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Subacute myeloid leukemia: a clinical review.

The data on 31 patients who fit into the clinical spectrum of subacute myeloid leukemia have been reviewed. The majority of patients were male with a median age of 61 years. The interval from onset of symptoms to actual diagnosis was extremely variable, with a mean of 16 months and a median of six months. Most patients presented with anemia and thrombocytopenia, although the white blood cell count varied from striking leukopenia to marked leukocytosis. Examination of the bone marrow invariably revealed abnormalities of all cell lines with megaloblastoid erythrogenesis and dysplastic megakaryocytopoiesis. Although the white cell line showed prominence of immature forms, there was more maturation than is seen in acute myeloid leukemia. Survival from diagnosis was variable, from less than one month to greater than 68 months, with a median of only six months. Anemia and hepatosplenomegaly were prognosticators of a poor outlook; patients with hepatosplenomegaly in association with either leukocytosis or thrombocytopenia had a particularly poor outlook, with a median survival of only one and a half months. Approximately half the patients received chemotherapy with no demonstrated effect on survival.

Adolescent↗

Leukocyte larceny: a cause of spurious hypoxemia.

Multiple blood specimens with different leukocyte counts from two patients with extreme leukocytosis secondary to leukemia and unexplained hypoxemia were tonometered with a gas of known oxygen concentration and the decay of oxygen tension (PO2) was measured over time. The decay in PO2 in the first 2 minutes for blood with leukocyte counts of between 55.2 X 10(3)/mm3 and 490.0 X 10(3)/mm3 ranged from 13 to 72 torr. The degree of PO2 decay was blunted by placing the blood on ice and was obliterated by adding potassium cyanide. Thus, extreme leukocytosis secondary to leukemia can cause spurious hypoxemia and spurious lowering of the mixed venous PO2 due to oxygen consumption by leukocytes ("leukocyte larceny").

Adult↗

Maternal deaths associated with postpartum vulvar edema.

Reported are three maternal deaths in four patients who presented with a similar syndrome following a normal antepartum course and normal labor and delivery managed by regional or local anesthesia and midline or proctoepisiotomy. Beginning about the second postpartum day, the patients developed unilateral perineal edema and induration which progressed to generalized vulvar, vaginal, perineal, and gluteal edema and induration. These patients developed marked leukocytosis, fever, and ultimately vascular collapse; three of them died. The one patient who survived had a similar course except for vascular collapse. Unilateral vulvar induration and edema associated with fever and marked leukocytosis are ominous signs. Aggressive treatment should include the use of multiple antibiotic, crystaloid, colloid, and steroid drugs and appropriate monitoring. By this report we hope to bring attention to this rare but lethal syndrome.

Adolescent↗

Interference of azelastine with anaphylaxis induced by ovalbumin challenge in actively sensitized rats.

The inhibition of the haematological alterations and prevention of death due to systemic anaphylaxis after antigen challenge were investigated in rats after various drug treatments. The i.v. injection of ovalbumin (250 micrograms/kg) into actively sensitized rats induced marked thrombocytopenia and haemoconcentration within 5 min and significant leukocytosis within 30 min, lasting for 2 h after the challenge. Pretreatment with meclizine or terfenadine (15-30 mg/kg i.p.) inhibited antigen-induced haemoconcentration, whereas WEB 2086 (2-10 mg/kg i.p.) and PCA 4248 (5-10 mg/kg p.o.), two platelet-activating factor (PAF) antagonists, interfered with thrombocytopenia only. Azelastine (1-20 mg/kg p.o.) dose dependently inhibited antigen-induced haemoconcentration and thrombocytopenia but failed to block leukocytosis. Azelastine also inhibited the thrombocytopenia observed after the i.v. administration of PAF (4 micrograms/kg). Administration of ovalbumin at a dose of 1.5 mg/kg resulted in a lethal anaphylactic reaction in about 85% of the rats. Pretreatment with WEB 2086 (10 mg/kg i.p.), meclizine (30 mg/kg i.p.) or both increased the survival rate from 15 to 57, 68 and 87%, respectively. Azelastine alone (20 mg/kg p.o.) completely blocked the lethal reaction. It was concluded that the ability of azelastine to antagonize histamine and PAF is important for its effectiveness against anaphylactic shock.

Anaphylaxis↗

Toxicological and hematological effects of sicklepod (Cassia obtusifolia) seeds in Sprague-Dawley rats: a subchronic feeding study.

Cassia obtusifolia and its seeds, common contaminants of agricultural commodities, are toxic to cattle and poultry. Toxicity has been attributed to anthraquinones which are major constituents of C. obtusifolia, but studies of the subchronic and chronic toxicity of naturally occurring anthraquinones are limited. To investigate the subchronic (greater than 30 days) toxicity of C. obtusifolia seed, ten rats/sex were fed diets containing 0, 0.15, 0.50, 1.5 or 5.0% C. obtusifolia seed for 13 weeks. Intermittent mild diarrhea was found in high-dose animals and body weights of high-dose males were decreased to week 10. Myeloid hyperplasia with peripheral leukocytosis, thrombocytosis and mild anemia were found in males and females fed diets containing greater than or equal to 0.50% C. obtusifolia seed. Leukocytosis resulted from neutrophilia, whereas peripheral lymphocyte counts were unaffected. Lymphoid hyperplasia and/or histiocytosis were found in the mesenteric lymph nodes in groups fed C. obtusifolia seed. Thus, a dietary 'no observable effect level' for subchronic ingestion of C. obtusifolia seed in rats was less than 0.15%.

Animal Feed↗

The effect of exercise on the granulocyte response to isoproterenol in the trained athlete and unconditioned individual.

Many factors will influence the tissue response to catecholamine stimulation. Isolated human granulocytes (PMNs) release the lysosomal enzyme beta-glucuronidase following incubation with complement-activated zymosan particles. Isoproterenol, histamine, and prostaglandin E1 (PGE1) inhibit this PMN release of beta-glucuronidase. The effect of exercise on this in vitro granulocyte response was studied in two groups: highly conditioned marathon runners (n = 6) and unconditioned subjects (n = 7). A 13-km run did not produce leukocytosis in the highly conditioned marathon runners and the granulocyte response to isoproterenol was unchanged in cells obtained immediately following the run. In contrast, the seven unconditioned subjects exercised to a maximal response on the treadmill. Following exercise there was an increase in plasma catecholamines, a significant leukocytosis, and granulocytes from the immediate postexercise period responded less well to isoproterenol.

Adult↗

Technique for quantification of LTB4-induced changes in peripheral granulocyte counts in vivo in the rabbit.

A method to quantify leukotriene B4-(LTB4)-induced changes in peripheral granulocyte counts in the rabbit is described. Rabbits were surgically prepared with vascular access ports cannulating the right external jugular vein. This preparation made possible rapid, accurate, and repeated sampling of venous blood. Intravenous infusion of LTB4 (0.5-2 micrograms/mL) into the left marginal ear vein was found reproducibly to cause an initial, rapid (1-5 min) leukopenia (64%-100% reduction) followed by an extended (20-30 min) leukocytosis (121%-178% increase). Saline infusion for 30 min resulted in no changes in peripheral granulocyte number. The method described was sensitive and reproducible enough to allow evaluation of the LTB4 receptor antagonist, LY223982 (10 mg/kg, i.v.), which was shown to block both the leukopenia and the leukocytosis induced by LTB4 infusion.

Animals↗

The effect of local and parenteral vaccination on the response of the guinea pig mammary gland to staphylococcal challenge.

Preparturient guinea pigs vaccinated locally (orally and intramammarily) or parenterally (intradermally) with killed Staphylococcus aureus (KS), were challenged intramammarily (IMM) with KS or viable S. aureus during the next lactation. The number and types of leukocytes emigrating into the milk were determined before and after IMM challenge. The milk leukocytosis after challenge with KS was the greatest in the intradermally (ID) vaccinated animals, moderate in the IMM vaccinated animals, and insignificant in the unvaccinated or orally vaccinated animals. The polymorphonuclear (PMN) leukocyte predominated in the milk of the IMM and ID vaccinated animals during the initial 30 h after challenge with KS. Later (30-102 h postchallenge), the mononuclear leukocyte (macrophage and lymphocytes) was the major cell-type. No significant changes in the number or types of leukocytes occurred in the milk of the unvaccinated or orally vaccinated animals after challenge. Intramammary challenge with viable S. aureus caused a large increase in the number of leukocytes in the milk of all animals. The milk leukocytosis occurred more rapidly in locally vaccinated guinea pigs than unvaccinated or ID vaccinated guinea pigs. The PMN leukocyte predominated in the milk of all animals during the period of maximum response. The incidence and severity of staphylococcal mastitis were less in guinea pigs vaccinated locally than ID vaccinated or unvaccinated animals.

Administration, Oral↗

Neutrophilia and lymphopenia in major mood disorders.

Alterations in peripheral blood leukocyte distribution in major depression, including lymphopenia, neutrophilia, eosinopenia, and monocytopenia, have been described. The present study was designed to replicate these results, but with methodological improvements, including age-, sex-, and race-matched control subjects; DSM-III and Research Diagnostic Criteria diagnoses based on the Schedule for Affective Disorders and Schizophrenia interview; objective and subjective severity of depression measured quantitatively; and consideration of psychosocial stressors (DSM-III, Axis IV). We found relative lymphopenia and absolute neutrophilia and leukocytosis in depression, but did not find decreased numbers of eosinophils or monocytes. The relative lymphopenia and absolute neutrophilia were present in the subgroup of only unipolar depressed patients, but not in the bipolar, currently depressed subgroup. However, these blood cell changes were not found in a subgroup of patients who had been medication free greater than or equal to 1 month but only in the subgroup of patients using medication at the time of phlebotomy. Groups formed on the basis of psychosocial stress levels were not found to have significant significant intergroup differences in white blood cell (WBC) counts. The clinical significance of these findings needs study. While leukocytosis and neutrophilia can be found in major depression, these changes are perhaps secondary to medication use.

Adult↗

The first open study of zonisamide, a novel anticonvulsant, shows efficacy in mania.

1. Zonisamide, an anticonvulsant developed in Japan, is structurally similar to serotonin. Zonisamide has been proven to have a pharmacological profile that is very similar to that of carbamazepine. Thus, the effect of zonisamide was examined in 24 psychiatric patients: 15 with bipolar manic state, 6 with schizoaffective manic state, and 3 schizophrenic excitement. 2. Approximately 25% of all the patients and 33% of the bipolar manic patients showed remarkable global improvement with the addition of zonisamide. Approximately 71% of all the patients and 80% of the bipolar group had more than moderate global improvement. 3. No serious adverse reactions were found and no patients required zonisamide withdrawal. One patient developed both leukocytosis and mildly abnormal liver function test. One developed leukocytosis and another reported mild sleepiness. These reactions disappeared when zonisamide was discontinued.

Adult↗

Pathology of acute Leptospira interrogans serotype icterohaemorrhagiae infection in the Syrian hamster.

The pathology of acute Leptospira interrogans serotype icterohaemorrhagiae infection in the Syrian hamster was investigated up to 7 days after infection using histology, electron microscopy and an indirect fluorescence test for leptospires. The disease was characterized by the presence of many leptospires in the tissues, jaundice, leukocytosis, haemorrhages, endothelial alteration and thrombotic glomerulopathy. The leptospires were present intravascularly, in the interstitium penetrating between liver cells and tubular epithelial cells and in the tubular lumina. The presence of leptospires was not necessarily associated with lesions. These findings support both pathogenetic mechanisms suggested in the literature, namely: the ability of leptospires to penetrate actively between cells with detachment of tight junctions, without obvious lesions to the cells, and an immune-mediated process with immune complex formation and binding and activation of complement resulting in leukocytosis, thrombotic glomerulopathy, endothelial alteration and haemorrhages.

Acute Disease↗

Protection of Pasteurella multocida dermonecrotic toxin-challenged rats by toxoid-induced antibody.

Two different doses of glutaraldehyde-treated Pasteurella multocida dermonecrotic toxin (PMDT) were used to immunize rats. Rats developed serum IgG antibodies specific for native PMDT, and IgG titers increased with dose and number of toxoid immunizations. Survival rates in both active immunization and passive serum neutralization experiments were dependent on dose of toxoid vaccination and serum levels of anti-PMDT IgG. Vaccination with toxoid prevented weight loss but not leukocytosis and increased complement titers in toxin-challenged rats. Toxoid, itself, induced minimal leukocytosis but no alterations in complement titers or weight gain.

Animals↗

Neuropharmacological profile of Eclipta alba (Linn.) Hassk.

The present study deals with the investigation of standardized and phytochemically evaluated aqueous and hydroalcoholic extracts of the plant Eclipta alba for sedative, muscle-relaxant, anxiolytic, nootropic and anti-stress activities. The hydrolyzed fraction of the aqueous extract was also subjected to similar studies in rats. The aqueous and hydroalcoholic extracts were administered in a dose of 150 and 300 mg/kg, p.o., while the hydrolyzed fraction was administered in a dose of 30 mg/kg, p.o. The findings indicated nootropic activity of the aqueous extract (300 mg/kg, p.o.) and its hydrolyzed fraction (30 mg/kg, p.o.). The effect of the extracts on stress-induced alterations was evaluated. The aqueous extract and the hydrolyzed fraction provided protection against cold restraint induced gastric ulcer formation and also normalized the white blood cell count in the milk induced leukocytosis challenge model. The hydroalcoholic extract on the other hand demonstrated a significant effect only in the milk induced leukocytosis challenge model. The results point towards the potential neuropharmacological activity of the plant Eclipta alba as a nootropic and also having the property of attenuating stress induced alterations. Further neurochemical investigations can unravel the mechanism of action of the plant drug with respect to nootropic activity and help to establish the plant in the armamentarium of nootropic agents.

Animals↗

Signs and symptoms of cytomegalovirus disease in kidney transplant recipients.

PURPOSE: To investigate the range of clinical presentations of cytomegalovirus (CMV) disease in kidney transplant recipients. MATERIALS AND METHODS: We retrospectively reviewed the records of hundred kidney recipients who developed CMV disease between 1984 and December 2002 for demographic characteristics, laboratory findings, and presenting signs and symptoms. RESULTS: The most common presentations were elevated serum creatinine in 74 patients, fever in 71, thrombocytopenia in 43, nausea in 32, vomiting in 25, elevated alkaline phosphatase in 24, leukocytosis in 22, and leukopenia in 21. Tissue involvement was relatively rare, but six patients had pneumonia, two had conjunctivitis, and one had vascular dermatitis. Four percent of the patients had received intravenous ganciclovir prophylaxis, and 7% had received oral ganciclovir prophylaxis. Fever was associated with number of hospitalizations (P = .006), elevated creatinine (P = .006), nausea (P = .017), vomiting (P = .031), and previous posttransplantation infections (P < .001). All the patients with conjunctivitis, pneumonia, pulmonary symptoms, and abnormal heart sounds and most of those with arthralgia, nausea, and vomiting were febrile during their CMV disease course. CONCLUSION: Our findings showed that leukocytosis should be considered as much as leukopenia when CMV disease is suspected. CMV-induced pneumonia is not common in renal transplant recipients compared to other organ transplant recipients. CMV invasion to other tissues is also rare. Finally, fever is a common symptom and important in assessing the severity and prognosis of the disease.

Adult↗

[The current clinical spectrum of pulmonary thromboembolism].

BACKGROUND. Mortality in pulmonary thromboembolism (PTE) decreases considerable when it is diagnosed early. The suspicion based on clinical and complementary data is essential for an early diagnosis. METHODS. Retrospective review of the clinical features in patients diagnosed of PTE in an Internal Medicine department from January 1993 to December 1999. RESULTS. A total of 117 patients with PTE were identified. The median age was 68.8 years. Sixty-six patients (56.4%) had one or more risk factors for PTE. The most common risk factor was immobilization (37.6%). Dyspnea was the most common symptom (74.4%) and tachypnea the most common sign (66.7%). Fever/low grade fever and leukocytosis were present in 16.2% and 31.6% of patients, respectively. Respiratory failure, alkalosis and hypocapnia were present in 44.4%, 38.5% and 47% of patients, respectively. An alveolar-arterial oxygen gradient > 20 mmHg was demonstrated in 96.6% of patients. Chest radiographs and electrocardiograms were normal in 52.1% and 23.9% of patients, respectively. A vein echo-duplex of the lower limbs demonstrated deep vein thrombosis (DVT) in 52.1% of patients. The hospital mortality rate was 6.8%. CONCLUSIONS. PTE still affects older patients mainly and frequently known risk factors are not detected. The presence of fever/low grade fever and/or leukocytosis does not rule out PTE. Both chest radiographs and electrocardiograms may be normal. Not demonstrating DVT in the lower limbs by the vein echo-duplex does not rule out PTE. The hospital mortality rate has not decreased considerably in the last few years.

English Abstract↗

The leukocytic reaction of the human uterine cervix to spermatozoa.

Cervical smears were taken before, and at intervals after, artificial insemination and scored for the ratio of leukocytes to squamous cells. Most women showed a significant rise in this ratio after insemination with whole fresh or frozen/thawed semen, but this was not seen when fresh or frozen sperm-free seminal plasma was used. Some women had received spermatozoa naturally less than 24 hours before our tests, and most showed some leukocytosis before insemination; even these women showed further response to artificial insemination with spermatozoa. It is concluded that women, like rabbits, normally respond by leukocytosis to cervical deposition of spermatozoa. The primary function of the leukocytes may be sperm selection by phagocytosis or the "mopping up" of introduced bacteria. Some of the patients became pregnant at the monitored cycle; so it is very clear that this is a physiologic response of the cervix, not a pathologic leukocytic reaction.

Cervix Uteri↗

Chest tube drainage of pleural effusion correcting abdominal ascites in a patient with severe ovarian hyperstimulation syndrome: a case report.

OBJECTIVE: To describe a patient with severe ovarian hyperstimulation syndrome (OHSS) demonstrating a beneficial result of reduction in abdominal ascites with a chest tube placed for bilateral pleural effusions. DESIGN: Case report. SETTING: Academic hospital. PATIENT: A 28-year-old white female with primary infertility on hMG (Pergonal; Serono Laboratories, Randolph, MA) therapy. INTERVENTIONS: Intravenous fluids, lasix, and albumin were administered for correction of laboratory abnormalities, including hemoconcentration, hypoalbuminemia, and leukocytosis. A chest tube was placed for treatment of pleural effusions. MAIN OUTCOME MEASURES: Laboratory values of hematologic measures and electrolytes. Resolution of pleural effusions and abdominal ascites as determined by chest roentgenogram and physical examination. RESULTS: Treatment of OHSS with intravenous fluids, lasix, and albumin corrected the hemoconcentration, hypoalbuminemia, and leukocytosis associated with OHSS. Placement of a chest tube corrected the pleural effusions and abdominal ascites. CONCLUSION: This case report demonstrates a beneficial result of reduction in abdominal ascites by a chest tube placed for pleural effusions.

Adult↗

Changes in leukocyte, granulocyte and lymphocyte counts following antenatal betamethasone administration to pregnant women.

OBJECTIVE: Preterm labor and premature rupture of membranes are associated with a mild leukocytosis. However, we have observed a higher maternal leukocyte count after antenatal betamethasone therapy. We planned this study to evaluate the effects of antenatal betamethasone treatment on maternal leukocyte, granulocyte and lymphocyte count. METHODS: Forty-six pregnant women with the diagnosis of preterm labor between 28 and 33 weeks of gestation age received 12 mg betamethasone at a 12-h interval. The control group consisted of 50 pregnant women between 28 and 33 weeks of gestational age with no medical or obstetrics problems. After a baseline venous sampling, serial leukocyte, granulocyte and lymphocyte counts were obtained every 6 h until it returned to baseline value. RESULTS: There were no statistically significant differences in the control group with respect to the total leukocyte, lymphocyte, and neutrophil count. Total leukocyte and granulocyte counts were increased by 29.8% and 17.8% within 24 and 12 h after betamethasone injection, respectively (P < 0.01). A significant reduction in lymphocyte count was observed within 12 h (45.4%) after betamethasone injection (P < 0.01). All changes in leukocyte, granulocyte and lymphocyte counts returned to baseline values within 3 days. CONCLUSION: Antenatal betamethasone therapy leads to an increase in maternal leukocyte count and a decrease in lymphocyte count. This effect is transient and any leukocytosis persisting for more than 3 days is not due to betamethasone administration.

Betamethasone↗