Poor clinical response to enteric-coated iron preparations.
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Administration, Oral↗
Biomedical subjects
D A Dotten
Publications and source records attributed to D A Dotten.
Fulminant gangrene in transient cold agglutinemia associated with Escherichia coli infection.
Fulminant gangrene of the fingers, toes and nose developed in a 57-year-old woman with Escherichia coli pneumonia. Cryoglobulinemia was noted, and the cryoglobulin was identified as IgM-IgG with anti-I cold agglutinin activity. The cold agglutinins possessed potent lymphocytotoxic and monocytotoxic activity and weaker granulocytotoxic activity. Treatment with plasmapheresis, steroids and antibiotics led to complete clinical recovery, although amputation of several toes was necessary. The patient died 1 1/2 years later; the main findings at autopsy were chronic and acute pyelonephritis and acute bacterial endocarditis. This seems to be the first case of IgM-IgG cold agglutinemia occurring during the course of E. coli infection and the third case of fulminant gangrene complicating transient cold agglutinemia.
Anemia, Hemolytic, Autoimmune↗
Acute leukemia in rheumatoid arthritis treated with cytotoxic agents.
Acute leukemia is described in two patients treated with cytotoxic agents for a destructive, seropositive rheumatoid arthritis. Both patients had received longterm azathioprine therapy. In addition, one patient had been treated with cyclophosphamide, the other with melphalan. Chromosomal abnormalities were noted in both patients. Studies in one patient included colony forming units, ferrokinetics, electron microscopy of bone marrow, and autopsy examination. All reports of acute leukemia associated with cytostatic drugs in the literature to date are reviewed and the possible mechanisms discussed. It is suggested that patients with rheumatoid arthritis treated with azathioprine and alkylating agents may have an increased risk of developing a therapy-related acute leukemia.
Acute Disease↗
Functional characterization of the cells in chronic neutrophilic leukemia.
Light and electron microscopy of neutrophils from chronic neutrophilic leukemia (CNL) did not reveal differences from normal mature neutrophils. However, functional characterization of CNL cells showed marked differences when compared to normal cells. CNL neutrophils were much less viable in suboptimal conditions. Their survival was further reduced by autologous serum and was corrected by normal human serm. CNL cells showed very active phagocytosis, but their bactericidal activity was reduced in suboptimal conditions. The total content of lysozyme and beta-glucuronidase was lower in CNL cells compared to normal neutrophils, but the release of these enzymes from stimulated cells was much higher than normal. This observation is compatible with a marked lysosomal lability. Cells from the patients' peripheral blood and bone marrow showed excessive growth in CFU-C assays. Marked susceptibility of CNL cells to cytotoxic activity of cold agglutinins, SLE sera, and CSFs was observed and may signify qualitative and/or quantitative differences in the membrane structure of CNL neutrophils, as compared to normal cells.
Aged↗
Multiple myeloma with discordant M components in the serum and CSF.
A patient with multiple myeloma was initially seen with Bence Jones-type kappa proteinemia and intermittent Bence Jones proteinuria. In the late stage of the disease, involvement of the CNS was observed, and abnormal plasma cells were found in the CSF. Chromosomal analysis of these plasma cells showed an accessory chromosome in the A2 group and an abnormal chromosome in the D13 group. In addition to Bence Jones-type kappa protein similar to that in the serum, the CSF contained IgA-kappa M component. Immunoquantitation detected 250 mg/dL of IgA in the CSF and only 33 mg/dL in the serum. T our knowledge, such discordance of M components has never been described before.
Bence Jones Protein↗
Alterations of human purine metabolism in megaloblastic anemia.
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Adenine Phosphoribosyltransferase↗
Cryocrystalglobulinemia.
A 40-year-old woman had cryocrystalglobulinemia with IgG2(K1). To date, 27 other cases of spontaneous crystallization of a plasma protein have been reported. In all, the protein, a cryoglobulin, has been found to be an IgG molecule. The disease most commonly associated with this phenomenon has been multiple myeloma. None of the patients have had Raynaud's phenomenon, but many have had purpuric skin lesions made worse by exposure to cold. In the two cases of essential cryocrystalglobulinemia, crystals were found in the peripheral blood film. Immunologic, biochemical and ultrastructural studies have so far not demonstrated any property common to all cryocrystalglobulins.
Adult↗
Acquired increases of human erythrocyte purine enzymes.
The alterations of three erythrocyte purine enzymes were studied in 12 patients with diseases associated with reticulocytosis, two patients with a partial deficiency of hypoxanthine-guanine phosphoribosyltransferase, seven patients with severe megaloblastic anemia, and 14 normal subjects. The specific activity of adenine phosphoribosyltransferase was positively correlated (r = 0.81) with the reticulocyte percentate in ten patients with a normal hypoxanthine-guanine phosphoribosyltransferase. Two apparent types of alterations of this enzyme were distinguished: (1) increased specific activity with a normal half life as in megaloblastic anemia, and (2) a prolonged half life with or without an elevation of specific activity as in the deficiency of hypoxanthine-guanine phosphoribosyltransferase. Hypoxanthine-guanine phosphoribosyltransferase and phosphoribosylpyrophosphate synthetase were increased in megaloblastic anemia, but were not correlated with the reticulocyte percentage and did not have a consistent change in the half life in the other disorders studied. The data show that acquired disorders associated with reticulocytosis may cause an elevation of the specific activity of purine enzymes in peripheral circulating erythrocytes. Therefore, these factors must be carefully considered in the interpretation of an elevated level of enzyme activity.
Adenine Phosphoribosyltransferase↗
Acute leukemia in rheumatoid arthritis treated with cytotoxic agents.
Acute leukemia is described in two patients treated with cytotoxic agents for a destructive, seropositive rheumatoid arthritis. Both patients had received longterm azathioprine therapy. In addition, one patient had been treated with cyclophosphamide, the other with melphalan. Chromosomal abnormalities were noted in both patients. Studies in one patient included colony forming units, ferrokinetics, electron microscopy of bone marrow, and autopsy examination. All reports of acute leukemia associated with cytostatic drugs in the literature to date are reviewed and the possible mechanisms discussed. It is suggested that patients with rheumatoid arthritis treated with azathioprine and alkylating agents may have an increased risk of developing a therapy-related acute leukemia.
Acute Disease↗