Venous reflux in patients with previous deep venous thrombosis: correlation with ulceration and other symptoms

PURPOSE

Deep vein thrombosis (DVT) in many cases leads to chronic symptoms in the damaged leg, even though the affected veins have recanalized. The major hemodynamic defect in such recanalized veins is reflux. The incidence and extent of reflux has been studied in patients with proven DVT and correlated with concurrent symptoms.

METHODS

Two hundred seventeen limbs in 183 patients were examined by duplex scanning from January 1989 to October 1992. All limbs had previous DVT diagnosed by venography. Sites and extent (proximal, distal, or both) of reflux were identified by meticulous duplex scanning of the whole venous system and correlated with presenting symptoms.

RESULTS

The patients were classified into nine groups on the basis of the classification of the system involved (superficial, deep, or superficial and deep) and whether the reflux was found proximal or distal to the knee or both. Eight-one limbs belong to chronic venous insufficiency class 1, 92 belong to class 2, and 38 belong to class 3. Reflux was confined to the deep venous system in 84 limbs (38.7%), to the superficial system in 31 (14.3%) limbs, and to both systems in 102 (47%) limbs. It was confined to proximal veins only in 48 (22.1%) limbs, distal only in 56 (25.8%) limbs and throughout the limb in 113 (52.1%) limbs. The incidence of swelling was increased by distal or a combination of proximal and distal reflux regardless of which system was involved. In limbs with superficial venous insufficiency (SVI) or deep venous insufficiency (DVI) only, the incidence of skin changes was not affected by the extent of reflux. However, in limbs with combined SVI and DVI, it was increased in the presence of reflux throughout the limb. Absence of distal reflux was associated with a low incidence of skin changes even in the presence of DVI. Ulceration increased with an increased extent of reflux in the presence of SVI. Absence of superficial reflux was associated with a low incidence, even in the presence of DVI.

CONCLUSIONS

The data suggest that as far as the skin changes and ulceration are concerned, distal reflux and reflux in the superficial veins are more harmful than reflux confined to the deep veins, even when such reflux extends throughout the deep venous system.

Glutamate-immunoreactive climbing fibres in the cerebellar cortex of the rat

The climbing fibre system, one of the two main excitatory inputs to the cerebellar cortex, is anatomically and physiologically well characterized, while the nature of its neurotransmitter is still a matter of debate. We wished to determine whether glutamate-immunoreactive profiles with the morphological characteristics of climbing fibres could be found in the rat cerebellar cortex. For this purpose, a monoclonal 'anti-glutamate' antibody has been used in combination with a sensitive postembedding immunoperoxidase method on semi-thin sections or in combination with a postembedding immunogold method on ultrathin sections. At the light microscopic level, climbing fibres appeared as strongly stained fibrous profiles, chains of interconnected varicosities or heavily labelled dots of various sizes, often in close apposition to principal Purkinje cell dendrites. At the electron microscopic level, certain labelled varicosities or more elongated profiles resembling climbing fibre terminals were in synaptic contact with dendritic spines of Purkinje cells. Quantitative analysis of gold particle densities showed that such elements were about three to four times more heavily labelled than their postsynaptic partners. The results obtained in this study demonstrate that at least a subset of climbing fibres and their terminals contain relatively high levels of glutamate-like immunoreactivity and provide additional evidence for a role of glutamate as transmitter in these cerebellar afferents.

Homocysteate-like immunoreactivity in multiform glioblastoma of human brain

Anti-homocysteate antibodies with postembedding immunohistochemistry for light microscopy were used to localize homocysteate-like immunoreactivity in human multiform glioblastoma. The most remarkable stained elements (6.8% of the total tumoral tissue) corresponded to distinct astrocytic cell bodies, intermingled fibrous processes and puncta of diverse size, some of them closely apposed to capillaries. In not affected peritumoral tissue, on the other hand, numerous labelled dots resembling portions of glial processes were observed in the neuropil and around blood vessels (2.7% of the total peritumoral tissue). However, glial and neuronal cell bodies could not be detected. These observations extend to a human brain tumor of glial nature the knowledge on the preferential localization of homocysteate in glia.

Thumb rule of visual angle: a new confirmation

The classical thumb rule of visual angle was reexamined. Hence, the visual angle was measured as a function of a thumb's width and the distance between eye and thumb. The measurement of a thumb's width when held at arm's length was taken on 67 second-year students of psychology. The visual angle was about 2 degrees as R. P. O'Shea confirmed in 1991. Also, we confirmed a linear relationship between the size of a thumb's width at arm's length and the visual angle.

Amperometric biosensor for the determination of phenolic compounds using a tyrosinase graphite electrode in a flow injection system

Selective and sensitive devices for the monitoring of phenol and phenolic compounds are required in clinical and environmental analysis. This paper describes a biosensor for the analysis of phenolic compounds in a flow injection system. The enzyme electrode is based on the use of immobilized tyrosinase and the amperometric detection of the enzymatic product at -50 mV vs. SCE. The enzyme is covalently immobilized on the surface of a carbodiimide-activated graphite electrode. The biosensor responds to a variety of phenolic substrates with different conversion efficiencies. The detection limit for phenol is 0.003 microM (S/N = 3), a quantification limit of 0.01 microM (rsd 3.7%), and an extended dynamic range up to 5 microM is achieved with a sample frequency of 110 samples per hour.

Long term follow up of haemophilic arthropathy treated by Au-198 radiation synovectomy

Intra-articular injection of Au-198 (gold synoviorthesis) has been used in the treatment of repeated haemarthroses of the elbows, knees, or ankles in 64 haemophiliacs. These patients had continued to have joint haemorrhages despite appropriate, episodic, substitutive therapy over a period of more than six months. Follow-up for an average period of 14 years in one knee in 38 male haemophiliacs showed 8 good, 23 fair, and 7 poor results with regard to their joint scores. It is concluded that Au-198 is an effective agent for radiation synovectomy, particularly in the early stages of the disease with minimal radiographic changes. It appears to reduce the incidence of haemarthrosis and to slow the rate of evolution of radiographic changes.

Retinal afferents on Golgi-identified vertical neurons in the superior colliculus of the rabbit. A Golgi-EM, degenerative and autoradiographic study

The characteristics and distribution pattern of retinal afferent terminals making synaptic contacts on narrow field vertical neurons in the stratum griseum superficiale of the rabbit superior colliculus were studied using the Golgi-gold substitution technique in combination with either autoradiographic or degenerative methods. At the level of light microscopy, identified gold-toned vertical neurons showed similar features to those previously described by others. Although their axons were frequently seen rising from the basal dendritic tuft, they could also emerge from an apical dendrite, but rarely from the cell body. The electron microscopic study revealed that these neurons received radiolabelled or degenerated profiles with typical features of retinal terminals, while more proximal parts seemed to receive fewer terminals but of larger size. Axo-somatic synaptic junctions were very rare and, interestingly, retinal terminals were not seen forming synapses on the basal dendritic arborization. The present results indicate that the narrow field vertical cells are targets for retinotectal projection.

Treatment of melphalan-resistant multiple myeloma with vincristine, BCNU, doxorubicin, and high-dose dexamethasone (VBAD)

A total of 65 patients (35 male/30 female) with multiple myeloma primarily (33) or secondarily (32) resistant to melphalan and prednisone were treated with vincristine, carmustine (BCNU), doxorubicin, and high-dose dexamethasone (VBAD) at 4-week intervals. Among 60 evaluable patients the overall response was 36.6% (21.6% objective response plus 15% improvements). The response rate was significantly higher in primarily resistant patients than in those becoming resistant after a prior response (48.4 vs. 24.1%, P < 0.05). The median duration of response was 17.5 months. When survival of responders and non-responders were compared by the conventional method, a highly significant difference was observed (P < 0.001). However, using the Mantel and Byar procedure and the landmark method, only a trend for longer survival in the responders was registered. These results indicate that although VBAD is effective in at least one third of patients with advanced multiple myeloma resistant to melphalan, its impact on survival is limited.

[Prognostic effect of beta 2-microglobulin in multiple myeloma]

BACKGROUND

The aim of the present study was to compare the prognostic influence of beta 2-microglobulin (B2M) corrected according to renal function versus the uncorrected form and relate these values with other characteristics of the disease in a series of patients with multiple myeloma (MM).

METHODS

The serum levels of B2M were determined by the radioimmunoassay method (RIA) in 107 patients with newly diagnosed MM and the prognostic influence of B2M was statistically evaluated with univariant and multivariant analysis.

RESULTS

The mean value of B2M obtained in patients with MM was 7.8 +/- 8.0 micrograms/ml, with a median of 5 micrograms/ml. Ninety percent of the patients studied presented serum values of B2M higher than the normal limit. The value of B2M corresponding to the median of the series (5 micrograms/ml) separated two groups of patients with different survival (48 vs 19 months) (p = 0.0001). Similarly, the most discriminative value of corrected B2M in agreement with creatinine (2.5 micrograms/ml) permitted the differentiation of two groups of patients although the differences in survival were less significant (36 vs 26 months, p = 0.03) demonstrating its lesser influence as a prognostic factor with respect to the uncorrected B2M. In contrast, a significant association was observed between high values of B2M and Bence Jones myeloma, clinical stage III, anemia, renal failure and intense involvement of the general state. Multivariant analysis demonstrated that B2M plays a greater prognostic role when used as a discrete rather than a continuous variable and that together with the degree of involvement of the general state, serum albumin and the proportion of plasma cells in the bone marrow, they make up the best set of variables for the prediction of prognosis in patients with MM.

CONCLUSIONS

Beta 2-microglobulin is one of the most important independent prognostic factors in multiple myeloma with its prognostic value being greatest when used uncorrected according to the values of creatinine.

Liquid chromatographic separation of phenolic drugs using catalytic detection: comparison of an enzyme reactor and enzyme electrode

A catalytic detection system based on the use of immobilized tyrosinase and two different transducers (photometric and electrochemical) is described. Comparison between tyrosinase immobilized in a packed-bed reactor and at the surface of a graphite electrode is discussed in terms of sensitivity in a flow injection system. The enzyme electrode configuration gives the highest sensitivity for the quantitation of dopamine. For the immobilized tyrosinase reactor with photometric detection the range for dopamine is linear up to 0.75 mM (136 micrograms ml-1) and the immobilized tyrosinase reactor with electrochemical detection and the tyrosinase electrode extends this dynamic range to 1 mM (181 micrograms ml-1). Liquid chromatographic separation and post-column detection using the tyrosinase electrode is shown for spiked samples of serum.

[Utility of the examination of plasma-cell morphology in the study of multiple myeloma]

PURPOSE

To assess the classification of Greipp et al in a group of multiple myeloma (MM) patients, in an attempt to correlate the morphological patterns with the clinico-biological features of the disease.

MATERIAL AND METHODS

Bone marrow aspirates from 135 patients with multiple myeloma were examined by two different observers.

RESULTS

Full accordance existed in 122 cases (90%). The four morphological MM subgroup distribution was: mature, 38%; intermediate, 30%; immature, 18%, and plasmoblastic, 14%. The analysis of the M component types with regard to morphology showed increased IgA cases within the intermediate (40%) and immature (48%) MM (p = 0.01), and Bence-Jones cases within the plasmoblastic MM (32%). On the contrary, no differences were found with regard to the clinical stage, although none of the plasmoblastic MM was in stage I. The incidence of renal insufficiency and of high bone-marrow infiltration progressively increased from mature to plasmoblastic MM, the difference between the extreme morphological groups being significant. The incidence of hypercalcaemia and lower paraprotein rates was higher in plasmoblastic myeloma, with significant difference with respect to mature myeloma (p = 0.05). The median survival was longer in intermediate (27.8 months) and mature (22.5 months) myelomas than in plasmoblastic (17.9 months) and immature (13.6 months) myelomas. After grouping the mature forms (intermediate plus mature) and the immature ones (plasmoblastic plus immature) the survival differences approached statistical significance (p = 0.07).

CONCLUSIONS

This study suggests that the morphological examination of plasma cells should be included in the prognostic criteria of multiple myeloma.

Lymphoid subsets and prognostic factors in multiple myeloma. Cooperative Group for the Study of Monoclonal Gammopathies

In a uniform series of 170 untreated myeloma patients (MM) we investigated the distribution of T cell subsets in peripheral blood (PB) and their relationship with the most relevant disease characteristics, including survival. CD4 cells were significantly decreased both in percentage and absolute numbers (P less than 0.0001). On the other hand, the CD8 cells only showed a slight increase in relative numbers. Upon correlating the abnormalities in the distribution of T cells with other clinical and biological disease characteristics the most remarkable correlation was with survival. A low number of CD4 cells (less than 700 x 10(6)/l) was associated with both an advanced clinical stage and a shorter survival (20 v. 43 months, P = 0.01). Moreover, a significant correlation also exists between the decrease in CD4 cells and both high beta 2-microglobulin (beta 2M) levels and anaemia. On the other hand, no relationship was found with the type of M-component nor with the plasma cell phenotype. Finally multivariate analysis showed that the number of CD4 cells add independent prognostic information to other well-established tests for the assessment of disease outcome in patients with multiple myeloma.

Increased expression of natural-killer-associated and activation antigens in multiple myeloma

The expression of both natural-killer (NK)-associated and activation antigens was studied by flow cytometry in the peripheral blood of 47 untreated multiple myeloma (MM) patients. A significant increase in both absolute and relative numbers of CD57 positive cells as well as in the proportion of CD16 and CD11b cells was observed in patients with MM, specially in those in early stages of the disease (clinical stages I and II), suggesting a possible surveillance mechanism in response to an emerging malignant clone. Additional double stainings showed that strong CD16+ NK cells coexpress the CD56, CD11b, and CD2 antigens, while they lacked CD3, CD5, and WT31 antigens. Moreover, the previously reported increase in CD8 cells present in MM would be mainly due to a subset of CD8 cells that coexpress the CD57 Ags. The expression of activation antigens, especially CD38, was increased in peripheral blood lymphocytes of MM patients, the differences reaching statistical significance both in absolute and relative numbers in those cases with high numbers of CD16 NK cells and thus suggesting that these cells are functionally activated. These results reveal the existence of an increase in NK and activated cells in the peripheral blood of myeloma patients that may reflect a host's immunological mechanism in an attempt to modulate tumor cell growth.

AIDS and hemophilia: experience in the La Paz Hemophilia Center

435 hemophiliacs are usually being attended in the La Paz hemophilia Center (Madrid, Spain). 257 (59%) of these patients have been infected by the human immunodeficiency virus (HIV-1) because of human plasma derivate substitution therapy. The infection has been more frequent among the severely affected patients and among the most treated patients. 82% of the infected patients are between 14 and 40 years old. By December 1991, 95 (37%) of 257 seropositive patients have developed full-blown AIDS. The most frequent opportunistic infection they had suffered was esophageal candidiasis. Looking for an evolution marker, we can point that the patients older than 35 years with CD4 levels below 200/mm3 had the worst prognosis. There was no difference in the evolution among the patients aged below 17 and those aged between 17 and 35 years. The amount of concentrate used between 1980 and 1984 did not hold any relation to the evolution. 49 patients (51%) of the 95 suffering from AIDS had died by December 1991. The evolution to the death was unrelated to the patient age, CD4 lymphocyte levels, and amount of substitution therapy. In our opinion, the most valuable marker could be the kind of opportunistic infection or tumor the patient suffers from. Finally, Retrovir has demonstrated to be useful in increasing the survival rate of the patients, but after 36 months of treatment, only 33% of those AIDS patients who began taking it remained alive. Retrovir was also used in asymptomatic patients, and during an average period of time of 15 months, a lesser bone marrow toxicity and a stabilization in CD4 lymphocyte levels could be observed, but this was unable to modify the disease progression in those patients who presented circulating p24 antigen.

[Inflammatory pseudotumor of the lung: presentation of 2 cases, one of them endobronchial]

Inflammatory pseudotumor (IP) is a rare pathological entity. Although, the pulmonary affection is the most frequent, any other organ can be involved. Its etiopathology is unknown. The disease is considered as a reactive process constituted by chronic inflammatory elements and a benign behavior. The lack of a specific clinical setting and the low profitability of the bloodless techniques makes mandatory the thoracostomy for a definitive diagnosis. We report two cases of pulmonary IP. One of them with an endobronchial localization which is a infrequent variety, scantily reported in the medical literature. We discuss the clinical and etiopathologic aspects of this rare pathological entity.

Cushing's disease and cutaneous alternariosis

Alternaria species are common plant pathogens, but a rare cause of human infection. We present a patient with cutaneous alternariosis that revealed a relapse of an old case of Cushing's disease. Immunosuppression following the excessive glucocorticoid production seemed to contribute to the development of dermatosis. We also present a review of the literature on the association of Cushing's disease and cutaneous alternariosis. Our case is unique because the ketoconazole therapy that we used was successful in the treatment of both diseases.

[Antibodies against hepatitis C virus. Experience with a second generation test]

A second generation recombinant immunoblot assay to detect antibodies against Hepatitis C virus (RIBA II, Ortho Diagnostic Systems) was applied to 30 serum samples repeatedly reactive to ELISA anti-HCV c100-3, 11 from hemodialysis patients, 11 from patients with chronic hepatitis and 8 from patients with cirrhosis. The assay detects individual antibodies directed to 4 antigenic components of the C virus, 2 antigens, c100 and 5-1-1 contained in the original ELISA assay and 2 new antigens, c33c and c22-3 the latter structural in nature. From the total of 30 samples, 23 (77%) were reactive, 4 (13%) indeterminate and 3 (10%) non reactive to the RIBA II assay. Much variation was observed regarding the response to each individual antigen. c22-3 was the most frequently reactive with the highest intensity. RIBA II assay confirmed a high percentage of the reactive results with the ELISA c-100-3, serum samples that were non reactive to RIBA showed a low optical density with ELISA. c22-3 was the most sensitive antigenic component.

Immunophenotypic heterogeneity of multiple myeloma: influence on the biology and clinical course of the disease. Castellano-Leones (Spain) Cooperative Group for the Study of Monoclonal Gammopathies

In 112 untreated myeloma patients we have analysed the immunophenotype of plasma cells both by immunofluorescence (IF) and immunocytochemistry (APAAP). Both techniques yielded similar results pointing to an important degree of heterogeneity in antigenic expression not only between different patients but also within the same patient. The expression of CD38 and Han-PC1 antigens (Ags) was almost constant (greater than 90% positive cases), while CD9 was detected in 66% of the cases. On the other hand, less than one third of patients were positive for CD10, CD20 and HLA-DR and generally with a weak expression (less than 30% positive plasma cells). In occasional cases plasma cells were weakly positive for the myelomonocytic markers CD13 (9%), CD15 (25%) and CD14 (6%). The possibility that this heterogeneity might be the result of different stages of differentiation of the neoplastic clone is suggested both by the positive correlation in the expression of some of these antigens (CD10, CD9, CD20, HLA-DR) and by the relationship between CD10 and myeloid antigens with immature plasma cell morphology. Finally, the cALLA antigen does not seem to be of significant value in predicting survival. Moreover, none of the other markers explored showed a clear influence in the course of the disease, although the tendency towards a lower survival found for the CD20+ cases as well as the association of the expression of some antigens and advanced clinical stage, may warrant further studies in a larger series of patients.

[Antibodies against hepatitis C virus in patients with liver diseases and in risk subjects. Preliminary report]

The recent discovery of an antigenic component of the causative agent of Non-A, Non-B hepatitis, has led to the characterization of this virus--Hepatitis C Virus (HCV)--and to the identification of an antibody present in infected subjects (anti-HCV) detected by means of the C-100 antigen derived from a nonstructural region of the viral genome. Using a commercial Kit (Ortho Diagnostic Inc.), the incidence of anti-HCV antibody was studied in the Military Hospital "Dr. Carlos Arvelo" of Caracas, Venezuela with the following results: Health personnel (doctors, nurses, laboratory staff): 102 persons studied, 2 positives (1.96%); 16 patients in chronic hemodialysis: 6 positives (33%); 20 subjects with antibodies against HIV virus, confirmed by Western Blot: 7 positives (35.4%). Of 10 patients with Surface Antigen negative Chronic Hepatitis, 7 (70%) positive for anti-HCV, of 25 patients with cirrhosis: 12 positive (48%), 2 patients with hepatocarcinoma 1 positive (50%). There was also a high incidence of total anti-core antibodies in the patients studied. The results suggest that the hepatitis C virus could be playing an important role as a causative factor of liver diseases in our Country.

Combination of interferon and dexamethasone in refractory multiple myeloma

The present pilot study was designed to analyse the efficacy and toxicity of the association of interferon (IFN) and dexamethasone (Dx) in 32 resistant and relapsed myeloma patients. Among the evaluable cases, 15 (68 per cent) responded to treatment (32 per cent achieved an objective response--OR--and 36 per cent a partial response--PR--), the 'remission' status lasting for more than one year in six of them. Moreover, four out of the seven OR patients showed a reduction in B.M. plasma cells to less than 5 per cent. Five out of 11 patients that were previously refractory to VBAD, that includes high dose dexamethasone (Dx), responded to IFN-Dx. The protocol was generally well tolerated with only four patients discontinuing therapy due to adverse effects. The present results show that the combination IFN + Dx is a promising therapeutic approach for patients with refractory myeloma.

[Pathogenesis of peripheral cytopenias in hemophiliac patients]

The frequent occurrence of peripheral cytopenias is a common clinical fact in patients with HIV-1 infection, and its pathogenetic mechanism is not clear, although several hypotheses have been proposed. Such cytopenias are frequently observed in haemophilic patients, in whom the immunologic alteration induced by continuous antigenic stimulants derived from plasma concentrate therapy has been postulated as an additional causative factor. One-hundred and forty five haemophiliacs treated with commercial antihaemophilic concentrates were studied. The patients were divided into three therapeutic groups according to the mean number of units of therapeutic factor VIII administered per Kg every year in the four years prior to the study (group I: less than 500 U; group II: between 501 and 1500 U; group III: more than 1500 U). The occurrence of cytopenias in the patients was co-ordinated with the presence or absence of HIV infection and the therapeutic group. The statistical studies showed clear correlation between peripheral cytopenias and presence of anti-HIV markers, regardless of the amount of concentrates perceived (except for the total neutrophil count).

Superoxide dismutase in strains of the genus Flavobacterium: isolation and characterization

Two electrophoretically different forms of superoxide dismutase, one of them containing manganese-protein and the other iron-protein, were detected in eleven different strains of the genus Flavobacterium. The activities of the different strains were similar to those described for other bacteria. The two molecular forms of the enzyme differed clearly with regard to activity, electrophoretic behaviour, sensitivity to cyanide and peroxide, and NaCl requirement. Both molecular forms were isolated from Flavobacterium halmephilum. Molecular mass absorption spectra, metal content, optimum pH, heat-sensitivity and stability were described.

[Analysis of the treatment of postoperative pain at 3 hospitals]

Postoperative pain management protocols have been examined in a total of 212 patients from three Spanish hospitals. Metamizole was the analgesic drug most frequently prescribed (50%) followed by pethidine (18.4%). To a lesser degree, aspirin, pentazocine, lysine acetylsalicylate, paracetamol and buprenorphine were used. Important differences among the hospitals were found when choosing the analgesic. The dosage prescribed varied and in general, drugs were prescribed at lower doses than the daily defined dose (DDD). Intramuscular route was the most used. Only 27.6% of the patients received the prescribed doses and 43.3% received a lower one. This was basically due to a greater interval of dosing. 14.6% of the patients were painless while 25.5% showed intense and unbearable pain. From this study one may conclude that when metamizole is preferably used as an analgesic drug, it is given at a smaller dose than that recommended and in addition, nurses decrease even more the doses. An important number of patients were found with intense pain even though analgesic drugs were given.

Acceptability of visual analogue scales in the clinical setting: a comparison with verbal rating scales in postoperative pain

Pain is the clinical symptom most difficult to evaluate. Although clinical trials methodology have permitted assessment of pain objectively through rating scales, these strategies have not been used in clinical setting. The present study was undertaken to determine if visual analogue scales could be useful in the measurement of postoperative pain in usual medical practice. The study comprised 212 patients with abdominal, orthopedic or gynecological surgical procedures within the previous 24 h. Patients evaluated their pain using a verbal rating scale (VRS) of five points or a visual analogue scale (VAS) of 10 cm. The investigators also evaluated patient pain through a VAS. The results obtained showed that a high correlation between VRS and VAS could be established in all patients (p less than 0.001). The VAS of patients and researchers were also found to be highly correlated (p less than 0.001). When values of each group were compared by pain intensity a total agreement of VAS scores at low pain level could be established, but differences were found at high pain intensity levels, suggesting that physicians scored lower than patients when pain was severe to unbearable. It is concluded that VAS could be a reliable method to assess pain in clinical setting.

Counterion micellar effects upon the reaction of low-spin diimine iron(II) complexes

The rate of reaction of tris(1,10-phenanthroline)iron(II) ion (1a), tris(3,4,7,8-tetramethyl-1,10-phenanthroline)iron(II) ion (1b), and tris(4,7-diphenhyl-1, 10-phenanthroline)iron(II) ion (1c) with hydroxide ion, in cationic micelles, is strongly affected by the concentration of micellar counterion in solution. The reaction of la in CTACl is modestly speeded up by the addition of added KCl, while the reactions of 1b and 1c are strongly inhibited by the addition of large amounts of KCl and KBr to micellar solutions of CTACl and CTABr, respectively. These rate effects fit the pseudophase-ion exchange model, assuming the binding of the substrates to the micelles depends upon the counterion concentration. Keywords: counterion micellar effects, low-spin diimine iron(II) complexes.

The nature of blast cells in myelodysplastic syndromes evolving to acute leukaemia

The blast cells from nine patients with an overt acute leukaemia following a previous myelodysplastic syndrome (MDS) are analyzed with a panel of monoclonal antibodies as well as by morphological and cytochemical criteria. By integrating the results obtained with these three approaches the leukaemia in 6 patients was assessed as myeloid-granulocytic and/or monocytic-, in two as mixed- megakaryoblastic/myeloid- and in one as lymphoid. A good correlation between morphology, cytochemistry and immunological markers was observed in 7 out of the 9 cases. In three cases a noteworthy percentage of J5+ cells was detected. The exceptional finding of lymphoid as well as megakaryocytic and myeloid transformations suggests that the target cell for these leukaemias could be a pluripotent stem cell.

Frequency and clinical and transfusional significance of rheumatoid factor in patients with haemophilia and von Willebrand's disease

Using a solid-phase radioimmunoassay for IgM rheumatoid factor, increased levels were found in 24% or 82 patients with haemophilia A, in 4 of 11 patients with haemophilia B, in 2 of 11 patients with haemophilia A with inhibitors and in 4 of 12 with von Willebrand's disease. The levels of rheumatoid factor increased significantly (p less than 0.02) after factor VIII concentrate or cryoprecipitate transfusions. No clinical or transfusional side effects could be attributed in these patients in relation to the presence of rheumatoid factor.

Effect of circulating immune complexes on transfusional therapy in patients with hemophilia or von Willebrand's disease

Circulating immune complexes were examined in patients with hemophilia or von Willebrand's disease in order to determine the immediate or long-term side effects after transfusion. The conglutinin binding assay which allows quantitation of C3bi-bearing immune complexes was used for 82 patients with hemophilia A. Immune complexes were detected in 37 (45%) of these cases prior to transfusion. Immune complexes also were detected in four of 11 patients with hemophilia A and factor VIII inhibitors, in five of 11 patients with hemophilia B, and in three of 10 patients with von Willebrand's disease. The levels of circulating immune complexes in 21 patients with hemophilia A and seven with von Willebrand's disease significantly increased 24 hours after concentrate or cryoprecipitate transfusions. Purified immune complexes from three patients with hemophilia A were shown to contain IgG, IgM, and complement components. No factor VIII coagulant or antigenic protein or fibrinogen was identified in the immune complexes using specific antisera. Side effects immediately after transfusion were not associated with immune complexes. The levels of factor VIII or IX after transfusion were not particularly decreased in relation to the presence of immune complexes. Finally, the presence of circulating immune complexes in the patients studied did not correlate with the number of transfusions, the units of concentrates injected, the presence of HBsAg or HbsAb, the levels of plasma aspartate transferase, or the presence of rheumatoid factor. Proteinuria was absent in all the patients studied.

Serum ferritin in haemodialysis patients: role of blood transfusions and 'haemochromatosis alleles' HLA A3, B7 and B14

In 48 patients on maintenance haemodialysis (HD), serum ferritin (SF) levels were measured and compared with 'haemochromatosis alleles', (HA), HLA A3, B7 and B14. A positive correlation was found between high SF levels and the presence of HA. When patients who had received 10 or fewer blood transfusions were studied, it was observed that this correlation did not exist, but it was evident, however, in patients who had received more than 10 blood transfusions. After 14 months in which blood transfusions were restricted, no significant difference in SF was observed between HA carriers and the rest. Our findings suggest that repeated blood transfusions can cause high SF in HD patients, especially in those with HLA A3, B7 or B14 antigens. Among our patients, restriction of blood transfusions seems sufficient to decrease high SF levels.