Lymphabstromszintigraphie bei einem artefiziellen Ödem des Unterschenkels

Es wird über eine junge Frau berichtet, die nach einem Trauma über ca. 2 Monate wiederholt zur stationären Diagnostik aufgenommen wurde, bevor die arte-fizielle Genese eines Ödems des linken Beines geklärt werden konnte. Die Lymphszintigraphie zeigte eine starke Beschleunigung des Lymphabstroms aus dem geschwollenen Bein.

[Not Available]

Allogeneic stem cell transplantation (alloSCT) is increasingly used in the treatment of hematological disorders. In order to demonstrate the national development of alloSCT as well as the effect of the foundation of local transplant centers, data of all alloSCT performed on patients living in Mecklenburg-Vorpommern (MV) during 1991 and 2000 were evaluated regarding date and location of the alloSCT, diagnosis and age of the patient as well as donor type. AlloSCT in patients from MV increased 6 fold from 1991 n=5 to 2000 n=30. Because of the lack of local transplant centers during the period between 1991 and 1997, alloSCT of patients from MV were exclusively performed in other locations, whereas in 2000 only 2 of 30 alloSCT were performed in transplants centers outside MV. With the establishment of local centers, the gap between the numbers of alloSCT between MV and Germany was closed (1991 Germany 4,17/Million inhabitants, MV 2,67/Million inhabitants, 2000 Germany 17,4/Million inhabitants, MV 16,7/Million inhabitants). The increase in the number of alloSCT was mainly due to an increased use of unrelated stem cell donors which increased from n=0 in 1991 to 12 out of 30 in 2000. Another important factor was the increase in the age limit with a mean age of 32 years in 1991 and 43 years in 2000 (upper range 60 years).

CONCLUSION

The data reflect the dramatic increase in alloSCT during the last decade caused by factors listed above. In addition, the development of the numbers of transplants of patients in MV supports the need for local transplant centers, since with the opening of local transplant centers the difference of the frequency of alloSCT between Germany and MV was completely eradicated.

Two new missense mutations in a non-Jewish Caucasian family with type 3 Gaucher disease

Gaucher disease is an autosomal recessive, lysosomal storage disease caused by a deficiency of the enzyme glucocerebrosidase. The prevalence of this disorder differs significantly among various populations and is highest in some Jewish populations. More than 35 disease-producing mutations of the gene have been reported. The change of the amino acid leucine at position 444 to proline (444Leu-->Pro) is the most common mutation in non-Jewish populations, and a second mutation at amino acid 370 (370Asn-->Ser) is the most common one in Jewish populations. However, most of the mutations have been reported in very few cases or even in only one pedigree. We performed a direct DNA sequencing analysis of the complete functional glucocerebrosidase gene in a 22-year-old neuronopathic non-Jewish patient with Gaucher disease type 3 with myoclonic epilepsy and slight mental disturbances and in most members of his family. After selective amplification of the complete coding region of the patient's functional glucocerebrosidase gene, we identified two hitherto unreported mutations in exon 9 (genomic nucleotide 5224G-->C; 417Val-->Leu) and in exon 11 (genomic nucleotide 6668C-->T; 510Thr-->Ile). Each parent showed one of these mutations. Once we sequenced the complete active gene, we could rule out the existence of further mutations. Data that show that in about 15 to 25% of non-Jewish patients with Gaucher disease no mutations within the glucocerebrosidase gene are found may be due to inappropriate screening methods, mostly used for the genotyping. Until we have precise information about the frequency and distribution of single-point mutations in patients with Gaucher disease, it is necessary to analyze the complete glucocerebrosidase gene.

[Lymphatic outflow scintigraphy in a case of artificial edema of the lower limb]

The case of a young woman is reported who after injury to the left leg was three times hospitalized for diagnosing the cause of her lower limb edema. It took two months to verify its artificial origin. Scintigraphy showed an intensive acceleration of the lymphatic outflow from the left leg.

Diffuse gastric antral vascular ectasia: cause of chronic gastrointestinal blood loss

In a patient with long-standing iron deficiency anemia, diffuse gastric antral vascular ectasia was found endoscopically. Diagnostic problems were the misinterpretation of the macroscopic finding as hemorrhagic inflammation and the microscopic confirmation of the diagnosis from small biopsy particles. Resection of the antrum resulted in a persistent normalization of hematologic parameters. Focal ischemia due to microthrombi in mucosal vessels might be the cause of the tendency of this vascular malformation to bleed.

Cell electrophoretic characterization of lymphoid cells from various sources in patients with malignant non-Hodgkin lymphomas

Lymphocytes of 36 patients with malignant Non-Hodgkin lymphomas (NHL) were characterized by electrophoretic mobility (EPM) and EAC-rosette and E-rosette formation. Unimodal cytopherograms found in patients with low-grade malignant NHL are compatible with a monoclonal origin of the proliferating lymphoid cells. Within the CLL subgroup, deviations from the general mean EPM value in the intermediumrange were not unequivocally related to the B- or T-cell origin of the lymphocytes and remain to be explained. Comparing distinct entities of low-grade malignant NHL characterized by lymphocyte arrest at a certain stage of differentiation (Kiel Classification) we found an increase of the mean EPM in the direction of CLL----lymphoplasmacytoid immunocytoma----polymorphic immunocytoma. This arrest of leukemic cells at a certain EPM level may support a cytogenetically oriented subclassification of NHL. The Limitations of the diagnostic value of cytopherograms and rosette formation in malignant NHL--especially in those of high malignancy--are outlined.

[Glomerulonephritis therapy. Immunosuppression or coagulation inhibitors - a comparison]

In 110 patients with mesangioproliferative glomerulonephritis the treatment (n = 48) with chlorambucil, warfarin, dipyridamol and prednisone (CAA) and the treatment with imuran and prednisone (CP, n = 23) are compared with the conditions of an untreated control group. The CAA-therapy is above all suited for active clinical pictures without sclerosis with short duration of the disease, even when the renal function is already restricted. The CP-therapy is suitable in non-active forms with sclerosis also in a longer duration of the disease.

[Therapy of primary glomerulonephritis. Comparative study on the effect of cytostatics-prednisone and cytostatics-anticoagulant-aggregation inhibitor combination]

The result of the treatment with chlorambucil, dipyridamol, heparin/warfarin and prednisone on 50 patients as well as with imuran and prednisone on 32 patients is compared. Basis for this is a detailed morphological and clinical subdivision. With the help of therapy results is tried to derive regions of indication: the therapy with cytostatics, anticoagulants and aggregation inhibitors is above all suitable for patients with a short duration of the disease and with sign of activity, also in renal insufficiency. On the other hand the therapy with cytostatics and prednisone is also successful in patients with longer duration of the disease and missing signs of activity.