Methicillin-resistant Staphylococcus aureus: colonization and development of infection in patients with haematological disorders

A retrospective study of 53 patients with haematological disorders whose bacterial cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA), was performed to analyse the risk factors for MRSA infection, and the prognostic factors. Sixteen patients showed colonization by MRSA but never developed infection(C), 16 showed colonization and subsequent infection(C-I), while 21 had MRSA infection at the time of first culture (I). Poor performance status, thrombocytopenia, increased serum urea nitrogen and decreased serum cholinesterase were more prominent in (I) than (C) + (C-I). The risk factors associated with the development of infection from colonization were age and serum cholinesterase. In addition, lower respiratory tract infection as a type of infection, non-remission status of the haematological malignancy and an inappropriate antibiotic therapy were associated with a poor prognosis for MRSA infection.

Schedule for rating disabilities; hemic and lymphatic systems--VA. Final rule

This document amends the Department of Veterans Affairs' (VA) Schedule for Rating Disabilities of the Hemic and Lymphatic Systems. The effect of this action is to update the hemic and lymphatic portion of the rating schedule to ensure that it uses current medical terminology and unambiguous criteria, and that it reflects medical advances that have occurred since the last review.

Chronobiology and chronotherapy in medicine

There is a fascinating and exceedingly important area of medicine that most of us have not been exposed to at any level of our medical training. This relatively new area is termed chronobiology; that is, how time-related events shape our daily biologic responses and apply to any aspect of medicine with regard to altering pathophysiology and treatment response. For example, normally occurring circadian (daily cycles, approximately 24 hours) events, such as nadirs in epinephrine and cortisol levels that occur in the body around 10 PM to 4 AM and elevated histamine and other mediator levels that occur between midnight and 4 AM, play a major role in the worsening of asthma during the night. In fact, this nocturnal exacerbation occurs in the majority of asthmatic patients. Because all biologic functions, including those of cells, organs, and the entire body, have circadian, ultradian (less than 22 hours), or infradian (greater than 26 hours) rhythms, understanding the pathophysiology and treatment of disease needs to be viewed with these changes in mind. Biologic rhythms are ingrained, and although they can be changed over time by changing the wake-sleep cycle, these alterations occur over days. However, sleep itself can adversely affect the pathophysiology of disease. The non-light/dark influence of biologic rhythms was first described in 1729 by the French astronomer Jean-Jacques de Mairan. Previously, it was presumed that the small red flowers of the plant Kalanchoe bloss feldiuna opened in the day because of the sunlight and closed at night because of the darkness. When de Mairan placed the plant in total darkness, the opening and closing of the flowers still occurred on its intrinsic circadian basis. It is intriguing to think about how the time of day governs the pathophysiology of disease. On awakening in the morning, heart rate and blood pressure briskly increase, as do platelet aggregability and other clotting factors. This can be linked to the acrophase (peak event) of heart attacks. During the afternoon we hit our best mental and physical performance, which explains why most of us state that "I am not a morning person." Even the tolerance for alcohol varies over the 24-hour cycle, with best tolerance around 5 pm (i.e. "Doctor, I only have a couple of highballs before dinner"). Thus, all biologic functions, from those of the cell, the tissue, the organs, and the entire body, run on a cycle of altering activity and function.(ABSTRACT TRUNCATED AT 400 WORDS)

Hematological manifestations of congenital cytomegalovirus infection

Nine infants suffering from congenital cytomegalovirus infection were studied for clinical features with special reference to hematological manifestations. The mean age of appearance of first clinical symptom of disease was 14 days and mean age at presentation was 58 days. Significant pallor, thrombocytopenia and evidence of hemolysis were present in 8 (89%), 4 (44%) and 4 (44%) patients respectively out of three bone marrow examination performed, paucity of erythroid and megakaryocytic cells were seen in two. The other clinical features included hepatomegaly in a (100%) splenomegaly in 6 (66%) each, petachial rash in 5 (55%), Hepatitis in 4 (44%) optic atrophy and corneal opacities in one patient each. Two patients died. Remaining patients showed symptomatic improvement without specific therapy.

The haematological manifestations of visceral leishmaniasis in infancy and childhood

The haematological manifestations were reviewed in 94 patients (55 males and 39 females) with visceral leishmaniasis. Their ages ranged from 4 months to 12 years (mean per cent 1.8 years). All patients had splenomegaly and were anaemic, while (73 per cent) were neutropenic and (56 per cent) thrombocytopenic. Coagulation abnormalities were encountered in 10 (11 per cent) patients; in four patients this was associated with disseminated intravascular coagulopathy. Bone marrow was hypercellular in (90 per cent), normocellular in (5 per cent), and hypocelluar in (4 per cent). Also variable degrees of erythrophagocytosis and leukophagocytosis were noted with preponderance of histiocytes (46 per cent) and granulomatous formation (25 per cent). Low haemosiderin content in the bone marrow was noted, which together with the finding of high serum ferritin is consistent with anaemia of chronic inflammation. Hypersplenism, haemophagocytosis and granulomatous lesions of the bone marrow, chronic inflammation, and dietary factors appear to be the most important factors in the causation of the haematological changes in visceral leishmaniasis.

Endometrial extramedullary haemopoiesis

Four cases of endometrial extramedullary haemopoiesis are reported, all with associated haematological disease. The diagnoses of a myeloproliferative disorder and thalassaemia trait were made as a consequence of the histological observations and subsequent haematological investigations in two cases. The third case occurred in a patient with an established diagnosis of chronic myeloid leukaemia. The diagnosis of extramedullary haemopoiesis in the final case was made on autopsy material from a patient with multiple myeloma. The endometrium from five other women with known myelofibrosis was examined but extramedullary haemopoiesis was not found. Endometrium from 32 fetuses did not contain haemopoietic elements, excluding the likelihood of the endometrium being a common site for extramedullary haemopoiesis in development. Endometrial extramedullary haemopoiesis is an uncommon finding, but it is worthy of note, as it may herald the presence of an underlying haematological abnormality.

[Department of the molecular bases of semiotics]

Department of molecular basis of semiotics was organized in 1986. The main task of the department was to work out new approaches in estimation of the state of immune and blood system at the tissue, cell and molecular levels, using biochemical, biophysical and molecular biology techniques. There are several main directions of scientific investigations at the department. Most informational methods were collected in "immunological portrait" for differential diagnostic and complex investigation of the immune system of autoimmune patients. This group of techniques was used to study changes in the immune system of Kievites after the Chernobyl disaster. A decrease of complement and thymic serum activity was detected. Antibodies against nuclear components appeared in 20% of donors. And a higher of circulating immune complex of low molecular weight was observed. Low level of thymic serum activity in blood of autoimmune patients with rheumatoid arthritis, lupus erythematosus, diabetes, herpes and other depends on the appearance of zinc-independent timuline inhibitor less then 2000 D. Another kind of thymic hormone inhibitors was detected in thymectomized adult mice. Its effect disappears when zinc added in blood rather due to competition for lymphocyte surface receptors timuline and its inactive analogue than other mechanism. Therapeutic effect of UV irradiation of patients' blood was shown to be closely connected with the changes in thymic serum activity in respect to stabilization of thymic hormone/inhibitor ratio. The immunochemical techniques were used to detect and investigate tumor-associated chromatin antigens in human and animal tumor cells. Antigens not found in normal tissues were detected when using rabbit antibodies against chromatin of rat hepatocarcinoma and human colon and carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth in patients after allogeneic bone marrow transplant for hematological diseases in childhood

The growth of 66 long-term survivors, transplanted in two centres (Genoa S. Martino and Monza) is reported. Patients were all under age 15 at the time of bone marrow transplantation (mean 9.8 +/- 3.4 years; range 1.07-15 years) with a minimum follow-up of at least 12 months. They were divided into four groups. Group 1: eight patients with severe aplastic anemia (SAA): conditioning included cyclophosphamide (CY) 200 mg/kg only. Group 2: 32 patients with acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML): conditioning included CY 120 mg/kg and 10-12 Gy fractionated total body irradiation (fTBI). Group 3: 20 patients with ALL, who had previously received cranial irradiation; conditioning included CY 120 mg/kg and fTBI with an additional testicular irradiation (4 Gy). Group 4: six patients with chronic myeloid leukemia (CML) and AML; conditioning included CY 200 mg/kg and busulfan (BU) 16 mg/kg. Group was impaired in all four groups, including the unirradiated groups (-0.2 +/- 0.7 and -0.5 +/- 0.6 delta-SDS in groups I and 4, respectively). Growth impairment-SDS was statistically significant in the two irradiated groups (-0.7 +/- 1.0 and -0.9 +/- 1.0 delta-SDS in groups 2 and 3, respectively), more marked in patients who had had previous cranial irradiation. Chronic graft-versus-host disease and its treatment were not found to have a major effect on growth.

Renal involvement in hematological disorders: monoclonal immunoglobulins and nephropathy

The study of monoclonal immunoglobulin-associated nephropathies is useful for analyzing the physicochemical properties of immunoglobulin components responsible for their deposition in the kidney. Notable advances include the first description of truncated heavy-chain deposition disease, characterization of protease resistance and binding properties of immunoglobulin light chains involved in myeloma-associated Fanconi's syndrome and cast nephropathy, and identification of hepatitis C virus as a plausible causative agent of the so-called essential mixed cryoglobulinemias.

Primary care for women. Assessment of hematologic disorders

This article reviews hematopoiesis, the pathophysiology of selected hematological disorders, and the components of the health history and physical exam that are needed to make a complete assessment of women with a variety of hematological disorders. The laboratory testing and interpretation of tests that augment the assessment of women with signs and symptoms of hematological disorders are also included.

[Retinochoroidal circulatory disturbances and blood component abnormalities]

The recent analysis of blood components has revealed that retinochoroidal circulation may be disturbed in patients with abnormalities of blood components. These blood abnormalities include iron deficiency anemia with or without thrombocytosis, dysplasminogenia, von Willebrand's disease, protein S deficiency, protein C deficiency, and abnormal platelet function. The ophthalmoscopic findings in these disorders include retinal vein occlusion, retinal artery occlusion, choroidal circulatory disturbance, and vitreoretinal hemorrhage. The incidence of blood component abnormalities is high in young patients who rarely have systemic hypertension or arterial sclerosis. We review these blood disorders and emphasize the importance of blood analysis in the patients with retinochoroidal circulatory disturbances.

Particle-fluid suspension model of blood flow through stenotic vessels with applications

The present study deals with the problem of blood flow through stenotic vessels when blood is represented by a particle-fluid suspension model, i.e. a suspension of red blood cells in plasma. The expression for the dimensionless resistance to flow, the wall shear stress, and the shearing stress on the wall at the maximum height of the stenosis are derived. The results obtained in the analysis are discussed in brief, both qualitatively and quantitatively by comparison with other theories. It is observed that the magnitudes of the blood flow characteristics significantly increase with an increase in the red cell concentration. The importance of the decreasing vessel diameter is also pointed out. Finally, to observe the biological relevance of the analysis, the results obtained are used to compute the blood flow characteristics for normal and diseased blood using the experimental data from published literature and results are compared with those computed using the present theoretical approach.

Hematologic disorders including sickle-cell syndromes, hemophilia, and beta-thalassemia

A review of the literature on rheumatologic manifestations in hematologic disease supports the idea that magnetic resonance imaging is useful in the identification of tissue patterns suggestive of vasoocclusion and myonecrosis in sickle-cell anemia and in diagnosing significant synovial hypertrophy in hemophilia. With reference to treatment, the use of yttrium-90 silicate and P-32 colloid for radiosynovectomy in patients with hemophilic arthropathy and the latest results of total joint replacement surgery in sickle-cell anemia and hemophilia patients are discussed.

Haematological parameters. What to order and why

With the enormous range of laboratory investigations available from a modern haematology laboratory it is not surprising that a clinician may at times feel 'at sea' when finding a way through the diagnostic process. It is hoped that this 'haematological map' will help the busy clinician.

Differences in the regulation of specific glycosylation in the pathogenesis of paroxysmal nocturnal hemoglobinuria and the Tn-syndrome

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hematologic disorder that resembles in several aspects the Tn-syndrome, in which bone marrow-derived cells are deficient in mucin-type beta 1,3 galactosyltransferase (beta 1,3Gal-T) due to the persistent repression of an intact allele. In the present study, we have investigated phytohemagglutinin (PHA)-activated T cells from the peripheral blood of an individual with the well-established clinical diagnosis of PNH. Only 10% of T cells were deficient in surface expression of the glycosylphosphatidylinositol (GPI)-linked CD48 antigen; in contrast, 95% of the patient's polymorphonuclear leukocytes harbored the defect. The cell-surface density of CD48 on unaffected T cells from this patient was two- to three-fold higher when compared to PHA-activated normal donor T cells. CD48-negative T cells were cloned and shown to belong to the CD4+ or the CD8+ antigenic subset. To test for the possibility that in PNH, as in Tn syndrome, gene repression may be responsible for the deficiency, CD48- T cell clones were treated with 5-azacytidine (5-azaC) and sodium n-butyrate (NaB). While such treatment reproducibly led to reexpression of a sialylated CD43 epitope on affected Tn-syndrome T cell clones, these drugs failed to induce reexpression of CD48 on affected PNH T cell clones. Our data suggest that despite many similarities, different pathogenetic mechanisms are responsible for PNH and Tn-syndrome. These CD48- T cell clones are the first to be described and may be useful to define the PNH lesion at a biochemical and genetic level.

Systemic complications of cyanosis in adults with congenital heart disease. Hematologic derangements, renal function, and urate metabolism

The regulation of red cell mass, the hemostatic derangements, the structure and function of the kidneys and the determinants of plasma urate levels are important concerns in the clinical management of adults with cyanotic congenital heart disease. Because these topics are interrelated, they are discussed together in terms of pathogenesis, clinical expression, and management.

Clinical features of systemic lupus erythematosus

Descriptive and analytic clinical research investigations dealing with systemic lupus erythematosus have focused on disease manifestations involving the heart, kidneys, and central nervous system, the complications of corticosteroid therapy, particularly cardiovascular and peripheral vascular disease, and outcomes of pregnancy. Studies exploring prognostic factors in patients with lupus nephritis as well as risk factors for the development of cardiovascular disease emphasize the importance of control of comorbid conditions, particularly hypertension and hyperlipidemia, in preventing poor outcomes in patients with systemic lupus erythematosus. The effectiveness of parenterally administered pulse cyclophosphamide has been demonstrated in patients with severe central nervous system involvement, and the effectiveness of plasmapheresis in patients with thrombotic thrombocytopenic purpura was reviewed.

Transient erythroblastopenia of childhood in Sweden: incidence and findings at the time of diagnosis

All cases of transient erythroblastopenia in children less than 10 years of age, diagnosed in Sweden during the years 1987-89, were identified. Almost all (51/53) were less than 3 years of age. In this group, the incidence was 4.3/100 000, which is the same as that of acute lymphatic leukaemia. No geographical, but a possible temporal, cluster was seen in 1989. The anaemia was severe in some cases; haemoglobin concentration was less than 40 g/l in 8 of 53 children. Thrombocytosis and neutropenia were common and were attributed to high endogenous erythropoietin activity. Thirty-seven of 53 children were given a blood transfusion. All children recovered and no complications or relapses were seen. Transient erythroblastopenia of childhood is a benign disease, and it is important to make a correct diagnosis to prevent unnecessary anxiety for leukaemia or aplastic anaemia.

Production and role of macrophage colony stimulating factor (CSF-1 or M-CSF) in hematological pathology

M-CSF, an homodimeric glycoprotein initially identified as a Colony Stimulating Factor, can now be considered as a cytokine-produced by multiple cell types, including T cells and acting on hematological and non hematological tissues. In this short article, we bring evidence that the production of M-CSF is inducible in T cells in vitro and in vivo and that it plays a central role in several hematological disorders. A particular emphasis will be given to EBV induced hemophagocytic syndromes and to related disorders during the oral presentation.

Coagulation abnormalities and cerebral infarction

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