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[Fever and chills due to leptospirosis after travel to Thailand].

Two weeks after rafting on a river in Thailand a Dutch 54-year-old male experienced chills and high fever. While rafting he had wounded his hand. Because of the history (water contact, the wound, high fever with chills), of the findings at examination (fever, conjunctivitis) and of the laboratory findings (leukocytosis, albuminuria, disturbance of liver enzymes), a clinical diagnosis of 'leptospirosis' was made. This was confirmed by serological tests and culturing of Leptospirae from the blood. Leptospirosis is a zoonosis, in man associated with certain occupations, water sports and inundations. The clinical picture varies from a mild febrile disease (sometimes pyrexia of unknown origin) to a severe condition with kidney and liver failure, bleeding tendency, lung oedema (Weil's syndrome). In travellers with fever, water contact, leukocytosis and neutrophilia, leptospirosis must be considered and specific diagnostic tests applied.

Antibodies, Bacterial↗

Labelled leukocytes for diagnosis of infectious diseases. Our experience in labelling and clinical usefulness.

BACKGROUND: To review our experience in infectious diseases diagnosis, using a simple labelling technique. METHODS: We made 101 scans in 91 patients with suspected infectious diseases confirmed by clinical, histologic or cultural specimens; a clinical or instrumental follow-up was available for every patient. Patients were divided into four subgroups: A: Inflammatory Bowel Diseases; B: Septic Syndromes; C: Bone diseases; D: Others. We used 99mTc-HMPAO in 80 scans and 111In in 21. In 20/80 frozen and stored HMPAO was used. RESULTS: 99mTc-HMPAO frozen and stored labelling yield was: 60%(SD15%), 99mTcHMPAO: 62(12)(p n.s.), 111In 75%(10%), (p < 0.05). Frozen-stored HMPAO was sterile and apyrogen. 27 had positive scan without leukocytosis or neutrophilia. No correlation between leukocytosis or neutrophilia and yield was observed. Transit lung times ranged between 14-16 min without differences among three radiopharmaceuticals. In each Group and in the sample as a whole True Positive, False Positive, True Negative, False Negative, Sensitivity, Specificity and Accuracy, were calculated. In Group B and in the sample as a whole Predictive Positive Value and Negative Predictive Value were also evaluated. CONCLUSIONS: Labelling yields and "viability" were good using the three radiopharmaceuticals; labelling procedure was simple and safe. Accuracy PPV, NPV, cost-effectiveness were good; 111In is the choice for diagnosis of bone and joint infections. Frozen-stored HMPAO should be introduced as a cost-saving labelling procedure in practice.

Adolescent↗

Prolonged survival in two cases of T-prolymphocytic leukemias with complex hypodiploid chromosomal abnormalities.

We encountered two cases of T-prolymphocytic leukemias (T-PLL) with complex hypodiploid chromosomal abnormalities. Both cases showed mild organomegaly and marked leukocytosis (144.5 x 10(9)/L, 102.6 x 10(9)/L, respectively). Although both cases developed into refractory progressive diseases at the terminal stage, the oral administration of dexamethasone was very effective for leukocytosis and thrombocytopenia in case 1 and oral cyclophosphamide was effective for reducing elevated leukocytes and the organomegaly in case 2. Despite the poor prognosis of T-PLL, our cases showed that less toxic therapies such as oral dexamethasone or cyclophosphamide may be the treatment of choice for patients with an indolent phase of T-PLL. Our study and previously reported findings suggest that complex hypodiploid chromosomal abnormalities are characteristic in T-PLL.

Aged↗

[Atypical manifestations of Whipple's disease].

We report 2 new cases of Whipple's disease (WD) with especial characteristics. In one case, an asymptomatic leukocytosis was the first manifestation, and after therapy the patient developed a gastric adenocarcinoma. In the second, the clinic suspect we led to try antibiotic treatment in absent of histological manifestations. The clinical, analytical and histological characteristics of both patients are described. We propose that WD should be listed in the differential diagnosis of unknown leukocytosis. Moreover, we indicate the possibility to try empirical antibiotic therapy in long-term cases without histological confirmation. Finally, we suggest a possible role of WD in the development of cancer.

Humans↗

[Procalcitonin in pyelonephritis and acute community-acquired pneumonia in adults].

OBJECTIVES: Procalcitonin (PCT) is an acute-phase protein involved in the specific inflammatory reaction to severe bacterial or fungal infections. This protein does however lack sensitivity in focal infections. PATIENTS AND METHODS: In this study, we investigated PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocytosis, and fibrinogen levels at admission among adult patients hospitalized for community-acquired pneumonia (n = 33) or pyelonephritis (n = 30) and in a control population (n = 27) of patients with viral infections and non-infectious inflammatory diseases. RESULTS: Median serum PCT in the control group (0.21 ng/ml) was significantly lower than in the pyelonephritis group (0.46 ng/ml, p < 0.0005) or the pneumonia group (0.88 ng/ml, p < 0.0005). In the control group, median CRP was 51.4 ng/l reaching 220 mg/l in the pyelonephritis and 198 mg/l in the pneumonia group (p < 0.0005 in both cases). The other markers of inflammation investigated (leukocytosis, ESR, fibrinogen) did not show such differences between the control group and the sepsis groups. The sensitivity of PCT (threshold 0.5 ng/ml) was 61% for the diagnosis of pneumonia and 44% for the diagnosis of pyelonephritis. Specificity was 92% in both cases. In comparison, the sensitivity of CRP (threshold 50 mg/l) was 94% and 91% for pyelonephritis and pneumonia respectively with a 33% specificity in both cases. CONCLUSION: PCT is a specific but poorly sensitive marker of community-acquired pneumonia and pyelonephritis among adults hospitalized in medical wards.

Adult↗

[Intestinal invagination in children. Reduction with pneumo-enema].

UNLABELLED: Pneumatic reduction of intussusception in children is an effective and safe procedure, although controversy persists concerning contraindications. The shown by this procedure when compared to barium reduction have led to its implementation in our Service. AIM: To evaluate the usefulness of a 'handicraft method' of pneumatic reduction of intussusception with very restricted contraindications (peritonitis or shock). MATERIAL AND METHODS: The prospective study included 50 attempts at pneumatic reduction in 48 children (age range: 1.5-24 months). After confirmation of the diagnosis by ultrasonography. Then, air insufflation of the colon was performed under manometric and fluoroscopic control. After confirmation of diagnosis by ultrasonography, air insufflation of the colon was performed under manometric and fluoroscopic control in an operative room. Evolution longer than 24 hours was considered diagnostic delay, leukocytosis if WBC > 15 x 10(9)/l and distal localisation after splenic angle. Immediate laparotomy was undertaken in case of unsuccessful or doubtful reduction. RESULTS: Thirty-five reduction procedures (70%) were effective ab initio. In the 15 children submitted to laparotomy, seven were completely reduced (14%), five were manually reduced (10%), two presented intestinal necrosis (4%) and one (recurrence) had an ileal duplication (2%). The "real" efficacy (84%) was lower, even though significantly affected by diagnostic delay (81% vs 83%), rectal bleeding (81% vs 100%) or leukocytosis (71% vs 81%); efficacy was significantly lower only in distal localised cases (67% vs 97%, p = 0.02). There was one more recurrence (4%) and no other complications. CONCLUSIONS: The adopted method of pneumatic reduction was highly effective with low morbidity. Restricted contraindications were appropriate.

Child, Preschool↗

Physiologic and biochemical abnormalities in self-induced drug overdosage.

The following abnormalities were observed during the first 24 hours of admission for 162 drug overdosage (OD) episodes in 152 patients: abnormal chest x-ray films; increased A-aO2 gradient; elevated white blood cell (WBC) counts; elevated serum enzyme levels; gross myoglobinuria; skin lesions suggestive of pressure necrosis; and abnormal electrocardiograms. Many sputum cultures were positive for single or multiple potentially pathogenic organisms. These correlations existed: all patients with OD duration of less than 12 hours were hyperthermic; as temperatures increased so did WBC counts; hyperthermic patients had higher creatine phosphokinase (CPK) values than those with hypothermia or normothermia; patients with skin lesions had higher temperatures and CPK values and longer OD duration; serum enzme levels increased with increasing OD duration; patients with CPK levels greater than 10,000 mU/ml had myoglobinuria; and patients with the most abnormal chest x-ray films had higher temperatures and larger A-aO2 gradients. Incidence of pneumonitis is low, even with abnormal chest radiograms, leukocytosis, hyperthermia, and positive sputum cultures. Abnormal temperatures and leukocytosis are probably secondary to stress, hypoxemia, acidosis, and specific drug ingestion rather than infection.

Adolescent↗

[High risk acute lymphoblastic leukaemia in children. Preliminary report after introducing a new version of New York (1997) protocol adjusted to the age of the patients. Report of the Polish Paediatric Leukaemia/Lymphoma Study Group].

The paper presents the experience of the Polish Paediatric Leukaemia/Lymphoma Study Group in the treatment of high-risk acute lymphoblastic leukaemia in children using a new version of the New York (1997-1999). Protocol with treatment intensity adjusted according to the age of the patients. From April 1997 to December 1999 a group of 49 children with leukocytosis ranging from 50 900/mm3 to 580 000/mm3 (median 122 000/mm3) and 6 children with leukocytosis below 50 000/mm3 and poor response to steroids were treated with this protocol. Children below 10 years (43 patients) were treated according to the previous protocol, children above 10 years (12 patients) were treated with intensified protocol (high doses of ARA-C in consolidation and intermediate doses of Mtx in maintenance). Induction was identical for all patients. Complete remission was achieved in 92.6% patients. There were 2 relapses. Six children died - 3 without remission, 2 due to a relapse, 1 due to treatment complications. The current opinions concerning classification of HRG-ALL and treatment possibilities in this group of children are discussed.

Adolescent↗

Clinical signs and scores for the diagnosis of ventilator-associated pneumonia.

The diagnosis of a pneumonia which occurs in critically ill patients undergoing positive pressure mechanical ventilation (ventilator-associated pneumonia, VAP) is often a problem. This is mainly due to the lack of sensitivity and specificity of clinical and radiographic signs of pneumonia in this patient population. Many studies investigated some clinical variables (fever, tracheal aspirates, blood leukocytosis, radiographic criteria): none of these, individually considered, resulted predictive enough to be useful for the bedside diagnosis of VAP. The Clinical Pulmonary Infection Score (CPIS) developed in 1991, based on 6 variables (fever, leukocytosis, tracheal aspirates, oxygenation, radiographic infiltrates, and semi-quantitative cultures of tracheal aspirates with Gram stain) is more sensitive to diagnose VAP. Compared with other associations of clinical variables this one is more flexible and it allows for the signs not to be all present at the same time.

Critical Care↗

[Rhabdomyolysis as a complication of Parkinson's disease].

BACKGROUND: Rhabdomyolysis is known as one of the possible causes of acute renal failure and can be triggered by different situations. In recent years, Parkinson's disease emerged as a condition that can be complicated by the development of rhabdomyolysis and consequently, in some cases, of acute renal failure. We report two cases of rhabdomyolysis, one of which complicated by an oligo-anuric renal failure, which occurred in patients affected by Parkinson's disease and admitted to our Division. METHODS AND RESULTS: The first case occurred in a 90-year-old Parkinsonian woman, under treatment with Levodopa-Benserazide and Bornaprine. She developed rhabdomyolysis (CPK 1746 U/L with MB isoenzyme 3.5 ng/ml, LDH 610 U/L, GOT 78 U/L) after she had been found lying on the floor, in a state of mental confusion, after 24 hours in which her relatives had not heard from her. During the first two days of hospitalization, the patient also had a fever (axillary temperature between 37 degrees C and 38 degrees C), accompanied by mild leukocytosis (WBC 13000/mm3) on entrance. The second case occurred in a 78-year-old Parkinsonian woman, under treatment with Levodopa-Carbidopa, Levodopa-Benserazide and Pramipexol. She developed a severe rhabdomyolysis (CPK 34800 U/L with MB isoenzyme 771 ng/ml, LDH 2133 U/L, GOT 785 U/L) complicated by acute renal failure with anuria, after two days characterized by several episodes of vomit and diarrhea. In the following days we learned that in the last 20 days before admission to hospital the patient had increased the dose of her anti-Parkinson therapy and was almost always disturbed by severe choreiform and dystonic movements. CONCLUSIONS: Regarding the first case, the clinical conditions in which the patient was found, the simultaneous presence of fever and leukocytosis and the absence of any reasonable explanation for a hypothetical fall to the floor induced us to think that this was a case of rhabdomyolysis in the context of an akinetic hyperthermic crisis. This is a syndrome that can develop in Parkinsonian patients after discontinuance or simply reduction of therapy with dopaminergic agents and is characterized also by rhabdomyolysis. The fact that the patient was living alone would confirm this hypothesis. On the other hand, the second case of rhabdomyolysis must probably be related to the severe choreiform and dystonic movements that the patient developed in the days just prior to admission. These movements were surely caused by the increase of the substitutive therapy with Levodopa by the patient herself. In conclusion, these two clinical cases, together with others previously reported by other Authors, show how the circumstances leading to the development of acute episodes of rhabdomyolysis in Parkinson's disease can be different and, at the same time, how these circumstances are always somehow related to the treatment of the basic disease with dopaminergic drugs.

Acute Kidney Injury↗

[A case of acute spongiositis with diabetes mellitus].

We report a case of acute spongiositis with diabetes mellitus. A 63-year-old man with a 7-year history of diabetes mellitus was admitted to our hospital complaining of perineal pain and pyrexia. Physical examinations revealed induration and tenderness of the corpus spongiosum, but no signs of rubor or erosion. A laboratory investigation showed leukocytosis (12,000/microliter), an elevated level of C-reactive protein (3.38 mg/dl) and hyperglycemia (532 mg/dl). Pyuria and bacteriuria were absent. Magnetic resonance imaging (MRI) yielded abscess-like lesion of the corpus spongiosum. Culture of the aspirated specimen demonstrated B-hemolytic streptococci. Treatment with antibiotics and insulin resolved leukocytosis and tenderness of corpus spongiosum. He left the hospital on the 23rd day after admission and no evidence of recurrence of the spongiositis was found for 1 year after discharge.

Acute Disease↗

[Biological properties and sensitivity to induction therapy of differentiated cells expressing atypical immunophenotype in acute leukemia of children].

The atypical immunophenotype (expression of determinant from the another cell lines than line of origin) of acute leukaemia blast cells are noted in a part of cases. The characteristics and classification of atypical immunophenotypes are not unified and the clinical significance is not yet fully described. The purpose of the study was: precise description of atypical immunophenotypes and analysis of their frequency in different types of acute leukaemia, analysis of association between expression of atypical immunophenotypes and the level of initial leukocytosis, percentage of blast cells in peripheral blood, expression of CD34, analysis of frequency of multidrug resistance molecule (MDR) expression and association between MDR and immunophenotypes of leukaemia cells, analysis of association between atypical immunophenotypes and proliferation, secretion of cytokines (IL-6, TNF) and spontaneous apoptosis of leukaemia cells, analysis of association between atypical immunophenotypes and sensitivity to induction therapy. The bone marrow samples used for routine diagnosis were the basic source of leukaemia cells for the study. The morphological examination and the immunophenotypes of leukaemia cells were done for classification of leukaemia. The immunophenotype and the expression of MDR determination was performed with flow cytometry after staining the cells with monoclonal antibodies (directly labelled) for CD determinants and MDR. The spontaneous proliferation of leukaemia cells was studied with 3H-Thymidine uptake after 3-days culture in vitro. The type of proliferation (autocrine, paracrine) was defined based on comparison of shorter (3-days) and longer (6-days) culture of leukaemia cells. The percentage of apoptotic leukaemia cells was analysed with flow cytometry after staining of leukaemia cells with propidium iodide in subdiploidal region of DNA profile. The secretion of cytokines (IL-6 and TNF) was determined by ELISA technique in supernatants of leukaemia cells cultured for 24 hr in vitro. The biological activity of TNF was determined in the bioassay using L929 mouse cells line. The effect of induction therapy was estimated base on time of cytoreduction in peripheral blood and time of reaching the haematological remission in bone marrow. The study included 230 children with acute leukaemia: lymphoblastic (ALL)--189 children (ALL-proB--19, common ALL--139, ALL-B--5 and ALL-T--26) and myeloid (AML)--34 children. Moreover, into the study 2 cases of acute undifferentiated leukaemia (AUL) and 3--acute mixed lineage leukaemia (AMLL) and 2--biphenotypic leukaemia were included. The all studies of leukaemia cells had been done before the therapy was installed. Basing on the assay of immunophenotypes the following forms of atypical immunophenotypes were distinguished: immunophenotype incomplete, hyperexpression of determinants, asynchronic immunophenotype, coexpression of determinants from the other line than origin of leukaemia cells, balanced expression of determinants from two cells lines (biphenotypic leukaemia) and three cells lines (mixed lineage leukaemia). The atypical immunophenotypes were observed in: 21.1% ALL-proB cases, 34.5% common ALL cases, 42.3% ALL-T and 58.8% AML. The most common form of atypical immunophenotypes was coexpression of determinants from the other cell line. There were no associations between atypical immunophenotypes and the level of initial leukocytosis and percentage of blast cells in peripheral blood. The expression of CD34, recognised as the one of markers of poorer prognosis, was analysed regarding the leukaemia type and immunophenotype of leukaemia cells. The lowest frequency of CD34 expression was noted in ALL-T (28.5%), the highest one in common ALL (62.3%). The significant association between frequency of CD34 and atypical immunophenotypes was observed in AML and ALL-T. Moreover, in common ALL the expression of CD34 was significantly higher when myeloid determinants were present on common ALL cells (common ALL + My) in comparison to coexpression of lymphoid determinants (common ALL + Ly). The frequency of MDR expression (cases with more than 10% of MDR positive cells) was in range between 16.6% in ALL-proB and 78.9% in AML. The mean percentage of cells expressing MDR was low in ALL-proB (10.7%) and high in ALL-T (39.6%). In ALL the atypical immunophenotype was associated with expression of MDR whereas in AML this association did not appear. The common ALL + My leukaemia cells showed higher ability to proliferation in vitro compare with common ALL without atypical immunophenotype. The opposite results were observed in AML. AML leukaemia cells with coexpression of lymphoid determinants (AML + Ly) showed lower proliferation in vitro than AML without atypical immunophenotype. The autocrine type of proliferation was observed frequently in AML (35.3% of cases) than in ALL (14.2%). This type of spontaneous proliferation was observed only when the leukaemia cells without changes in immunophenotype had been cultured. The low level in common ALL and high in AML of spontaneous release of IL-6 and TNF were noted. AML leukaemia cells without changes in immunophenotype released significantly higher amount of these cytokines than AML cells with atypical immunophenotypes (AML + Ly). The above observations suggested that coexpression of myeloid determinants in ALL and lymphoid determinants in AML were leading to changes of some biological properties of these cells. The ALL + My leukaemia cells behaved similarly to myeloid leukaemia cells, while AML + Ly cells showed features of lymphoid leukaemia cells. The common ALL and AML leukaemia cells with atypical immunophenotype showed higher percentage of apoptotic cells (16.1% and 16.9% respectively) comparing to common ALL and AML without changes in immunophenotype (9.0% and 9.2% respectively). The weak negative association of MDR expression and apoptosis suggested the indirect inhibiting influence of MDR on ability of cells to undergo into the apoptosis process. In common ALL and AML with typical immunophenotype of leukaemia cells and ALL-T the level of apoptosis was associated positively with the spontaneous proliferation, whereas this relation was negative in AML with atypical immunophenotype. There were no differences of the time of cytoreduction of leukaemia cells in peripheral blood in B cell origin ALL and AML with or without changes in immunophenotype of blastic cells. In ALL-T + My the time of cytoreduction was significantly longer. However, the expression of CD10 in ALL-T had no effect on cytoreduction time. The expression of MDR in ALL-T with typical immunophenotype was independent marker associated with elongation of cytoreduction time. The time of reaching the complete haematological remission was analysed in 186 children with ALL (ALL-proB--18 children, common ALL--137 children, ALL-T--26) and only 19 children with AML. The longest period of time for reaching the remission was observed in AML, shortest--in ALL-T. In common ALL and ALL-T the expression of myeloid determinants was associated with significant elongation of time of reaching the remission. In the majority of AML cases with coexpression lymphoid determinants, the complete remission was reached. The time needed for the reaching of remission was similar in AML with or without coexpression of lymphoid determinants. The results of this study suggest that coexpression of determinants from the other cell line modify the biological properties of leukaemia cells into the cells from the line of origin of these additional determinants. In ALL the combined expression of MDR and atypical immunophenotype of leukaemia cells were associated with poorer response to induction therapy. In AML the combined expression of CD34 and atypical immunophenotype were associated with response to induction therapy by reaching the complete remission, but without any influence on the time of reaching this remission. The results of analysis of cytoreduction time and time of reaching the remission improved the usefulness of these parameters for the estimation of response to the induction therapy. The clinical importance of these observations consist in characterisation of leukaemia cells potentially resistant to the induction therapy what may suggest the modification and individualization of the induction therapy.

Adolescent↗

[A case of meningoencephalitis and spondylodiscitis caused by Campylobacter fetus subsp. fetus infection].

Campylobacter fetus subsp. fetus (C. fetus) is a gram-negative, curved, rod-shaped microaerophile, occasionally may cause meningitis or meningoencephalitis in humans. This report documents the case of 49-year-old man with lumbar spondylodiscitis and meningoencephalitis caused by C. fetus infection. On admission, the patient was delirious and severe inflammatory reactions were seen in his serum. Cerebrospinal fluid (CFS) revealed normal glucose concentration and moderate mononuclear leukocytosis. Campylobacter species, which was very difficult to be identified, was cultured from the blood and CSF. During his clinical course, the patient complained of severe back pain, and lumbar MRI showed low intensity in a T1-weighed image of the L4 and L5 vertebral bodies and high intensity in a T2-weighed image of the L4-5 disc. The patient was diagnosed with spondylodiscitis caused by C. fetus infection. Meningoencephalitis may have occurred as a secondary infection. Antibiotics were administered, and the patient's condition improved. To our knowledge, only a few cases of spondylodiscitis caused by C. fetus have been reported. A CSF glucose concentration in the normal range and mononuclear leukocytosis are atypical findings in patients with pyogenic meningitis. Therefore, neurologists must be fully aware of the possible symptoms and signs of C. fetus infection.

Campylobacter Infections↗

Inflammatory pseudotumor (plasma cell granuloma) of the pelvic cavity. A case report.

BACKGROUND: Inflammatory pseudotumor (IPT), also called plasma cell granuloma, is a rare, benign, tumorlike lesion composed of proliferating spindle cells admixed with an inflammatory infiltrate and usually affecting the lungs. Other locations can also be affected. CASE: An 18-year-old woman complained of abdominal pain and discomfort. Sonographic evaluation revealed a hyperechogenic mass measuring 32 x 36 mm and located between the right ovary and uterus. CBC showed mild leukocytosis. Laparoscopic resection of the mass revealed histologically an inflammatory pseudotumor. CONCLUSION: IPT may occur at any age and affects both sexes equally. The clinical presentation usually includes fever, leukocytosis and weight loss, although many cases are asymptomatic, especially in the pelvis. The lesion usually presents with distinct borders and a firm consistency and is tan to white. The course of IPT is usually benign and self-limited. Surgical resection is the most common therapy, whereas corticosteroids and, in rare cases, chemotherapy are used. Recurrences have been described. Because of the rarity of this condition, it is unusual for the diagnosis to be made preoperatively.

Adolescent↗

[Peripheral blood morphology during chronic bronchitis complicated by the effect of ozone].

In workers afflicted with chronic bronchitis (ChB) after breathing ozone leukocytosis gives place to leukopenia against development of lympho-, monocyto- and neutropenia. In contrast to the workers, in citizens who have not previously contacted ozone chronic obstructive bronchitis is characterized by leukocytosis with less expressed lympho- and neutropenia. Changes in peripheral blood in ChB patients (development of leuko-, lympho-, monocyto- and neutropenia) grow drastically in 5-8 years of ozone inhalation.

Adult↗

High pretreatment interleukin-10 is an independent predictor of poor failure-free survival in patients with Hodgkin's lymphoma.

AIM: The aim of this study was to investigate the relationship of pretreatment serum IL-10 (sIL-10) levels with known prognostic factors and with failure-free survival (FFS) in patients with Hodgkin's lymphoma (HL). PATIENTS AND METHODS: Interleukin-10 (IL-10) levels were measured in the sera of 36 untreated patients with HL and were subsequently correlated with clinical and laboratory prognostic parameters as well as with FFS. RESULTS: 36 untreated HL patients (21 men, median age 31 (18-62) years) were studied. Of the subjects, 19 (52.7%) had elevated IL-10 levels (> or = 10 pg/ml). High IL-10 correlated with bulky disease, high serum lactate dehydrogenase (LDH) and leukocytosis (P = 0.015 for all three variables). High IL-10 (P = 0.015) and low serum albumin (P = 0.001) were associated with worse FFS, but only high IL-10 emerged as an independent predictor of inferior FFS in multivariate analysis (P = 0.04, hazard ratio 2.21, 95% CI 1.12-14.67). Median FFS of IL-10-positive patients (30 (12-47) months) was significantly shorter compared to that of IL-10-negative ones (39 (12-58) months, log-rank test P = 0.0185). CONCLUSIONS: IL-10 was found to be elevated in approximately half of untreated patients with HL, to correlate with bulky disease, high LDH and leukocytosis and to be an independent predictor of FFS.

Adolescent↗

Serum cytokine level and production of reactive oxygen species (ROS) by blood neutrophils from a schizophrenic patient with hypersensitivity to neuroleptics.

BACKGROUND: There have been few publications concerning the role of the immune system in neuroleptic intolerance. Some studies have shown that in neuroleptic malignant syndrome (NMS), associated with disseminated intravascular coagulation (DIC), the serum level of tumor necrosis factor alpha (TNF-alpha) increases significantly, which is thought to trigger the onset of DIC. CASE REPORT: A 23-year-old woman suffering from catatonic schizophrenia developed hypersensitivity to neuroleptics. One month before being referred to the present authors, she had a haloperidol-induced NMS episode in another psychiatric hospital, with high temperature, CPK activity, muscle rigidity and leukocytosis. On admission to our clinic and after treatment with promazine, laboratory tests showed an increase in serum CPK activity and mild leukocytosis. Neuroleptic treatment was discontinued, and the serum level of CPK and white blood cell count was monitored daily for 7 days, as well as the serum level of some cytokines and the production of reactive oxygen species (ROS) by blood neutrophils. The serum levels of interleukin 1 alpha (IL-1), IL-6 and TNF-alpha changed significantly over the observation period, forming waves with peak activity of IL-6 and TNF-alpha exceeding normal levels. The level of IL-1 alpha was within the control range. ROS production by the patient's blood neutrophils was also increased, as well as catalase serum activity. CONCLUSIONS: Some proinflammatory cytokines may participate in the mechanisms leading to the development of neuroleptic intolerance in schizophrenic patients. Cytokine-stimulated ROS production may participate in tissue injury and increase CPK serum activity.

Adult↗

[Chronic neutrophilic leukemia associated with myeloma. Simultaneous presentation].

A case of chronic neutrophilic leukaemia associated with multiple myeloma is reported. The patient had a 6 months history of bruising and weight loss, and showed mature neutrophilic leukocytosis, hepatosplenomegaly, high neutrophil alkaline phosphatase score, hyperuricaemia, neutrophils with pseudotoxic granulation and scarce Döhle bodies; moreover, a monoclonal IgG lambda was detected amounting 57.3 g/L. The bone marrow was grossly hypercellular with marked myeloid hyperplasia and aggregates of immature plasma cells. After treatment during 1 year with melphalan and prednisone she is well, although persisting with neutrophilic leukocytosis, slight splenomegaly, and the monoclonal IgG decreased to 25.8 g/L.

Bone Marrow↗