Biomedical subjects
Publications and source records attributed to R Marra.
The authors describe 2 cases of acute myeloid leukemia (AML) with ovarian granulocytic sarcoma (GS) and central nervous system (CNS) involvement. The patients had an unfavorable clinical course in a short period of time. It has been reported that GS or CNS involvement does not have a bad prognostic significance. We suggest that the association of these two complications worsens the prognosis of AML.
Neurological involvement in acute myeloid leukaemia has become more common in recent years. The increase seems to be related to the longer survival rates made possible by more intensive treatment protocols. The predictive elements appear to be the tumour mass, cytomorphological variety M5, splenomegaly and serum LDH. Prophylaxis with craniospinal radiotherapy or spinal chemotherapy does not modify the course of the leukaemia or diminish the frequency of neuromeningeal complications. Six cases of AML involving the central nervous system were examined, two at onset and 4 at first relapse. Neuromeningeal complications are to be feared since they are extremely difficult to eradicate completely and the prognosis is extremely unfavourable especially if a bone marrow relapse occurs simultaneously.
Cerebrospinal fluid (CSF) beta-2-microglobulin (B2m) has been proposed as a marker of central nervous system (CNS) involvement in myelo-lymphoproliferative diseases. Recently its reliability has been put in question because of false positive and false negative results. In our study, B2m was measured in 574 CSF samples collected from 74 patients affected by ALL, ANLL or lymphomas; 20 of these patients had CNS-involvement while they were under observation. There was a significant difference in CSF B2m between the patients with and without CNS-involvement (p less than 0.001). No false positive or false negative results were obtained. In 4 cases the rising of CSF B2m was observed 8, 6, 4 and 4 wk before the clinical and laboratory diagnosis of CNS-involvement. In all patients the clinical and laboratory improvement of the neurological disease was associated with a progressive decrease of CSF B2m. Some hypotheses about the origin of CSF B2m are discussed. The authors conclude that CSF B2m is a useful and reliable marker of CNS-involvement in myelo-lymphoproliferative disease.
Fourteen patients with hematologic neoplasia (11 acute myeloid leukemias, 2 non-Hodgkin's lymphomas and 1 blast crisis of chronic myeloid leukemia) who underwent high-dose cytosine arabinoside (HIDARAC) therapy with or without sequential asparaginase (ASNase) were investigated in order to evaluate liver toxicity and a possible decrease in antithrombin III (AT III) plasma level. AT III was found decreased only in patients who received ASNase, whereas HIDARAC alone did not influence AT III levels. It is pointed out that a single dose of ASNase seems to be sufficient to induce a decrease in AT III. A mild and transient liver toxicity due to HIDARAC therapy does not seem to be of any clinical relevance.
The cerebrospinal fluid (CSF) and serum beta-2-microglobulin (B-2-m) level was determined in 15 patients affected by lymphoma with and without central nervous system (CNS) involvement and in 15 normal controls. No statistical difference in CNS B-2-m was found between patients affected by lymphoma without CNS involvement and normal subjects. CSF B-2-m was significantly increased (p less than 0.001) in patients with CNS involvement as compared to normal subjects or patients without CNS involvement. These findings suggest that CSF B-2-m can be used as a useful marker of CNS involvement in patients affected by lymphoma.
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The role of beta 2 microglobulin (beta 2-m) in Systemic Sclerosis (SS) has been evaluated. Twenty-four female patients have been examined: 15 of them were affected by acrosclerosis (Group 1) and 9 of them by diffuse sclerosis (Group 2). 46.6% of Group 1 and 44.4% of Group 2 had values significantly higher than normal controls. (P less than 0.01 and P less than 0.005 respectively). The authors deal with the validity of the use of B2-m as index of inflammatory activity of the disease.
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In order to investigate some aspects of blood coagulation and of platelet function in cerebral ischemia, 18 healthy subjects, 24 patients with previous cerebral infarction and 12 patients with transient ischemic attacks were studied. All patients were in a non-active state of the illness. In all subjects, platelet count, prothrombin time, activated partial thromboplastin time and determination of the fibrinogen concentration were performed as routine. All subjects were tested for platelet adhesiveness, circulating platelet aggregates, factor VIII coagulant (VIII C), factor VIII-related von Willebrand factor (VII RWF), factor VIII-related antigen (VII RAg), antithrombin III (AT III) concentration and activity and euglobulin clot lysis time. No significant difference between patients and controls was found in routine tests, platelet function, AT III concentration or activity. Plasma levels of VIII C, VIII RWF, VIII RAg were significantly increased in both patient groups. The VIII RAg/VIII C ratio was significantly increased only in patients with previous cerebral infarction. Euglobulin clot lysis time was significantly increased in both patient groups.
75 patients with atherosclerosis divided into five disease groups (previous myocardial infarction and cerebral thrombosis, angina pectoris, transient ischemic attacks, arteriosclerosis obliterans) were studied and compared to 20 healthy subjects. Antithrombin III (AT III) concentration was determined by single radial immunodiffusion; AT III and factor Xa-inhibitor (Xa-I) activities were measured by amidolytic methods. No significant difference was found in any group of patients as compared to normal controls by all the methods. A positive correlation was found between AT III concentration and AT III activity, AT III concentration and Xa-I activity, AT III activity and Xa-I activity. Results are discussed in relation to the literature data.
A favorable outcome was obtained in the case of an infected diabetic ulcer that resulted from neglect. The importance of appropriate antibiotic therapy and the advantage of a newer generation cephalosporin, cefamandole nafate (Mandol), is discussed. Optimal diagnostic information relative to the presence of osteomyelitis may be obtained by concomitant use of conventional radiographic technique and bone scanning. The most complete information concerning the status of diabetic control is gained by evaluation of standard blood glucose levels in conjunction with glycosylated hemoglobin A1C.
In order to investigate the factor VIII complex trend in atherosclerosis, 96 patients suffering from atherosclerosis, divided in 6 groups (angina pectoris, previous myocardial infarction, transient ischemic attacks, previous cerebral thrombosis, diabetes without symptoms of vascular injury and diabetes with vascular complications), were studied and compared to a control group of normal subjects. Plasma levels of Factor VII Coagulant (VIII C), Factor VIII-Related von Willebrand Factor (VIII-RWF) and Factor VIII-related Antigen (VIII ARg) were measured in all subjects. A significant rise of VIII RAg was noticed in all groups of patients as compared to the control group: this increase appears to be related to the severity of vascular injury. A significant rise of VIII RWF, parallel to the VIII RAg increase, was also noticed in all groups. Besides, all groups of patients showed a significant and uniform increase of VIII C. The average ratio of VIII RAg/VIII C was raised in all groups, except diabetics without complications; but the increase was statistically significant only in those patients with a heavier vascular injury which is related to the marked rise of VIII RAg in such clinical situations. The findings of this study are discussed in relation to the literature data. The significance of the determination of VIII RAg/VIII C ratio and of the VIII RAg assay as methods for monitoring the severity of the vascular injury in atherosclerosis are also discussed.
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Data from cattle herds infected with brucellosis and from control (noninfected) herds were collected and analyzed using case control techniques. It appeared that herds located close to other infected herds and those herds whose owners made frequent purchases of cattle had an increased risk of acquiring brucellosis, particularly those who made purchases from other herds or from cattle dealers. Infected herds had a lower level of vaccination than noninfected herds. However, the percentage vaccinated was highly variable in each group. Vaccination per se did not appear to adversely influence the interpretation of serological test results nor did it appear to protect the individual animal. Once infected, the time required to become free of brucellosis was increased by large herd size and/or loose housing. Closed herds also took longer to become brucellosis free than more open herds. The percentage of animals removed from the herd was increased by active abortion. Those herds with multiple serological reactors (positives and questionables) at the first herd test after the imposition of quarantine had the highest percentage of cattle removed.
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Serum lactate dehydrogenase (S-LDH) and its isoenzyme pattern were assayed in 63 non-Hodgkin's lymphoma (NHL) patients, 37 at diagnosis, 15 at relapse and 11 in complete remission (CR). S-LDH in NHL patients with active disease was higher than in normal subjects and CR patients (p less than 0.001). Among the isoenzymes, LDH-2 and LDH-5 showed no remarked differences; LDH-1 was reduced and LDH-3 and LDH-4 raised in comparison to the normal group (p less than 0.001). S-LDH levels and isoenzymes 1 and 4 were influenced by the stage, the histological subgroup and by the presence of general symptoms. In fact, cases in stage IV, with "high-grade malignancy" and with general symptoms, had higher S-LDH levels and more evident LDH-1 and LDH-4 changes than the other stages, the other histopathological subgroups and the cases classified as "A". S-LDH was the same as in normal subjects in the "low-grade" and "intermediate-grade" malignancies as was LDH-1 in stage II and LDH-4 in stages II and III, in "low-grade" malignancy and in the A cases. In contrast, LDH-3 was always high, with no significant difference in relation to the variables considered. Thus, in NHL, LDH-3 seems to be a reliable marker of the presence of the disease in any case, whereas S-LDH is more related to the spread of the lymphoma.