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PubMed1991

[Biological diagnosis of malaria: dangers of the automated blood differential count].

Automated differential counting systems deprive laboratories of blood smear study and so malaria risks not to be diagnosed if plasmodium search is not prescribed by the physician. Some abnormalities (atypical lymphocytes called LUC and thrombopenia) can induce a blood smear. But a study of 96 patients shows that, during the first analysis, these abnormalities can miss for nearly a third of one's case. So it is very important to prescribe malaria search on blood smears when there is the least clinical symptom.

Adult↗
PubMed1991

[Materno-fetal dengue. Apropos of 5 cases observed during the epidemic in Tahiti (1989)].

During the dengue 3 epidemic which occurred in French Polynesia between September 1989 and March 1990, number of cases of Dengue Haemorrhagic Fever (DHF) were reported among children and infants. Of interest, five cases of neonatal infections were recorded and involved the transmission of the virus from mother to child as the end of the pregnancy. Detailed observations on these cases are presented in this paper. Fever in mother, when delivering or just a few days before, represents the circumstances of the diagnosis. Analysis of the clinical features shows that fever and vasomotor troubles (blotches) were the dominating traits of the disease in the newborns. Also, hepatomegaly was constantly observed. Concerning the biological results, thrombopenia (platelets count: 100,000/mm3) was reported for all cases. According to these data, all cases were classified into DHF cases. Laboratory confirmation was obtained by serological investigations (antidengue IgM immunocapture ELISA and Haemagglutination Inhibition Tests) and/or virus isolation in both mother and child. Thus, virus was recovered in two newborns while IgM were detected in all infants and in four mothers. Severity of the disease was variable. However, out of five cases one fulfills the WHO definition of Dengue Shock Syndrome (DSC). Moreover, the authors discuss about the difficulties encountered to classify the cases according to WHO criteria for the grade classification of DHF.

Dengue↗
PubMed1976

[Prognosis and treatment of idiopathic thrombocytopenic purpura in children].

The following conclusions can be drawn from the study of 55 cases of I.T.P. of childhood. 1. I.T.P. evolving more than 6 months must always be considered as chronic, the disease having in these cases few chances of recovery without splenectomy. After 6 months evolution, it is probably possible to establish a prognosis and a therapeutic approach with little risk of error. 2. Among the clinical and biological criteria noted at the onset of the disease, the intensity of thrombopenia alone is statistically different in acute and chronic I.T.P. Consequently, there are few criteria allowing the early recognition of evolution to chronic I.T.P. 3. The corticoids have no curative value in I.T.P. Prolonged corticotherapy is therefore useless in this disease. 4. As a palliative, the value of the corticoids can only be statisfactorily demonstrated in chronic I.T.P. Here it is certain in 6 cases on 16. 5. The value of corticoids for capillary resistance is evident, even in small doses. 6. Splenectomy must be considered in all cases of severe or corticodependant chronic I.T.P. Cure is obtained in most cases. 7. The contribution of immunosuppressive agents and in particular azathioprine, cannot be usefully assessed on the basis of the series studied. In the absence of decisive results, it would be worthwhile to evaluate this treatment by means of a greater number of clinical trials.

Acute Disease↗
PubMed1991

[Phase I clinical study of zinostatin stimalamer (YM 881) by intravenous injection].

A phase I clinical study by intravenous injection of zinostatin stimalamer (YM 881), a protein anti-cancer drug, was conducted in 50 patients with malignant tumors. The initial dose was 0.5 mg/m2 (n) in the single dose test, and 0.2 mg/m2/day in the repeated dose test for 5 successive days. Doses were increased up to 12n according to the modified Fibonacci's method in both the single and repeated dose tests. The dose limiting factor was thrombopenia in both the single and repeated dose tests. The maximum tolerated dose was 6.0 mg/m2 (12n) in the single dose test, and the subtoxic dose was 2.4 mg/m2/day in the five day repeated dose study. These results indicate that dose of 1.0 to 1.4 mg/m2/day (5 n to 7 n) are appropriate for the phase II repeated dose study.

Adult↗
PubMed1991

[Autoimmune thrombocytopenic purpura and pregnancy: significance of fetal blood punction].

The authors report three cases of percutaneous fetal blood sampling at 38 weeks of pregnancies complicated by immunologic thrombocytopenia. In each case, the purity was perfect which is essential for using the examination with a view to the obstetrical management. The birth is programmed 24 or 48 hours later. In two cases, the neonatal control is in agree with the fetal blood sampling. In the third observation, the fetal platelet count in 142,000/mm3 and the newborn control 55,000/mm3: the only explanation is a very active process as usually state with newborns. There was no accident, and these samplings led to natural births. This approach seems to be the more effective for the evaluation of fetal platelet count and allow the choice of birth management. A cesarean section is decided in case of fetal thrombopenia lower than 50,000/mm3.

Adult↗
PubMedDate not supplied

[Platelet changes during heart surgery with extracorporeal circulation].

The changes in the number of platelets during anesthesia and operation were evaluated in 24 patients (8 females and 16 males) scheduled for cardiac surgery with cardiopulmonary bypass. There was a significant (p less than 0.05) thrombopenia at the beginning of perfusion, which persisted 60 minutes after the end of cardiopulmonary bypass. There were no significant differences when these changes were evaluated depending on the type of oxygenator, the need for transfusion or the duration of cardiopulmonary bypass. There was a reduction in the platelet count at the beginning of the bypass (207 to 124 x 10(9).1(-1), when blood contacts with the synthetic surfaces of the circuits and the oxygenator, al though-the most marked reduction was found at the end of bypass (95.9 x 10(9).1-1), coinciding with protamine administration. The function and number of platelets tended to become normal in the first hours of the postoperative period.

Adult↗
PubMed1991

[Fotemustine: a pilot phase II trial in sarcoma of the soft tissues].

Fotemustine has been administered to 10 patients with metastatic or redux soft sarcoma in a phase II pilot study. The main inclusion criteria were: at least one measurable site, Karnofsky index (KI) higher than 60%, no specific treatment within the last 4 weeks, correct haematological status. Induction treatment comprised fotemustine 100 mg/m2 D1-D8-D15 in a 1 h intravenous infusion protected from light, followed by a 5-week rest period. In patients with no progressive disease, maintenance treatment comprised fotemustine 100 mg/m2 D1 q 3 weeks, until progression or toxicity. Patients characteristics were: 9 M/1 F; median age: 51 years [26-66]; median KI 90% [60-100]; median number of previous drugs: 5 [2-8]; 6 patients had two or more metastatic sites and one patient had developed a sarcoma following chest radiotherapy. Evaluation was carried out in weeks 4 and 8, following the first fotemustine injection. One case of minor response and one case of stabilisation were observed, but they were of short duration. The main toxicity was haematological with delayed leucopenia and thrombopenia (nadir: week 6). In patients who have undergone previous chemotherapy, fotemustine is not efficient according to the first step of the Gehan statistical guidelines.

Adult↗
PubMed1991

[Albers-Schönger disease disclosed by maxillary osteitis. Apropos of a case in an African].

The authors reported here a case of dominant form of osteopetrosis. The patient was a 28 years old man hospitalized for a mandibular osteitis consecutive to a tooth extraction. The clinical examination detected a splenomegaly. The laboratory tests showed anemia and thrombopenia. A radiographic skeletal survey detected a typical generalized osteocondensation. The authors pointed out the radiologic signs of the disease and underscored the difficulties in managing osteomyelitis of the jaw in such patients.

Adult↗
PubMed1991

[Clinical experiences with hyperthermochemotherapy of hepatic metastasis from gastric cancer].

Thermochemotherapy was performed on gastric cancer cases of hepato-metastasis. The subjects were 12 gastric cancer cases having hepato-metastatic lesions (10 synchronous, 2 heterochronous). Using 8 or 13.58 MHz-dielectric heating apparatus, thermotherapy was carried out for 40-60 min (twice a week, 5-35 times, averaging 12.8 per case) at an intra-tumoral temperature greater than 42 degrees C. Chemotherapy consisted of hepato-arterial infusion of MMC 10 mg/BW, CDDP 75 mg/m2 once per 3-4 weeks and consecutive daily administration p.o. of UFT 800 mg/BW. Effect greater than PR was noted in 75% (9/12) on the whole and in 100% (5/5) and 57% (4/7) for H1-2 and H3, respectively. Mean and 50% survival periods were 9.3 and 7.2 months, respectively, with a one-year survival rate of 38%. Chemotherapy-induced side effects were nausea and vomiting in 83% and leukopenia and thrombopenia in 67%, while the only thermotherapy-induced side effect was subcutaneous fatty tissue necrosis in 3 cases. The above results suggested the effectiveness of the present thermochemotherapy in the treatment of hepato-metastasis of gastric cancer.

Administration, Oral↗
PubMed1991

[Continuous arteriovenous hemofiltration and hemodiafiltration in a newborn infant with acute kidney insufficiency].

A boy of 10 days old with acute renal failure was treated with continuous arterio-venous hemofiltration and continuous arterio-venous hemodiafiltration over a period of 14 days. Hemodynamically both technics were well tolerated. Fluid overload was treated effectively by continuous fluid withdrawal and during continuous arterio-venous hemodiafiltration there was an adequate solute removal. One bleeding episode was observed during controlled general heparinization and was probably related to thrombopenia. In conclusion, continuous arterio-venous hemofiltration and hemodiafiltration are efficient modes of treatment in hemodynamically unstable infants in whom other forms of conventional dialytic therapy are contraindicated. Only continuous arterio-venous hemodiafiltration offers both fluid withdrawal and adequate solute removal and consequently may be preferred to continuous arterio-venous hemofiltration.

Acute Kidney Injury↗
PubMed1991

[Malaria of importation in the child: epidemiological, clinical and therapeutic analysis. Apropos of 70 cases observed in a pediatric hospital in Paris].

Seventy children from 7 months to 15 years old have been treated for malaria at Hospital Trousseau (Paris) during years 1987 and 1988. Thirty nine of them were living in France usually. The infection was one chiefly in Africa (68 cases), and by P. falciparum in 78% of children. The digestive symptoms were frequent (40/70); splenomegaly was observed in 40 children and hepatomegaly in 31. Anemia was present in 59 cases and mild thrombopenia for 31 cases. The C. reactive protein raised in 92% of cases. The diagnosis was late in 31 patients. Only one cerebral malaria case was observed. The chemoprophylaxis was unfitted or absent in 74% of children living in Paris. The chloroquino-resistance was clinically present in 17 cases and the mefloquine was more often used during 1988 year.

Africa↗
PubMed1991

[Respiratory distress and multiple organ failure after intravesical instillation of BCG].

A case of probable hypersensitivity reaction with multi-organic failure, following bladder installation of BCG, in a male with a diagnosis of bladder carcinoma is presented. The patient developed respiratory, renal and liver failure as well as leukocytosis, thrombopenia and an increase in muscular enzymes. It was resolved with hemodynamic support. The rare complication, occasionally described in medical literature and its probable pathogenic mechanisms are discussed.

Administration, Intravesical↗
PubMed1991

[Blood coagulation disorders in leukemia].

Bleeding and septicemia are the most common causes of death in patients with acute leukemia. Additionally to thrombopenia, which is present in most patients, in part of the patients severe coagulation abnormalities are observed. The prevalence of severe coagulation abnormalities in patients with acute myeloid leukemia including all FAB types is around 12%, in patients with promyelocytic leukemia the prevalence is more than 50%. The etiology of this coagulation abnormality remains unclear. There are 3 mechanisms currently under discussion: activation of coagulation, activation of fibrinolysis and an increased activity of specific leucocyte proteases. In particular, in promyelocytic leukemia the risk of cerebral bleeding is high (10 to 15% of early deaths). The most important therapeutic consequence is an intensified thrombocyte replacement regimen. Additional therapeutic efforts, like administration of heparin or antifibrinolytic drugs, have failed to improve the prognosis of patients with severe coagulation abnormalities.

Disseminated Intravascular Coagulation↗
PubMed1991

Antitumor activity of 7-N-[[2-[[2-(gamma-L-glutamylamino)ethyl]dithio]ethyl]]-mitomycin C.

Through the extensive investigation of new mitomycin C (MMC) derivatives, several compounds with disulfide at N-7 were found to show activities superior to MMC against murine Sarcoma 180 solid tumor. Among them, 7-N-[[2-[[2-(gamma-L-glutamylamino)ethyl]dithio]ethyl]]- mitomycin C (KW-2149) was selected for further evaluation of antitumor activity and toxicity in mice. KW-2149 exhibited activity superior to MMC in increasing survival of i.p. inoculated P388 leukemia-, M5076 sarcoma-, and B16 melanoma-bearing mice. KW-2149 administered i.v. also exhibited superior activity in inhibiting the growth of s.c. inoculated P388 leukemia, M5076 sarcoma, and colon 26 adenocarcinoma and in increasing survival of i.v. inoculated P388 leukemia- and M5076 sarcoma-bearing mice. Furthermore, KW-2149 remarkably increased the life span of MMC-resistant P388 leukemia- and L1210 leukemia-bearing mice. KW-2149 and MMC inhibited the growth of human tumors inoculated into nude mice. The activity of KW-2149 was prominent in human lung carcinoma Lu-65 and Lu-99, bladder carcinoma T24, and epidermoid carcinoma A431. KW-2149 was comparable to MMC in decreasing the number of WBC in the peripheral blood, and the thrombopenia induced by KW-2149 was mild and recovery was rapid. The in vitro anticellular spectrum of KW-2149 against 23 human tumor cell lines was similar to that of MMC. However, KW-2149 inhibited the growth of the cell lines at concentrations of 10- to 100-fold lower than MMC and showed efficient cytotoxicity against MMC-insensitive tumor cell lines. These included lung epidermoid carcinoma Calu-1, stomach carcinoma MKN-28, colon adenocarcinoma DLD-1, colon adenocarcinoma LoVo, bladder carcinoma HT-1197, sarcoma G-292, and melanoma SK-MEL-28 cells. These results indicate that KW-2149 bears interesting characteristics as a new anticancer drug and warrants further development.

Animals↗
PubMed1977

[Hematological and clinical manifestations of bone marrow metastasis of carcinomas. Apropos of 36 cases verified by biopsy].

A retrospective study of 36 cases of bone marrow metastases from carcinoma is reported. In all cases, the presence of tumour cells was confirmed by needle biopsy of the bone marrow. The clinical picture was fairly typical: decline in general health, fever, bony pain and skin and mucosal hemorrhages. Radiological lesions of the skeleton were present in 64% of cases. Sometimes the blood disorders were isolated. Anemia was almost constant (86), normochromic, normocytic, and may be associated with leukocytosis and thrombopenia. Pancytopenia is rarer as also is a rise in the number of platelets. Erythremia, very suggestive, is demonstrated in 73% of the blood smears. In 31% of the slides examined again, schizocytes were found among the normal red cells. Disorders of hemostasis were easily circumscribed. As fibrinolysis was sometime found, hemostasis was studied as a routine in all patients. The special recruitment of a hematology unit explains the high frequency of blood abnormalities in this series of bone metastases.

Aged↗
PubMed1991

[The implantation of Hickman catheters. A new function of interventional radiology].

Hickman catheters are used mainly in patients with hematologic diseases, especially lymphatic and myelotic leukemias, and malignant lymphomas. They facilitate the administration of chemotherapeutics, hyperosmolar solutions and other substances with local toxicity as well as frequent taking of blood samples. Usually Hickman catheters are placed by surgical cut-down on a jugular vein. In lieu of this surgical placement, we recommend the implantation of Hickman catheters by means of interventional radiology techniques. In a period of 13 months 78 Hickman catheters were placed in 67 patients, 37 catheters (= 47%) stayed more than one month, 8 catheters (= 10%) stayed 5 to 8 months in the central venous system, 26, respectively 6, of these catheters are until now in situ. Lethal or life threatening complications did not occur. There were no infections at the introduction site of the catheter. The main complications were: pneumothorax without drainage: 3.2%, pneumothorax with drainage: 3.2%, slipping back of the tip of the catheter: 4.8%, thrombosis of the subclavian vein: 3.2%, fluid in the pleural cavity: 1.6%. In correspondence to the literature the complications of Hickman catheter placement by means of interventional radiology are less serious than by means of surgical cutdown. Further advantages are: general anesthesia can be avoided (less strain on severely ill patients, no problems to wean from assisted ventilation in patients with respiratory insufficiency), the smooth curve of the implanted catheter avoids sharp kinking and occlusion of the lumen, very small skin incisions are sufficient (lesser risk of hematomas in patients with thrombopenia), time and cost are reduced in comparison to surgical placement.

Adolescent↗
PubMed1991

[Clinical findings in newborn infants of mothers with kidney transplants].

Renal transplant patients who become pregnant require continued immunosuppression. Little is known on the risk of infants born under these conditions. We observed 6 neonates of renal transplant patients, of whom 4 were premature and 3 small for gestational age (SGA). There were no congenital malformations. Transient thrombopenia in 1 preterm baby probably resulted from maternal immunosuppression. Further 232 cases were published since 1980. Among the total of 238 patients, including our observations, rates for prematurity (49%) and SGA-infants (29%) were high, 6% had congenital malformations. Maternal immunosuppression with Cyclosporin A, as compared to Azathioprine, seems to carry a higher risk of prematurity (66 vs. 43%) and SGA-babies (56 vs. 19%). On the contrary, Azathioprine might be more muta- and teratogenic. At present, no data are available on the long-term outcome of these children.

Adult↗
PubMed1975

[Appearance of coagulation disorders in the non-healthy newborn infant].

Coagulation abnormalities are particularly frequent in neonatal pathology and justify exploration of hemostasis in the newborn. First of all we established a profile of coagulation in the newborn using our own results and data from the literature. Contrasting with a deficit in numerous factors (II - VII - IX - X - XI - and XII), overall coagulation is normal, or even increased. The fibrinolytic system is characterized by a low plasminogen level but the activity of this system is transitorily increased. Then we recall the known syndromes: avitaminosis K, constitutional deficits in the coagulation factors, isolated thrombopenia, disseminated intravascular clotting. However numerous problems persist. Abnormalities in the clotting factors are frequently difficult to interpret. Correlation between the clinical and laboratory pictures does not always exist. We emphasize the necessity for preventive measures.

Blood Cell Count↗