Case Report: Autoimmune Hemolytic Anemia in Chronic Granulocytic Leukemia

A patient with chronic granulocytic leukemia developed autoimmune hemolytic anemia. He was found to have a cold agglutinin and a nonspecific warmpanagglutinin. Therapy with prednisone appeared to control the hemolyticcrisis and did not affect the granulocytic process. The patient died of bronchopneumonia, and at autopsy no other neoplasm was found.

Submitted on March 2, 1967 Accepted on April 17, 1967     

Transseptal Defibrillation Is Superior for Transvenous Defibrillation

The conventional electrode configuration of current internal defibrillation systems most commonly use superior vena caval (SVC) or combined SVC and subcutaneous (SC) electrodes as anode, and right ventricular apex (HVA) electrode as cathode. We have demonstrated earlier that the septal mass is important for defibrillation. The purpose of the present study was to compare a transseptal to a conventional electrode arrangement in the canine model. Three endocardial electrodes, 5 French EnGuard™ were positioned in RVA, SVC, and the right ventricular outflow (RVO) in eight dogs. A 5 French SC electrode was positioned in the fifth left intercostal space. RVA-RVO^-/SC⁺ (configuration 2) was compared to SVC-SC⁺/RVA^-(configuration 1). Defibrillation threshold testing was performed using asymmetrical biphasic shock, 6 msec⁺/2 msec^-. Probit fit was used to compare the results at 40%, 50%, 60%, and 90% probabilities, and the logistic regression analysis to estimate the impact of variables. Electrode configuration had the strongest predictive value. Configuration 2 was superior to configuration 1 (P = 0.0016). At any voltage settings the probability of success for configuration 2 was greater, and current less (P < 0.00005). The energy requirements were reduced by approximately 33% for configuration 2. There were no significant differences in impedance between the two configurations. We conclude that transseptal defibrillation is more effective because of the improved lead geometry and voltage gradient.     

Electrode Surface Area Is An Important Variable for Defibrillation

Previous studies have established efficacy of transseptal defibrillation. The purpose of the present study was to evaluate the role of transvenous electrode surface area for defibrillation. Sixteen dogs were randomized to 8 French and 5 French EnGuard™ electrodes; 8 dogs in each group. The length of the defibrillation coils was identical for both, but the surface area was different due to differences in the electrode diameters. Defibrillation threshold (DFT) testing was performed using a biphasic shock waveform, 6 msec⁺/2 msec^-. Logistic regression analysis was used to determine if the probability of defibrillation adjusted for voltage, current, and energy was different for 8 French electrodes. Logistic regression analysis found significant differences between 8 French and 5 French electrodes, with less voltage (P < 0.005), current (P < 0.03), and energy (P < 0.001) required at any level of probability to defibrillate for 8 French electrodes. These results support the conclusion that the surface area for endocardial electrodes is a significant factor for defibrillation. Therefore, when designing endocardial electrodes a desirable objective of reducing the electrode size should be weighed against the need to minimize DFTs.     

Constrictive bronchiolitis associated with paraneoplastic autoimmune multi-organ syndrome

Background and objective:   Constrictive bronchiolitis is a rare and potentially fatal manifestation of paraneoplastic autoimmune multi-organ syndrome (PAMS), also called paraneoplastic pemphigus. The current review aimed to assess the frequency and clinical features of constrictive bronchiolitis occurring in patients with PAMS.
Methods:   A computer-assisted search of medical records identified 17 patients with PAMS seen during the period 1994–2007. Medical records, radiological studies and biopsy results were reviewed.
Results:   There were 10 men and 7 women; the median age at diagnosis of PAMS was 60 years (range 33–72 years). Non-Hodgkin's lymphoma and chronic lymphocytic leukaemia were the underlying neoplasms in over two-thirds of these patients. Constrictive bronchiolitis was diagnosed in three patients who had respiratory symptoms, severe airflow obstruction on pulmonary function testing and evidence of air trapping on CT scanning with no other identifiable cause for these findings. In contrast to previous reports, two of the three patients with constrictive bronchiolitis presented with skin and respiratory manifestations in the absence of a known neoplasm. Seven patients with PAMS died (41%) after a median interval of 13 months (range 1–33 months) and the deaths included two of the constrictive bronchiolitis patients who continued to worsen despite immunosuppressive therapy.
Conclusions:   In a minority of patients with PAMS, constrictive bronchiolitis occurs and tends to cause progressive airflow obstruction that responds poorly to immunosuppressive therapy. Constrictive bronchiolitis in these patients may be manifest prior to the discovery of the underlying neoplasm and the diagnosis of PAMS.     

Chemical synoviorthesis with oxytetracycline clorhydrate (Emicine®) in recurrent haemarthrosis

Summary.  This is a non-controlled experimental prospective clinical study that evaluates the satisfactory results in the chemical synovectomy (synoviorthesis) with oxytetracycline clorhydrate (Emicine^®, Lab. Pfizer Ltda, Guarulhos, Sao Paulo, Brazil) in recurrence haemarthrosis in different joints, demonstrating that it is an effective method in the treatment of these recurrent haemarthrosis in haemophilia. 84 patients of whom 77 concluded the full course of treatment. 82 joints were injected. The dosage injected was 5 cm³ of the drug (25 mg) in 5 cm³ of anaesthesia for the knee, 2 cm³ with 1 cm³ of anaesthesia for the elbow and 1 cm³ plus 1 cm³ of anaesthesia for the ankle. These injections were administered once weekly with a reinforcement in 1 month. In case of failure the same can be administered repeatedly. Subjective parameters included pain, range of movement and use of the joint involved. Pain decreased from a mean of 6.5 to 0.9 (Likert scale). Range of movement increased from 5.9 to 9 and joint use increased from 5.9 to 9.2. Objective parameters included joint diameter and range of movement. Range of movement for flexion and extension improved from 72.2 and 149.2 to 73.7 and 167, respectively, for the knees. From 57.3 and 160 to 66.6 and 170, respectively, for the shoulder. And, from 22.7 and 10.8 to 34 and 18.6, respectively, for the ankle. This procedure has multiple advantages such as immediate therapeutic effect, short period of treatment, easy technique, much less AHF coverage (30% above coagulation level), less costly than radiocolloid treatment, which make it a perfect alternative treatment for developing countries.