Biomedical subjects
Publications and source records attributed to S Gross.
We describe a case of a child with severe Factor X deficiency who had three episodes of intracranial hemorrhage during the first 6 months of life. Since that time he has been successfully managed with prophylactic therapy using prothrombin complex infusions via an indwelling central venous line. This prophylactic therapy may prevent the poor outcome usually described in these patients.
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Recurrent parotitis in children is a well described but rare condition of unknown cause. The clinical features of 11 children with recurrent parotitis are described.
OBJECTIVE: To report two cases of fixed drug eruption induced by methylphenidate. CASE SUMMARY: Two children with attention deficit disorder treated with methylphenidate as a simple drug developed fixed drug eruption of the scrotum. Drug discontinuation was followed by a complete resolution of the skin eruption. Rechallenge resulted in the same drug rash. Macrophage migration-inhibiting factor (MIF) assay with methylphenidate was positive. DISCUSSION: The pathogenesis of fixed drug eruption and the role of MIF assay in the diagnosis of adverse drug reaction is discussed. CONCLUSIONS: Fixed drug rash induced by methylphenidate is a possible but rare phenomenon.
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We report the nonrandom occurrence and frequency of the t(1;22)(p13;q13) in acute myeloid leukemia (AML) and its close association with the French-American-British M7 subtype of AML in infants (less than 1 year). This chromosomal abnormality occurred in 6 of 252 (2.4%) children and adolescents with AML (6 of 28 infants, 22%; 6 of 18 M7 AML cases overall, 33%; and 6 of 6 M7 cases in infants). Infants with AML of M7 subtype and the t(1;22) often presented with prominent abdominal masses. Two of these infants were not treated and died early. Three of four treated infants entered complete remission with therapy for AML; the remaining infant died of hemorrhage on day 8. Of the three infants who entered remission, only one remains alive and disease free at 5+ months. The other two infants relapsed in the bone marrow at 5 and 2 months from the start of therapy, respectively. We conclude that M7 AML with the t(1;22) usually presents in infants with extensive infiltration of abdominal organs by leukemic cells and may confer a poor prognosis despite intensive AML-directed treatment. Identification of this nonrandom translocation exclusively in infants with acute megakaryoblastic leukemia (AMkL) implies that it may serve as an additional diagnostic marker for this disease and links it to the pathogenesis of AMkL in infants.
A 36-year-old patient was investigated for a lifelong history of epistaxis and delayed bleeding after minor surgeries. Deficiencies or abnormalities of the coagulation system, of platelet function, or of factor XIII and alpha-2-antiplasmin were excluded. Consistently, however, over a period of 7 years, a high basal euglobulin fibrinolytic activity was observed that was characterized by a high tissue-type plasminogen activator (t-PA) activity, normal t-PA antigen, and undetectable plasminogen activator inhibitor type-1 (PAI-1) antigen and activity. The high specific activity of t-PA (640,000 IU/mg) and the minimal amounts of t-PA/PAI-1 complexes detected by fibrin zymography suggest that in this patient all t-PA was active. This is in striking contrast to normal plasma, where the majority of t-PA is complexed to PAI-1. Thus, in this patient, a severe deficiency of PAI-1 is associated with a delayed type bleeding tendency. Our observation underscores the importance of plasma PAI-1 for the stabilization of the hemostatic plug.
We describe a case of a patient that presented to our center with Cushing syndrome and was found to have an extensive metastatic adrenal carcinoma. He underwent debulking of the abdominal disease followed by eight courses of VP-16/carboplatinum. The patient had a remarkable response and is currently alive and in complete remission.
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We conducted a pilot protocol at seven Pediatric Oncology Group (POG) institutions to examine the feasibility, toxicity, and efficacy of using a common regimen of high-dose chemoradiotherapy (HD CT/RT) supported by autologous or allogeneic marrow infusions in children with metastatic neuroblastoma (NBL) in first or second remission. During a 57-month period, we accrued 101 patients. We report here results for the 81 who completed treatment at least 2 years ago. The HD CT/RT regimen consisted of melphalan 60 mg/m2/d for three doses, and total body irradiation (TBI) either 1.5 Gy (n = 27) or 2.0 Gy (n = 54) twice daily for six doses. Twenty-three patients also received irradiation consisting of 1.2 Gy twice daily for 10 doses to persisting disease sites. Seventy-four were given autologous and seven allogeneic marrow, 64 autologous marrows being purged immunomagnetically. Fifty-four children were in first complete (CR) or partial (PR) remission and 27 in second CR or PR. As of October 1, 1990, follow-up was from 32 to 72 months. Forty-seven of these 81 children relapsed, 10 died of complications, one of unknown cause, and 23 continue in remission, including 21 of the 54 treated in first remission, and 16 who completed treatment more than 3 years ago. The 2-year actuarial event-free survival (EFS) probabilities are first CR (CR1) 32% (SE 10%), first PR (PR1) 43% (SE 9%), second CR (CR2) 33% (SE 27%), and second PR (PR2) 5% (SE 5%). Probability of EFS correlated with remission number (first better than second, P less than .001), with interval from diagnosis to HD CT/RT (greater than 9 months better than less than 9 months, P = .055), and with TBI dose (12 Gy better than 9 Gy, P = .031). These encouraging results may partly reflect selection for this treatment of patients with NBL who have a slower disease pace.
Two cases of Enterobius granuloma containing eggs only are reported. The first case involved the vulva, where no such granuloma has been reported previously. The coexistence of peritoneal granuloma and rectal adenocarcinoma in the second case suggests the possibility of direct penetration of the damaged colonic wall by the parasite, as emphasized by several previous reports of neoplastic involvement and perforation of the intestinal wall in cases of ectopic infections. The diagnostic criteria of Enterobius eggs granuloma, which might be a diagnostic dilemma for pathologists who are not familiar with such criteria, are described herein.
Patients with chronic renal disease in whom erythropoietin production is inadequate invariably experience moderate to severe debilitation-induced fatigue. Unlike the direct humeral control of erythropoiesis, neutropenia in the same cohort of patients appears to be under indirect control, very likely brought about by the suppressive effect of increased levels of low-density lipoprotein (LDL) on granulocyte-monocyte colony formation. Markedly elevated LDL levels were identified in plasma samples obtained from a study population of 179 chronic renal disease patients. The effect of the elevated LDL levels in the plasma of these patients resulted in a greater than 60% decrease in granulocyte-macrophage colony-forming unit in comparison with age-matched plasma from normal individuals. Careful review of all nutritional and therapeutic events in these patients did not offer any evidence, other than the elevated LDL levels, in support of the etiology of the chronically low absolute neutrophil counts.
Uteroferrin is a purple progesterone-induced glycoprotein containing two molecules of iron per 35,000 molecular weight polypeptide, which has high amino acid sequence homology with Type 5 acid phosphatases from normal human placentae, from sera of patients with hairy cell leukemia, Gaucher's disease, and osteoporosis, as well as from normal spleens of pigs, cattle, rats, and mice. Results of the present study indicate that uteroferrin also has colony-forming unit (CFU) activity for committed erythroid (BFU-E) and granulocyte-monocyte/macrophage (CFU-GM) cell lines and exists as far back as the granulocyte, erythrocyte, monocyte/macrophage, megakaryocyte (CFU-GEMM) committed lineage. Uteroferrin exerts maximum CFU activities at 1 microgram/ml in serum-free culture medium with no supplemental iron (90 micrograms/ml ferric iron). However, when ferric iron concentration in medium was increased to 200 micrograms/ml, uteroferrin had maximum CFU activities at 100 pg/ml. Preincubation of uteroferrin with polyclonal antiserum or monoclonal antibody to uteroferrin effectively eliminated its CFU activities. Uteroferrin derived from human term placentae also exhibits BFU-E, CFU-GM, and CFU-GEMM activities. The mechanism by which uteroferrin stimulates proliferation and differentiation of primitive hematopoietic stem cells is unclear.
We report a case of T cell lymphoma which was exclusively located within the epidermis. The T cells of this lymphoma were all of suppressor-cytotoxic phenotype. They did not express the CD7 antigen and a molecular biology study showed T cell type genotypic rearrangements. Both immunohistochemical and ultrastructural studies showed close contacts between lymphoma and Langerhans cells.
The hemorrhagic risk of an association of the low molecular weight (LMWH), Fraxiparine injected intravenously at the dose of 7.500 AXalCU or of unfractionated heparin (UFH) injected intravenously at the usual dose used during hemodialysis (3.750 +/- 1.280 IU + 1.000 IU after 2 hours of dialysis) to the subcutaneous administration once daily of a thromboembolism preventive dose of Fraxiparine (7.500 AXalCU) was evaluated on the modification of the following hemostasis parameters: thrombin time, activated partial thromboplastin time (APTT), anti Xa activity, in 13 uremic patients on hemodialysis. The association of intravenous and subcutaneous Fraxiparine prevented efficiently the clotting of the extracorporeal circulation without inducing a detectable antithrombinic activity. In contrast, the association of I.V. UFH to subcutaneous Fraxiparine induced a significant increase of the thrombin time and of the APTT, so explained by the activity of UFH. It is concluded that subcutaneous Fraxiparine at the thromboembolism preventive dose can be associated as well to I.V. Fraxiparine as to UFH without increasing the potential hemorrhagic risk. Nevertheless the association of SC and IV Fraxiparine 7.500 AXalC u seems preferable to the association of SC Fraxiparine with UFH.
Many in vitro techniques have been developed for removing cancer cells from the marrow of patients who are to undergo autologous bone marrow transplantation (ABMT). These purging techniques can be classified as immunological or pharmacological. The immunomagnetic technique has been widely used in neuroblastoma patients. It depends on an interaction between target neuroblastoma cells in the marrow and a complex of specific monoclonal antibodies and magnetized microspheres, the target cells being selectively removed by passage through a magnetic field. Laboratory studies with neuroblastoma and acute lymphoblastic leukemia cells have shown the high efficiency of this technique in selectively removing cancer cells while retaining adequate numbers of normal hematopoietic cells for subsequent reinfusion into the patient. Clinical studies in several hundred neuroblastoma patients, as well as small numbers of acute lymphoblastic leukemia, breast cancer, and myeloma patients, suggest that this is a clinically safe and effective technique. However, no clinical trial has been conducted comparing ABMT with and without in vitro marrow purging. Until such time, we will regard immunomagnetic purging as "standard of care" for neuroblastoma patients receiving ABMT.
In an effort to reduce non-specific binding interactions (binding in the absence of antibody), sheep anti-mouse IgG1 (Fc) antibody linked to magnetic microspheres (also referred to as microbeads or beads) were treated with phosphatidylcholine (PC), phosphatidylglycerol (PG), or a mixture of PC and PG. The lipid-treated microspheres were mixed with Kelly neuroblastoma cells, which had been pre-labelled with Hoechst fluorochrome. After 30 minutes of incubation, the microsphere adherent cells were separated from the non-adherent cells and counted. PC or mixed lipid treatment of beads reduced nonspecific binding to 8.3%, compared to 25.8% in the untreated samples. PG, on the other hand, increased non-specific binding. Lipid treatment of beads did not adversely affect specific antibody mediated binding. When a non-specific antibody was added to the incubation mixture, non-specific binding of untreated control beads to cells was increased, but binding of PC-treated beads was unaffected.
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