[The effectiveness of granulocyte transfusions in the treatment of severe injections in granulocytopenic patients. A controlled trial (author's transl)].
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Biomedical subjects
Publications and source records attributed to E Feliu.
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Polymorphonuclear leucocyte function was investigated in twenty patients with alcoholic cirrhosis and three patients with cryptogenic cirrhosis. Bacterial ingestion, oxygen-dependent bactericidal capacity, and chemotactic response were measured. Serum dependent abnormalities were common; they included deficiencies of ingestion and of all subsequent oxygen-dependent metabolic events (three patients), all oxygen-dependent metabolic events (one patient), cytochrome c reduction and iodination deficiencies (six patients), isolated cytochrome c reduction deficiency (ten patients), and chemotactic deficiencies (fourteen out of eighteen patients). Serum-independent abnormalities were much less common; they included increased ingestion rate (four patients), decreased stimulated reduction of nitroblue tetrazolium (three patients), and decreased myeloperoxidase content (eight patients). Polymorphonuclear leucocyte abnormalities are frequent in cirrhosis and may account in part for increased susceptibility to infection in that disease.
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The functional capacities of granulocytes in patients with chronic granulocytic leukemia are still a subject of controversy, probably due to the heterogeneity of the abnormalities observed from patient to patient. For a better definition of these abnormalities, 14 patients with untreated chronic granulocytic leukemia were studied. The patients were divided into three groups on the basis of the functional activities of their phagocytosing granulocytes. In four patients (group I), the granulocytes were normal in respect to particle ingestion, nitroblue tetrazolium (NBT)-stimulated reduction, cyanide-insensitive oxygen (O2) consumption, superoxide anion (O2-)-stimulated production, hydrogen peroxide (H2O2) production, and iodination. They also had a normal myeloperoxidase (MPO) content. In four patients (group III), the granulocytes were significantly defective in all of these activities. In the six remaining patients (group II), all the initial metabolic steps of the phagocytosing granulocytes (ingestion, NBT reduction, O2 consumption, O2-production, H2O2 production) were normal, as were the MPO content of the granulocytes, while iodination was strikingly decreased. These metabolic features suggested a degranulation defect which was observed ultrastructurally in the only patient studied among these six. The phagocytosing granulocytes of this patient did not degranulate and no deposits of MPO activity were seen in the phagosomes.
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The morphology of granulocytes collected by continuous-flow centrifugation (CFC), discontinuous-flow centrifugation (DFC), and continuous-flow filtration (CFF) was investigated in 18 healthy donors by means of light microscopy and transmission electron microscopy. Light microscopy study of semithin sections of granulocytes collected by CFC and DFC showed minimal morphologic abnormalities, compared to granulocytes procured by CFF. Ultrastructural study of granulocytes procured by CFF showed more conspicuous qualitative and quantitative abnormalities (the most prominent being "microvilli," degranulation, and bazarre chromatin) than in granulocytes obtained by the other two methods. Controls showed that the bulk of CFF-cell abnormalities was due to the "tapping" of the filters. Factors such as the mechanical compression (plasma extractor) used in DFC method, donor pretreatment with anticoagulants and steroids, hydroxyethyl starch, and duration of leukapheresis scarcely influenced granulocyte morphology.
Recent reports suggest that non-A, non-B, non-C viruses might not be uncommon etiologic agents of hepatitis-associated aplastic anemia. A 52-year-old woman without previous contact with toxic substances or drugs developed severe aplastic anemia sixteen days after the onset of acute hepatitis. Even after exhaustive serologic testing for hepatotropic viruses and PCR study for hepatitis C virus the etiologic agent could not be demonstrated. Evolution was fatal despite treatment. In this case the time lapse between the onset of hepatitis and the development of aplasia was shorter than in previously referred incidents. This fact supports the hypothesis that different non-A, non-B, non-C agents might be implicated in hepatitis-associated aplasia.
Invasive tracheobronchial aspergillosis is an uncommon form of Aspergillus lung infection observed in immunocompromised patients. A 43-year-old patient diagnosed with acute lymphoblastic leukemia presented prolonged fever and hemoptysis during remission induction chemotherapy. The bronchoscopic examination showed pale mucosa with multiple raised white-colored nodules of 3 to 5 millimeters in diameter in all the bronchi. Hyphae of Aspergillus sp were observed in the biopsy of one of the nodules and in the examination of the bronchoalveolar lavage. Despite amphotericin B therapy, the patient developed bilateral necrotizing pneumonia and multiple abscesses in the brain and in the thyroid gland, and died. From a review of the literature in the Medline database, four similar cases (two in AIDS patients, one in lymphoma and the remaining case in an acute myeloid leukemia patient) have been reported.