Palliative treatment at home for patients with haematological disorders

 Supportive treatment of patients with haematological disorders mainly takes the form of transfusions of blood and platelets, and sometimes palliative chemotherapy is given. Most patients are treated in hospital or at the outpatient clinic. However, it is often difficult for the patients to arrange to come to the hospital, as they need transport by ambulance or taxi and sometimes a relative to help them. Throughout 1996 we offered such patients supportive treatment at home. A nurse was employed on the project, who was supplied with a car and a mobile telephone. Treatment was given at home. In all, 17 patients were treated, with a total of 90 blood and 40 platelet transfusions. At three visits chemotherapy was administered. No complications were seen, and the patients felt safe and content. We conclude that supportive treatment at home is safe and well accepted by patients and their relatives. In addition, the costs for transportation and hospital care of this patient group were reduced.     

Reversal of cold induced haemoconcentration

Summary Classically, cold induced plasma volume reduction is explained by an increased diuresis which is generated by an inhibition of antidiuretic hormone release. However, most of the haemoconcentration appears to be reversible during rewarming. This observation weakens the former statement. The aim of this study was to clarify the mechanisms involved in the reversal of the cold induced haemoconcentration. Six young males, resting in a dorsal reclining position, were exposed successively to a thermoneutral environment (30 min), a cold environment (1° C; cold) or thermoneutrality (control) for 120 min, and during a 60-min recovery period in thermoneutral conditions. During cold stress, a reduction of 15% (i.e. 510 ml) of the plasma volume was observed, and osmolality was unchanged. After the 60-min recovery under thermoneutral conditions, plasma volume variation between the Cold and the Control experiments was reduced and reached 3% (i.e. 100 ml). This volume equalled the increased amount of urine production observed during the cold stress experiment. Haemoconcentration cannot be explained by increased urinary water loss (± 100 ml) alone. Therefore a transient shift of plasma water from vascular to interstitial spaces, due to an increase of blood pressure, could be involved in the reduction of plasma volume.     

Comparison of two automated multichannel haematology analysers in domestic animals

Blood samples from 33 dogs, 28 cats, 24 horses and 25 cattle were analysed in duplicate on the Coulter Counter S-Plus IV and the Baker 9000 multichannel haematology analysers. The precisions of each instrument and the correlations between the instruments were evaluated. The precisions of both systems were good but, the Baker 9000 system showed more variability between duplicate determinations for all parameters. The Baker 9000 had better precision for white blood cell count, haemoglobin concentration, and MCV. Correlations between the two instruments were excellent except for MCHC. Neither analyser reliably provided feline platelet counts and the Baker 9000 also failed to report error messages for 8 of 10 apparently false platelet counts. The Coulter instrument consistently reported higher haemoglobin concentrations and higher feline and lower canine white blood cell counts than the Baker 9000.     

Concurrent infections with vector-borne pathogens associated with fatal anaemia in cattle: haematology and blood chemistry

An outbreak of a fatal haemolytic anaemia in a dairy herd of cattle in Switzerland was shown to be associated with infections with five vector-borne pathogens, namely Anaplasma marginale, A. phagocytophilum, Babesia bigemina, a Theileria spp belonging to the buffeli/sergenti/orientalis complex and haemotrophic Mycoplasma spp. The latter three had not been documented before this outbreak in Switzerland. To characterise the haematological and blood chemical changes in these unique cows, packed cell volume was determined in all 286 blood samples, blood smears, and complete haematology were performed from 285 and 173 blood samples, respectively, and biochemical parameters were assayed in 105 serum samples. Regenerative anaemia was the key sign of illness. Red blood cells of anaemic cattle were hypochromic and macrocytic. Anaemic animals had reduced platelet cell counts and increased total white cell counts. In addition, increased serum bilirubin, blood aspartate aminotransferase, gamma glutamyltransferase, glutamic dehydrogenase and blood urea nitrogen and decreased magnesium, calcium and albumin levels were found in anaemic cattle when compared to animals with normal packed cell volume. Most changes could not be attributed to a single infection. A. marginale seemed to be important in causing the outbreak, but co-infections may have aggravated the disease development and clinical signs. Thus, when encountering cattle with haemolytic anaemia, all of the mentioned pathogens should be included as differential diagnosis.     

Comparative haematological and plasma chemistry values in purpose-bred squirrel, cynomolgus and rhesus monkeys

Haematological and blood chemistry data have been compared for three species of purpose-bred primates, Macaca mulatta (rhesus monkey), Macaca fascicularis (cynomolgus monkey), Saimiri sciureus (squirrel monkey). These species were housed over a 9-month period in identical conditions (diet, tap water, room temperature and relative humidity, and lighting regime) in our primate facility. Blood and urine assays were conducted using the same pre-analytical conditions (blood sampling procedure, anticoagulant and storage of sample), and analytical methods (reagent and equipment).The results indicated that squirrel, rhesus and cynomolgus monkeys have essentially biologically similar values for all of the parameters examined. However, haemoglobin level, reticulocyte, plasma total cholesterol, triglyceride, albumin and urea nitrogen values, and urinary osmolality in cynomolgus monkeys were statistically lower than those of rhesus monkeys. Erythrocyte count, plasma ALT, calcium and potassium in cynomolgus monkeys were statistically higher than those of rhesus monkeys. Erythrocyte count, haemoglobin level, haematocrit, reticulocyte, plasma total bilirubin and chloride and urinary osmolality in cynomolgus monkeys were statistically lower than those of squirrel monkeys. Leucocyte count, plasma total protein, albumin and calcium in cynomolgus monkeys were statistically higher than those of squirrel monkeys. Squirrel monkeys showed marked deviations in four assays from the other two species: ratio of lymphocytes to neutrophils, AST, ALT and urine volume.The results obtained in this study will be used as baseline data for haematology and clinical chemistry characteristics for three species of purpose-bred monkeys.     

Association of antiviral prophylaxis and rituximab use with posttransplant lymphoproliferative disorders (PTLDs): A nationwide cohort study

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation (SOT). Most PTLD cases are associated with Epstein–Barr virus (EBV) infection. The role of antiviral prophylaxis or rituximab therapy for prevention of PTLD in SOT recipients is controversial. In a nationwide cohort, we assessed the incidence, presentation, and outcome of histologically proven PTLD. We included 4765 patients with a follow-up duration of 23 807 person-years (py). Fifty-seven PTLD cases were identified; 39 (68%) were EBV positive (EBV+ PTLD). Incidence rates for EBV+ PTLD at 1, 2, and 3 years posttransplant were 3.51, 2.24, and 1.75/1000 py and 0.44, 0.25, and 0.29/1000 py for EBV− PTLD. We did not find an effect of antiviral prophylaxis on early and late EBV+ PTLD occurrence (early EBV+ PTLD: SHR 0.535 [95% CI 0.199–1.436], p = .264; late EBV+ PTLD: SHR 2.213, [95% CI 0.751–6.521], p = .150). However, none of the patients (0/191) who received a rituximab-containing induction treatment experienced PTLD, but 57 of 4574 patients without rituximab induction developed PTLD. In an adjusted restricted mean survival time model, PTLD-free survival was significantly longer (0.104 years [95% CI 0.077–0.131]) in patients receiving rituximab as induction treatment. This study provides novel data on the association of rituximab induction and reduced risk for PTLD.     

Cytochemistry and morphology of granulocytes of the caecilian <Emphasis Type="Italic">Siphonops annulatus</Emphasis> (Amphibia,Gymnophiona)

The caecilians (Amphibia, Gymnophiona) constitute one of the least known groups of terrestrial vertebrates because most species live underground in quite inaccessible environments. Siphonops annulatus is an exclusively fossorial species and is the most extensively distributed caecilian in South America. Little is known of this order concerning circulating granulocytes, including their morphological and cytochemical structure and ultrastructure. This paper is part of a project covering the study of granulocytes in representative species of the order Amphibia. Blood extensions were carried out and submitted to Leishman, Toluidine Blue, Periodic acid Schiff, Sirius Red and hydrogen o-toluidine peroxide methods. Part of the samples was prepared for conventional transmission electron microscopy. Among granular leukocytes, mature and immature neutrophils and eosinophils were identified, plus basophils. The most frequent granulocyte encountered in S. annulatus peripheral blood is the neutrophil. This is a cell with a hyper-segmented nucleus and with a very clear cytoplasm when compared to the eosinophil, which presents large cytoplasmic acidophilic granules. On the other hand, the basophils present basophilic and metachromatic granules. Glycogen was detected in the cytoplasm of the neutrophils and eosinophils, while basic protein rich in amino acids was observed in the eosinophil’s granules. Myeloperoxidase activity was detected in the cytoplasm of the neutrophils and eosinophils. Neutrophils were ultrastructurally detected with three types of small granules: eosinophils with large and small spherical granules and basophils with large spherical granules with lamellate structures.     

Surgery of the spleen

A normally functioning spleen is critical in providing adequate immune protection and in regulating blood homeostasis. Whereas primary disorders of the spleen can attenuate these important functions, absence of the spleen, most commonly as a result of surgical excision, carries the grave and lifetime risk of devastating systemic sepsis. With some historical exceptions, splenic surgery has classically involved removal of the entire organ at open surgery, either following traumatic injury or to supplement the medical management of haematological disorders. Performed primarily for this latter indication, laparoscopy has emerged over the last two decades as the strongly favoured approach for elective splenectomy, with very large splenic size being one of the few remaining reasons for a planned open approach. Even in skilled hands, laparoscopic splenectomy can prove technically demanding, where careful patient selection and recognition of major complications including haemorrhage, portal system thrombosis and pancreatic injury, requires considerable experience. Whether performed under emergency or elective circumstances and undertaken as an open or laparoscopic procedure, an optimal surgical outcome depends on the successful collaboration between surgeon, anaesthetist, haematologist and radiologist in the preoperative and postoperative phases. Finally, it is paramount that in patients undergoing splenectomy, sufficient attention is given to providing effective lifelong prophylaxis against post-splenectomy infection.     

吲哚胺2,3-双加氧酶在肿瘤及肿瘤耐药中的研究现状

吲哚胺2,3-双加氧酶(IDO)是一种肝外催化色氨酸沿犬尿氨酸途径降解的限速酶。IDO抑制药被用在不同恶性肿瘤及耐药肿瘤治疗的相关实验中,特别是与放疗和化疗相结合时取得了良好的效果。本文将对IDO及其抑制药对肿瘤及肿瘤耐药的影响进行综述。