Derivative (6)t(1;6)(q22;p21) revealed in bone marrow cells by FISH 9 months before diagnosis of acute T-lymphoblastic leukemia

A chromosomal clone with unbalanced translocation resulting in partial trisomy of segment 1q22-qter and partial monosomy of segment 6p21-pter was revealed by fluorescence in situ hybridization (FISH) using a panel of different whole chromosome painting probes. The pathologic clone appeared after sequential chemotherapy treatment for AML-M5 when the patient was in complete remission before development of T-ALL. However, this clone was present during the whole period of treatment for T-ALL. The clone remained the only chromosomal aberration found. Breakpoints were detected more easily and more precisely with the use of the FISH technique than with G-banding only.

[Treatment of post-partum atonic hemorrhage with prostaglandin F2 alpha analogs]

In the authors' group of patients with haemorrhage during childbirth, in 1990-1994 a total of 28 atonic haemorrhages were recorded, 15 of them were controlled by uterotonic treatment, in the remaining 13 cases haemostasis using PG F2 alpha was applied after ruling out post-partum injury. Some patients were given moreover saline infusions. According to initial results and consistent with the literature analogues of PG F2 alpha are effective uterotonic preparations of a new generation. With regard to their simple and rapid administration they are becoming the drug of first aid in the treatment of acute atonic haemorrhage.

[Treatment of chronic myeloid leukemia with bone marrow transplantation at the Institute of Hematology and Blood Transfusion in Prague]

The outcomes of bone marrow transplantation (BMT) performed at the Institute of Haematology and Blood Transfusion from April 1988 to December 1994 in 31 patients with chronic myelogenous leukemia are presented. Age of the patients range from 18 to 49 years, median 34 years. Male:female ratio was 1.58:1. The conditioning regimen consisted of Cyclophosphamide and total body irradiation (TBI) or Busulfan and Cyclophosphamide. The results are evaluated as of January 1, 1995. Nineteen patients (61.3%) are alive, 12 patients (38.7%) died. The causes of death are discussed. The median time of follow up all patients is 10.4 months, range 0.3-81.5. The median time of follow up of surviving patients is 21.8 months, range 2.5-81.5. Probability of 2 years survival by Kaplan-Meier analysis is 58 +/- 10%. Of the 24 transplanted in the first chronic phase, 18 patients are alive. Of the 7 transplanted in advanced phase of the disease, 1 patient is alive. Of the 27 patients, who received bone marrow from an HLA identical sibling, 19 are alive. Of the 4 patients who received bone marrow from other donor than an HLA identical sibling, none is alive. Acute GvHD III.-IV. grade developed in 5 patients (16.1%), moderate and severe chronic GvHD developed in 11 patients (31.5%). Cytogenetic relapse was diagnosed in 1 patient, hematological relapse in 2 patients. Karnofsky scores of patients surviving after BMT range from 30% to 100%, median 90%.

[Induction of cervical maturation using hydrophilic Dilapan rods in term pregnancy]

During the period between July 1, 1993 and July 31, 1994 the authors preinduced 52 pregnant women in term using the cervical dilator Dilapan. The group comprised patients with single pregnancies > or = 38 weeks, vertex presentation, cervical score < 5 and reactive NST. They introduced into the cervical canal 4 Dilapan rods for 12-18 hours and after extraction of the rods, depending on the finding, the patients were induced with Prostin e.a. or oxytocin i.v. The preinduction was successful in 46 patients (88.5%), in 16 patients (30.8%) uterine contractions were induced by Dilapan alone. Forceps delivery was performed 4 times (7.7%) and Caesarean section 12 times (23.1%). Apart from pain in the hypogastrium resembling menstruation pain, no side-effects were recorded. There were no irregularities such as the length of labour stages, blood loss due to injury during labour and the incidence of neonatal hypoxia. Based on the described experience Dilapan can be recommended as a preinduction method for maturation of the portio uteri.

[Induction of cervical maturation using vaginal administration of estrogens]

During the period between September 1, 1993 and September 1, 1994 the authors preinduced 38 pregnant women in term by oestrogen administered by the vaginal route. The group comprised patients with a single pregnancy, PPH, CS 5n and reactive NST. For preinduction 150 mg oestradiol in a viscous gel were used which along with a pessary was inserted 24 hours before the planned induction of delivery by the vaginal route on the portio uteri. After removal of the pessary the CS was evaluated and then delivery was induced by intracervically administered prostaglandin. The preinduction was successful in 32 patients (84.3%), in 6 patients uterine contractions started during preinduction, delivery by forceps was used twice (5.3%) and Caesarean section six time (15.8%). In the course of preinduction there were no side-effects, no irregularities in the course of parturition were observed. The described method can be recommended as the method of choice for the treatment of an immature portio uteri before planned induction of delivery.

[Dilatation of the cervical canal with Dilapan before induced abortion in the first trimester of pregnancy in primigravidas]

During the period between Oct. 1, 1993 and June 30, 1994 the authors inserted by the intracervical route in 32 primogravidae with unwanted pregnancies before abortion with pregnancies shorter than 8 weeks a hydrophil dilator Dilapan. After 12 hours the rod was removed under general anaesthesia and the pregnancy terminated by vacuum aspiration. In three instances after Dilapan insertion slight haemorrhage occurred which, however, did not call for removal of the rod. Apart from slight tenderness in the hypogastrium, similar as during menses, no side-effects were observed. In two instances during Dilapan extraction the rod was disrupted and the residue had to be removed by means of Kocher's forceps. In all patients the dilation of the cervical canal was sufficient for a 6 mm suction curette and further dilation of the cervix by means of metal dilators was not necessary. On examination after menstruation the patients did not report more massive bleeding nor febrile complications or residues. Based on the described results, the authors are of the opinion that gradual dilation of the cervix before abortion in the first trimester should be part of the procedure and all women who must face this situation should be given this opportunity.

[Results of induction therapy in newly diagnosed acute myeloid leukemias in study 911 at the Institute of Hematology and Blood Transfusion]

Thirty-seven patients with de novo acute myeloid leukemias were admitted to the Institute of Hematology and Blood Transfusion in Prague in February 1991-December 1993. Their age was 18-85 years with a median of 46 years. Two patients died on the day of admission, chemotherapy was initiated in 35 patients. Altogether 27 patients (77%) achieved complete remission (CR), i.e. 18 (81%) of 22 patients younger than 55 years and 9 (70%) of 13 patients older than 55 years. Only 7 (35%) of 20 patients achieved CR after a single therapy course 3/7 consisting of 3 doses of daunorubicin 45 mg/m2 on days 1, 3, 5 and cytosine arabinoside 150-200 mg/m2 every 12 hours for 7 days. However, 8 (61%) of 13 patients achieved CR after a single treatment course 4/7 with 4 doses of daunorubicin 45 mg/m2 on days 1, 3, 5, 7 and identical doses of cytosine arabinoside as in the 3/7 treatment. We used the course with 10 high-doses of cytosine arabinoside 2000 mg/m2 every 12 hours and daunorubicin 45 mg/m2 on days 4 and 5 (treatment HDAC/DNR) as the 1st, 2nd or 3rd induction therapy in 12 patients and 9 (75%) of them achieved CR. The treatment was associated with a high toxicity. An intensified therapy 3/7h similar to the 3/7 one but with the doubled dose of cytosine arabinoside 300-400 mg/m2 on days 5-7 was given to 5 patients as the 2nd induction but it did not improve the CR rate and it was associated with a high toxicity similar to the HDAC/DNR therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[A female patient with near-tetraploid acute myeloid M4 leukemia]

BACKGROUND

Acute myeloid leukemias (AML) are a heterogeneous group of diseases, several types of them are well characterized by typical morphologic, immunologic and cytogenetic features of their leukemic blasts in the MIC classification. We have recently described 2 patients with a new AML type--poorly differentiated near-tetraploid AML L0. The occurrence of very large blasts in a heterogeneous blast population seemed to be a morphological sign of this new type of AML.

RESULTS

The same morphologic characteristics were observed by us when we studied blasts of another 80-year-old patient with a near-tetraploid karyotype. However, 34% of blasts were positive for myeloperoxidase and they exhibited in 24-33% surface myelomonocytic markers CD11b, CD13, CD15 and CD14. The illness was classified as acute myelomonoblastic leukemia M4 without significant dysplastic changes in erythroid and megakaryocytic lineages. The growth of granulocyte-macrophage bone marrow progenitors CFU-GM was low. The patient refused cytotoxic chemotherapy and expired 3 months later on supportive treatment.

CONCLUSIONS

The finding of very large blasts is a typical sign in cases of near-tetraploid AML. Precise classification of leukemia type is essential for successful therapy.

[Late and slow diagnosis of acute promyelocytic leukemias--the main cause of early death]

Acute hypergranular promyelocytic leukemia (AML M3) belongs to malignant diseases leading very rapidly to death. Immediate treatment based on early diagnosis may cure one third of patients. The typical finding in peripheral blood of patients is pancytopenia with or without atypical promyelocytes. In published studies only 15-25% patients exhibit leukocyte counts above 10 x 10(9)/l. Five of our ten patients studied had leukocyte count above 10 x 10(9)/l. The difference might be in connection with late and slow diagnosis of AML M3. AML is not taken into consideration during medical examination even if the disease occurs in medical family. Thus we describe clinical signs of AML M3 that could be divided into three main groups: bleeding, infections and anemia. In patients with bleeding or anemia or with infections repeating within a short period or with an infection and concurrent signs of bleeding or anemia the complete blood cell count should be examined immediately. If blood cell count abnormalities are found the patient should be sent immediately to hematology unit for further examination and treatment. Early diagnosis enables to start "differentiation therapy" with all-trans retinoic acid that could be administered as monotherapy only in patients with leukocytes below 5 x 10(9)/l. Early diagnosis of AML M3 might ameliorate the fate of patients, since four of our five patients referred to us with elevated leukocyte counts expired in the first five days.

Near-tetraploid poorly differentiated acute myeloid leukemia M0 diagnosed by short-term cultures with a phorbol ester TPA

Leukemic blasts of two patients with acute leukemia exhibited similar characteristics. They were heterogeneous in size with a diameter of 14-30 microns in smears and unclassifiable by morphological, cytochemical, immunophenotypic and ultrastructural examinations. Cytogenetic examinations of both revealed a near-tetraploid karyotype. Blasts from both patients differentiated into macrophages in cultures with 10 ng/ml 12-O-tetradecanoylphorbol-13-acetate (TPA) which is a feature specific for myeloid blasts and the cases were thus classified as poorly differentiated acute myeloid leukemias (AML M0). Near-tetraploid poorly differentiated acute myeloid leukemias M0 seem to be a special category of AML in the morphologic, immunologic and cytogenetic (MIC) classification. The presence of very large blasts in the heterogeneous blast population in acute unclassified leukemias could be a morphological sign of near-tetraploid leukemias AML M0.

[Ripening the cervix using intracervical administration of PGE2 with a butterfly needle in terminating pregnancy]

By intracervical administration of 0.75 mg PGE2, using a butterfly needle, the authors preinduced 32 patients with an immature portio vaginalis cervicis (CS 5 points) who had indications for termination of a full-term pregnancy. Slow administration lasted cca 6 hours. Maturation of the portio vaginalis cervicis occurred in 93.5%, in 71% regular uterine contractions started. The length of labour stages, the loss of blood, frequency of injuries during labour and foetal hypoxia were similar as in spontaneous deliveries. Side-effects were recorded in 20.7%. The described method is a suitable alternative to administration of gel substances, in particular because it is cheaper because it is well tolerated by the patients and is simple.

Partial trisomy of 3q detected by chromosome painting in a case of juvenile chronic myelomonocytic leukemia

Juvenile chronic myelomonocytic leukemia (JCMMoL) is a rare disease with no specific type of chromosome aberration yet delineated. We report a 2-year-old boy who had in his leukemic bone marrow (BM) and peripheral blood (PB) cells the 46,XY,der(15)t(3;15)(q13.1;q26) karyotype. Phytohemagglutinin (PHA)-stimulated lymphocytes of peripheral blood had a normal 46,XY karyotype. The origin of the duplicated part of 3q was proved by fluorescence in situ hybridization (FISH) with the pHSR(sat III 15p) DNA probe and a chromosome 3-specific DNA library (i.e., chromosome painting). The chromosome finding in our case provides further proof of the close relationship between the rearrangement in region 3q13-->3q26 and the pathogenesis of acute myeloid leukemia (AML). Our patient has transformed into erythroleukemia [M6 according to the French-American-British (FAB) classification] during the course of the disease.

Granulocyte colony-stimulating factor treatment of mice modulates differently the sensitivity of blood and bone marrow hematopoietic progenitors to retroviral vector infection

The effect of recombinant human granulocyte colony-stimulating factor (G-CSF) administration to mice on the retroviral-mediated transfer of the selectable marker gene neo to hematopoietic cells was studied. After G-CSF treatment, blood mononuclear cells and bone marrow cells were infected with the retrovirus, and the efficiency of gene transfer into myeloid progenitors was increased in peripheral blood and decreased in bone marrow cells. Bone marrow four to six months after transplantation from G-CSF treated mice revealed the presence of the transferred neo gene in 4 out of 104 mice, which is an eightfold lower proportion than in the control group. These data suggest that G-CSF in vivo treatment decreases bone marrow sensitivity and increases the sensitivity of peripheral blood cells to retroviral infection.

[Intercellular communication and signal transduction mechanisms]

Cells in multicellular organisms coordinate their functions by signalling molecules serving as means of communication. Specific receptors enable transduction of chemical information from extracellular environment into a cell. Inside the cell the signal is multiplied and transduced further by intracellular signalling molecules and enzymatic cascades. Phosphorylation of proteins on tyrosine, serine or threonine residues, guanosine triphosphate binding by special G proteins and regulation of DNA transcription seem to be the most important biochemical mechanisms of signal transduction. Products of cellular protooncogenes are involved in all levels of signal transduction, the detailed knowledge of signal pathways is therefore important for our understanding of pathophysiology of malignant disease and strategies for the therapeutic use of growth factors in oncology and haematology.

[The role of the second-look operation in modern therapy of ovarian carcinoma]

The authors evaluate the results of second look operations of ovarian cancer in a group of 34 women. The second look operation was preceded by intraperitoneal and intravenous chemotherapy. This therapeutic protocol contributed to improvement of therapeutic results. In 50% of thus treated women it proved possible to remove the residual tumour and the survival time was prolonged in 75% of women by 1-3 years. The advantages of this therapeutic procedure are according to the authors in particular reduction of the risk of super-radical primary operations and facilitation of the decision whether to terminate treatment or proceed with it.

[Monocytosis and myelomonocytic dysplasia in myelodysplastic syndrome]

Myelodysplastic syndrome (MDS) is frequently associated with monocytosis in the blood and myelomonocytic dysplasia in the bone marrow. In two groups of patients with MDS, all subtypes excluding CMML, the authors demonstrated that monocytosis was present in 15% of the patients in group I according to the haemogram at the time when the diagnosis was established and in 19% in group II where it was required that at least in half the haemograms throughout the course of the disease there were more than 10% monocytes. No difference was found in the prognosis of patients with monocytosis, as compared with patients with monocytopenia as regards the life span and frequency of transformation into AL. The cytogenetic and cultivation findings did not differ either. In some instances, in particular in patients with RA and RAS significant monocytosis was not associated with the expected proliferation of monocytoid cells in bone marrow. The authors assume that proliferation and differentiation of germ cells in the monocytic series is easier than in the granulocytic series and that monocytosis can be considered a manifestation of substituted neutropenia. The work indicates the difficulties associated with the differential diagnosis of RA, RAS and RAEB with monocytosis, MDS with a dominating change of the type of myelomonocytic dysplasia and CMML proper.

[Labor induction using extra-amniotic administration of PGE2]

The authors induced 105 deliveries by extraamniotic administration of PGE2 (prostin Upjohn). The initial dose was 1-2 tablets, depending on the maturity of the portio uteri. If the contractions did not start within two hours, the dose was repeated. The sac was disrupted when the contractions were regular and the os uteri was larger than 2 cm. If necessary uterine activity was stimulated by small doses of Oxytocin (in 29%). Indication for induction was a programmed delivery (44.7%), protraced pregnancy (31.5%), diabetes mellitus (10.5%), a period of more than 24 hours after drainage of amniotic fluid without contractions (5.7%), hypertension or renal disease during gestation (4.8%) and hypotrophy of the foetus (2.8%). Inductions were successful in 96.2% of the patients. The parity of the patients influenced the interval between the onset of induction and the onset of uterine contractions, the duration of the first and second stage of labour and the consumption of Prostin tablets. The age of the patient, occupation, obesity and operation on the uterus did not affect the success of induction. There were no serious pathological findings during the third stage of labour, nor serious side-effects. The condition of the neonates was satisfactory.

[Personal experience with labor induction using prostaglandins 1985-1987]

The authors evaluate 56 Labors induced with Enzaprost and 141 with Prostin. The main indication for induction was a postdate pregnancy (33%), rupture of the amniotic sac 24 hours previously without contractions (24.5%) and a planned confinement (23%). An initial dose of 1 microgram of Enzaprost per min. was administered or 1 tablet of Prostin in increasing doses after 30 mins. up to three tablets. There were 87.5% successful Enzaprost inductions and 96.5% successful Prostin inductions. The difference is significant at the 5% level.

[Personal experience with labor induction using oxytocin from 1982 to 1987]

The authors made a retrospective investigation of 584 induced childbirth during the period between Jan. 1, 1982 and June 30 1987. In group I, i.e. induction by drop infusion of oxytocin without primary disruption of the sac they were successful in 59.2%. In group II, i.e. induction by oxytocin infusion 24 hours after escape of amniotic fluid without uterine activity or after previous disruption of the amniotic sac they were successful in 83.3%. Oxytocin was administered in doses of 3.5 million units/min. and increased after 15-minute intervals till regular uterine contractions were recorded. When the portion of the uterine cervix is mature, in group II success in 85% can be foreseen.

Antidiuretic and pressor actions of vasopressin in age-dependent DOCA-salt hypertension

The role of antidiuretic and pressor effects of vasopressin (VP) in deoxycorticosterone acetate (DOCA)-salt hypertension was studied in young and adult Brattleboro rats. The antidiuretic VP action was a necessary prerequisite for the development of severe DOCA-salt hypertension. The insufficient expansion of extracellular fluid volume in DOCA-salt-treated VP-deficient (DI) rats was associated with the attenuation of their hypertensive response, although they had highly increased blood volume and extracellular sodium. Chronic [deamino]-D-arginine vasopressin supplementation that restored volume and distribution of body fluids in DI rats permitted the full development of DOCA-salt hypertension. Blood pressure response to DOCA-salt treatment was always greater in young than in adult Brattleboro rats (even in animals lacking pressor or both VP effects). In animals in which antidiuretic VP effects were present, the pattern of body fluid response to DOCA-salt treatment was also age dependent. There was a tendency to intravascular expansion in young hypertensive rats, whereas an increase of interstitial fluid volume was found in adult animals. The elimination of VP pressor action lowered systemic resistance much more in adult than in young hypertensive rats. We conclude that 1) in adult but not in young rats antidiuretic VP effects are essential for the occurrence of blood pressure response to DOCA-salt treatment, 2) the restoration of body fluids due to antidiuretic VP action enables the development of hypertension in both age groups of DI rats, and 3) pressor VP effects contribute to the maintenance of hypertension, especially in adult animals.