Chronic myelogenous leukemia in a 16-yr-old

OBJECTIVE

To present an unusual case of chronic myelogenous leukemia (CML) in an adolescent with a complaint of leg pain. Clinical presentation is highlighted and a brief review of the childhood leukemias and common clinical features are outlined.

CLINICAL FEATURES

A 16-yr-old black male was seen after suffering from leg and knee pains for 7 months. Exquisite tibial pain, normal radiographs and an abnormal CBC led to the diagnosis of leukemia. Subsequent referral for bone marrow examination confirmed the final diagnosis of chronic myelogenous leukemia.

INTERVENTION AND OUTCOME

The patient was referred to a pediatric hematologist-oncologist for medical management of his condition. He is currently receiving chemotherapy and the search for a suitable donor for bone marrow transplant is in progress.

CONCLUSION

This case demonstrates the importance of considering one of the more common pediatric malignancies, such as leukemia, in the differential diagnosis of children with musculoskeletal complaints. Chronic myelogenous leukemia accounts for only 3-5% of cases of childhood onset. Its rare incidence in childhood constitutes the basis for this case report.

Histobiochemical changes in lung of protein deficient rats following repeated exposures of MIC vapour

Adult male albino rats, maintained on normal or protein deficient diets from weanling, were exposed to repeated doses of MIC vapour (0.32 mg/L for 8 min for 5 consecutive days) under static conditions. Histopathology and the activities of alkaline and acid phosphatases and GSH content of lung were studied upto day 14 after exposure. Mild but repeated exposures of MIC vapour caused severe pulmonary lesions like denudation of bronchiolar epithelial lining tissue, cellular infiltration, edema, emphysema followed by hyperplasia, hypertrophy, fibrosis and intraluminal fibroplasia. The activities of alkaline and acid phosphatases were increased at earlier intervals while GSH content decreased significantly and remained low throughout the experimental duration. Protein deficiency was found to aggravate the toxic potentials of MIC in present condition.

Immunohistopathological spectrum in cutaneous tuberculosis

Granulomas of lupus vulgaris were characterized by a raised CD4+/CD8+ ratio, while in scrofuloderma this was significantly decreased. Tuberculosis verrucosa cutis showed intermediate changes. These immunological variations suggest that cutaneous tuberculosis forms a spectrum with strong cell-mediated immunity seen in lupus vulgaris, and weaker cell-mediated responses in scrofuloderma; tuberculosis verrucosa cutis is intermediate between the two.

A rapid and gentle method for the isolation of genomic DNA from mycobacteria

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Very low calorie diets and pre-fasting prolonged QT interval. A hidden potential danger

The association of torsade de pointes and a prolonged electrocardiographic QT interval is well described. A prolonged QT interval may be congenital or acquired in several ways--by the use of anti-arrhythmic agents exemplified by quinidine, by the presence of hypocalcaemia or hypokalaemia, by the use of psychotropic drugs, and by the presence of intrinsic cardiac disease or bradycardias. Possibly less well appreciated is the potential for drastic weight loss to prolong the QT interval, as the present case report illustrates. A young woman weighing 244 pounds lost 24 pounds in two weeks with a consequent prolongation of QTc interval from pre-diet value of 0.57 seconds to 0.72 seconds at admission, when severely symptomatic paroxysms of torsade de pointes were recorded. Successful therapy with lignocaine and prompt re-feeding suppressed the arrhythmia and, three days later, the QTc was reduced to almost its pre-diet state. A (UK) DHSS report offers guidelines in the use of very low calorie diets. This case suggests that a pre-diet electrocardiogram should be carefully assessed for QT prolongation before initiation of dieting to achieve serious weight loss.

Inhalation toxicity of methylisocyanate: assessment of germ cell mutagenicity and reproductive effects in rats

Adult male Wistar rats were exposed to methylisocyanate (MIC, 3.2 mg/l, single inhalation exposure for 8 min under static condition) or ethyl methanesulphonate (EMS, 150 mg/kg, single ip dose) for the assessment of germ cell mutagenicity and reproductive effects. Sequential matings of treated males with normal females on days 1-7, 8-14 and 15-21 post-exposure did not indicate any induction of dominant lethal mutation (increased frequency of preimplantation losses and early fetal deaths) by MIC but it was significantly induced by EMS as compared to respective controls. Males, necropsied after 21 days of exposure, showed no effect of MIC on epididymal sperm density and morphology. EMS also had no effect on sperm density but it significantly induced morphological abnormalities in sperm as compared to untreated controls. There was an acute and transitional reduction in reproductive performance (10-21%) of MIC-exposed males during days 1-14 post-exposure followed by recovery to the normal level during days 15-21 post-exposure. The progeny of MIC-exposed males was also normal in terms of litter size, litter weight, neonatal survival and body weight gain in litters up to 10 days post-partem. It is concluded with the evidence at hand that the observed failure of MIC to cause germ cell mutagenicity is related to its poor biodistribution to the target site(s) and a transient reduction in the reproductive performance of MIC-exposed males is a result of general stress and disconsolate copulation.

[Paresthesias]

A 23-year-old patient suddenly experienced paresthesia in both legs which progressively ascended to the region of the umbilicus and finally also occurred in all fingers. The physical examination revealed a decreased sensation for touch, discrimination and vibration in all paresthetical regions and on the stem even up to dermatome C5. A mild elevation of the protein content, a mononuclear pleocytosis and oligoclonal bands were found in the cerebrospinal fluid. Magnetic resonance imaging of the cervical spinal cord showed a hyperintensive lesion in the region of the posterior tract at C6. With respect to these findings and after exclusion of other neurological affections, multiple sclerosis was diagnosed. The symptoms subsided spontaneously within five weeks, and the patient was discharged without any complaints. The diagnostic accuracy of the various findings is discussed.

[Plasma progesterone of ewes at the end of the gestational period after destruction of the fetal hypophysis. Effect of dexamethasone administration]

Destruction of the foetal pituitary has been performed in ewes at day 120 of pregnancy and progesterone has been assayed by radioimmunology. The plasma progesterone remains at a steady level from day 138 and throughout the prolongation of pregnancy, even after injection of dexamethasone on day 145.