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Biomedical subjects

P Coeur

Publications and source records attributed to P Coeur.

At least 19 recordsLinked to original sources

Distinct chromosome 3 abnormalities in persistent polyclonal B-cell lymphocytosis.

Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare entity of unknown etiology characterized by a polyclonal expansion of B-lymphocytes with typical bilobulated forms, elevated serum IgM, and an additional isochromosome for the long arm of chromosome 3 as the sole change. In the present study, we investigated four cases of PPBL by means of conventional cytogenetic analysis and FISH. In all patients, the polyclonality of the lymphoproliferation was demonstrated by immunophenotypic studies, and PCR analysis failed to demonstrate clonal IGH rearrangements in three evaluated cases. In two patients, in addition to +i(3)(q10), banding techniques identified unrelated clones with trisomy 3. FISH studies using a chromosome 3 long arm-specific probe provided evidence that all cases had both +i(3)(q10) and +3. To determine more precisely the distribution of the chromosomal abnormalities within the peripheral lymphocyte population, we investigated two of these cases using a technique of simultaneous fluorescence immunophenotyping and interphase cytogenetics (FICTION). We demonstrated that both abnormalities were randomly distributed among the B-lymphocytes, independently of the kappa or lambda light chain isotype and the nuclear aspect. These data lead us to conclude that trisomy 3 represents, in addition to +i(3)(q10), another recurrent cytogenetic change in PPBL, suggesting that this lymphoproliferative disorder is associated with an increased frequency of chromosome 3 instability.

Adult↗

Translocations involving the short arm of chromosome 17 in chronic B-lymphoid disorders: frequent occurrence of dicentric rearrangements and possible association with adverse outcome.

Unbalanced translocations involving chromosome arm 17p, where the TP53 tumor suppressor gene localizes, are rarely described in chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL), but recent use of molecular cytogenetic techniques have indicated a significant incidence of TP53 deletions, suggesting the involvement of chromosome 17p in these disorders. By conventional karyotype, we have identified unbalanced translocations involving 17p in 14 out of 123 (11%) CLL/SLL patients with clonal abnormalities. Cases were characterized by resistance to chemotherapy and a poor clinical outcome. The karyotypes presented a high incidence of complex rearrangements and 17p translocations were characterized by various partners. In 10 cases a centric fusion was assessed by fluorescent in situ hybridization (FISH) experiments using specific centromeric probes. The incidence of dicentric translocations in these series is therefore significantly higher than usually described, arising in up to 71% (10 out of 14 cases). In all cases, translocations led to a monosomy 17p and to a TP53 monoallelic deletion. The adverse clinical outcome confirms that structural abnormalities involving chromosome 17p are associated with disease progression in patients with chronic lymphoproliferative disorders.

Antineoplastic Agents↗

Unbalanced X;autosome translocation (X;18)(q13;p11) in a case of aggressive natural killer non-Hodgkin lymphoma.

Recent evidence has shown that rare cases of aggressive non-Hodgkin lymphomas (NHL) derive from cells belonging to the natural killer (NK) lymphocyte lineage and a new clinico pathologic entity has been proposed. Though well documented in B- and T-cell NHL, chromosome abnormalities are rare findings in NK-NHL and to date, no recurrent cytogenetic abnormality has been described. The present study reports the clinical data, cytogenetic and fluorescence in situ hybridization (FISH) analysis of a new case of typical NK-NHL characterized by a primary unbalanced translocation (X;18) (q13;p11). Recent data of X;autosome translocation in malignant lymphomas have proposed Xp22 and Xq28 as the location of NHL-related oncogenes. According to other published reports on the involvement of the Xq13 region in NHL and particularly in aggressive forms, we hypothesize the existence of additional putative lymphoma-associated oncogenes at the band Xq13.

Adult↗

Distribution of the cytogenetic abnormality +i(3)(q10) in persistent polyclonal B-cell lymphocytosis: a FICTION study in three cases.

Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare entity characterized by a moderate but sustained lymphocytosis where some binucleated or bilobulated circulating forms constitute, even if they are not entirely specific, the cytological hallmark of the disease. An additional chromosome long arm i(3)(q10) has recently been reported as a recurrent cytogenetic aberration, contrasting with a usual polyclonal immunoglobulin expression. To determine more precisely the distribution of the chromosomal abnormality within the peripheral lymphocyte population and study the relationship between the +i(3)(q10) and the bilobulated character, we investigated three new cases of PPBL displaying the cytogenetic abnormality on the karyotype, using a technique of simultaneous fluorescence immunophenotyping and interphase cytogenetics (FICTION). We demonstrated that the +i(3)(q10) was restricted to the B lymphocytes, independently of the kappa or lambda light chain isotype and was present in both bilobulated and non-bilobulated cells. Therefore it is likely that the cytogenetic abnormality occurs at an early stage of lymphocyte differentiation in a precursor cell already committed to the B-cell lineage, before any rearrangement of immunoglobulin genes has taken place.

Adult↗

Detection of gram-negative bacteraemia in early sepsis by a quantitative chromogenic and kinetic endotoxin assay. The Study Group.

A kinetic chromogenic limulus test was carried out in order to investigate the possibility of a sensitive and specific detection of circulating endotoxin during the first 24 h of septic shock or severe sepsis in 76 patients. Two commercial kits, Whittaeker (W) and Chromogenix (C), were used. Blood culture was taken as a reference. At 1:10 plasma dilution (a currently used dilution in the end point limulus test) abnormal reaction kinetics were found in 13% and 41% of tests, for C and W respectively (P = 0.0008), resulting in unreliable results. Retesting plasma at a greater dilution, until the reaction kinetic was identical to calibration curve control values, gave similar results between the two kits and a better accuracy. Beyond a 0.5 EU mL-1 endotoxin level, the probability of Gram-negative bacteraemia was high (sensitivity = 0.53 and 0.47; specificity = 0.95 and 0.93 for C and W respectively). This kinetic limulus amoebocyte lysate (LAL) test may be useful in therapeutic decisions for treatment of endotoxaemia.

Aged↗

Prothrombin time sensitivity and specificity to mild clotting factor deficiencies of the extrinsic pathway: evaluation of eight commercial thromboplastins.

Prothrombin-time (PT) sensitivity and specificity to mild clotting factor II, V, VII and X deficiencies have rarely been studied. We therefore carried out a prospective study, in 350 patients, of eight commercial thromboplastins (CTs) in their ability to detect mild clotting factor deficiencies, notably in factor VII. In each patient the factor II, V, VII and X clotting activities and PT performed with each CT were determined. For each CT, PT sensitivity and specificity in detecting factor deficiencies below 0.5 U/ml or below 0.4 U/ml were determined at various PTs, and then Receiver Operator Characteristic curves constructed. At optimum PT threshold level (sensitivity = specificity), exactitude varied from 0.64 to 0.74 (p < 0.01) and from 0.67 to 0.81 (p < 0.0001) in detecting deficiencies below 0.5 and 0.4 U/ml respectively. In conclusion, this study shows the limits of the PT test as performed with 8 CTs in patients with mild clotting factor deficiencies. The impact of such differences in sensitivity and specificity on monitoring certain patients subjects to decrease in coagulation factor, and, in particular, of those under low dose oral anticoagulant, remains to be determined.

Blood Coagulation Disorders↗

[Occurrence of a circulating anticoagulant, factor V inhibitor after surgical intervention].

A case is reported of an endogenous inhibitor to factor V occurring one month after subtotal gastrectomy and splenectomy, with peroperative radiotherapy, for gastric adenocarcinoma. Preoperative coagulation tests were normal: 31 s for activated kephalin time (control 31 s) and 93% for prothrombin level. There was a fall in this latter during the first three postoperative days. Four hundred ml plasma without cryoprotein were therefore given, bringing the coagulation tests back to the normal range. On day 25, a routine check showed an activated kephalin time of 71 s (control 31 s), a prothrombin level of 13% with a thrombin time of 18 s (control 18 s). There was no associated haemorrhagic diathesis. Measurement of all the individual coagulation factors showed that there was a fall in factor V level (0.05 IU.ml-1). A large amount of antifactor V antibody was then found (47 IU.ml-1). No treatment was undertaken, the patient being so well. Two months later, the antibody had disappeared. The usual circumstances in which this antibody can be seen and the management of the related severe haemorrhages are discussed.

Aged↗

Intra-cytoplasmic crystalline inclusions in acute myeloid leukemia: a rare event.

Unusual intracytoplasmic crystal-like inclusions within granulocytic precursor cells from a patient with acute myeloid leukemia (AML) are described. Based upon their cytochemical and immunochemical properties, the possible composition and origin of these inclusions are discussed. They represent a rare event in leukemic cell metabolism since, to our knowledge, only 1 case with identical characteristics has previously been reported.

Aged↗

[Assessment of the risk of postpartum thromboembolism by measuring antithrombin III levels. A false hope].

In order to predict better thrombo-embolic complications that sometimes occur after delivery, we studied the variations of antithrombin III levels (A.T. III) in 703 women, at the 8th month pregnancy (275 levels), on the first day (609 levels) and the 5th day (516 levels) after delivery. The average antithrombin III levels were respectively 90.8%, 83.4% and 98.7%. We found 120 levels (8.5%) lower than 80% (normal range for A.T. III = 80-120%), 107 of which on the first day after delivery were followed by a rapid increase to the normal range; these women however were satisfactory in the post-partum period. Therefore predicting thrombo-embolic complications in the post-partum period through A.T. III levels determination would seem to be pointless.

Adult↗

[Therapeutic management of pregnancy complicated by congenital antithrombin III deficiency associated with pregnancy nephropathy].

Thrombo-embolic complications in pregnant women who have congenital antithrombin III deficiency are usually prevented by giving injections of sub-cutaneous heparin from the beginning to the end of pregnancy and with the administration of concentrated doses of antithrombin III (A.T. III) at delivery and in the following days. When we discovered a severe pre-eclampsia at the 28th week of pregnancy in a patient who had congenital deficiency of A.T. III and who had a past history of very severe thrombo-embolic complications we administered concentrated A.T. III as well as continuing the heparin treatment and anti-hypertensive treatment during the pregnancy. Severe fetal distress made us carry out a caesarean operation after 32 weeks of amenorrhoea. Delivery and the post-partum period were conducted without any complications. The newborn baby, who did not have congenital A.T. III deficiency, is very well.

Adult↗

Serum vitamin K1 concentration and vitamin K-dependent clotting factor activity in maternal and fetal cord blood.

The serum concentration of phylloquinone (vitamin K1) was measured in 34 healthy mothers and in the arterial cord blood of their newborn infants. In addition, the activities of factor II and of factors VII plus X were determined simultaneously in 16 paired maternal and fetal bloods. The serum vitamin K1 concentration was similar to that of control subjects in 27 mothers: 9.03 +/- 4.9 micrograms/L (mean and SD), with a simultaneous concentration of 10.4 +/- 5.3 micrograms/L in cord blood. Six mothers exhibited high serum vitamin K1 concentrations from 40 to 240 micrograms/L (median, 82) and the concentration in cord blood ranged from 25 to 115 micrograms/L (median, 71). One mother had a normal concentration of vitamin K1: 9 micrograms/L while no vitamin K1 was detectable in the serum of her infant. The activity of factor II and factors VII plus X was 7% and 7%, respectively, in this infant and 100% in the mother. All other mothers showed normal factor II and factors VII plus X activity, while the median activity was 47% (28%-56%) for factor II and 65% (35%-100%) for factors VII plus X in cord blood. These data suggest that vitamin K1 can cross the placental barrier but not in every case. Therefore the systematic administration of vitamin K1 to the newborn infant seems to be required to prevent the occurrence of the hemorrhagic disease.

Blood Coagulation Factors↗

[Evaluation of the performance of the Coagulyzer II (Lancer)].

The automation of equipment is essential in laboratories performing a large number of procedures with high precision. An evaluation of performance characteristics of a photoelectric automated coagulation instrument, the Coagulyzer II (Lancer) is reported and compared with performances of the Coag-a-pet 200.

Autoanalysis↗