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PubMed1987

Lymphocyte subpopulations and immunoglobulins in idiopathic thrombocytopenic purpura (ITP).

Data gained from observations of the humoral and cellular immunity of 22 patients with ITP (11 in remission and 11 splenectomised) are presented. The amount of T-lymphocytes according to E-rosetting decreased significantly. In tests performed with monoclonal sera the amount of OKT-4 cells was significantly lower then normal, and the ratio of OKT-4/OKT-8 was also reduced. The C-4 complement fraction showed a significant reduction, and a rise was observed in the three Ig classes. No differences could be found, however, between patients in remission and in relapse, and between the splenectomised cases, those treated with prednisolone, and those who had no such treatment. Apart from the primary role of antiplatelet antibodies that cause thrombopenia, a complex disturbance in immune regulation also occurred in ITP, and this manifested with changes in the T-lymphocyte subpopulations. Its pathological progress still remains to be justified, but the plasma of healthy individuals and gammaglobulin have a favorable effect by blocking their receptors and they result in the cessation of the symptom and thrombocytopenia.

Adult↗
PubMed1986

Treatment of severe aplastic anemia.

A total of 100 patients with severe aplastic anemia were treated and evaluated in a prospective study at our hospital between January 1976 and October 1983: 28 patients had an HLA-identical sibling donor and were treated with bone marrow transplantation, and 72 patients without an HLA-identical sibling donor were given antilymphocyte globulin followed by oral low-dose androgen therapy. At 1 1/2-9 years after treatment, 13 patients (46%) survive in the transplant group and 45 patients (75%) survive in the second group. All except one in the second group have self-sustaining hematopoiesis without need for transfusions. There is one major difference between the two therapies. Marrow transplantation restores bone marrow function completely and no late hematologic complications have been seen in this group. The majority of patients treated with antilymphocyte globulin in contrast have residual abnormalities of hematopoiesis: macrocytosis, mild granulocytopenia, and mild thrombopenia. Relapse (11 of 72 patients) and clonal hematologic disorders, such as paroxysmal nocturnal hemoglobinuria (four patients) and leukemia (one patient) can occur years after complete bone marrow reconstitution with antilymphocyte globulin. These late disorders are of concern. Despite this, we conclude that antilymphocyte globulin treatment is an effective therapy with low early mortality and morbidity and a high chance for a long, sustained remission. Results are better or at least equivalent to bone marrow transplantation and patients with donors should be given the option of transplant or antilymphocyte globulin.

Adolescent↗
PubMedDate not supplied

Psychological etiology in cardiovascular disorders. Basic findings and new trends.

Five theories advocate the existence of psychogenic factors in the etiology of cardiovascular diseases. The first of these theories involves a behavioral pattern. Pattern A is predictive of cardiovascular diseases and their risk factors. The second of these theories implies three personality patterns: IRA (Impulsiveness, Repression, Aggressiveness), HHD (Hypochondriasis, Hysteria, Depression) and SAD (Stress, Anxiety, Depression). IRA discriminates significantly people with cardiovascular diseases from healthy subjects. IRA-like patterns account for some 60% of the variance. HHD discriminates to some degree people who show thrombopenia as a reaction to stress. Cardiovascular patients stereotype their defenses and seem to cluster in two subamples: 66% of them repress their aggressiveness and 34% use opposite defense mechanisms. SAD is a reliable predictor; stressful events constitute a risk factor, mainly in anxious or depressed and hostile subjects.

Aggression↗
PubMedDate not supplied

[A probable laboratory contamination with Plasmodium falciparum].

A student working in a medical biology department presented a severe Plasmodium falciparum malaria, with high thrombopenia, hypercalcemia and hypophosphoremia. The mode of infection seems to be a laboratory contamination with a highly contaminated blood sample through skin excoriations.

Adult↗
PubMed1986

Doxorubicin versus mitomycin versus doxorubicin plus mitomycin in advanced breast cancer: a randomized study.

In a randomized trial the antineoplastic and toxic effects of doxorubicin (ADR), mitomycin (MMC), and the combination of the two were evaluated in postmenopausal patients with advanced breast cancer using the following treatment regimens: ADR (75 mg/m2 by iv bolus every 3 weeks); MMC (20 mg/m2 by iv bolus every 6 weeks); and ADR (45 mg/m2 by iv bolus every 3 weeks) and MMC (10 mg/m2 by iv bolus every 6 weeks). One hundred one patients were entered in the study. Entrance to single-agent MMC therapy was stopped after allocation of 12 patients because of unacceptable side effects, especially nausea and vomiting, and the suggestion of minor efficacy. One of these patients had partial response, eight had no change, and three had progressive disease. The patients in the ADR and ADR plus MMC group were similar as to the following: age (median, 60 years); menopausal age; disease-free interval; performance status, extent of previous cytotoxic therapy (approximately 90% were pretreated) and radiation therapy; and dominant site of disease but with significantly more involved organ sites in the ADR plus MMC group. Among evaluable patients (42 in the ADR group and 39 in the ADR plus MMC group), response rates were as follows: complete response--21 versus five; partial response--26 versus 44; no change--40 versus 38; and progressive disease--12 versus 13 (P greater than 0.10). Median times to disease progression were 5.2 and 7.8 months, respectively (log-rank test, P = 0.03), but survival times were similar, 9.3 and 10.2 months, respectively (log-rank test, P greater than 0.40). For the two treatment groups suppression of wbc count was similar, while anemia, thrombopenia, and nausea and vomiting were significantly more common among the ADR plus MMC-treated group. Five treatment-induced deaths were observed in the ADR plus MMC group (one from sepsis; two from diffuse hemorrhage; and two from cardiomyopathy), compared to none in the ADR group. In conclusion, this study disclosed no major advantage of the combination of ADR plus MMC compared to ADR alone as second-line treatment of advanced breast cancer, but results from other studies may imply a possible role of MMC as part of second-line combination chemotherapy regimens.

Aged↗
PubMed1987

[Human leptospirosis in New Caledonia and dependencies. Apropos of 57 cases observed between 1 June 1983 and 31 May 1985].

57 cases of leptospirosis were diagnosed in New Caledonia (South Pacific French Territory) between June 1983 and May 1985. 25% cases are severe infections; thrombopenia and renal failure are frequently observed. Leptospires are found in blood or spinal or urine culture confirmed by haemagglutination tests on microplates (Martin et Petit). Epidemiological studies are being performed during 1985-1986 to devise preventive measures adapted to the territory.

Adult↗
PubMed1987

[Characterization of chronic lymphocytic proliferation in a female patient having rheumatoid polyarthritis with neutropenia].

The authors have studied the case of a female patient with rheumatoid polyarthritis, who developed a lymphocytic proliferation in the blood, the marrow, and the liver, associated with a neutropenia. Several similar cases have been recently reported in the literature. The cellular proliferation is made of large granulous lymphocytes and the study of membrane markers enables to find the following homogeneous phenotype: E rosette+, CD8+, HNK-1+, FcR+, CD4-luminal diameter "divided by degrees - -, IgS-, HLA class II-. This lymphocytic sub-population produces little interleukin-2, responds weakly to mitogens (PHA, CON A, PWM), and inhibits the response of normal lymphocytes to the same mitogens. These lymphocytes have a weak natural killer activity but, on the contrary, develop a very strong cytotoxic activity which is antibody-dependent. Clinically, splenomegaly, anemia and infections are frequent and hepatomegaly or thrombopenia more rare. Adenopathies are never present. The evolution is chronic in nature and not very aggressive, although the lymphocytic proliferation is monoclonal in origin, as demonstrated in molecular biology studies. The neutropenia might be secondary to an inhibiting effect of lymphocytes on the granular precursors of the bone marrow. There is a definite association between this lympho-proliferative syndrome and rheumatoid polyarthritis, and this association appears to be different from the Felty's syndrome.

Adult↗
PubMed1978

[A study of the use of sequential chemotherapy in 176 cases of glioblastoma (author's transl)].

Sequential administration of VM 26 and CCNU has been used in France for the treatment of glioblastoma since 1973. Results have shown that this association can cause a remission lasting, on average, from seven to eight months after starting chemotherapy. It seems that, adding Adriamycin to this sequential therapy does not increase its efficiency. On the other side, dosage and the interval between cycles of chemotherapy appear to be a determining factor in the activity, but the limits are very narrow. Therapy is either ineffective or has doubtful efficiency in about one third of patients, and even when prolonged clinical remission is obtained, cessation of therapy, usually due to a persistent thrombopenia is followed by progression of the tumour in the following months. The large amount of research being made in the field of cellular kinetics and pharcacology will, hopefully, lead to improvement in results.

Adult↗
PubMed1987

[Plasma exchange in acute abdomen with multiple organ failure--a case report].

Following four weeks of conservative treatment of acute pancreatitis a 43 years old female was admitted to our ICU in severe circulatory shock (MAP less than 50 mmHg despite dopamine and dobutamine 5 mcg/kg/min, and norepinephrine 0.4 mcg/kg/min), respiratory failure, incipient renal failure and coma. Laboratory examination revealed thrombopenia (14 G/l) and leucopenia (0.5 G/l), as well as impaired prothrombine time (20%) and partial thromboplastine time (greater than 2 min). As abdominal sepsis was suspected to be the most likely cause of the patients multiple organ failure, a laparotomy was planned. To improve coagulation prior to surgery, plasmapheresis was performed exchanging 4.8 liters of plasma with fresh frozen plasma. In addition 3 units of platelets were transfused. The effects of the plasmapheresis were an improvement of circulatory as well as coagulatory parameters. Laparotomy revealed toxic megacolon, whereas the pancreas seemed to be normal; a coecostomy and a transversostomy were performed. The patient thereafter improved gradually; catecholamine doses were reduced, renal function recovered and five days postoperatively weaning from the ventilator was possible. Platelet substitution (6 more units), fresh frozen plasma administration (76 units à 200 ml) and AT III substitution (total 10,500 U) had to be continued throughout the first week. Five weeks after this operation, which would have been impossible without preoperative plasmapheresis, the patient was discharged in good health.

Abdomen, Acute↗
PubMed1986

[Caval thromboses and systemic diseases].

Sixty-five patients presenting with a vena cava syndrome have been examined over a 7 years period; incidence of systemic diseases as an etiologic factor has thus been studied. A systemic disease was diagnosed in 17 cases, that is 25 p. 100 of cases. This incidence is higher in inferior vena cava syndromes (15 cases out of 45). Two diseases appear as the main factors: on one hand, Behçet disease, liable for 8 vena cava thrombosis, 7 inferior and 8 superior thrombosis; on the other hand, severe disseminated erythematous lupus liable for 5 cases of inferior vena cava thrombosis. Other etiologies are mentioned such as: Churg and Strauss disease (1 case), Horton disease (1 case) and hemorrhagic rectocolitis (1 case). In the patients presenting with lupus, two died from various pulmonary embolisms; a vena cava clip was required in 3 cases. As for lupus, the immuno-hepatologic exploration did demonstrate a thrombopenia in 5 cases, an hemolytic anemia with a positive Coombs test in 2 cases, and a circulating anti-coagulant (antiprothrombinase type) in one case. Though high frequency of systemic diseases in this series may depend on the patients' recruitment, systemic lupus as well as Behçet diseases are to be researched in case of vena cava thrombosis, above all if diagnosed in a young patient and failing to be explained by a congenital abnormality of hemostasis.

Adult↗
PubMed1986

[Cerebral vascular accidents in anticoagulant therapy].

Thirty-three patients hospitalized as they presented with cerebral vascular lesions during anticoagulant therapy (25 intracerebral hemorrhages, 7 subdural hematoma, and one ischemia lesion). Frequency of intra-cerebral hemorrhages along with anticoagulant therapy was about 11 p. 100, this of subdural hematoma ranged from 12 to 38 p. 100. Intra-cerebral hemorrhages failed to show any peculiar topography and volume was variable. A predisposing factor thus existed in about 50 p. 100 of cases: high blood pressure or arterial aneurysm. Previous cranial traumatism was only demonstrated in 48 p. 100 patients presenting with a subdural hematoma. Prognosis as for these intracranial hemorrhages might be compared to this of hemorrhagic lesions appearing under other etiologic conditions. Ischemia lesion was secondary to a severe thrombopenia to heparin.

Acute Disease↗
PubMed1986

[Hemolytic-uremic syndrome during oral contraception].

A hemolytic and uremic syndrome is described in a 41 year old woman on oral contraceptives for 18 years, only discontinued during the course of 4 normal pregnancies. A renal biopsy performed on the 20th day, after correction of the thrombopenia, confirms the typical aspect of advanced thrombotic microangiopathy. The usual etiological work-up is negative, but the search for steroidal anti-hormones antibodies by radioimmuno assay is positive. The evolution is favorable with hemodialysis, perfusion of fresh plasma during the sessions, calciparin, dipyridamol and anti-hypertensive drugs with, eight months later, a creatinin clearance of 45 ml/min and important persisting ischemic lesions in a new renal biopsy. The hemolytic and uremic syndrome following oral contraceptives remains rare (about thirty cases reported in the literature) and its prognosis remains severe despite a well adjusted treatment. Prevention includes the detection of risk patients and the search for steroidal anti-hormones antibodies could certainly play a role which remains to be evaluated.

Adult↗
PubMed1985

[Monitoring of treatment involving 5-fluorocytosine].

The occurrence of hematologic and neurologic complications probably caused by an overdose of 5-FC has prompted us to study 5-FC pharmacokinetics in 10 patients under a 5-FC and amphotericin B. On the basis of our findings we have determined the optimal dosage that achieves desired concentrations. In 5 cases this dosages was found to differ from that suggested by the manufacturer. 5-FC concentrations were however higher than predicted levels as a result of the association with amphotericin B. A subsequent modification of dosage was needed in 10 patients. 5 undesirable side effects were recorded: thrombopenia (1 case), neutropenia (1 case), diarrhea (2 cases), and isolated rise in transaminases. In 4 patients with high 5-FC concentrations, chromatograms showed a peak possibly formed by 5-FU, suggesting that 5-FC may be converted into 5-FU.

Amphotericin B↗
PubMed1985

[Toxic epidermal necrolysis (Lyell's syndrome) caused by piroxicam, with fatal outcome from disseminated aspergillosis].

A case of Lyell Syndrome provoked by ingestion of an antirheumatic drug (Piroxicam) is commented. The evolution under treatment with steroids and broad spectrum antibiotics was excellent but once recovered from this, the patient died subsequently to a systemic infectious process caused by an Aspergillosis with pulmonary involvement and secondary affectation of the kidneys, brain liver, and heart. The hepatic involvement during the acute stage is discussed and evaluated (increase of transaminases), amylasemia, amylasuria, anemia and thrombopenia which persisted throughout the process and presumably conditioned the evolution of the disease.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1985

[Brain stem infarction, systemic lupus erythematosus and circulating lupus anticoagulant].

A 30 year old man admitted with a brain stem infarct presented with intellectual deterioration. A diagnosis of systemic lupus erythematosus (S.L.E.) was based on the presence of five A.R.A. criteria :photosensitivity, arthralgia, leukopenia and thrombopenia, false positive syphilitic serology, antinuclear factors on immunofluorescence. A lupus type circulating anticoagulant (L.C.A.) was no longer detected after corticotherapy. This appears to be a case of the "hematologic" form of S.L.E. in which the presence of L.C.A. predisposes towards thrombosis, not only of veins--which is typical--but also of arteries. These may be isolated and reveal the underlying disease as in the present case. The L.C.A. is an antibody possessing antiphospholipid specificity which explains the anticoagulant action in vitro and the thrombogenic effect in vivo. Some authors consider this to be sufficient justification for administration of anticoagulants and/or antiplatelet agents, but corticotherapy may be effective.

Adult↗
PubMed1985

[African trypanosomiasis of icterohemorrhagic form].

A case report of trypanosomiasis (T. rhodesiense), observed in a French tourist is described. The clinical picture associated a cytolytic hepatic jaundice, a thrombopenia with hemorrhagic manifestations, a renal insufficiency and secondarily a neutropenia with anemia. Moderate and transitory anomalies in the cerebrospinal fluid were noted. The cure was effectuated by administration of pentamidine.

Eflornithine↗
PubMed1985

[Analytical and technical reliability of the ELT-8 laser hematologic counter].

The ELT-8 laser haematological cell counter is a fully mechanized instrument, which measures the forward scatter of light from a helium-neon laser caused by suspended particles. The apparatus has high practicability, and uses a very small sample volume of 100 microliters. The operational procedure is simple and quickly learned. In the second year of operation, down time for the instrument was, on average, 8 hours/month. Depending on the parameter, the precision of the measurements are between 0.5 and 4% in series, and 1-9% day-to-day. The highest scatter of results was shown for thrombocyte counting, but this may be due to instability of the control samples. There was no carry over between samples containing different concentrations of any of the measured parameters. Lipaemia and haemolysis of samples can lead to false results or false interpretation of results. Cold agglutinins, active against erythrocytes and thrombocytes, can cause significant interference, and this influence can be recognized from discrepancies between the erythrocyte count and haemoglobin concentration or mean corpuscular volume (MCV), and from the presence of thrombopenia in the absence of clinical symptoms (pseudothrombopenia). In such cases a histogram is useful. The stability of 72 blood samples was investigated during storage for 4 days at 4 degrees C. The erythrocyte count was very stable, whereas thrombocyte and leukocyte counts sometimes showed irregular variations. The apparatus gives a linear response up to the following limiting values: leukocytes 85 X 10(9)/l, erythrocytes 8 X 10(12)/l, thrombocytes 10(12)/l, haemoglobin 230 g/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Agglutinins↗
PubMed1985

[Kasabach-Merritt syndrome in infants. 2 cases].

Two infants presenting with Kasabach-Merritt syndrome point out several points: the hemangioma may look innocuous with small proportions. The coagulopathy may be represented by a simple thrombopenia or an intravascular coagulation (PDF, ethanol test) of bad prognosis. A review of 150 observations of Kasabach-Merritt syndrome suggests a simple therapeutic approach: corticotherapy (2 to 4 mg/kg) for 2 to 4 weeks or, if failure, antiaggregant drugs. Radiotherapy is proposed in cases of emergency. Heparin and antifibrinolytic treatments are restricted to cases with severe coagulopathy.

Female↗