data from 536 patients treated for cervical cancer between 1996 April to 2007 March were collected and reviewed. Cox proportional hazards regression model was used to identify independent prognostic factors for overall survival. Subsequently, the prognostic significance of pretreatment WBC count was prospectively investigated in 156 patients newly diagnosed cervical cancer from 2007 April to 2010 March.

Results

In a retrospective analysis, patients with leukocytosis (WBC ≥ 10,000/μl) showed significantly higher treatment failure rate (P < 0.0001) and shorter OS (P < 0.0001) than the patients without leukocytosis. Tumors from patients with leukocytosis showed significantly stronger immunoreactivity for G-CSF than those obtained from patients without leukocytosis. Multivariate analyses revealed that clinical stage, tumor diameter, histology, and elevated WBC count (≥ 10,000/μl) were significant prognostic factors in terms of overall survival. In a prospective investigation, patients with leukocytosis showed significantly higher treatment failure rate (P < 0.0001), shorter PFS (P < 0.0001), and higher serum G-CSF concentrations (p = 0.001) than the patients without leukocytosis. Multivariate analyses revealed that clinical stage, tumor diameter, and elevated WBC count were significant prognostic factors in terms of PFS.

Conclusion

Pretreatment leukocytosis is an independent prognostic factor in patients with cervical cancer. Our finding can be used to identify patients with poor prognosis and to design future tailored clinical trials.