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PubMedDate not supplied

[White thrombus syndrome. Apropos of 4 new cases].

Four new cases of the white thrombus syndrome have been treated over the last 3 years. This is a rare but serious complication of heparin therapy, multifocal arterial thrombi developing in all three patients without signs of a hemorrhagic syndrome due to the thrombopenia. Physiopathologic mechanisms of this immunity phenomenon are discussed. The diagnosis should be evoked in all patients receiving heparin who on about the 10th day present vascular manifestations of the thrombosis type, rarely in association with a hemorrhage. Blood platelet levels are reduced to below 5000/mm3. Confirmation of diagnosis is by positive results of hematologic and immunologic tests. Treatment involves immediate cessation of heparin and administration of anti-platelet aggregation agents and anti-vitamins K or low molecular weight heparin, combined with arterial thrombectomy or prevention of pulmonary emboli.

Aged↗
PubMed1985

[Autoimmune thrombocytopenic purpura in malignant lymphoma. Report of 2 cases and review of the literature].

Two cases are reported of thrombocytopenia mediated by platelet-directed autoantibodies occurring in a patient with Hodgkin's disease in remission and a patient with non-Hodgkin lymphoma at the time of relapse. 0.5-1.5% of patients with malignant lymphoma have autoimmune thrombopenia, but few cases have been published. The detection of anti-platelet autoantibodies involves methodologic problems, and a specialized laboratory is needed for accurate diagnosis. Treatment is aimed at the malignant lymphoma, as steroids have little effect while the malignant disease is active. However, splenectomy may help even in these cases.

Adult↗
PubMed1985

[Combination vindesine, cyclophosphamide, cis-platinum and CCNU in esophageal epidermoid cancer. Preliminary analysis of 64 cases].

We have treated 64 patients with esophageal squamous cell carcinoma using a combination of Vindesine 1.4 mg/m2 on day 1-2, Cyclophosphamide 200 mg/m2 on day 2-3-4, Cis-Platin 100 mg/m2 on day 3 and CCNU. 28 of the 37 patients considered to be inoperable were evaluable. We observed three complete responses and three partial responses in this group (overall response rate 21,5%). Twenty seven patients considered to be operable received the same chemotherapy without CCNU, owing to the risk of thrombopenia. 23 of these patients were evaluable in whom we observed 35% partial responses and no complete responses. No severe toxicity related to the chemotherapy protocol was observed. The mediocre results among the group of inoperable patients suggest that other chemotherapy protocols need to be tested. On the other hand, in the group of operable patients, the preliminary results encourage us to continue this study.

Adult↗
PubMedDate not supplied

[Typhoid fever in children in Tananarive (Madagascar). Comments on 97 cases].

97 cases of typhoïd fever in child are reported. This disease remains frequent and even severe in tropical zone where its evolution is of endemoepidemic type. Established fever, in spite of an appropriate treatment, is one of the main features of this disease. A certain number of clinical signs call for it; although classical, some others are less significant. Complications are frequent, without any correlation between the date of hospitalizing and the beginning of the disease. They are sometimes severe but mortality rate during hospitalization is quite low. Leukoneutropenia and thrombopenia are both exceptional. Blood culture and serology are always the background of any diagnosis, the latter appearing to the authors much more valuable than the former. Sulfamethoxazole-trimethoprime is an antibiotic to be recommended in first instance. Precocity of treatment has no influence on the time of apyrexia is appearing. If hopes put on oral vaccine could be confirmed, so it might be used on a large scale for children living in endemia zones.

Adolescent↗
PubMed1985

[Angiolymphoid hyperplasia with eosinophilia. Extensive form associated with thrombopenic purpura].

The authors report a case, on a 59-year-old female patient, of angiolymphoid hyperplasia with eosinophilia (AHE) associated to a thrombopenic purpura (TP) of which the evolution is parallel. The clinical aspect is made of sub-cutaneous nodules of various sizes (1 or 2 cm on an average) and of more superficial, erythematous, sometimes telangiectatic, pseudo-angiomatous nodules. There are (about) 25 nodules, located on the face, the neck, the arms and the thorax, sometimes pruriginous: the rest of the examination is negative excepting axillary and inguinal small size lymph nodes and of a dermographism. The anatomopathological examination in optical microscopy, shows a dermo-epidermal lymphocytic infiltrate with which mingle numerous eosinophilic leucocytes. The dermal vessels are very altered, with a swelling endothelium and a proliferation of endothelial and perithelial cells filling up in large part the vascular section. The biological investigation show essentially: a slight and altering hypereosinophilia (between 500 and 800/mm3); a low amount of blood-platelets (between 95,000 and 130,000/mm3); an increase of the seroconversion enzyme of angiotensin (75 UI; N less than 52 UI); are normal or negative: ESR, protein electrophoresis, immunological tests. The diagnosis of AHE is held back and the clinical evolution is done in several stages: under general corticotherapy (prednisone 1 mg/kg/j): progressive decrease of the nodules, but stopping of the therapy by the patient after 4 months; testing of treatment by thalidomide (100 mg/day) interrupted after 2 weeks because of the aggravation of the thrombopenia (25,000/mm3); occurrence of a thrombopenic purpura (TP) (amount of platelets 10,000/mm3) without a serious haemorrhagic syndrome, evolving in a parallel way to the outbreak of AHE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed1979

[Hematologic aspects of alcoholism (author's transl)].

Alcohol causes different hematologic alterations on each of the three bone marrow cellular series. Its effect on the red series leads to the appearance of megaloblastic disturbances, erythroblastic vacuolization, iron metabolism abnormalities, and hemolytic syndromes. Megaloblastic disturbances may arise as a consequence of folic acid or vitamin B12 deficiency or of a direct toxic effect of ethanol on the erythroblasts. Iron metabolism alterations include reversible sideroblastic anemia, and hemosiderosis. The three hemolytic syndromes related to the consumption of ethanol are: acanthocytosis, stomatocytosis, and Zieve's syndrome. Alcohol induces leukopenia and functional deffects of the leukocytes; these facts explain the frequent susceptibility of chronic alcoholics to infection. Ethanol may act upon the megakaryocytic series to produce reversible thrombopenia and various alterations in platelet function. Thus alcohol exerts toxic effects on bone marrow, which interfere with the proliferation, maturation, release and survival of the three cellular series, either directly or by means of complex mechanisms related to the metabolism of folic acid, vitamin B12, pyridoxine, or iron. Alcoholism should therefore be considered as a possible cause whenever an obscure hematological condition comes under scrutiny.

Alcoholism↗
PubMedDate not supplied

[Children typhoid fever in Saigon (Vietnam) : epidemiological and biological aspects (author's transl)].

A review of 130 children cases of typhoid fever in Saigon (Vietnam). Leuco-neutropenia is far from regular but thrombopenia is frequent. The typhoid bacillus is generally cultivated from blood during the first two weeks of the evolution. There is evidence in most S. typhi strains of a plasmid resistance for streptomycine, chloramphenicol, tetracycline and sulfamides. Strains of the various other enterobacteria of the intestinal flora are generally resistant for many more antibiotics than S. typhi.

Adolescent↗
PubMedDate not supplied

Continuous intravenous bleomycin (NSC-125066) therapy with vinblastine (NSC-49842) in stage III testicular neoplasia.

Twenty-three patients with stage III germinal neoplasia of the testis were treated with a variation of our original vinblastine-bleomycin program. This modification consisted of 0.4 mg/kg of vinblastine given in two fractions on Days 1 and 2 followed by continuous intravenous administration of 30 units of bleomycin in 1000 cc of 5% glucose and distilled water over a 24-hour period for 5 successive days beginning on Day 2. Therapy was repeated every 28-35 days as toxicity permitted. There were 17 responses, nine of which were complete (39%). Eight of the complete responses were in patients with massive disease in whom a low complete response rate was expected. Toxic effects consisted of severe leukopenia in 90% thrombopenia in 50%, and unexplained transient hyperbilirubinemia in about 30% of the patients. Bleomycin pneumonitis occurred in one patient and resulted in death. Hypertension was a new and unexpected side reaction experienced by four patients. Further trials are indicated since the complete response rate in patients with advanced massive disease appears to be improved.

Adolescent↗
PubMed1975

[Cytochemical studies in megakaryocytes in hematologic diseases].

Bone marrow smears of 48 patients consisting of 12 normal cases, 36 patients with different haematological diseases-among them 9 cases of idiopathic thrombopenia, 4 cases of polycythaemia, and 9 cases of Hodgkin's disease - were examined cytochemically. Acid phosphatase, unspecific esterases, naphthol-AS-D-chloroacetate esterase, peroxydase, and leucin-aminopeptidase were represented; in addition the PAS reaction, fastgreen staining at pH 1.1, methyl-green pyronin staining and the lipid representation with Sudan black B were carried out. Besides those responses known from literature the different behaviour of acid megacaryocyte phosphatase in different haematological diseases must be particularly emphasized from all reactions.

Acid Phosphatase↗
PubMed1979

A potent inhibitor of cell proliferation in "middle molecules" isolated from the urine of uremic patients.

A potent inhibitor of cell proliferation was found in the urine of a patient with chronic renal failure. This substance included in "middle molecules" (MM) fraction, was obtained by chromatography. This factor was shown to inhibit noticeably the proliferation of various cells : lymphocytes stimulated by allogeneic cells, monolayer cell lines of normal or tumorous origin and leukemic cell lines derived from acute lymphoblastic leukemia. This effect was reversible and thus could not be related to a direct, rapid cytotoxic effect of MM. Such substances could play an important part in uremic symptoms, such as immunodeficiency, anemia, thrombopenia, gastrointestinal or skin manifestations.

Animals↗
PubMed1982

[Interferon/Controlled study in 3-year survival of patients with osteosarcoma (author's transl)].

In eight patients with osteosarcoma we conducted a controlled tolerance study with human lymphoblast interferon. Interferon was applied for 12 months and the control period after stopping interferon has lasted 12-42 months up to now. 4 out of 8 patients who received interferon did not show any adverse reaction concerning clinical and laboratory tests during the course of a 1-year application and during the follow-up period, resp. Only reversible thrombopenias and an increase in the alpha 2-globulins fraction were observed in the interferon and in the control group, resp. All of the 8 patients have up to now survived tumor-free.

Adolescent↗
PubMed1978

[Cutaneous plasmacytosis and polyclonal cryo-immunoglobulinemia].

A 65-year-old male patient is described who presented with (1) large violet cutaneous plaques on the left side of the body, characterized by dense plasmocyte infiltration of the dermis which appeared benign and largely negative to immunofluorescence, (2) massive polyclonal cryoglobulinemia (type III) without paraproteins, and (3) intermittently marked peripheral monocytosis and thrombopenia without significant medullary changes. Compared with the cases reported in the literature, and after a thorough immunological investigation, this syndrome cannot be entirely assimilated to any entity described up to the present time. Hypothetically, a reactional disorder is the most likely.

Aged↗
PubMed1978

[Thrombosis of the renal artery in a newborn (author's transl)].

Very rare informations about thrombosis of the renal artery in newborns in the literature could be found. In a six years old girl in the course of a perinatal asphyxia complicated by shock a renal artery thrombosis was observed. Profuse bleeding, anemia, thrombopenia, prolonged bleeding time and coagulation time and a low percentage of the thrombotest suggested an intravascular coagulation as a possible factor of this disease. The treatment of the coagulopathia was effective. The physical and psychical development of the girl is normal. The inhibition of the renal function, however, is in a compensated state.

Child Development↗
PubMed1983

[Malignant form of Mediterranean boutonneuse fever. 6 cases].

Six cases of severe Mediterranean boutonneuse fever are reported. The clinical diagnosis, based on the presence of summer fever with an erythematous rash plus an escharr in three patients, was confirmed by serology (microagglutination in 1 case, indirect immunofluorescence in 4). The symptoms resembled those of Rocky Mountain spotted fever associating, as they did, a purpuric rash with neurological signs (impaired consciousness in all 6 cases, convulsion in 2), respiratory symptoms (5) and digestive signs (diarrhoea in 1 case, enlargement of the liver in 4). Laboratory examinations showed thrombopenia (6), rise in serum transaminases (5), LDH (5) and CPK (6), increased in blood urea and creatinine levels (6), hyponatraemia (6), hypokaliaemia (5) and hypocalcaemia (5). Two patients treated with doxycycline recovered and 4 died. Among these, 1 had received erythromycin, 1 a tetracycline and 1 doxycycline.

Adolescent↗
PubMed1984

[Blood serotonin and histamine in sheep with endemic scrapie: initial results].

The whole blood histamine levels of sheep without clinical scrapie but living in infected farms, control, and scrapie infected sheep are not significantly different. By contrast whole blood serotonin is decreased both in sheep living in infected farms and in scrapie-infected sheep as compared to controls. Thrombopenia may account for the hyposerotoninemia of sheep living in infected farms except those genetically linked to scrapie-infected sheep for which, as for scrapie-infected sheep, platelet serotonin appears also to be diminished. Whole blood serotonin determination might therefore be useful to detect sheep living in infected farms (these sheep probably play an important role in scrapie infection) and perhaps also humans with high susceptibility to Creutzfeldt-Jakob disease.

Animals↗
PubMedDate not supplied

[Hemorrhage in liver cirrhosis : new suggestions (author's transl)].

Current management of hemorrhage in cirrhotic patients is disappointing, probably because it deals only with the portal hypertension, while the coagulation disorders are neglected. Some new suggestions can be made : 1) Hemorrhage originates in coagulation disorders. The mechanical lesion of the mucosa is only the opportunity for these disorders to become apparent. The lesion may be : infrequently, a ruptured esophageal varix or a gastroduodenal peptic ulcer ; a lesion of the cardia (hiatal hernia, reflux, esophagitis, minimal traumatic tears) ; a gastric anomaly (hemorrhagic gastritis, superficial ulcerations, petechiae) ; in some cases no mucosal lesion is apparent. 2) Any widespread liver disease results in lasting hypercoagulability which is responsible for : permanent lysis, consumption, DIC. The spleen is responsible for the functional alteration of the platelets. Splenectomy is followed by permanent recovery. 3) Changes involving the platelets are responsible for most hemorrhages. Thrombopenia and severe anomalies of platelet aggregation are common findings in liver cirrhosis. Further deterioration can be induced by acetylsalicylic acid, especially if it is absorbed after an immoderate ingestion of alcohol. Emergency treatment consists in platelet transfusions. 4) Stasis in the portal system may, however, result in permanent activation of coagulation. 5) Cirrhosis results in chronic hypercoagulability and severe platelet deterioration. Any stress involving coagulation mechanisms may therefore induce hemorrhage : infection, acetyl salicylic acid, respiratory distress, estrogens, massive transfusion. It is always dangerous to "feed" consumption or to restrain lysis. 6) Coagulation tests should be performed rapidly, in order to evaluate hypercoagulability, consumption, lysis, and evidence of DIC ; FDP can probably be responsible for inflammatory changes in the liver and spleen. 8) Coagulation disorders are permanent since the hepatic alterations are irreversible.

Blood Coagulation↗
PubMed1982

[Spontaneous hemarthrosis in adolescents and adults, excluding hemophilia].

The various etiologies of spontaneous hemarthrosis in adolescents and adults are reviewed: they include systemic diseases and local or regional disorders of the bones or joints. Among systemic diseases, the two main causes are coagulation disorders and hemoglobinopathies. Coagulation disorders may be either acquired (leukemia, thrombopenia, and hypoprothrombinemia induced by anticoagulant drugs with hemarthrosis being one of the major complications) or inherited (hemophilia which is not considered here, von Willebrand disease, and congenital thrombopathies). Hemoglobinopathies, particularly sickle-cell disease, are responsible for hemarthrosis in a few patients. Among local or regional disorders of the bones or joints, tumors such as hemangioma or synovial sarcoma are uncommon causes. Hemarthrosis is the main feature of pigmented villonodular synovitis. Hemarthrosis may occur in degenerative and metabolic diseases: while it is extremely rare in arthritis, it is frequently encountered in articular chondrocalcinosis which is the first diagnosis to consider when hemarthrosis occurs in an elderly patient. The search for an etiology, which is often difficult, should include a review of prior illnesses, a study of coagulation, and local clinical, radiological and biological investigations, with a study of the synovial fluid; in some instances, arthroscopy, synovial biopsy and even surgical exploration are required. Management includes rest, analgesics, antiinflammatory drugs and, above all, arthrocentesis which is essential for the prevention of articular damage and functional sequellae. Specific therapy is dependent on the etiology. In recurrent hemarthrosis, isotopic synoviorthesis may ensure lasting resolution of the effusion.

Adolescent↗
PubMed1983

[Thyrotoxicosis, then hypothyroidism caused by iodine overload (amiodarone) associated with neuropathy. Failure of plasma exchange].

A 54-year-old woman, with no previously documented thyroid disease, treated with amiodarone (200 mg/day, five days a week for 33 months) for paroxysmal tachyarrhythmia complicating mitral stenosis, suddenly developed extremely severe thyrotoxicosis. After therapeutic failures with carbimazole and propylthyrouracil (PTU) associated with beta-blockers, she was transferred to intensive care for plasma exchange (PE). Two PE were performed, temporarily aggravating the cardiovascular status of the patient, with no secondary improvement. The quantity of T3 removed was very small, about 1,000 ng per exchange. On the 14th day PTU had to be discontinued (toxic thrombopenia) and only symptomatic treatment was maintained (assisted ventilation, digitalis, hyperalimentation). In the 4th month, while the patient had a high total serum iodine, hypothyroidism developed due to partial block of the organification of the iodine with high TSH and fixation; this state also lasted 4 months. Spontaneous recovery was observed after 8 months. In addition a severe peripheral neuropathy was observed during the hyperthyroid phase confirmed by electromyography, distinct from the signs of thyrotoxic myopathy. This gradually regressed over 7 months and may be attributed to amiodarone therapy. The association of these two successive types of thyroid disorder due to amiodarone is an exceptionally rare phenomenon. Severe thyrotoxicosis generally requires long-term symptomatic therapy, its natural course being towards spontaneous regression. PE are ineffective on the circulating hormonal levels and were dangerous because of the underlying cardiac disease. The development of hypothyroidism at the 4th month is explained by the persistent iodine overload, and therefore prolonged surveillance after withdrawal of therapy is advised. The neurological complication of amiodarone was quite distinct from the hyperthyroid myopathy.

Amiodarone↗