Granulomatous bone marrow inflammation during treatment of chronic myeloid leukaemia with interferon alpha-2b

A patient with chronic myeloid leukaemia developed bone marrow granulomas during treatment with interferon alpha-2b. Some granulomas had necrotic centres and giant cells and there was marked eosinophilia surrounding them. The granulomas disappeared when the interferon treatment was discontinued. Mycobacteriosis was ruled out. The most likely explanation for the granuloma formation was drug hypersensitivity.

Divergent effects of interleukin-10 on cytokine production by mononuclear phagocytes and endothelial cells

Interleukin-10 (IL-10), a product of T helper type 2 (TH2) cells and monocytes, inhibits cytokine production in mononuclear phagocytes. Given the similarities and interrelationship between cells of the monocyte-macrophage lineage and endothelial cells, we examined the effects of IL-10 on vascular endothelium. Murine IL-10 induced low levels of IL-6 production and amplified induction of IL-6 by lipopolysaccharide (LPS) or IL-1 in the murine tEND.1 endothelioma line, used for these studies because it retains properties of normal endothelium. The effect was more evident after prolonged (48-72 h) exposure to IL-10. IL-10 had similar activity on other endothelioma lines, whereas it inhibited IL-6 production by peritoneal macrophages. Induction and amplification of cytokine production by IL-10 was associated with higher levels of mRNA, which were maintained longer (up to 48 h) than in controls. In addition to IL-6, murine IL-10 induced or amplified expression of the chemoattractant cytokines monocyte chemotactic protein-1 (MCP-1) and KC. Human IL-10 inhibited IL-6 release by LPS-stimulated human peripheral blood mononuclear cells, whereas it did not interfere with cytokine production by LPS- or IL-1-stimulated human umbilical vein endothelial cells. The selective inhibitory action of IL-10 on mononuclear phagocytes versus endothelial cells may play a role in the pathophysiology of TH2-directed responses.

Significant decrease of gram-negative anaerobic bacteremia in a major hospital from 1967-73 to 1981-89: an effect of the introduction of metronidazole?

Declining rates of anaerobic bacteremia are reported from medical centres all over the world. At Odense University Hospital the frequency of Gram-negative anaerobic bacteremia decreased from 1.62% in 1967-73 to 0.83% in 1981-89 (p < 0.001). Metronidazole prophylaxis prior to bowel surgery seems to be the most important explanation, as the association of Bacteroides bacteremia with surgery decreased from 80% to 48% (p < 0.01) and no cases of Bacteroides bacteremia occurred during metronidazole treatment without the presence of abscess or gangrene. A contributory factor may be improved methods for abscess localization and drainage. Other drugs having an effect on anaerobes seem of minor importance. A new category of patients seems to be those who have undergone aorto-femoral bypass operation for aneurysm of the aorta. They contract anaerobic Gram-negative bacteremia from infected hematomas or intestinal gangrene.

[Serious infections in alcoholics. 2. Etiology of bacteremia and meningitis in alcoholics discharged from hospitals in Funen 1981, 1984 and 1986]

In 1981, 1984 and 1986 relatively more episodes of bacteremia with Corynebacterium in one or two tubes out of twelve were found in alcoholics and these normally negligible episodes may be a iatrogenic marker of intubation and esophagoscopy in alcoholics. Definite bacteremic episodes with E. coli, Staphylococcus aureus, Klebsiella, Streptococcus pneumoniae, Proteus, Pseudomonas aeruginosa, Enterobacter, Streptococcus faecalis, haemolytic Streptococcus and Bacteroides were found in 0.79% of alcoholics and 0.37% of non-alcoholics (0.01 greater than p greater than 0.001). The frequency per 100,000 discharged patients with positive blood cultures irrespective of bacteriological diagnosis, and also alcoholic liver cirrhosis was 8.12 = about two thirds of the number of deaths from cirrhosis per year. In selected cases of severe infections in alcoholics, the frequency of cirrhosis or steatosis was 29/48 = 60%. Foci were more often demonstrated bacteriologically in patients without cirrhosis or steatosis (0.01 greater than p greater than 0.001). Bacteremia with Staphylococcus aureus was a complication of treatment 6-18 days from admission, whereas bacteremia with E. coli and Pneumococci was present on admission. Serious bacteremia in alcoholics was not found in patients over 70 years of age and the many geriatric alcoholics (4.7%) did not show a greater morbidity than the average geriatric patient. The mortality of bacteremic alcoholics was more than 45% over a 6-year period.

Outbreak of infection with Achromobacter xylosoxidans from contaminated intravascular pressure transducers

Achromobacter xylosoxidans contaminating transducers caused 15 cases of hospital infection. In the eight patients with bacteraemia the interval from inoculation to fever was an average of 6.6 days. All the infected patients recovered. Computerization of laboratory records allowed retrieval of previous isolates, and review of clinical records focused the problem on patients with cardiac and aortic diseases. The problem arose from the re-use of disposable equipment after disinfection with a benzalcone.

Lipofuscinosis of the human uterus

A case of uterine lipofuscinosis in a patient with Friedreich's ataxia is described. Ultrastructural investigation confirmed the mitochondrial origin of the lipofuscin. Clinically, the patient suffered from brown bowel syndrome. Both the brown bowel syndrome and the uterine lipofuscinosis in the present case may be related to Friedreich's ataxia.

Sudden unexpected natural death in young persons

In a series of 1920 medico-legal autopsies, 78 cases fulfilled the criteria of sudden unexpected natural death in the age group 2-30 years. In 39 (50%) of these cases a health hazardous condition was known. A large group included epileptics, alcoholics, obstetric/gynecologic conditions, and drug addicts. For prophylactic reasons the medical intervention should focus on earlier detection, if possible, of acute myocarditis, better instruction to epileptics as to thorough medication and information of parents. Physicians should be reminded about the danger of inflammatory processes in the upper respiratory tract, especially acute tracheobronchitis and acute epiglottitis.